Background: Persons with serious mental illness (SMI) and co-occurring substance use disorder (SUD) are disproportionally represented within the criminal justice system (Waters et al., 2023). Mental illness occurs at higher rates among people in the criminal legal system when compared to the general population with 16% to 27% individuals in community supervision, 41% in jails, and 56% in state prisons (Waters et al., 2023). Jail diversion policies and programs serve as an alternative to entering the criminal justice system. Jail diversion is especially important amid individuals with SMI and co-occurring SUD. Mack, (2017), discusses that there are great barriers for people suffering with mental illness and substance use disorder to access timely mental health and rehabilitation services in their community (Mack, 2017). The Michigan Mental Health Code (MMHC) aims to divert youth and adult persons with mental illness, serious emotional disturbance, or substance abuse disorder from unnecessary jail detention or incarceration (Michigan Compiled Laws MCL 330.1207, section 207). This policy analysis project will evaluate MMHC jail diversion policies MCL 330.1468, MCL 330.1469a, MCL 330.1461 court ordered assisted outpatient therapy (AOT) and MCL 330.1206a, mediation to resolve a dispute (Michigan Legislature, 2023). These are distinguished policies that have shown successful outcomes as early intervention initiatives (Michigan Legislature, 2023). Problem: Both AOT (MCL 330.1461, section 461) and mediation (MCL 330.1206, section 206a) impose restrictions that prevent them from achieving a greater benefit in successful jail diversion outcomes. AOT as dictated by the MMHC limits the role of the examiner and the witness in court to a psychiatrist or licensed psychologist (MCL 330.1461), excluding other mental health professionals such as certified nurse practitioners (NPs) and physician assistants (PAs). This restriction reduces the chances of treating incapacitated individuals who are not receiving adequate care for their mental illness, especially in the context of a psychiatrist shortage and the availability of NPs and PAs (Michigan Legislature, 2023). HB 4746 (MCL 330.1461) proposes to amend section 461 to allow NPs or PAs working under a psychiatrist to exam and testify for the need of involuntary treatment, including AOT (Michigan Legislature, 2023). Mediation (MCL 330.1206, section 206a) and notification of rights is determined at the time service begins and then annually. This restricts the accessibility to mediation meetings and thus restricts the role of mediation. HB 4748 adds section 469b, adding language pertaining to mediation in AOT (Michigan Legislature, 2023). HB 4748 expands on who can request mediation, meaning the recipient or recipient's representative or care provider can request mediation at any time and that an issue can be mediated without the need to seek court intervention through Community Dispute Resolution Centers (Michigan Legislature, 2023). Mediation is a valuable tool in the effort to avoid hospitalization and incarceration and is an effective way to solve disputes. Mediation is embedded in court ordered AOT and allows for follow ups on treatment plans and fosters compliance. Methods: This project is guided by Centers for Disease Control and Prevention (CDC) Policy Analytical Framework (CDC, 2013) and directed by the following 1) conduct a comprehensive policy analysis of current legislation related to AOT and mediation jail diversion policies in Michigan, 2) assess 19 this legislation and initiatives in relation to identified best practices and similar legislation and initiatives in other states, and 3) develop recommendations for the implementation of jail diversion best practices in all Michigan counties through policy reform. This policy analysis intends to address the gaps in current legislation. Discussion HB 4746 was introduced and sponsored by republican [R] Senator Doni Steele on June 6, 2023, (Michigan Legislature, 2023). This bill sits at the Health Committee and has not yet been passed by the house nor the senate as of January 31, 2024. This project speculates that the fact that the sponsor and cosponsors of HB 4746 are [R] and that the state is primarily composed of democratic legislators (democratic party governorship and democratic majority in both chambers of the estate legislature) may be a barrier for this bill to be passed to the senate. It may be necessary that the house and senate be debriefed by health policy advocates such as NPs and PAs on HB 4746 significance to the health of their Michigan constituents so that HB 4746 has a chance to move forward toward enactment. Another possibility is that HB 4746 may need to be reintroduced and co-sponsored by democratic legislators, becoming a bipartisan bill. At this point, this policy project believes that the best chance for HB 4746 to be enacted would be for the bill to be reintroduced as a bipartisan bill. This means that democratic legislators would need to support and sponsor/co-sponsor the bill among the republican legislators.
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