Survey Responses Suggest Few U.S. Jails Use Screenings and Assessments for Behavioral Health Diversion

A survey of administrators at U.S. jails shows that only about one-third of facilities use information from behavioral health screening and assessment tools to divert people from jail. Most facilities do conduct screenings and assessments, but few use them for diversion purposes. That represents a significant missed opportunity to connect people to the care they may need.

The Pew Charitable Trusts invited more than 1,400 U.S. jail administrators through their professional association, the American Jail Association, to take the survey that was fielded from May 2023 to February 2024. (See methodology for details.) One hundred jail administrators responded, a relatively small sample but enough to provide some insights into what’s happening in the nation’s jails.

Jail administrators were asked about facility practices related to mental health and substance use screenings and assessments. These screenings are brief, routine procedures that can include short interviews or self-reporting to identify if an individual has urgent health concerns when entering a facility. Assessments, meanwhile, are more in-depth evaluations that help determine treatment and care of individuals with health issues, including diversion from jail to treatment, and care while in jail or after release.

Overall, jails reported high usage rates for these tools: 88% reported screening everyone for mental health needs and 80% conducted assessments based on information gained through screenings or prior records. Additionally, 86% of responding jails screened everyone entering their doors for substance use issues and roughly 65% performed assessments based on those screening results.

But few facilities used that behavioral health information to help move people out of jail and into appropriate care settings: just 33% used screenings and assessments to divert people with mental health concerns and only 33% used those tools to divert people with substance use issues.

Ideally, individuals experiencing mental health or substance use emergencies are not arrested, but connected with appropriate treatment options, such as medication and counseling, in their communities. That is often not the case. The reality is that many people with behavioral health needs find themselves in jail: More than 1 in 9 adults with co-occurring mental health and substance use disorders were arrested annually between 2017 and 2019.

When people with urgent behavioral health needs, such as psychosis or substance use withdrawal, are arrested and jailed, they can be diverted out of the legal system—usually in the first 48 hours after arrest, before or during an initial appearance in court. Jails that use information from behavioral health assessments to divert these individuals are connecting them with the immediate care they need and reducing the strain on jail resources.

Jail administrators are not always able to divert people with behavioral health issues to treatment, but screenings and assessments are still useful in connecting people with services and care while they are incarcerated and post-release. The survey found that 84% of facilities used assessment tools for treatment planning of those with mental health needs while incarcerated, but only 58% of responding jails with assessment tools used them to connect people with appropriate services in the community once they leave jail. In terms of addressing substance use issues, 87% of facilities used these tools for treatment planning for people while incarcerated, while only 58% used them for post-release planning. Release planning is urgently important for those with substance use disorder, in particular; people recently released from jail have high rates of overdose mortality in the weeks following their release.

For a variety of reasons, including limited planning time, jails do not always provide treatment resources for the more than 9 million people who cycle through their doors each year. Using screening and assessment information to connect people leaving jail with services—such as housing and mental health support and substance use treatment—could reduce overdose risk, provide stability, and help prevent them from returning to the criminal legal system after release. And that would simultaneously help reduce the costs to jails.

Screenings and assessments can help jail administrators better manage the behavioral health needs of people in their custody and set them up for a more successful reentry upon release. States and jurisdictions seeking to improve behavioral health outcomes and manage public health costs and resources should examine how these tools are being used in their local jails, and how they can be used more effectively and consistently to help people with substance use and mental health needs.

Alexandra Duncan is the project director for The Pew Charitable Trusts’ substance use prevention and treatment initiative. Julie Wertheimer is the project director for Pew’s mental health and justice partnerships project.