In counties across the country, local jails struggle daily with the challenges stemming from having too many people with mental illnesses in custody. Nationally, an estimated 2 million jail admissions a year involve a person with a serious mental illness like bipolar disorder or schizophrenia. Three-quarters of these individuals have co-occurring substance use disorders.
Often, people are arrested for minor crimes like trespassing, public intoxication or other minor offenses that are typically associated more with symptoms of a person’s illness than an intent to do harm. Once incarcerated, people with mental illnesses tend to stay longer in jail and upon release are at a higher risk of returning than individuals without these illnesses.
Without comprehensive systems of care in place to serve people with these illnesses, hospital emergency departments and jails are often the first response when a person is experiencing a mental health crisis. Lack of funding and care providers — particularly in rural areas — has led to jails becoming de facto treatment facilities for people with mental illnesses.
The large number of people cycling in and out of county-run jails and emergency departments comes at a great financial cost to county governments and at personal and societal costs to communities, families and individuals.
County leaders have recognized the need to act. In 2015, the National Association of Counties (NACo) and its partners at The Council of State Governments Justice Center and the American Psychiatric Association Foundation launched Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails.
Since the initiative started, more than 500 counties in 43 states have passed Stepping Up resolutions pledging to work with community partners to develop comprehensive plans for systems-level change. This includes 12 counties in Texas at the time of this writing. Bell, Bexar, Brazos, Dallas, El Paso, Fort Bend, Lubbock, McLennan, Tarrant, Travis, Waller and Wise counties have stepped up to join this groundbreaking initiative.
Texas county leaders are fostering partnerships between traditionally siloed systems like behavioral health, law enforcement, the courts and housing systems to develop policies and programs to keep people out of jails in the first place and to help them transition back into the community after being in custody.
Department leaders in these counties are building systems to share data and identify areas for improvement. The active use of data is helping counties recognize where individuals are falling through the cracks and where better efforts can be made to connect people to health care, housing and treatment services. Counties are hiring employees who have personal experiences with mental illnesses and the justice system to help link people to these services.
In early 2019, Lubbock County became one of 15 counties nationwide nominated as a Stepping Up Innovator County. Lubbock County has implemented strategies to accurately identify people in jails who have serious mental illness, collect and share data on these individuals to better connect them to treatment and services and use this information to inform local policies and practices.
This is just one example of the significant work happening in Texas counties to address this challenge. We know that many more counties are starting or enhancing efforts to reduce the number of people with mental illnesses in jails.
If you are interested in getting Stepping Up launched in your county visit www.StepUpTogether.org. The Stepping Up website offers a variety of resources such as webinars, planning exercises, a self-assessment tool, case studies and research to help guide counties through the process.
Nastassia Walsh is the associate program director for justice at the National Association of Counties. Feel free to contact her at firstname.lastname@example.org or (202) 942-4289 for more information.