Vera Institute of Justice

While there have been significant shifts in the understanding of mental health over the past 50 years, many of the responses to people with mental illness have changed very little. In the mid-1950s more than half a million people were held in U.S. psychiatric institutions for long periods and often in deplorable conditions. Sixty years later, an equivalent number of people with mental illness are held in the nation’s prisons and jails on any given day. 

During the 1960s and 1970s, endemic problems of involuntary confinement and abuse in psychiatric hospitals and a new generation of psychotropic medication that could be administered to people with mental health needs living in the community led to a dramatic shift away from residential, inpatient care. It was part of a movement that sought more compassionate care for patients in the context of their communities, based on a vision of people receiving the support they needed to lead stable, functional lives. However, the network of community-based mental health services that was necessary to realize this vision never materialized. In the absence of appropriate policies and practices to respond to people with mental illness, for many people the criminal justice system has become the provider of last resort. 

Today there is a growing awareness that the justice system is no substitute for a well-functioning community mental health care system. Courts, public defender agencies, probation offices, and police departments around the country are increasingly adopting initiatives to connect people with mental health needs to treatment and other supportive services. 

However, while initiatives to identify and divert people are desperately needed, their success depends on the existence of effective and accessible services. This report addresses fundamental questions about the effectiveness of services for people with mental illness who come into contact with the justice system. Drawing upon interviews with experts in the field, the authors address shortcomings in existing services and describe steps to reach people sooner with interventions that can help prevent future arrest and incarceration. Modeled on promising approaches in the mental health field to people experiencing a first psychotic episode, the report stresses early intervention, an understanding of the social determinants that underlie ill health and criminal justice involvement, and recovery-oriented treatment. 

The United States has hundreds of thousands of people with mental illness languishing in the nation’s jails and prisons. This is a crisis that demands a fundamental rethinking of how to serve people struggling with mental health disorders. Developing new approaches that can convert an initial contact with the justice system into the first step along a path toward long-term mental health and desistance from crime should be part of that goal.