Pre-Arrest Diversion: A NACo Opioid Solutions Strategy Brief

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“The purpose of [pre-arrest] diversion is to increase public safety by averting incarceration and its negative consequences . . . in favor of options that present a minimal risk to public safety and a greater opportunity for rehabilitation.”

— U.S. Bureau of Justice Assistance1

What is Pre-Arrest Diversion?

Pre-arrest diversion strategies enable law enforcement officers to refer community members with unmet needs to trauma-informed case management and support services in lieu of arrest, prosecution and incarceration.2 Effective pre-arrest diversion strategies increase engagement with necessary behavioral health and social services3 and have the potential to reduce crime, reduce recidivism, reduce substance use, improve quality of life and deliver significant cost savings to the community.4

A growing number of jurisdictions have built on the success of pre-arrest diversion efforts by enabling community members to request assistance for individuals in distress without necessitating law enforcement involvement. Such approaches enable community members to request immediate assistance from behavioral health professionals and/or peer support specialists through local emergency (9-1-1) or non-emergency (3-1-1) call systems.5,6

Click here to learn about Atlanta's approach to community-initiated diversion.

There are several frameworks for pre-arrest diversion that can facilitate intervention at different touch points. These include:

  • Self-referral: a community member can initiate contact with law enforcement or other first responders
    without fear of arrest and receive an immediate referral to services7
  • Active outreach: community members in need of services are identified by law enforcement or other first
    responders and subsequently contacted by qualified behavioral health or peer support specialists7
  • Post-overdose outreach: community members who have recently survived an overdose are identified by
    law enforcement or other first responders, contacted by behavioral health or peer support specialists and
    offered naloxone and linkage to services7–11
  • Prevention referral: a law enforcement officer or other first responder refers any community member to
    case management and services in order to improve that person’s wellbeing and prevent future criminal
    justice involvement,4,7 and
  • Intervention referral: law enforcement officers respond to a chargeable offense committed by a
    community member by referring that person to case management and services while declining to file
    charges or holding charges in abeyance.4,7

What evidence supports pre-arrest diversion?

Punitive responses to individuals with substance use disorder, including arrest, prosecution and incarceration,
are associated with increased likelihood of future arrest and overdose.12 Pre-arrest diversion programs can help
counties improve public health and public safety in multiple ways. For example:

  • Pre-arrest diversion improves quality of life for community members in need. Housing is the most significant need for individuals engaged in pre-arrest diversion, followed by basic survival needs (e.g., food, clothing), unemployment, unmet mental health needs and substance use-related concerns.13 People who are diverted from arrest to case management and services are more than twice as likely to be housed and 33% more likely to receive a legitimate income or benefits compared to before the individual was diverted.14
  • Pre-arrest diversion reduces recidivism and re-arrest.14 Individuals engaged in pre-arrest diversion have 60% lower odds of re-arrest and 39% lower odds of felony arrest after diversion, compared to those who were arrested for suspected drug charges.15
  • Pre-arrest diversion is cost effective. Diversion to appropriate health and social services reduces costs by preventing immediate arrest, subsequent arrest, health-related emergencies and other emergencies that require an urgent response.16,17 Multiple studies indicate that diverting a single person from arrest produces about $2,000 in cost savings.18 For example, in 2020, pre-arrest diversion efforts in Massachusetts resulted in $14 million in total cost savings statewide.17

Are there risks to my community or institution if we don’t support pre-arrest diversion?

Yes.

People with unmet behavioral health needs represent a substantial proportion of incarcerated persons in the U.S.19 An estimated 63 percent of people sentenced in local jails are living with substance use disorder,20 a rate 15 times higher than in the general population at the time of the study.21 Further, incarceration is a primary risk factor for overdose.22 Within the first two weeks of release, formerly incarcerated individuals are 40 times more likely to experience an overdose than the general population.23

Pre-arrest diversion prevents exposure to the risks associated with incarceration, thereby reducing overdose risk.12,22–24 Communities without diversion pathways may face exacerbated overdose rates. Further, arrest and incarceration are expensive. Arresting, booking and holding a single individual pre-trial can cost local jurisdictions tens of thousands of dollars per person per year.25 With over 500,000 people held in county jails on any given day,26 a lack of diversion pathways may contribute to excess costs.

