Referring to himself as a “medical criminal” because he was arrested numerous times as a result of manifestations of his bipolar disorder, Paton Blough took the microphone at a national launch event last week to put a human face on the problem of jail populations swelling with inmates who have a serious mental illness.

As one of many speakers who favor more effective crisis intervention and other strategies to avert incarceration for these individuals, Blough said of the typical jail experience of persons with mental illness, “They’re a lot more screwed up when they come out than when they go in.”

The May 5 event in Washington, D.C., was held to announce a joint initiative sponsored by the National Association of Counties (NACo), the Council of State Governments and the American Psychiatric Foundation to reduce the ranks of the more than 2 million adults with serious mental illness who are jailed in the United States each year. The Stepping Up initiative will seek to lessen the human toll on a population that, once jailed, tends to stay incarcerated longer than the general population and that runs a greater risk of being jailed again.

Among Stepping Up’s aims will be an effort to highlight effective alternatives that are already being implemented in a minority of communities, and to encourage their replication. “By creating a national conversation and offering technical assistance, we will take advantage of the moment and translate it into a movement,” Fred C. Osher, M.D., director of health systems and services policy at the Council of State Governments Justice Center, told MHW in an interview prior to the official launch announcement.

Impacts on counties

While Osher said an initiative such as this will require a number of collaborative steps because “this isn’t any one system’s problem to fix alone,” he believes it was important to involve the national organization representing county governments because “that’s the front door of the system.” Counties have a total investment of around $70 billion in local justice systems.

NACo’s incoming president, El Paso County, Colo., Commissioner Sallie Clark, says both county governments and county residents with mental illness pay a heavy price in a punishment-focused system where public safety ultimately is not being protected. “Inmates who receive federal benefits end up having to reapply for their benefits after jail,” Clark said in citing one example of a negative outcome from incarceration.

El Paso County is one of many communities around the country that have established specialty courts to seek to identify and treat offenders with mental health needs, but Clark says the program in her region is relatively small in scope.

Stepping Up will comprise two main components:

  • A call to action in which county elected officials will be asked to work with justice officials and community stakeholders toward numerous steps, including quantifying the jail population with mental illness and its recidivism risk; examining present service capacity in order to identify programs that can help individuals with mental illness and co-occurring substance use disorders; and developing a concrete plan to reduce the number of incarcerated individuals with mental illness.
  • A national summit to be held in the spring of 2016, to include the counties that have committed to the call to action. According to a summary from the initiative’s sponsors, “The summit will help counties advance their plans and measure progress, and identify a core group of counties that are poised to lead others in their regions.”

The sponsoring organizations expect that sometime after the summit next year, there may be opportunities to leverage public and private grants to offer more intensive assistance to some counties.

Osher said that some of the more widely applied strategies to combat the overrepresentation of persons with mental illness in jails include use of mobile crisis intervention teams, specialty courts and offender re-entry services.

Making strides

Blough, who is active in the National Alliance on Mental Illness and lives in Greenville, S.C., said the reasons why he had been detained by law enforcement numerous times in his lifetime had “zero to do with my character.” At the same time, he did not fault police for the experiences he endured, including once having a Taser used on him in the back of a police car. “They didn't have [Crisis Intervention Team] training,” Blough said of the police officers he encountered around a decade ago.

To demonstrate how awareness and training have improved in recent years, Blough said one of those police officers now accompanies him on speaking engagements in the community.

Others attending the launch event in Washington last week included U.S. Sen. Al Franken (D-Minn.), who discussed the progress of the bipartisan Comprehensive Justice and Mental Health Act that he co-sponsored with Sen. John Cornyn (R-Texas). The bill, which would reauthorize legislation adopted a decade ago and would extend crisis intervention training to all police officers (as well as extend support for specialty courts and corrections-based services), unanimously cleared the Senate Judiciary Committee in late April.

Franken said a major reason why the United States has 5 percent of the world population but 25 percent of the world’s prison population is “because we’ve criminalized mental illness.” He added, “We’re using our criminal justice system as a substitute for a fully functioning mental health system.”

Former U.S. Rep. Patrick Kennedy, who championed behavioral health parity legislation in Congress, emphasized county governments’ opportunity to rearrange dollars to establish new approaches to keep individuals with mental illness out of jail.

“We moved the people out of the old asylums and into the new asylums, our jails and prisons,” Kennedy said. “We arrest them for not being treated. That just doesn’t add up.”

Bottom Line

The Stepping Up initiative will seek to have a direct impact on reducing the number of individuals with mental illness who are housed in county jails, and highlighting alternative strategies that leaders say beg for replication.