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Working to Decriminalize Mental Illness


Yesterday, I participated in a briefing on Capitol Hill that focused on the national epidemic of the criminalization of people with mental illness. Our nation’s jails and prisons are ill-suited to treat people with mental illness, yet in many locales they have become the leading mental health facilities. As a forensic psychiatrist, I have dedicated a substantial part of my career to researching the intersection of mental illness and the criminal justice system, so this is an issue that is never too far from my thoughts.

The criminalization of the mentally ill is nothing short of a national tragedy – one that exacts a large medical, emotional and economic toll on some of the most vulnerable members of our society and their families each day.

Each year, approximately 2 million people who suffer from complex illnesses – such as schizophrenia and bipolar disorder -- are admitted into correctional facilities. Once incarcerated, they tend to spend more time behind bars and face higher recidivism rates than other members of the prison population. They also face long odds for receiving adequate care for their mental illness – which often co-occur with substance use disorders and other medical conditions – once they are incarcerated.

As health care providers, we need to work with leaders in government and law enforcement to address this tragedy by finding solutions that prioritize treatment and recovery rather than punishment and incarceration. That’s why I’m glad I was joined at the briefing by Mary Ann Borgeson, Chair of the Douglas County Board of Commissioners in Nebraska; Rich Stanek, Sherriff of Hennepin County in Minnesota; Robert Trestman, M.D., Ph.D, a Professor of Medicine and Psychiatry at the University of Connecticut Health Center and the Executive Director of Correctional Managed Health Care; and Ron Honberg, National Director for Policy and Legal Affairs at NAMI.

Recently, the APA has teamed with the Council of State Governments Justice Center and National Association of Counties to launch the Stepping Up Initiative, a comprehensive effort that unites stakeholders behind the single goal of reducing the number of people with mental illness in the nation’s jails without compromising public safety. Participants in Stepping Up are committed to taking action in several critical areas, such as assessing the mental health and recidivism risk factors for adults being admitted into jails, evaluating treatment and service capacity, and developing comprehensive treatment and service plans with measurable outcomes that meet the unique needs of the patient population.

Despite these efforts, health care providers, local governments and law enforcement personnel continue to face daunting obstacles. These obstacles include limited staffing or financial resources, inadequate training, little coordination between the criminal justice and treatment systems, and of course, the enduring stigma of mental illness.

Significant reforms to the current system are a necessity if any progress is to be made on this issue. Investments in alternatives to incarceration, such as jail diversion policies, collaborative courts, and Assertive Community Treatment are also needed.

I’m pleased that Congress has begun to show growing interest in addressing this tragedy. Several bipartisan bills have been introduced that seek to prioritize treatment over incarceration, namely the Comprehensive Justice and Mental Health Act, the Comprehensive Addiction and Recovery Act of 2015, the Helping Families in Mental Health Crisis Act of 2015, and the Mental Health Reform Act of 2015. Numerous provisions in these bills would give local jurisdictions the support they need to reduce the number of persons with serious mental illnesses who are jailed each year.

The APA has taken the lead in collaborating with leaders in Congress toward the furtherance of these goals, but we can’t do it alone. I urge you to get involved with your state and local legislature and communicate to them the unique issues that your community faces in regards to the criminalization of people with mental illness. Talk to them about the issues your patients face, and the gaps that exist in your community that cause them to end up in jail rather than in treatment.

Through effective collaboration and communication with local government and law enforcement, we can achieve our ultimate goal of a safe community where people with mental illness receive the treatment they need, rather than punishment.


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  • Levi Williams III

    Most would agree that decriminalizing mental illness is important. Yes, treatment and recovery are tantamount. However, most first responders such as police officers may not have the training to recognize signs of mental illness before feeling compelled to respond to an alleged perpetrator. In addition, with the onset of globalization and the diversity of cultures, what is "normative behavior?"


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