What are best practices for implementing pre-arrest diversion?

  • Integrate diversion principles throughout the emergency response system through strategies like emergency dispatcher training, first responder training and written police protocols.27
  • Invest in high-quality case management and services for diversion participants.28
  • Support ongoing diversion opportunities for past diversion participants. Persons with more severe behavioral health needs are more likely to have subsequent police contact after diversion and will benefit from repeated linkage with case management and treatment services should police contact reoccur.29
  • Train responders in trauma-informed response, as compassionate and non-coercive diversion efforts produce better outcomes.28,30
  • Do not use coercion (i.e., threat of police involvement or incarceration) to engage individuals in treatment. Contact with the criminal justice system interrupts access to services and increases overdose risk and involuntary treatment produces worse outcomes.11,30,31
  • Facilitate regular meetings between agencies involved in first response, health, behavioral health and social services to coordinate diversion procedures and service delivery.31,32
  • Support the creation of an emergency drop-in or diversion center with a no-refusal policy where services can be streamlined and where officers can transport the person whom they would otherwise decline to arrest but cannot leave at the scene.31,33
  • Implement pre-arrest diversion alongside additional diversion efforts including pre-charge, pre-trial, pre-plea and post-adjudication.27,34,35

What are some examples of successful pre-arrest diversion programs?

The Policing Alternatives & Diversion Initiative (PAD), a community-based organization in Atlanta, Ga., implements alternatives to criminal justice involvement by referring residents in need to mental health and substance use services. PAD also provides direct case management services and housing support. Persons in need of these services are identified through Atlanta’s 3-1-1 non-emergency services line and through pre-arrest diversion referrals from law enforcement.36

Local leaders in the City of Seattle and King County, Wash. launched the first Law Enforcement Assisted Diversion (LEAD) program in the U.S in 2011.37 Results of a three-year evaluation, conducted in 2015, found that LEAD participants were 58% less likely to be arrested after enrollment in the program.38 Later evaluations found that LEAD participants were more than twice as likely to be sheltered and nearly 50% more likely to be on the employment continuum (i.e., in training, employed or retired) than they were before LEAD involvement.39

Numerous counties have replicated the LEAD model in their unique contexts. For example, Leon County, Fla., now issues civil sanctions for offenses that would have otherwise led to arrest, allowing diversion participants to fulfill civil sanctions (such as community service) while simultaneously receiving evidence-based treatment and case management in the community.40 Similarly, stakeholders in Jones, Story and Black Hawk counties, Iowa operate diversion programs through a partnership between law enforcement, local prosecutors and treatment providers. Paid coordinators work in each county to assist clients with treatment navigation, referrals, case management and facilitate participant success.41

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Author

Jennifer J. Carroll, PhD, MPH

Dr. Carroll is a medical anthropologist, research scientist and subject matter expert on substance use and public health. She is currently an Assistant Professor of Anthropology at North Carolina State University.

Additional Resources

Informational Resources

Implementation Guidelines and Best Practices

Roll Call Videos for Law Enforcement 

The SHIELD Training Initiative

The SHIELD Training Initiative provides effective, scientifically tested training strategies for training law enforcement on topics including substance use, overdose response and diversion. The SHIELD Training Initiative offers direct technical assistance by request to communities focusing on this and similar law enforcement-facing strategies.

National LEAD Support Bureau

The National LEAD Support Bureau offers training and technical assistance to local jurisdictions seeking to implement diversion and linkage-to-service programs. Requests for technical assistance can be made directly or through the U.S. Bureau of Justice Administration technical assistance website.

Treatment Alternatives for Safe Communities (TASC)

TASC’s Center for Health Justice offers technical assistance and training support on current research and best practices for responding to behavioral health concerns — including substance use disorders — within criminal and juvenile justice systems. TASC offers support for deflection and pre-arrest diversion, pre-trial and jail-based interventions and prosecutorial diversion.

