Contextual Determinants of the Implementation of a Mental Health Diversion Policy in California

In 2018, California passed Assembly Bill 1810, creating a pathway for pretrial diversion of individuals with mental health disorders. State statute dictates certain aspects of diversion eligibility and implementation. However, implementation of diversion occurs at the county level and counties have some degree of discretion as to how they implement the policy. This study conducted a qualitative implementation assessment of the contextual factors that have shaped the implementation of the state's mental health diversion policy. We recruited nine counties and conducted semistructured interviews with a total of 29 implementation partners. Qualitative coding was conducted to explore themes related to program implementation and these codes were analyzed using the Consolidated Framework for Implementation Research. An early challenge to the implementation process was the need to create infrastructure to support diversion and ensure oversight of mental health evaluations, treatment plans, and client progress. Many counties started with a decentralized process but found that standardizing the process was an important facilitator (e.g., having a dedicated judge for diversion cases). Some of the key implementation barriers related to perceptions of prosecutors and concerns related to public safety; however, even defense attorneys must balance diversion with other options their clients have (e.g., taking a plea in exchange for a short sentence). Jurisdictions implementing new mental health diversion programs can draw on the implementation science and literature related to other programs, such as drug courts, to address these implementation barriers.