Americans may not realize it, but they are paying for the most expensive and least effective way to handle people with mental illnesses who run afoul of the law courts, jails and prisons.
There is also a high and painful price paid by the offenders who typically cannot behave properly because of their illnesses.
"By default, we (the criminal justice system) have become the most expensive provider of care," Sim Gill, the Salt Lake City prosecutor, told a forum at the University of Utah Tuesday. "It is a problem for all of us."
Gill and three other experts spoke at a forum titled "The Criminalization of Mental Illness," co-sponsored by the Hinckley Institute of Politics and the National Alliance on Mental Illness.
The speakers noted that those who are mentally ill frequently end up in an unfortunate cycle of getting arrested, being hospitalized and/or jailed and stabilized on medication once again only to have everything go wrong when they are released. Either they stop taking their medication or don't have the outpatient treatment they need to think clearly and obey the law.
Gill said the problem arose in the 1970s when government began de-institutionalizing mentally ill people with the idea that it would be cheaper and more humane to get them out of mental hospitals and into the community, where they could live independently with help from community-based services. The problem was that there was little funding for those community services.
This created a huge population of untreated mentally ill people who often became homeless because they lacked the "infrastructure" of family, friends and health insurance.
Gill said between 1970 and 2005, the population in U.S. jails and prisons increased 700 percent. "The U.S. is the leading jailer in the world. No. 2 is China. No. 3 is Russia. No. 4 is Cuba. Anyone see anything incongruent with a free democracy here?"
Third District Judge Judith Atherton said a better alternative is mental health court, which brings mentally ill offenders into a system where their cases are reviewed by representatives of many agencies that can assist them with treatment, housing, legal concerns and other needs.
People who take part in mental health court, which is voluntary, get a lengthy probation term and typically must come before a judge on a weekly basis to ensure they are taking necessary medication and also to make sure their other needs are met.
Atherton presides over one of five mental health courts and says she handles the cases as a judge but in a very different way in these "problem solving" or "rehabilitation" courts, as opposed to regular court.
The therapeutic model has been going for seven years and has shown that its participants are far less likely to break the law again. It also is a more civilized and caring way to deal with their situations.
"The value to me is a human value of doing the right thing," Atherton said.
Brian Miller, the Salt Lake County Mental Health director, said about 30 percent of the inmates at the Salt Lake County Jail have been diagnosed as mentally ill. Nationwide, for every person hospitalized for a mental health problem, there are 16 mentally ill people in jail.
"More than half have been incarcerated for nonviolent offenses," Miller said. "This is a problem of epidemic proportions."
Ron Bruno, a Salt Lake police detective who is program director for Crisis Intervention Training, said his department has been working to teach CIT team members what to expect when on the scene with a mentally ill individual, how to de-escalate the situation and then, if possible, find a more permanent solution.The CIT program also helps bring together various agencies that can serve the mentally ill.