Today, after decades of deinstitutionalization of all but the most critically ill patients from state mental hospitals, America's jails are the central address for the mentally ill. Two million people with serious mental illness are incarcerated each year. There are 10 times more people with mental illness in the justice system than are being treated in psychiatric hospitals, and 60 percent of jail inmates had a mental health problem in the past year.
Inmates with mental illness are incarcerated for longer periods of time and are more likely to be placed in solitary confinement. They are twice as likely to be involved in an assault and to sustain injuries during an altercation in jail. They seldom receive treatment while incarcerated, and many leave jail sicker than they arrived.
As a society, we pay an extremely high financial and human cost for criminalizing behavior better addressed by diversion into mental health treatment. Incarceration costs for those with mental illness run from 60 percent to 20 times higher than those for than other inmates. It isn't hard to see why jurisdictions that have implemented diversion programs are saving millions of dollars every year.
Certainly for violent offenders with mental illness, incarceration is in the best interest of public safety. But for low-level, non-violent offenders, who constitute the vast majority of those with mental illness in our justice system, incarceration is expensive and inappropriate. Many are jailed for offenses such as trespassing, disorderly conduct, loitering or disturbing the peace -- offenses often precipitated by their underlying illness.
Yet research shows that with treatment, most low-level offenders with mental illness can return to productive lives and remain crime-free. Diversion into treatment can address the underlying conditions that may have led to their inappropriate and criminal behavior.
Nationally, momentum toward diversion is beginning to build. Among the most promising developments is the formation of Stepping Up, a collaboration among the National Association of Counties, the American Psychiatric Foundation and the Council of State Governments Justice Center that not only promotes alternatives to incarceration but also provides tools for jurisdictions to measure their progress and documents successful demonstration projects. Projects like Stepping Up have a lot to build on in the experiences of jurisdictions around the country that have moved aggressively to divert mentally ill people from their justice systems.
Miami, for example, saves $12 million a year on jail costs alone by diverting people in mental health crisis to treatment instead of arrest. Portland, Ore., saved $16 million in jail costs in a two-year period by pairing police officers with mental health professionals to deliver coordinated services in the community. And diversion through the use of special mental health courts has saved Bexar County, Texas, $10 million a year.
One of the oldest and most exemplary diversion programs is in Memphis, where the police department has worked with mental health specialists since 1988. This pioneering program has reduced arrest rates, lowered rates of injury to officers and to individuals with mental illness, increased access to mental health treatment, and reduced rates of jail suicides. The model has been codified into a rigorous curriculum that is being used by a growing number of police departments.
Hampden County, Mass., won an Innovations in American Government Award for its diversion program, which lowers recidivism for mentally ill inmates with proactive screening and service delivery. Inmates receive treatment while locked up and upon leaving get a discharge plan, medications and an appointment to see a community mental health provider. The program has reduced crime and the use of emergency-room services, and released inmates show improved mental health and greater success with employment and family functioning.
All of these are commonsense approaches, but one can't help wonder why they are bright spots of innovation rather than ubiquitous. Every jurisdiction could benefit from reducing the numbers of non-dangerous mentally ill people in their jails. Diversion to treatment helps families, offenders and taxpayers. But each of these initiatives requires stepping outside of habit -- a police officer walking in the shoes of a behavioral health counselor, a corrections employee thinking like a health care broker. Making diversion ubiquitous calls for leadership and a willingness to work across organizational lines.