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

By Mary Giliberti, J.D. | May. 05, 2015

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.

My brother was diagnosed in prison with mental illness and now they're trying to take him back into prison because his mental illness is bad he met the wrong person this girl was nothing but that news from the start and because of her he is going now to prison for 16 years for carrying her purse full of drugs because mental illness does not let you think and see people that they are bad people with mental illness they just want help and want to be loved and understood but our society does not understand and rejects them especially if they've been in prison and gone back are system needs to change and help these people to give them a chance to live in the real world with help they need instead of putting him in prison give the people with mental illness that help that they need.
11/29/2017 3:01:16 PM

I'm struggling. My son is bypolar he is 36 year old on July he has maniac episode. I tried tu put him in the hospital and he refused. He get worse starting using cristal met. Make him more crazy. He is in jail. Can please help me how he can recibe treatment and be transferred from jail
To a Rehabilitación. He is a father of 12 years old girl. l need him back. He was a college student at the time his episode started. Is tragedy for our family l pleaded to the lawyer to help. They don care they send mental illness people to the streets. I leave in Los Angeles.
11/15/2017 12:58:11 PM

It is so sad that the system is so screwed up. My son was recently incarcerated, and shut down. He was already severely depressed and in a bad state of mind, and we were in the process of helping him get psychatric care before he was arrested. He's not eating in jail and having paranoid thoughts and hallunications. Its so sad that he is not being evaluated and treated like he should be. The system needs alot of work and improvement to defend the mentally ill
7/15/2017 3:47:03 PM

Joanne Coleman
It's all empty talk. Ten years my son has been in the "system". Schizoaffective bipolar diagnosis. Long history of noncompliance. Conserved twice. Last three years in San Francisco he's been in jail most of the time for misdemeanors. It's all "voluntary" ... can't force, he has rights, he has to buy into it, he's making the choice etc etc. It's beyond comprehension... beyond inhumane.. beyond a racket .. no funding .. no housing... tent cities everywhere .. anyone notice how many homeless people there are on the streets? Certainly a lot more than 5, 10, 20 years ago! Why? What's going on? All this talk means nothing. Nothing will change. It's disgusting. Yet, we can talk ad nauseam about issues that really aren't all that important. Republicans and democrats have done nothing to address mental illness. I won't stop advocating but I certainly don't have faith.
7/11/2017 12:11:07 AM

I am one of those mothers heart broken seeing my son in and out of jail due to mental illness. None of his crimes are violent. His last incident with the law the media posted his picture on every newspaper & fb saying why he was arrested. Innocent until proven guilty??? He lost all his friends & the love of his life. Humiliation & dehumanization!!Pure evil.

I am lost as I am not a lawyer but this just dissent sound legal.
7/2/2017 5:45:21 PM

antonia l banks
My son is going through a bad situation now we have court tomorrow, for 2 felony strangulation charges and 1 felony of assault I placed a TDO for my 19 year old son to go to Chesapeake general hospital for psychosis schizophrenia which has a critical care unit for mentally ill and he was sent to eastern state and afterwards va beach psychiatric hospital after he was released we found out about the charges that say he assaulted a police officer and a security card it's almost like a set up you call them for help ur family member not in their right mind police either kill ur family member or press charges against a person who would never act this way if their weren't suffering from mental illness just wanna know what do we do why does society seem to treat mental illness as a crime I feel like we need a better choice than dealing with police officers for help with mentally ill
5/30/2017 9:26:05 PM

Keith McGee
What are the statistics or the percentage of the inmates in prison or jail with mental illness are from drug or alcohol addiction?
4/11/2017 11:32:48 AM

I call crisis line(suicidal ideation), officer arrested me for not obeying orders really! 6 hours laying on cement floor in jail,charged with a crime. Police are annoyed responding to mental health calls,they are not trained for mental health calls. Mentally ill asking for help are criminals to police. This is Wrong. Mentally ill are abused by police,never call police for help. Stepping up is a right wing Trump supporter. SAD
3/19/2017 1:06:38 PM

