01/11/2013 02:46 pm ET Updated Mar 13, 2013

Mental Illness and Criminal Justice: Our Impossible, Contradictory Polices and Their Tragic Impact

In recent months, the nation has suffered a string of unspeakable horrors carried out by individuals with significant emotional problems. The list of shootings is not short; the toll of dead and wounded continues to mount: 20 students and six school personnel in Newtown, Conn.; two firefighters in Webster, New York; movie-goers in Aurora, Col.; Congresswomen Gabrielle Gifford and others in Tucson, Ari.. The tragedies followed shooting massacres at Virginia Tech and Columbine High School.

Some of the assailants had received mental-health treatment; others had not. The events nonetheless heightened the erroneous perception of a strong link between mental illness and violence. The incidents deepened the stigma of mental illness. Research shows that the mentally ill, in fact, exhibit low levels of violence, with only 5-7 percent of all mentally ill persons ever committing a serious criminal act, and rarer still, an act of violence targeting strangers. What little violence is carried out by the mentally ill is usually committed by untreated individuals who are abusing drugs and alcohol.

Even so, in the U.S. we've seen the criminalization of mental illness over the last three decades, a damaging trend that continues largely unabated. With the closing of state hospitals and reductions in mental-health hospital beds, the criminal justice system has come to assume the primary role for responsibility for the mentally ill. The U.S. holds more than 2.1 million individuals in local jails and state and federal prisons, and it has been estimated that more than 700,000 have a mental illness diagnosis, locked up in overwhelming percentages for nonviolent offenses. In New York City, the Riker's Island jail may have, of 16,000-plus inmates in total, 15-30 percent who have a mental illness. This significant subset often experiences longer stays and greater intimation from other inmates. Mentally ill prisoners stand at a higher risk of suicide and rarely receive adequate discharge planning. Their rates of re-hospitalization or re-arrest are higher than average.

Not surprisingly, the criminalization of mental illness is expensive. The price of keeping a mentally ill person in Rikers is two times higher, at $60,000, than providing community and residential care. A recent New York Times article by Brent Staples indicates that 40 percent of inmates sentenced to life imprisonment are mentally ill, often after committing a minor, nonviolent felony, such as shoplifting or passing a bad check, that constituted a third offense under states' "three-strikes" sentencing laws.

Additionally, in prisons where the guards are not trained to work with the mentally ill, such inmates are disproportionally subject to lengthy periods of solitary confinement.

We have also witnessed the criminalization of mentally ill juveniles, who spend lengthy stretches in juvenile justice facilities without adequate mental health care. Research suggests that more than 70 percent of juvenile detainees have mental health and drug and alcohol problems. Meanwhile, the community-based mental health system that exists for children and teenagers is in a continual state of crisis, with only 20 percent of those needing services receiving them, and only after long waits. Parents and other caretakers of mentally ill adults and children typically do not know where to turn.

Additionally, few localities have mental health crisis teams, instead relying on police to respond to incidents. The quality of police training varies markedly by jurisdiction. Many police agencies have complained about having these responsibilities.

One major consequence of our present situation is the continuing stigma of mental illness. The stigma reduces the support of the public to enhance funding of mental health services. Funding of mental health services have been reduced dramatically, a worrisome ongoing trend.

The Newtown killings have led to calls for dramatic changes. Most are focused on gun control, an important and necessary action. But the focus on our broken mental health care systems must not be lost. It is imperative that attention be devoted at state and national levels to discussions about retooling mental health systems. We need to look closely into: (1) the availability of psychiatric beds; (2) establishing longer term residential services (60-90 days) that provide onsite treatment of the mentally ill; (3) enhancing outreach and crisis services for the mentally ill, including services that provide for legal sanctions to require the most seriously mentally ill to receive treatment; (4) increasing support for relatives of the mentally ill to receive support (5) dramatically increasing services for mentally ill children and their parents; (5) increasing programs to assist community members, teachers and other providers to more easily recognize signs of increasing violence by the mentally ill; (6) launching a large scale community education program to assist in reducing the public stigma of the mentally ill.

I wish I could feel highly positive of these actions occurring, but they need to start, and public advocacy for these kinds of actions and others will be an important catalyst for change.