Treatment, Not Jail: It’s Time to Step Up

MAY. 05, 2015

By Mary Giliberti, J.D.

Frequently, I travel around the country speaking at NAMI state conferences. I also get to talk with individuals and families from all walks of life who are affected by mental illness.

One of the top concerns they have—no matter whether it is in Arizona, Georgia, Massachusetts, Ohio, Texas or elsewhere—is what happens when a person living with mental illness encounters the criminal justice system. The stories people share should shock the conscience of America. Mothers tell me about sons who are put in jail for minor non-violent offenses and go without treatment. Fathers talk about daughters who have been arrested repeatedly, but are never connected to the help they need.

Individuals, who have survived encounters, talk about being thrown into solitary confinement—and being left alone hearing voices while praying to God to end their misery.

Taking calls on the NAMI HelpLine, I also hear from others who can’t understand how in the 21st century, so many people who are sick through no fault of their own, are abandoned to a cruel and inhumane system.

Each year more than 2 million people with serious mental illness are booked into jail. That number is equal to every man, woman and child in Houston, the largest city in Texas and the fourth most populous city in the United States. Half of these inmates get no treatment in jail—even though county jails today serve as the nation’s largest mental health facilities

The costs to taxpayers are high and the outcomes are poor. It doesn’t take a rocket scientist to realize the absurdity of a system in which the cost of incarcerating a person with mental illness is three times the cost of incarcerating a person without one. Housing an inmate with mental illness in jail costs $31,000 annually, while community mental health services cost about $10,000. The difference could pay for a year of college for an in-state student.

One important reform leader is Sheriff Tom Dart of Cook County, Ill., who oversees one of the nation’s largest jails. One-third of the inmates have a serious mental illness. When I was in Chicago last year, Sheriff Dart’s staff gave me a tour of the jail. Sheriff Dart is one of the most compassionate and caring members of the law enforcement community, but he will be the first to say that the situation is heartbreaking—and an injustice. Jails are no place for mental health care. What I heard from him and inmates themselves echoed what I had heard from so many others.

Like Sheriff Dart, there are many people who are trying to change things. Criminal justice reform is one of NAMI’s top priorities for advocacy at all levels—national, state and local—and this week support for NAMI’s advocacy grew.

The National Association of Counties and Council of State Governments and numerous mental health and substance abuse organizations, including the American Psychiatric Foundation, have launched The Stepping Up Initiative to challenge county, state and local leaders to adopt reforms that can work in their communities. Launch rallies are being held in California, Florida, Kansas and Washington, D .C. NAMI is part of the coalition, bringing our unique voice and strength in grassroots mobilization.

Many reforms are needed. One is nationwide expansion of crisis intervention team (CIT) programs for law enforcement. CIT programs train police officers to respond more safely and humanely to individuals experiencing mental health crises by using “verbal de-escalation” skills and taking them to where they can get medical care rather than to jail. Today, there are approximately 2,800 CIT programs around the country, but they represent only 15% of police jurisdictions. It’s time for others to step up.

Many communities are making progress. In San Antonio, screening and diversion efforts have saved $10 million per year and reduced jail overcrowding. In Miami, reforms have saved $12 million and the number of inmates has fallen from about 7,800 to 4,800. Especially important of course is providing appropriate, effective mental health services in communities before crises ever occur.

Reform is possible. We need to build on success. Step by step, we can both save money and save lives The Stepping Up Initiative provides the opportunity for change. We can save lives and save money, but it is going to require everyone doing their part.

Learn more about Stepping Up and take a step today toward a better future where no one is punished for being ill and people with serious mental illness get treatment, not jail.

Submit to the NAMI Blog

We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices.

Check out our Submission Guidelines for more information.