When Symptoms Matter More Than Charges: How Psychosis Shapes Jail Diversion Decisions

Abstract Police increasingly serve as first responders to behavioral health crises, making critical jail diversion decisions at the intersection of law enforcement and mental health systems. While charge severity typically predicts diversion outcomes, it remains unclear whether this relationship operates consistently across different clinical presentations. This study examined whether psychotic presentations moderate the association between charge severity and jail diversion outcomes using data from Massachusetts’ statewide jail diversion program database. The retrospective cohort analysis included 6,911 encounters involving potential criminal charges across 155 programs over 21 months (April 2023–January 2025). Logistic regression models examined main effects and interactions between psychosis status and charge severity. Results showed that while charge severity was the strongest predictor of diversion overall, psychotic presentations significantly moderated this relationship. Although individuals with psychosis had increased overall diversion likelihood, the association between less severe charges and diversion was attenuated when perceived psychotic symptoms were present. Among individuals without psychosis, less severe charges were associated with a 35-fold increase in diversion odds compared to severe charges, but this association was reduced by 82% when perceived psychotic symptoms were present. Very severe charges combined with psychosis further reduced diversion likelihood beyond what charge severity alone would predict. These findings suggest that diversion personnel weigh clinical complexity more heavily than legal severity when psychotic symptoms are present, highlighting the need for specialized training protocols and decision-making frameworks tailored to these complex presentations