  1. U.S. Bureau of Justice Assistance. Diversion. BJA. Accessed March 14, 2024. https://bja.ojp.gov/program/psrac/implementation/structured-decision-making/diversion
  2. LEAD National Support Bureau. What is LEAD? LEAD National Support Bureau. Published 2022. Accessed October 25, 2022. https://www.leadbureau.org/about-lead
  3. National LEAD Support Bureau. Core Principles & Fact Sheets. LEAD National Support Bureau. Published 2022. Accessed October 25, 2022. https://www.leadbureau.org/resources
  4. Charlier J. Deflection: A Powerful Crime-Fighting Tool That Improves Community Relations. Police Chief Magazine. Published March 1, 2017. Accessed October 24, 2022. https://www.policechiefmagazine.org/deflection-a-powerful-crime-fighting-tool-that-improves-community-relations/
  5. Policing Alternatives & Diversion Initiative. Community Response Services. Policing Alternatives & Diversion Initiative. Published 2022. Accessed October 25, 2022. https://www.atlantapad.org/community-response-services
  6. Durham Community Safety Department. Community Safety. City of Durham. Published 2022. Accessed October 25, 2022. https://www.durhamnc.gov/4576/Community-Safety
  7. Center for Health & Justice at TASC. Pre-Arrest Diversion/Deflection Frameworks: A Decision Making Tool for Police Leaders. Published online 2017. Accessed October 25, 2022. https://www.centerforhealthandjustice.org/tascblog/Images/documents/Publications/DeflectionFramework-excerpt_Final.pdf
  8. Dahlem CH, Scalera M, Anderson G, et al. Recovery opioid overdose team (ROOT) pilot program evaluation: A community-wide post-overdose response strategy. Substance Abuse. Published online 2020. doi:10.1080/08897077.2020.1847239
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  10. Scott CK, Dennis ML, Grella CE, et al. Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment. Journal of Substance Abuse Treatment. 2020;108:65-74.
  11. Formica SW, Waye KM, Benintendi AO, et al. Characteristics of post-overdose public health-public safety outreach in Massachusetts. Drug and Alcohol Dependence. 2021;219:108499. doi:10.1016/j.drugalcdep.2020.108499
  12. Zhang A, Balles JA, Nyland JE, Nguyen TH, White VM, Zgierska AE. The relationship between police contacts for drug use-related crime and future arrests, incarceration, and overdoses: a retrospective observational study highlighting the need to break the vicious cycle. Harm Reduct J. 2022;19(1):67. doi:10.1186/s12954-022-00652-2
  13. Policing Alternatives & Diversion Initiative. Policing Alternatives & DIversion Initiative 2021 Report. Published online 2022. Accessed October 26, 2021. https://static1.squarespace.com/static/5e9dddf40c5f6f43eacf969b/t/628f901103f1ba526b27e0c9/1653575697710/PAD+2021+Report.pdf
  14. Clifasefi SL, Lonczak HS, Collins SE. Seattle’s Law Enforcement Assisted Diversion (LEAD) Program: Within-Subjects Changes on Housing, Employment, and Income/Benefits Outcomes and Associations With Recidivism. Crime & Delinquency. 2017;63(4):429-445. doi:10.1177/0011128716687550
  15. Collins SE, Lonczak HS, Clifasefi SL. Seattle’s Law Enforcement Assisted Diversion (LEAD): Program effects on recidivism outcomes. Evaluation and Program Planning. 2017;64:49-56. doi:10.1016/j.evalprogplan.2017.05.008
  16. Massachusetts Department of Mental Health Division of Forensic Mental Health Services. Pre-Arrest Law Enforcement-Based Jail Diversion Program Report : July 1, 2011 to January 1, 2014. Department of Mental Health, Forensic Services; 2014. Accessed October 26, 2022. https://archives.lib.state.ma.us/handle/2452/680978
  17. Massachusetts Department of Mental Health. Jail/Arrest Diversion Grant Program FY2020 Annual Report. Published online April 2021. Accessed October 26, 2022. https://archives.lib.state.ma.us/handle/2452/856177
  18. Collins SE, Lonczak HS, Clifasefi SL. Seattle’s law enforcement assisted diversion (LEAD): program effects on criminal justice and legal system utilization and costs. J Exp Criminol. 2019;15(2):201-211. doi:10.1007/s11292-019-09352-7
