About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline

LOG IN
LOG IN


14 Health & Just. 1 (2026)

handle is hein.journals/hlthjs14 and id is 1 raw text is: Johnson etal. Health& Justice (2026) 14:1 Health & Justice https://doi.org/10.1186/s40352-025-00390-0 R ESEARCH Open Access Strengthening community services to keep individuals with mental illness out of jail: a qualitative analysis of implementation mechanisms in 52 U.S. Counties Jennifer E. Johnson'*, Maji Hailemariaml, Faye Taxman2, Benjamin J. Mackey2, Hiywote Eshetu1, Jiaxin Wei2, Olzhas Zhorayev2, Neelam Shukla2, Niloofar Ramezani3 and Rochelle Rosen4 Abstract Background Identifying mechanisms of implementation approaches helps improve them. This qualitative analysis examined how hypothesized mechanisms (performance monitoring, interagency teams, common goals/mission across agencies, and system integration) influenced implementation outcomes (number of evidence-based services [adoption], people served [reach], and resources to support evidence-based services [component of sustainment]) in county-level efforts to improve community services to keep people with mental illness out of jails. Methods Our study statistician chose a representative sample of 60 U.S. counties and respondents from a sampling frame consisting of community mental health, community substance use, jail, and probation administrators in 950 U.S. counties. We reached and interviewed representatives from 52 of 60 counties (68 respondents in 52 interviews). Interviews were recorded, transcribed, de-identified, and coded using thematic analysis with deductive codes. Study team members created analysis summaries for each mechanism, which were reviewed and verified by other team members. Results Administrators viewed all hypothesized implementation mechanisms as helpful for at least one outcome. They viewed performance monitoring (tracking metrics over time) as helping counties obtain resources to provide services, re-allocate existing services to better meet clients'needs, and provided feedback needed to improve services. Interagency teams (i.e., regular meetings with multiple agencies) increased integration and continuity of care across treatment and jail/probation settings, improved client mental health and substance use outcomes, provided access to additional trainings and programs, and helped to change attitudes and policies to support evidence-based practices. Agreement on goals and mission across agencies improved availability of evidence-based practices, client outcomes, and collaboration between community providers and criminal justice partners, and facilitated interagency problem- solving. Integration of care across agencies helped get clients faster, more appropriate care, eliminating unnecessary frustration, illness, incarceration, and suffering. The presence of one mechanism tended to support use of other *Correspondence: Jennifer E. Johnson JJohns@msu.edu Full list of author information is available at the end of the article ME The Author(s) 2025. Open Access This artice is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this artide are included in the artice's Creative Commons licence, unless indicated otherwise in a credit line tothe material. if material is not included in the articies Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy ofthis licence, visit http://creativecormons.org/licenses/by/4.0/.