County leaders across the country are grappling with a crisis: A large number of people in their jails have mental illnesses. Over the past several decades, county commissioners and supervisors, sheriffs, judges, corrections administrators, public defenders, prosecutors, law enforcement, community-based service providers and advocates have mobilized to better respond to the disproportionate number of people with mental illnesses in jails. This crisis is indeed solvable, but it requires a new approach—one that is data-driven and focused on systems-level change.
Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails (Stepping Up) was launched in May 2015 by the National Association of Counties, the American Psychiatric Association Foundation and The Council of State Governments Justice Center to rally local, state and national leaders to build awareness and provide counties with the resources to further address this crisis. Since the launch, more than 400 counties have passed a resolution or proclamation to join the initiative and committed to creating cross-system, sustainable plans to reduce the number of people with mental illnesses in their jails.
Although counties have made progress in addressing this crisis locally, many still struggle to effectively communicate their intentions with their work to the public and the media. This guide provides key talking points for county leaders to use when discussing their Stepping Up efforts.
Key Talking Points
- An estimated two million of the nearly 11 million annual jail admissions annually involve a person with a serious mental illness such as schizophrenia, bipolar disorder or major depression.1 Nearly three-quarters of these individuals also have a co-occurring substance use disorder.2
- Federal and state policy and funding barriers, along with limited opportunities for law enforcement training and arrest alternatives in many communities, have resulted in county and other local jails housing more people with mental illnesses than state mental health hospitals.
- Many people with mental illnesses in jails were arrested for relatively minor crimes such as loitering or causing a public disturbance, which tend to stem more from their illness than from intent to do harm. Research shows that incarcerating people with mental illnesses often exacerbates their symptoms and can increase the likelihood of recidivism.3
- Once incarcerated, people with mental illnesses tend to stay longer in jail and are at a higher risk of re-incarceration than people without these illnesses.4
- Jails spend an estimated two to three times more money on people with mental illnesses than they do on people without these illnesses.5
- The vast majority of individuals who have committed minor offenses can be safely treated in the community, instead of being incarcerated.
- In many jurisdictions, decisions on programs, policies and funding are not data-driven; this ultimately makes inefficient use of taxpayer money, does little to protect public safety, crowds jails, puts law enforcement officers at risk and leads to poor outcomes for individuals and counties as a whole.
- Without accurate local data to illustrate the scope of the problem, it is difficult to determine the appropriate local responses and to track progress on efforts to overcome the problem.
- These challenges will not be overcome by simply starting a new program or opening up more mental health beds – these are important steps, but real solutions require creating sustainable, data-driven, systems-level policy and practice changes to better link people to treatment and services while improving public safety in fiscally responsible and effective ways.
- Creating data-driven policy and practice changes to reduce jail bookings, length of stay and recidivism and to increase connections to community-based treatment for people with mental illnesses will ultimately lead to lower numbers of people with mental illnesses in jail.
- Doing this involves a commitment to implementing a robust system for identifying people with mental illnesses in the jail, regularly collecting accurate and accessible data on these individuals, using these data to quantify the scale of the problem, developing a strategic action plan that effectively targets scarce resources and identifying solutions and tracking progress on efforts.
- Many of these changes – even if they require initial startup costs – will likely end up helping the county to more effectively use public dollars in the long run. The sooner these efforts start, the sooner they can have an impact. And some changes to policy or practice won’t cost the county any money to implement.
- Jails are the most expensive and least humane way to house and treat individuals with mental illnesses, most of whom can be safely served in the community. Finding opportunities to keep individuals who are not a risk to public safety in the community while they receive appropriate treatment can only serve to help them get back on track and keep them from getting re-involved in the criminal justice system.
 Steadman, Henry, et al., “Prevalence of Serious Mental Illness among Jail Inmates.” Psychiatric Services 60, no. 6 (2009): 761–765. These numbers refer to jail admissions. Even greater numbers of individuals have mental illnesses that are not “serious” mental illnesses, but still require resource-intensive responses.
 Abram, Karen M., and Linda A. Teplin, “Co-occurring Disorders Among Mentally Ill Jail Detainees,” American Psychologist 46, no. 10(1991): 1036–1045
 See, e.g., Kim, KiDeuk, et al., The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System: A Scan of Practice and Background Analysis (Washington, D.C.: Urban Institute, 2015)
 See, e.g., Torrey, E. Fuller, et al., More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States (Virginia: Treatment Advocacy Center and National Sheriff’s Association, 2010)
 See, e.g., Swanson, Jeffery, et al., Costs of Criminal Justice Involvement in Connecticut: Final Report (Durham: Duke University School of Medicine, 2011).Blue