The majority of mentally ill people in the nation’s prisons and jails don’t belong there. That was the message APA, law enforcement officers, and mental health professionals delivered to the House of Representatives’ Judiciary Subcommittee on Crime last month.

The Department of Justice estimated last year that about 16 percent of inmates suffer from severe mental illnesses.

"The Los Angeles County jail and the New York Riker’s Island jail are the two largest psychiatric inpatient treatment facilities in the country," testified Steven Sharfstein, M.D., vice chair of APA’s Joint Commission on Government Relations.

There are nearly five times more mentally ill people in jails and prisons than in state psychiatric hospitals, he added.

"Most of these people should have been treated in hospitals and community-based mental health treatment if these services were available and accessible," Sharfstein testified.

Many states closed their psychiatric hospitals in the move to deinstitutionalize patients but didn’t provide the funding necessary to increase the number of community treatment programs. In addition, untreated patients and changing standards for involuntary hospitalization have led to homelessness and criminalization of the mentally ill, said Sharfstein.

He emphasized that most mentally ill people taken into custody have committed misdemeanor crimes. "Mentally ill individuals who are being treated are no more violent than the general public. Individuals who are not being treated or who have dropped out of treatment have a greater potential for violent episodes," testified Sharfstein.

To solve the "criminalization crisis," Sharfstein recommended these strategies to the subcommittee:

• Increase community services such as the Program for Assertive Community Treatment and structured residential services.

• Provide incentives to states to adopt assisted-treatment laws that foster treatment adherence.

• Increase collaboration between the criminal justice and mental health systems to establish mental health courts, jail diversion programs, and postrelease community-based treatment.

Rep. Ted Strickland (D-Ohio), a psychologist, and Sen. Mike DeWine (R-Ohio), a former prosecutor, testified in support of America’s Law Enforcement and Mental Health Project, which they introduced in the House and Senate, respectively, last year. The Senate passed the bill unanimously last month, but the House version is still before the Judiciary Subcommittee on Crime.

HR 2594 would provide federal grants of up to $400,000 each to 25 communities to establish mental health courts to direct nonviolent mentally ill offenders away from jail and into long-term treatment, testified Strickland.

The Senate version (S 1865), cosponsored with Sen. Pete Domenici (R-N.Mex.), calls for the creation of 125 pilot mental health courts and authorizes $10 million in appropriations annually from 2001 through 2004.

Strickland also urged the Judiciary subcommittee to approve the Mental Health Early Intervention, Treatment, and Prevention Act of 2000 introduced by him in July. Among the bill’s provisions are grants to expand mental health treatment centers, create mental health court programs that include training police to identify the mentally ill and direct them into treatment, and fund jail and prison screening and treatment programs, according to Strickland’s written testimony.

At press time, the Senate companion bill introduced in May by Senators Edward Kennedy (D-Mass.), Paul Wellstone (D-Minn.), and Domenici was before the Committee on Health, Education, Labor and Pensions.