County budget priorities shape how local criminal justice systems manage individuals with mental illness when community treatment capacity is limited. Using data from one Texas rural hub county, a 2-year observational analysis paired county budget allocations with hospital emergency department encounters and jail bookings of individuals with serious mental illness. Results showed stable budget priorities favoring correctional and judicial operations over community mental health services. During the same period, jail bookings were concentrated among a small subset of individuals with serious mental illness. They were dominated by low-level, nonviolent, and administrative charges rather than charges involving violence. Detention length of stay varied widely and did not increase systematically with booking frequency, although repeated bookings led to greater incarceration exposure. Emergency department encounters involving serious mental illness did not show higher clinical severity, longer hospitalizations, or greater costs than encounters without serious mental illness. Most encounters involved medical diagnoses rather than psychiatric. Findings indicate local governments relied on jails and emergency departments as default crisis responders to unmet community mental health needs. The study contributes a framework linking budget composition, justice system contact, and emergency care in a rural hub setting, and highlights institutional substitution as a product of local governance and fiscal priorities.
Gittner et al. (Sat,) studied this question.