Examining the Implementation of a Novel Pretrial Diversion Program for People with Serious Mental Illnesses

Abstract

A Justice and Mental Health Collaborative (JMHC) was established in Cook County, Illinois with the primary goal of reducing lengthy jail stays and confinement in state psychiatric institutions for defendants with serious mental health concerns. A diverse group of stakeholders, including public defenders, prosecutors, judges, service providers, and researchers, developed a “Fitness Diversion Program” which began its pilot phase in 2019. This program sought to divert its target population away from cumbersome clinical exams for competency to stand trial. Upon successful completion of diversion programming, misdemeanor charges were dismissed. This manuscript analyzes programmatic development, implementation, and expansion through qualitative thematic analysis of interviews with stakeholders using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Qualitative analysis allowed the research team to identify barriers and facilitators to implementation, focusing on themes connected to each RE-AIM domain. This manuscript’s findings demonstrate a case of programmatic drift to accept a larger range of cases, highlighting the importance of programmatic flexibility, attention to sustainability and capacity, and efforts to divert individuals with serious mental illness from continued criminal-legal involvement.