Unveiling Intersecting Experiences: Investigating Health Care and Jail System Interaction Before and After Incarceration Among Adults with Serious Mental Illness in San Francisco

Individuals with serious mental illness (SMI) are overrepresented in the criminal justice system. They frequently cycle between jail and emergency departments and experience poor health outcomes. Some jails offer mental health services, but the criminal justice environment is not conducive to optimal treatment and recovery. Individuals with SMI may require targeted interventions, but few studies have examined characteristics of individuals in jail with and without an SMI or compared their post-release trajectories. We conducted a retrospective cross-sectional study using health services and jail system data from the City and County of San Francisco from July 1, 2011 to June 30, 2021. We included 1568 adults with at least one jail incarceration from July 1, 2017 to June 30, 2018, stratified by the presence or absence of an SMI diagnosis, and compared health services use, jail system interactions, and associated factors. Compared to individuals without SMI, those with SMI had higher rates of substance use disorder (82.5% vs. 53.3%) and homelessness (82.2% vs. 61.0%). The longest single jail incarceration averaged 11.3 days longer for individuals with SMI (p < 0.05, 95% CI: 1.38, 21.26). Post-release, individuals with SMI had higher rates of health services use and reincarceration. We found that individuals with SMI in jail have higher rates of homelessness, health services use, and jail reincarceration. This underlines the responsibility placed on jails to address the complex needs of individuals with SMI. Investment should focus on reentry and diversion programs, as well as expanding jail and community-based mental health care for individuals with SMI.