Calgary Diversion Program: A Community-based Alternative to Incarceration for Mentally Ill Offenders.

BACKGROUND

The management of mentally ill people committing minor criminal offences has been a social concern in Canada for more than thirty years. Processing of these individuals through the Justice system results in a well-known 'revolving door' syndrome. One approach to this problem is the diversion of these offenders from the Justice system to the network of health and social services that can address their overall well-being. A lack of empirical evidence on diversion programs has been identified as a main roadblock to their acceptance.

AIMS OF THE STUDY

To describe outcomes and service utilization of clients using the Calgary Diversion Program, a community-based alternative to incarceration for persons with serious mental disorders who commit minor offences.

METHODS

The study employed mixed quantitative and qualitative methods, and used a quasi-experimental design with the clients serving as their own controls. The Calgary Diversion Program was formed in 2002, with this study spanning client enrollment (n=179) from 2002-2003.

RESULTS

Before to after program enrolment comparisons found justice system complaints, charges and court appearances to have been reduced between 84% and 91% in those clients that participated successfully in the program, while at the same time found reductions of between 25% and 48% of acute services. Both quantitative and qualitative results indicated a high degree of satisfaction on the part of both providers and clients. Statistically significant improvement in the Brief Psychiatric Rating Scale values between baseline and three months after program entry were observed, while quality of life measurement showed statistically significant improvements in six of nine indicators. Acute health care and justice system costs were compared for the nine months prior to referral and the nine months following referral, with an average reduction in total costs of CAD 1,721 per client.

DISCUSSION

The findings presented in this paper are the first significant contribution to empirical research on diversion programs in Canada. The study suggests improved outcomes, support from clients and providers, and reduced overall costs. However, the nature of the study design limits firm conclusions to be made. Longer term follow-up is a key area for future research. IMPLICATION FOR HEALTH POLICIES: This results identified through the study, as well as the accompanying information on the Calgary program's implementation and functioning, are an important building block in moving towards a strategy to address a long-standing social concern. In an era of cost-consciousness, policy makers need to consider programs that not only have the opportunity to improve patient outcomes, but as well show promise in reducing health and other social service costs.