In 1949, in recognition of the number of World War II veterans suffering from mental illness upon their return from war, Congress designated May as National Mental Health Awareness Month. Despite annual observations of the month for nearly three-quarters of a century, the U.S. Department of Health and Human Services issued a statement on May 3, 2023, that the United States is currently facing an “unprecedented mental health crisis,” affecting people of all ages and backgrounds. The National Alliance on Mental Illness estimates that almost 58 million adults, or more than 22 percent of the U.S. population, experienced mental illness in 2021 alone. Similarly, a recent White House proclamation acknowledges the tens of millions of Americans experiencing mental health conditions and the legislation that has passed to increase access to services for prevention and treatment. Yet the criminal justice system continues to be the de facto treatment provider, with the Los Angeles County, Cook County and New York City jails being the three largest mental health centers in America.

Policing People in Crisis

Did you know that at least 20 percent of police calls for service involve a mental health or substance use crisis? Another study found that between 21 and 38 percent of 911 calls were for non-urgent issues related to mental health, substance use, homelessness and other quality-of-life concerns that would be better handled by people other than the police.

These calls for service are extremely complex and time-consuming, distracting officers from priority public safety issues and violent crime. Police are often ill-equipped to handle these scenes safely and effectively, owing to the disproportionate amount of training spent on firearms, tactical skills and combat. Even when properly trained, the mere presence of a police car or officer in uniform can exacerbate the feelings of distress a person in crisis is experiencing, making the situation more volatile for all parties. If lethal force is used, the police are demonized. Fatal outcomes are not uncommon; 25 percent of all fatal police shootings between 2015 and 2020 involved a person with mental illness, and people with untreated mental illness are 16 times more likely than the average citizen to be killed in police encounters. Protests, criminal charges and civil suits for individuals like Walter Wallace, Jr., Ricardo Muñoz, Laquan McDonald, Ethan Saylor, Raul de la Cruz and others have become commonplace as police are increasingly called to respond to persons in crisis. This also contributes to frustration and trauma among police officers as they struggle to meet the needs of the communities they serve.

Overrepresentation in Incarceration

Did you know that 64 percent of jail inmates, 54 percent of state prisoners and 45 percent of federal prisoners have reported some type of mental health concern, including substance use disorder? This translates to an estimated 960,000 of the nearly 2 million people that are currently incarcerated.

The overrepresentation of people with mental health disorders unduly burdens administrators and staff who are ill-equipped to provide adequate services and exacerbates the symptoms and circumstances of inmates with mental health disorders, including substance use disorder. Mentally ill inmates are more likely to harm themselves, to attack others and to be attacked, resulting in disciplinary procedures, solitary confinement and more time behind bars. This contributes to the deterioration of their psychiatric conditions at the expense of the taxpayer.

Even short periods of incarceration produce long-term mental health issues. Individuals suffering from mental illness have a harder time reentering society and are more likely to be homeless and unemployed, forgo treatment, recidivate and be returned to prison sooner than their counterparts without serious mental illness or co-occurring disorders. The end result is the cycling of the same individuals through the system, often for minor offenses. Not only does this strain jail resources, but it also increases danger and burnout among staff. The number of mentally ill inmates who have died while in custody is equally troubling.

Increased Illness and Decreased Treatment

Did you know that almost two-thirds of individuals with a history of mental illness do not receive any mental health treatment while incarcerated in state and federal prison? Inmates have historically lacked access to the physical and mental health treatment they need because the necessary resources, including psychiatrists and psychologists, to screen and treat are in short supply. Public sentiment and administrative decision-making may also play a role. Declining correctional budgets and increased inmate populations limit treatment to only the most severe patients or result in the outsourcing of medical care. This outsourcing has resulted in substandard medical care in hundreds of jails and prisons across the country.

The dramatic increase in inmate populations, especially those with mental health and/or substance use disorder, combined with staffing issues and fiscal constraints has placed jails in a state of crisis across the nation. The associated lack of safety for all involved makes it more difficult to recruit and retain the professionals that are needed to respond to the physical, mental and substance abuse treatment needs of millions of inmates. Thousands of inmates have died while awaiting trial, largely of suicide and drug overdose. The lack of treatment services for inmates and the fragmented approach to transitioning them to the community results in thousands more dying in our streets or cycling through our criminal justice system.

The Solution

Although an estimated 58 million adults have a reported mental health issue, many do not receive treatment while in the community. These experiences contribute to worsening symptoms and the deterioration of their mental stability. Given the unprecedented rates of mental illness, including substance use disorder, a more holistic approach is needed. Reform efforts should focus on the six Ps: prevention, police-led deflection, pretrial release, prosecutorial diversion, programming while incarcerated and parole release planning.