Breaking the Cycle: Reforming Mental Health Care in the Criminal Justice System

Introduction: A System in Crisis

Imagine a world where jails aren’t makeshift mental health facilities, where people in crisis receive care instead of handcuffs. For millions, this isn’t reality. Each year, roughly two million people with serious mental illnesses are booked into U.S. jails, often for minor, nonviolent offenses like trespassing or disorderly conduct. The criminal justice system has become a de facto mental health provider, but it’s ill-equipped to address the complex needs of these individuals. This blog post explores the intersection of mental health and criminal justice, highlighting recent reform efforts, their challenges, and the path forward to a more humane system.

The Problem: Criminalizing Mental Illness

Across the United States, jails and prisons house a disproportionate number of people with mental health disorders. Nearly 44% of individuals in local jails and 37% in state and federal prisons have a diagnosed mental health condition. Many end up incarcerated not because they’re dangerous but because they lack access to proper care. Untreated mental health issues can lead to behaviors—such as public disturbances—that draw police attention, starting a cycle of arrests, incarceration, and recidivism.

Take Kimberly Comer’s story, shared by the National Alliance on Mental Illness (NAMI). Her untreated bipolar disorder led to 13 arrests and a seven-month stint in a maximum-security prison. Without insight into her condition or access to treatment, she spiraled deeper into the justice system. Stories like hers reveal a stark truth: jails are not treatment centers. They often worsen mental health conditions, with isolation and punitive measures replacing therapy and support.

Police officers, too, are thrust into roles as “de facto mental health workers.” A 2024 study in Michigan showed that mental health mobile response programs can divert people from jails to care, but such programs are underfunded and unevenly implemented. Meanwhile, the lack of psychiatric beds—12 per 100,000 people compared to the recommended 40–60—leaves law enforcement with few options beyond arrest.

Recent Reform Efforts: A Glimmer of Hope

The good news? States and communities are waking up to the need for change. Here are some promising initiatives:

• Mental Health Courts: In Floyd County, Kentucky, a new Mental Health Court program mirrors drug courts, connecting justice-involved individuals with mental health services instead of incarceration. These courts aim to “bridge gaps” between the community and the justice system, offering treatment for mental illness, substance use disorders, and intellectual disabilities.

• Diversion Programs: Harris County, Texas, has diverted over 340 individuals from jail to treatment since January 2025, according to District Attorney Sean Teare. These efforts focus on rehabilitation over punishment, reducing strain on jails and addressing root causes. Similarly, Los Angeles County’s program, supported by the MacArthur Safety & Justice Challenge, allows charge reductions or dismissals for those completing community-based mental health treatment.

• Mobile Crisis Response: Programs like CAHOOTS in Eugene, Oregon, pair mental health professionals with police to respond to crises. A 2024 Michigan study found these programs reduce emergency room visits and improve community-based care, keeping people out of the justice system. Hennepin County, Minnesota, expanded its Justice Behavioral Health Initiative to provide more drop-off points for police, diverting individuals to care instead of jail.

• Legislative Reforms: Illinois’ Pretrial Fairness Act, passed in 2021, abolished money bond and limited pretrial detention, ensuring fewer people with mental health issues are jailed simply because they can’t afford bail. Virginia’s House Bill 1269 (2024) allows formerly incarcerated individuals to work in mental health treatment programs, breaking down employment barriers and fostering recovery-focused systems.

• Mental Health Treatment Requirements (MHTRs): In the UK, MHTRs provide mental health support as part of community orders, reducing prison sentences for those with untreated conditions. Despite their potential, they remain underused, as noted by nurse and magistrate Mignon French.

Challenges: Roadblocks to Reform

Despite these efforts, systemic barriers persist. Underfunding is a major issue—years of disinvestment have left the justice system “on the brink of collapse,” according to UK barrister Peter Joyce KC. In the U.S., the shortage of psychiatric beds and mental health professionals exacerbates the crisis.

Stigma also plays a role. Society often equates mental illness with violence, despite evidence that most individuals with mental health conditions are not dangerous. This misconception fuels punitive approaches. For example, California’s Proposition 36, passed in 2024, rolled back progressive reforms by reclassifying some nonviolent crimes as felonies, potentially increasing incarceration for those with mental health issues.

Moreover, reforms are inconsistently applied. While Harris County and Hennepin County show progress, many regions lack the resources or political will to implement similar programs. In Illinois, inmates sued the Department of Corrections in 2025, alleging reliance on isolation over treatment, even after court-ordered reforms were abandoned.

The Path Forward: A Call to Action

To break the cycle, mental health must be at the core of justice reform. Here’s how we can move forward:

1. Invest in Community-Based Care: Expand mobile crisis units and drop-off centers to divert individuals from jails to treatment. Programs like CAHOOTS and Hennepin County’s initiative show this works.

2. Expand Mental Health Courts: These courts should be a national standard, offering tailored treatment plans over incarceration. Floyd County’s model is a blueprint.

3. Increase Funding: States must prioritize mental health budgets to increase psychiatric beds and train professionals. The correlation between low mental health access and high incarceration rates is clear—addressing one reduces the other.

4. Educate and Destigmatize: Training for police, prosecutors, and judges can shift perspectives, emphasizing care over punishment. Metro Community College’s new mental health course for criminal justice students is a step in the right direction.

5. Advocate for Policy Change: Support legislation like Illinois’ Pretrial Fairness Act and Virginia’s HB 1269 to reduce incarceration and promote recovery.

Real Stories, Real Impact

Consider Ronny Hough, a homeless man in Pittsburgh with a history of mental illness and addiction. His repeated arrests, culminating in a violent assault in 2024, highlight the system’s failure to intervene early with treatment. Or Matthew Caseby, a UK mental health patient who died after escaping an understaffed facility in 2020, underscoring the need for better oversight and care. These tragedies aren’t isolated—they’re symptoms of a broken system.

Conclusion: A More Humane Future

The criminal justice system doesn’t have to be the default for mental health crises. By prioritizing treatment over punishment, we can reduce recidivism, save lives, and ease the burden on law enforcement and taxpayers. Recent reforms show progress, but they’re just the beginning. As advocates, policymakers, and communities, we must push for a system that heals rather than harms.

Thought Questions for Readers

1. How can your community expand access to mental health services to prevent justice system involvement?

2. What role should police play in mental health crises, and how can training improve their response?

3. Are mental health courts a viable solution in your area, and what barriers might prevent their implementation?

4. How can we balance public safety with the need for compassionate, effective mental health reform?