Statistical response to Interested Party
To the person questioning the statistics of the article: Perhaps the article should have been clearer, but, There is a difference between average number of persons in jail on an average day, how many mentally ill persons are booked into (through) jail in a year, and how many total are booked into (through) jails in a given year. Of the 2 million mentally ill persons booked into jails per year, many only stay for a few months or weeks so they get incorporated into the total number per year. Not sure where you got the 2 Million persons in jail nationally number but the Bureau of Justice gives numbers on our incarceration rates and they show 10.9 million admissions per year (2015), with 721,300 average on any given day; so the 2 million Mentally ill patients quoted by this article represent about 18% of the inmate population over the course of the year, which seems to be consistent with other articles I've seen. Search Bureau of Justice dot gov "jail inmates in 2015" if the link doesn't work.
1/19/2017 10:17:21 PM

Estella Berkley
My son who is mentally ill, took a ride with someone from Texas to California. Since he has been here, he has been homeless, beaten and stabbed, tazed in the head by the LA police, arrested several times. He has a crime committed using his identification card and the only reason he was not originally charged with that crime was because he was incarcerated at the time of the incident, but that crime is still attached to his name.

He has been constantly arrested and the last time (September 2016) he was released to go to a voluntary facility which he stayed only a short time. At that time I thought he was remitted to a mental institution. I hadn't heard from him in months but thought that he couldn't call until he'd completed some sort of mental health process.

Someone contacted a relative through facebook and said that someone should come and get him because he was walking around in a very bad condition and could not be put on a bus to Houston unattended.

I drove from Houston to LA on the 2nd of this month. When I got here to LA, I stopped at the local police department to fill out a missing person's report for help in locating him. When the LA policeman ran his name, he found that he had been arrested the day before (1/2/2017) for shoplifting in Santa Monica, CA. The officer called and discovered that my son would be going to court the next day. When they brought my son out and the judge and public defender discussed his offenses and his not completing the program that was assigned to my son and then made deliberations, my son just sat there oblivious of all that was going on between the judge, da, and defender. When they gave him the paper, he said, 'I don't know what yall talking about.' He was totally confused with the whole process.

The public defender talked to me and told me that my son did not finish the program that they placed him in and I asked her if the program was voluntary and she said that it was and that he should have completed it. I asked her how could he if he was not mentally capable of understanding that the program was crucial to his freedom and she said that she he could make the decision. It was obvious to me that the defender had no clue of the difficulty of reasoning in a mentally ill individual. He is being treated as if he can process and understand.

Watching his treatment at the hands of the justice system has been horrifying. I don't know what to do. I came hoping that I could find him and take him home. But his trial was set for the 18th of this month and I can't afford to stay and must get back to Houston this weekend to get to my grandchildren. Hopefully someone knows of resources that I can contact before I leave.

1/5/2017 3:51:16 PM

Melanie Videc
My son is severely mentally challenged and is in jail at the Sauk County jail in Baraboo WI. He is being mistreated and neglected and refused his medications that he desperately needs. The medical staff are very rude and snotty. They also are refusing his request to see the doctor that only comes in once a week. If any one knows who to contact about this please let me know. My email address is, any resource information that would help. Thank you
10/28/2016 6:40:23 PM

Donna Jackson
My son has been in jail off and on half his life he's 42 due to mental illness disorders at TWIN towers Facility los Angeles ca they keep putting him on probation/parole he NEED help not JAIL
6/1/2016 7:24:50 AM

Informative Party
In response to Interested Party: as someone who works in the county courthouse, there is a difference between number of people booked per year and number of people currently serving time in prison or jail throughout the year. About 10 million people are arrested (i.e. booked) each year. Some are released, some are temporarily moved to hospitals, some stay for days, while some stay for longer periods. At any given time there are only about 2.1 million people in jail/prison serving time or awaiting trial but there are a lot more being filtered in and out throughout the year. 2 million people (20% of people arrested each year) actually appears to be a conservative estimate because the number of people in jail with serious mental illnesses at any one time is usually closer to 30% for jails. Speaking from my own experience handling people being arraigned on criminal charges, way more than 20% even 30% are suffering from psychosis.
3/27/2016 8:56:19 PM

Interested Party
You say "Each year more than 2 million people with serious mental illness are booked into jail." But how can this be so? We have 2.1 million people in jails and prisons nationally, all of them are not mentally ill. You need to be careful with your statistics. This makes me doubt the rest of your information.
10/9/2015 10:39:09 AM

