Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 269A JAIL DIVERSION PROGRAMFrequently encountered in jail, for example, are people with both substance abuseproblems and mental disorders such as schizophrenia and bipolar disorder. Theusual office-based treatment is often not successful for such people becausesubstance abuse interferes with treatment of the psychiatric illness and vice versa.To prevent such people cycling repeatedly through jail, the mental health centerand criminal justice and correctional agencies in Boulder County, in 2000,established a collaborative community treatment program for suitable jail inmatesthat borrows some of the concepts of intensive community support (describedbelow) and incorporates the following services for those who can benefit:• collaborative treatment planning between the judge, the district attorney, thepublic defender, community corrections and the mental health professionals;• daily administration of medications and monitoring of mental status;• sobriety testing with breathalyzers and urine screens;• case management services to help clients obtain housing, financial benefits andmedical care;• job placement and support;• psychiatric evaluation and counseling, probation and community correctionsand other services provided on the same site.Those accepted into the program (called the PACE program) are released fromjail and receive services at a neutral location not associated with the criminaljustice system or the mental health center. In the first year of operation the PACEprogram reduced the amount of time the enrolled clients spent in jail from anaverage of nine days a month before enrollment to two days a month afterwards.There were also improvements in sobriety and employment and big cost savingsfor the criminal justice system. 5Besides developing special programs for repeat offenders, the task of mentalhealth administrators and action groups is to put pressure on their legislators tomaintain adequate funding for hospital care and for an array of communitytreatment programs such as those described below, so that jails are not used as aback-up treatment resource.INTENSIVE RESIDENTIAL TREATMENTCedar House is a large house for 15 psychiatric patients in a residential and businessdistrict of the city of Boulder. It functions as both an alternative to acute care in apsychiatric hospital and as a half-way house. Like a psychiatric hospital it offers allthe usual diagnostic and treatment services but, at less than half the cost of privatehospital treatment, it is feasible for patients to remain in residence for quite longperiods of time if necessary. Admitted with some kind of an acute psychiatric