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.
"We 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," 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't have many options.
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Instead, many disappeared and got re-arrested. Sometimes within minutes.
"They'd walk out the door, they were ill, they'd act out, because [the jail] is next to the courthouse there are several officers out there, and they'd get re-arrested," 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.
"Over a five-year period, these 97 individuals were arrested almost 2,200 times and spent 27,000 days in the Miami-Dade Jail," Leifman says. "It cost the tax payers $13 million."
Sheriff Greg Hamilton of Travis County in Austin, Texas, also sees the flaws in the system.
"It seems to me that we have criminalized being mentally ill," Hamilton tells Sullivan.
Hamilton has been the Sheriff of Travis County for seven years. In that time, he's 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's seen was 258 days.
Hamilton's 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's a broken system, but Hamilton notes that this was never the way the mentally ill were suppose to be treated.
"The jail was never meant to be a state hospital or a treatment facility," he says, "but we have been thrown out there and we've got to take the hand that we were dealt."
Judge Leifman is trying to prevent individuals with mental illnesses who have committed minor crimes from ending up in jail. He's creating a novel facility in Miami-Dade that will serve as what's known as a "forensic diversion facility." 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.
"They'll continue to step down until they're actually ready to go back to the community," Leifman says.
The facility will be run on a "clubhouse model," meaning people with mental illnesses will take an active role in planning activities.
Leifman acknowledges the facility won't keep everyone with mental illness out of jails, but says "if we can keep 50 percent of the people who are coming into our jail out who have serious mental illness we've made a huge dent in the problem."