  19. McNiel DE, Binder RL, Robinson JC. Incarceration associated with homelessness, mental disorder, and co-occurring substance abuse. Psychiatric services (Washington, DC). 2005;56(7). doi:10.1176/appi.ps.56.7.840
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  21. U.S. Substance Abuse and Mental Health Services Administration. 2007 NSDUH Detailed Tables. SAMHSA. Published 2008. Accessed March 21, 2024. https://www.samhsa.gov/data/report/2007-nsduh-detailed-tables
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  25. U.S. Department of Justice, U.S. Bureau of Prisons. Annual Determination of Average Cost of Incarceration Fee (COIF). Federal Reguster. 2023;88(183):65405-65406.
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  27. National Judicial Task Force to Examine State Courts’ Response to Mental Illness. Collaborative Court and Community Diversion for Individuals with Behavioral Health Needs. Published online June 21, 2021. Accessed October 25, 2022. https://www.ncsc.org/__data/assets/pdf_file/0024/66426/Court-and-Community-Diversion.pdf
  28. Broner N, Lattimore PK, Cowell AJ, Schlenger WE. Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study. Behav Sci Law. 2004;22(4):519-541. doi:10.1002/bsl.605
  29. Kopak AM. Behavioral health indicators and time-to-rearrest in an adult pre-arrest diversion program. Behav Sci Law. 2020;38(1):66-76. doi:10.1002/bsl.2452
  30. Tori ME, Cummins E, Beletsky L, et al. Warrant checking practices by post-overdose outreach programs in Massachusetts: A mixed-methods study. Int J Drug Policy. 2022;100:103483. doi:10.1016/j.drugpo.2021.103483
  31. Hartford K, Carey R, Mendonca J. Pre-arrest diversion of people with mental illness: Literature review and international survey. Behav Sci Law. 2006;24(6):845-856. doi:10.1002/bsl.738
  32. Heller D, Bradley O’Brien D, Harocopos A, et al. RxStat: Technical Assistance Manual. Published online 2014. Accessed April 5, 2021. http://www.pdmpassist.org/pdf/PDMP_admin/RxStat-3.pdf
  33. Policing Alternatives & Diversion Initiative. The Center for Diversion and Services. Policing Alternatives & Diversion Initiative. Published 2022. Accessed October 26, 2022. https://www.atlantapad.org/diversion-center
  34. Vera Institute of Justice. Diversion Programs, Explained. Vera Institute of Justice. Published 2022. Accessed October 26, 2022. https://www.vera.org/diversion-programs-explained
  35. U.S. Substance Abuse and Mental Health Services Administration. The Sequential Intercept Model (SIM). SAMHSA. Published 2022. Accessed August 15, 2022. https://www.samhsa.gov/criminal-juvenile-justice/sim-overview
  36. Policing Alternatives & Diversion Initiative. The Issue. Policing Alternatives & Diversion Initiative. Published 2022. Accessed October 25, 2022. https://www.atlantapad.org/theissue
  37. National LEAD Support Bureau. Background on LEAD. LEAD National Support Bureau. Published 2022. Accessed October 25, 2022. https://www.leadbureau.org/about-lead
  38. National LEAD Support Bureau. LEAD Fact Sheet. Published online 2016. Accessed October 25, 2022. https://www.leadbureau.org/_files/ugd/6f124f_6c348a0648d045508966dceb187e9fb8.pdf?index=true
  39. Clifasefi SL, Lonczak HS, Collins SE. LEAD Program Evaluation: The Impact of LEAD on Housing, Employment, and Income/Benefits. Published online 2016. Accessed October 25, 2022. https://www.leadbureau.org/_files/ugd/6f124f_dbde96f835db4526abf7bfda03d0040f.pdf
  40. Bureau of Justice Assistance. Law Enforcement and First Responder Diversion: Pathways to Diversion Case Studies Series. Published online August 2020. Accessed March 14, 2024. https://bja.ojp.gov/library/publications/law-enforcement-and-first-responder-diversion-pathways-diversion-case-studies
  41. Woolrey, Dale. "Iowa Pathways to Addiction Recovery: Law Enforcement Assisted Pre/Post Arrest Diversion." Published online 2020. Accessed May 22, 2024. https://comment.iowa.gov/Notice/DownloadNoticeAttachment?SystemName=50710b9a-c855-4e03-a97f-3200ac6cebfd

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