Johnson said it is important to define what the criminal legal system is, as it includes millions of Americans every year, not just those who serve long sentences in prison.

"When people hear this, they think people who are serving life in prison and really that's .01% of the system," Johnson said. "There's 200 million 911 calls every year; there's 53 million police contacts. The crisis care continuum in the community is part of the system. Even if you're arrested and spend a night in jail, most of the time you're out within a week. There's a really broad continuum."

After completing another study that found the accessibility of community mental health and substance use services predicted a lower county jail population, Johnson wanted to look further into recommended practices and how widely they are used.

One practice Johnson believes is particularly important is Medicaid eligibility continuity. Currently, an individual’s Medicaid eligibility is paused when they are incarcerated, even if it is only for a night, and it is not restarted automatically upon release.

This can leave individuals with mental illnesses vulnerable to further risk behaviors as they miss several days of their medication, Johnson said. 

Another top recommended practice Johnson found was including crisis intervention teams in police dispatches. She said a common message from jail nurses and social workers was that a number of incarcerated individuals were there because there was nowhere else for them to go.

"We have a lot of folks, unfortunately, with developmental disabilities who end up in jail or folks with dementia who, for whatever reason, were driving the wrong way or got in an argument with somebody," Johnson said. "Jail's maybe not the best place for them, or really even a safe place for them, but the police didn't have another good option."

Including crisis intervention teams and establishing crisis centers for individuals who need support but may not deserve a jail sentence would reduce jail populations, Johnson said. 

"The number one thing would be to have counties think about their crisis care continuum," Johnson said. "When the police are called, and the person can't stay where they are, what are their options? Do they have any other options besides the jail and the emergency department?"

Johnson has worked in this field since 2004. She said one of her biggest motivators are the people she has met through her research.

"When I started, I started doing work at a combined women's prison jail in Rhode Island, and when I went out there, I was 30 at the time, I had a six-year-old, an eight-year-old, and that's who I saw looking back at me — women in their 20s and 30s with children,” Johnson said. "Listening to the women's stories, it was amazing how I could see that but for one twist of fate or one bad decision, it could be me."

Johnson said the connections she created with many of the people she met pushed her to try and set in place resources and services that can keep individuals safe and healthy, even in moments of crisis.

"You see how your life hinges on very small decisions," Johnson said. "It's humbling, to realize just how quickly life can change."

Students and faculty who want to read the full study themselves have access through the MSU Library.