Three hundred and fifty thousand: That鈥檚 a conservative estimate for the number of offenders with mental illness confined in America鈥檚 prisons and jails.
More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City and Cook County Jail in Illinois.
鈥淲e have a criminal justice system which has a very clear purpose: You get arrested. We want justice. We try you, and justice hopefully prevails. It was never built to handle people that were very, very ill, at least with mental illness,鈥� Judge Steve Leifman tells Laura Sullivan, guest host of weekends on All Things Considered.
A failing system
When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. Leifman saw the problem first-hand decades ago in the courtroom. When individuals suffering from mental illness came before him accused of petty crimes, he didn鈥檛 have many options.
鈥淲hat we used to do, which I tell people was the definition of insanity [鈥 was they would commit an offense, the police would arrest them, they鈥檇 come to court, they鈥檇 be acting out so we would order two or three psychological evaluations at great expense, we would determine that they were incompetent to stand trial and we鈥檇 re-release them back to the community and kind of held our breath and crossed our fingers and hoped that somehow they鈥檇 get better and come back and we could try them,鈥� he says.
Instead, many disappeared and got re-arrested. Sometimes within minutes.
鈥淭hey鈥檇 walk out the door, they were ill, they鈥檇 act out, because [the jail] is next to the courthouse there are several officers out there, and they鈥檇 get re-arrested,鈥� he says.
Not only was the system inefficient, it was costly as well. When Leifman asked the University of South Florida to look at who the highest users of criminal justice and mental health services in Miami-Dade County, researchers found the prime users were 97 people, individuals diagnosed primarily with schizophrenia.
鈥淥ver a five-year period, these 97 individuals were arrested almost 2,200 times and spent 27,000 days in the Miami-Dade Jail,鈥� Leifman says. 鈥淚t cost the tax payers $13 million.鈥�
A look Inside One Jail
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Sheriff Greg Hamilton of Travis County in Austin, Texas, also sees the flaws in the system.
鈥淚t seems to me that we have criminalized being mentally ill,鈥� Hamilton tells Sullivan.
Hamilton has been the Sheriff of Travis County for seven years. In that time, he鈥檚 seen more and more mentally ill people filter into his jail.
He says the lack of space at the local hospitals means his jail has become the default treatment center. He says the average stay of a mentally ill person in a Travis jail is about 50-100 days. But Hamilton says the longest term he鈥檚 seen was 258 days.
Hamilton鈥檚 jail only has a handful of counselors on staff to deal with the 400 inmates they house daily. The individuals who do get stabilized find it hard to get their medication replenished or see a psychiatrist once they leave the jail.
It鈥檚 a broken system, but Hamilton notes that this was never the way the mentally ill were suppose to be treated.
鈥淭he jail was never meant to be a state hospital or a treatment facility,鈥� he says, 鈥渂ut we have been thrown out there and we鈥檝e got to take the hand that we were dealt.鈥�
Reforming the system
Judge Leifman is trying to prevent individuals with mental illnesses who have committed minor crimes from ending up in jail. He鈥檚 creating a novel facility in Miami-Dade that will serve as what鈥檚 known as a 鈥渇orensic diversion facility.鈥� The program provides a sentencing alternative in cases where the offender has mental health issues. Those entering will begin in a higher-security area, more like a jail, and once stabilized move to a different part of the building for treatment.
鈥淭hey鈥檒l continue to step down until they鈥檙e actually ready to go back to the community,鈥� Leifman says.
The facility will be run on a 鈥渃lubhouse model,鈥� meaning people with mental illnesses will take an active role in planning activities.
Leifman acknowledges the facility won鈥檛 keep everyone with mental illness out of jails, but says 鈥渋f we can keep 50 percent of the people who are coming into our jail out who have serious mental illness we鈥檝e made a huge dent in the problem.鈥