Patients NOT prisoners.
7/10/2015 5:04:22 PM

This article is 'soft' it just hits the surface & offers no solutions. CIT is a good step but the issue is also on the Justice systems because the police have nowhere to take a Mentally Ill person if they get into trouble. What happened to Mental Health Courts? I hear that some exist but they seem elusive, I can't find any info that they're being used. My schizoaffective son got arrested on a misdemeanor charge & spent 4 months in Jail, it took me that long to convince the court to release him to treatment but they wouldn't drop the charge, so now he has a record which negatively impacts his ability to find work/ housing. Hospitals are useless, they won't admit someone with MI unless they're a danger to themselves or others, what happens to those that don't meet this criteria & can't get treatment in overcrowded MI clinics? The article states it costs 10K a year for treatment, that's a low number, it costs me 25k a year.
I haven't read a good article on MI that looks into all the problems / solutions in the justice system. Yes, everyone knows the jails are human storage facilities for the mentally ill, but no one addresses the options.
6/25/2015 1:23:03 PM

Cathy Pietrzyk. this is so encouraging!
What a refreshing article to read! Being a RN who has worked in a county jail on the mental health pods and witnessed people being incarcerated that should have been in a different type of facility to address their REAL needs. Their mental health needs not being met or barely being addressed was a heart wrenching fact to deal with on a daily basis. I have a mental health diagnosis and I would think to myself 'there for the Grace of God go I'.The entire situation is sad and it is so deep rooted that we cannot point fingers any longer, the best thing to do in my opinion is to move forward with initiatives like this one. I think it is wonderful and I hope I can be a part of it, any part of it would be beautiful!
6/24/2015 10:03:05 PM

Diane Townsend
My loved one is 63 years old. He is a business owner, Marine Corps Veteran, Father, and community member of 40 years. His life took a turn and he fell into depression and despair. In his attempt of suicide, law enforcement officers arrived at his home and in their untrained efforts, managed to get themselves injured. My Love one is now serving a 10 year sentence because law enforcement officers were injured. This Man is a loving and caring man who was in the need of mental healthcare, not 10 years sentenced to sadness..
Thank You NAMI for your fight for mental healthcare!
6/24/2015 8:26:46 PM

Marlena Morton
I was arrested and confined to the county jail in Gadsden County, Florida. No one was receiving psychotropic medications although many had bipolar disorder. The sheriff explained that "they are too expensive." I have schizoaffective disorder and was experiencing a psychotic delusion that I was in protective custody. After, finally, seeing the forensic psychologist I was given Haldol and started to come out of my delusion. I was found unable to stand trial and released. It was the ordeal from hell. I can't believe that jails don't have to provide medication for people with mental illness. I feel that they should be mandated by law to do so. Hopefully, I will never end up in jail again, but what about all the others suffering with no medication?
6/18/2015 3:09:12 PM

My 18 yr old son was thrown in prison here in Oahu,HI In March of this year.
My heart is breaking knowing he is there alone struggling without the help he needs.
Is there anyone out there that I can meet with to put pressure on our lawmakers here on Oahu ?
Please help.
5/29/2015 2:37:57 PM

Thank you so much for this article. Texas will hopefully catch up with the rest of America in
the understanding of the power of mental illness and start to try, sentence and treat people
5/12/2015 3:55:36 AM

Jay Gilpatrick
Glad to hear NAMI is joining the Stepping Up campaign. I believe there are alternatives to arrest and incarceration for non-violent offenses. CIT are a part of the solution. Mental Health Courts are a part of the solution. Community service is also. Along with ending homelessness. Negotiation between parties in non-violent cases can also help. Peers have a role to play in diversion programs helping to prevent arrest and helping to reintegrate people into society after an arrest or incarceration. Time Magazine stated that 40% of the population of jails and prisons are people who have a mental illness. I agree with you it is not right. Ms. Giliberti, I am happy you support this campaign for social justice!
5/7/2015 7:59:17 PM

Liz Belile
YES. This. Thank you. I'm in. When can we launch here in Texas?
5/7/2015 12:35:53 AM

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