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

• DOI: 10.1177/0032885521991092
• Author: Barbara Andraka-Christou,Dennis P. Watson,Monte D. Staton
• Published date: 01 March 2021
• Date: 01 March 2021
• Subject Matter: Articles

https://doi.org/10.1177/0032885521991092

The Prison Journal

2021, Vol. 101(2) 187 –209

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DOI: 10.1177/0032885521991092

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Article

Isomorphic Pressures

on Jail Diversion: From

Serious Mental Illness to

Opioid Use Disorder

Monte D. Staton1, Barbara Andraka-Christou2,

and Dennis P. Watson3

Abstract

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®.

Keywords

jail diversion, mental illness, opioid use disorder, isomorphism

Introduction

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.

Email: staton@uic.edu

991092TPJXXX10.1177/0032885521991092The Prison JournalStaton et al.

research-article2021

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.

Background

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