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Access to Healthcare

Local Justice Systems Explore New Ways To Help, Not Punish Mentally Ill Offenders

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Criminal justice systems are bearing the brunt of increasing cuts to a psychiatric system that has been slashed since the 1960s. That’s the contention of police and sheriffs who encounter the mentally ill on runs and in jails on a daily basis. The National Alliance on Mental Illness estimates that between 25 and 40 percent of mentally ill Americans will be jailed at some point in their lives. 

An estimated 2 million adults with serious mental illnesses are jailed in the United States each year, according to a 2009 study -- 50 times the number of beds available in state psychiatric hospitals.

In May, the American Psychiatric Association, the Council of State Governments Justice Center and the National Association of Counties launched an initiative called Stepping Up, asking local governments to adopt resolutions to reduce the number of people with mental illness in jails.  As of this writing, 72 counties in 27 states have done so, according to the program’s website.

And in fact, some cities and counties have made changes in recent years to divert mentally ill offenders towards treatment and in many cases, away from incarceration. Here’s a roundup of some noteworthy efforts.

Chicago: The Nation’s Largest Jail Doubles as a Mental Hospital

Mental health training is not usually required to work as a corrections officer. But when Sheriff Tom Dart took over administration of Chicago’s Cook County Jail in 2006, he realized he needed employees to be more than just guards. Now all new staff members are required to receive 60 hours of advanced mental-illness treatment training, according to an article published earlier last month in the Atlantic.

Each new inmate receives a mental health screening, and those who have experienced severe mental illness or assault are often given protective custody. Qualifying prisoners are offered the opportunity to sign up for Medicaid. Last summer the county opened a Mental Health Transition Center, with daily group therapy sessions, GED and job-readiness training, and a garden tended by inmates. 

The number one thing that we have to keep in our head is respect. Regardless of how this person looks, smells, sounds....you have to build that person up, not tear that person down. -James Alexander, Maryhaven Engagement Center, Columbus

Miami: Crisis Intervention Training For Police Is Reducing Arrests

In Miami-Dade County, police typically respond to 10,000 mental health-related calls a year, according to a report in Stateline. A few years ago, more than 800 of those calls led to arrests.

But recently Miami cops were trained in crisis intervention, where they learned tactics to speak more gently to the mentally ill and de-escalate tense situations.  They also began sending the mentally ill to treatment rather than jail. Now the department reports arresting only nine mentally ill people per year.

Judge Steve Leifman, told Stateline the average daily jail population in the city of Miami and Miami-Dade County has dropped from 7,800 to 5,000 inmates. The effort has been so successful the county has closed one jail, saving it $12 million a year. Leifman said the recidivism rate among mentally ill people charged with a misdemeanor has dropped from 75 percent to 20 percent.

Los Angeles: Cops and Mental Health Clinicians Work In Teams

The LAPD’s mental evaluation unit is the largest of its kind in the country according to a recent article from Kaiser Health News and Southern California Public Radio. If an officer encounters a situation where mental illness may be a factor, she is required to call headquarters. There, she’ll reach a specialized mental health triage desk staffed by police officers and mental health workers from the county health department. If triage decides the situation calls for it, a cop-clinician team will go to the scene. The LAPD has 18 such teams, and they assisted patrol officers in more than 4,700 instances last year.

Detective Charles Dempsey, who is in charge of training for the mental health unit, told reporter Stephanie O’Neal that the setup allows for police to combine their access to criminal justice records with mental health workers’ knowledge of medical records -- without violating confidentiality on either end. Dempsey says about two-thirds of the calls don’t result in arrest. “We engage them, they get help, they get services and we never hear from them again,” he told O’Neal.

Seattle: Housing and 24/7 Support Keeps Homeless Out Of Jail

Like other cities around the country, Seattle struggles with a population with serious mental illness, who are frequently incarcerated and often homeless. In 2008, King County launched a program called Forensic Assertive Community Treatment  (FACT) aimed at this population. Participants receive housing vouchers and have 24-hour access to crisis services, case management, addiction and mental health treatment and vocational training in their communities, without having to travel to an office.  

In the program’s first year, participants experienced an average of six weeks fewer in prison than they had the year before, and psychiatric hospital admissions declined 25 percent, according to an evaluation by the King County Department of Community and Human Services.

Indianapolis, IN and Columbus, OH: Transition Centers To Help the Most Vulnerable

An estimated 40 percent of inmates at the Marion County jail in Indianapolis have mental health issues, and each day, employees there administer 700 doses of psychotropic drugs, according to a story published on wfyi.org. The city of Indianapolis announced plans to open a 30-bed residential facility later this year to serve arrestees with chronic mental health and/or substance abuse issues, with a focus on the homeless.  The center will offer recovery services and have social workers available to connect patients to outside services.

According to deputy director of the Department of Public Safety Val Washington, an arrest for public intoxication is costly for the county as well as the arrestee. “When someone is arrested, they generally lose their health insurance benefits. And so, the [county] sheriff’s office is responsible for that arrestee healthcare,” Washington says.

The Indianapolis program will be similar to one that Columbus, Ohio, has run for 16 years. According to program director James Alexander, the Maryhaven Engagement Center saves the city of Columbus and the surrounding county an average of $2 million each year in jail and hospital expenses, and other services. Between July 2013 and June 2014, the center served over 1,000 people, referred 64 to mental and behavioral health treatment, and placed about 200 in permanent housing.

Alexander says helping homeless and addicted or mentally ill people turn their lives around requires a shift in attitude. “The number one thing that we have to keep in our head is – respect. Regardless of how this person looks, smells, sounds or whatever, you have to respect him or her. You have to treat the person with dignity. You have to build that person up, not tear that person down,” he says.

WFYI Indianapolis reporter Leigh DeNoon contributed to this reporting.