By Stephanie Brooks Holliday, Elizabeth Marsolais, Samantha Matthews

The Los Angeles County Rapid Diversion Program (RDP) is a pretrial mental health diversion program that was established in 2019. RDP serves individuals whose mental health diagnoses (which can include substance use disorders) played a role in the criminal charges that they are facing. The concept for RDP was developed with several local departments at the table, including public defense, prosecution, behavioral health services, and the Los Angeles County Sheriff’s Department. The program is now overseen by the Justice, Care and Opportunities Department (JCOD). When RDP launched, it focused on people facing low-level, nonviolent misdemeanor charges. RDP has expanded from one courthouse to seven in its first five years of operation. It now diverts qualifying people facing misdemeanor or felony charges. In addition to mental health and/or substance use disorder treatment, RDP clients receive case management services to help them address other needs (e.g., housing, obtaining benefits). Successful completion of RDP leads to the dismissal of charges. The figure depicts the RDP process.

Evaluating the Rapid Diversion Program

RAND researchers aimed to understand how RDP is being implemented, the successes and challenges that the program faces, and the characteristics of clients served by the program. The research team reviewed relevant documents, observed courtroom proceedings, conducted interviews with program implementation partners and graduates, and analyzed program data. In their assessment, the researchers found both strengths in implementation and challenges to consider while contemplating the expansion of RDP. Overall, public defenders, prosecutors, and clinicians support expanding the program.

Key Findings

Building a Diversion Program

RDP was developed on the foundation of three guiding principles that have helped address limitations to the traditional pretrial mental health diversion process under the California Penal Code, Section 1001.36: (1) identifying a set of charges that the defense, prosecution, and courts can agree are appropriate for diversion; (2) embedding clinical staff directly in the courts, which avoids the lengthy process of retaining a forensic evaluator to assess the client and then developing a treatment plan; and (3) providing case management to both address additional client needs and help ensure program compliance.

Rapid Diversion Program Client Characteristics and Outcomes

Among the findings on client characteristics and outcomes:From March 2022 to April 2024, more than 4,300 people were evaluated, and more than 1,200 were diverted.Most clients are Hispanic (about 47 percent) or Black (28 percent).About 35 percent are unhoused and 42 percent are in temporary housing when they enter the program.About one-half of the individuals approved for diversion are facing misdemeanor charges, and one-half are facing felony charges.As of April 2024, more than 660 clients had graduated from the program, and 91 percent had avoided having a new case filed for an offense occurring after graduation.

Santa Monica, CA: RAND, 2024. 2p.

By Scott Poland

Importance of Training: School personnel, especially counselors, need proper training to effectively handle suicidal students and understand the warning signs.

Administrative Support: Gaining support from top administrators is crucial for implementing a successful suicide intervention program.

Family Involvement: Notifying and involving parents is essential when dealing with suicidal students.

Confidentiality: While students expect confidentiality, it must be broken if a student's welfare is at risk

Guilford Press, 1989, 213 pages

By, Louis Favril,, Josiah D Rich, Jake Hard, and Seena Fazel

   Summary Background People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. Methods In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre registered with PROSPERO, CRD42023404827. Findings Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9–12·8) for major depression, 9·8% (6·8–13·2) for post-traumatic stress disorder, and 3·7% (3·2–4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0–26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5–46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0–20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small study effects. Interpretation People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health.

Lancet Public Health 2024; 9: e250–60