Isomorphic Pressures on Jail Diversion: From Serious Mental Illness to Opioid Use Disorder

AuthorBarbara Andraka-Christou,Dennis P. Watson,Monte D. Staton
Published date01 March 2021
Date01 March 2021
Subject MatterArticles
The Prison Journal
2021, Vol. 101(2) 187 –209
© 2021 SAGE Publications
Article reuse guidelines:
DOI: 10.1177/0032885521991092
Isomorphic Pressures
on Jail Diversion: From
Serious Mental Illness to
Opioid Use Disorder
Monte D. Staton1, Barbara Andraka-Christou2,
and Dennis P. Watson3
This article explains how jail diversion introduced in one Midwestern
county changed its focus over time from persons with serious mental illness
(PSMI) to persons with opioid use disorder (POUD). Applying the theory
of institutional isomorphism, the authors use both qualitative interview and
quantitative program data to explore the isomorphic pressures that caused
programming change resulting from an opioid addiction crisis at the expense
of arrested PSMI not appropriate for treatment with Vivitrol®.
jail diversion, mental illness, opioid use disorder, isomorphism
This article presents a 4-year case study of one Midwestern county’s post-
booking jail diversion program that transformed from a program for arrestees
with severe mental illness (SMI) to a “Vivitrol® program” for arrestees with
1University of Illinois at Chicago, USA
2University of Central Florida College of Medicine, Orlando, USA
3Lighthouse Institute, Chicago, IL, USA
Corresponding Author:
Monte D. Staton, Center for Dissemination and Implementation Science, Department of
Medicine, University of Illinois at Chicago, 818 S. Wolcott Avenue, Chicago, IL 60612, USA.
991092TPJXXX10.1177/0032885521991092The Prison JournalStaton et al.
188 The Prison Journal 101(2)
opioid use disorder (OUD). In this study, we sought to understand implemen-
tation of a new mental health-criminal justice treatment program and subse-
quent changes that occurred in program structure and operations in response
to internal and external factors over time. Case study research allows for in-
depth research of a current phenomenon in its real-world setting (Yin, 2014).
The rise of the current opioid epidemic has led to a wave of responses by
health and criminal justice agencies across the country. The case study pre-
sented here represents an in-depth exploration of how one jurisdiction’s col-
laborative, multi-agency program aimed at diverting persons with serious
mental illness (PSMI) from the criminal justice system dramatically changed
its focus in response to the current opioid epidemic, creating differing and
sometimes conflicting priorities in health treatment programming for crimi-
nal justice defendants. We found that a program aimed at diverting persons
from jail into a network of mental health treatment services transformed in a
relatively short time period into a program wherein a single medication for
treating substance use disorder (extended-release injectable naltrexone)
became the dominant treatment. We apply the theory of institutional isomor-
phism of the neoinstitutional perspective to understand the program changes.
Using this theory, we argue that the program dramatically changed in response
to a surge in opioid misuse across the country, a new funding environment,
and growing acceptability of Vivitrol® as a treatment for persons with opioid
use disorder (POUD) in the criminal justice system.
Establishment of Jail Diversion Programs
Following deinstitutionalization, law enforcement officials throughout the
United States became the de facto managers of many PSMI living in the com-
munity who were not receiving adequate treatment (Kiesler et al., 1983). Law
enforcement agencies experienced increased involvement with mentally ill
persons whose behavior was too problematic for the community (Goldkamp &
Irons-Guynn, 2001). Furthermore, mental illness and substance use disorder
(SUD) are often interrelated, and offenders with co-occurring disorders often
cycle between incarceration and living in the community (McNeil et al., 2005).
Aware of these issues, criminal justice and mental health officials began
collaborating to develop programs that divert PSMI away from incarceration
and into mental health treatment (Steadman et al., 1995). There are two major
types of diversion programs: pre-arrest programs based in policing, and post-
arrest programs based in jails or problem-solving courts (Steadman et al.,
1995). In 2010, there were 298 post-booking, pretrial diversion programs

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