Equity considerations in mental health diversion in California
Overview
Mental health diversion under California Assembly Bill (AB) 1810 created a pretrial pathway for individuals to enroll in community-based treatment as an alternative to incarceration if they have a mental illness that played a significant role in the crime for which they were charged. Mental health diversion may be a promising approach to addressing racial disparities in incarceration. This qualitative, community-partnered study examines how racial equity was considered in the design and implementation of mental health diversion under AB 1810 in nine counties across California.
The research explored five main themes: 1. involvement of community stakeholders; 2. cultural competence of providers; 3. availability of diversion across counties; 4. efforts to monitor demographics; and 5. diversion as an opportunity to address racial disparities in the criminal legal system.
Findings
There were limited efforts to formally track the demographic characteristics of the “diversion pipeline” – that is, the people who were being identified as potentially good candidates for diversion; those who are formally diverted; and those who successfully complete diversion.
Though mental health diversion is technically available throughout each county, there are many other factors that may limit participation, such as barriers related to insurance coverage and variability in the quality of services. These factors can be associated with race and ethnicity and/or neighborhood resources, and therefore may also contribute to inequities.
Some stakeholders do perceive mental health diversion as an opportunity to address racial disparities in criminal justice involvement in their counties, but others noted that there would need to be more intentional efforts to examine and address disparities for this to be the case.
Policy Implications
There are policy shifts that could be used to further center equity in the design and implementation of mental health diversion.
Local agencies could establish policies to improve the cultural responsivity of care, such as writing requirements related to training and capabilities into their contracts/MOUs with service providers.
Though mental health diversion is possible under a state legislation, there has been only limited funding to implement diversion (and the funding is focused on a specific subpopulation of people eligible for diversion). Counties would have a greater ability to address barriers to serving clients - such as expanding the availability of community-based services in all areas of the counties and providing supplemental services (e.g., transportation) – if they received dedicated funding for the program.
Most diversion clients receive publicly-funded insurance (i.e., Medi-Cal), and Medi-Cal cannot be transferred across county lines. Therefore, if someone is arrested in a different county than they reside, it means they might not have access to as many services. There could be policy change to increase the ‘portability’ of insurance.
There are also disparities in the services covered by public vs. private insurance, with some providers noting that Medi-Cal funded services are better than that covered by private insurers.There could also be policy work to address these discrepancies.