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by Stephen A. Ragusea, PhD

Once again, people are talking about establishing a Mental Health Court. Good!  And we should all support this endeavor.   

Our county, our state and our national governments continue to participate in a quiet crisis that is devouring our youth, our mentally ill, and our tax dollars.  As has been true for more than two decades, the United States incarcerates a higher percentage of its population than any other nation in the world. More than 2.5 million Americans are now behind bars. Think about that.  Once again, America is number one, but, not in a good way.


Let’s start by admitting that there are violent people, real criminals, who need to be locked up behind bars for life, in order to protect those of us who aren’t violent and aren’t criminals.  As a psychologist, I’ve done a lot of work in prisons.  I’ve evaluated and treated prisoners who I don’t ever want to see walking down my family’s street!  But, it turns out that the number of dangerously violent offenders is actually a very small number.  And, dangerous folks aren’t the only people being locked up in American prisons.   

Most prisoners are under the age of 30, half are convicted of crimes related to substance abuse, and approximately 15% of the total are people who meet the generally accepted criteria for a mental illness, and about half of them are considered seriously mentally ill.  

According to a recent 215-page report (ISBN: 1564322904) from the national organization, Human Rights Watch, “One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.”  One of the report’s authors, Jamie Felner, observed, “Prisons have become the nation’s primary mental health facilities.”   

According to a recent lead story in The Citizen, one Monroe County prisoner – just one – has spent 2,459 days in jail on minor charges related to his mental illness.  How much does that cost us taxpayers?  The answer is, approximately $200,000 based on average rates for incarcerating prisoners in county jails.  That does not include the costs for police, court staff, prosecutors, probation officers, etc.  And, that’s just one case.   

The money for building prisons was stolen from our public mental health system.  Part of John Kennedy’s vision for an American Camelot included a national system of well-funded community mental health centers that would serve the mentally ill in their own hometowns, thereby permitting the closing of a well-developed system of state mental hospitals that had been providing inpatient treatment for the severely mentally ill.  Those of us old enough to remember the 1970s recall an era of widely available, well-funded, mental health care provided through local Community Mental Health Centers.  Oddly enough, the systematic under-funding and disempowering of our Mental Health Centers coincided with the increase in funding of the prison system to support the “Get Tough on Crime” movement that spread like a well-intentioned plague from sea to shining sea.   

Is there anything to be done about all this?  There are pressures building which will undoubtedly force some changes.  According to reports from the New York Times, “State legislatures, facing budget crises, are rethinking tough sentencing laws passed in the last two decades; in the past year, 25 states have passed laws eliminating some of the lengthy mandatory minimum sentences, restored early release for parole and offered treatment instead of incarceration for some drug offenders.”  The state of Missouri is now requiring that judges consider the dollar cost of incarceration before a person is sentenced.   In this regard, “The state’s sentencing advisory commission is an appointed board that offers guidance on criminal sentencing.”  For example a judge is provided with information that a prison term might cost $50,000 while the cost of probation and treatment might be $9,000.     

For starters, what we need is the establishment of what are called Mental Health Courts and Drug and Alcohol Courts.  These new courts operate under a different set of regulations and expectations from our normal criminal courts.  Provision is made to include mental health professionals, judges are given wide discretion, and the focus is more on rehabilitation and prevention than it is on punishment. These courts are a good place to begin.  Then, we need to improve the funding for our mental health system and stop wasting billions on the largest prison system in the history of the world.    

We need to do more than get just tough on crime; we need to get smart about it.  We can do better.    

Mental Health Courts: What We Do
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