OVER THE PAST 70 years, the number of people with mental illness held in hospitals has decreased dramatically while the number held in jails and prisons has increased exponentially. The promise of deinstitutionalization has been replaced for many by the misery of incarceration.
In 1957, New Hampshire’s population was 750,000 and the number of citizens served at New Hampshire Hospital, our state psychiatric facility in Concord, was 2,700 adults. Today, with a population of 1.3 million, the number of child and adults beds at New Hampshire Hospital is a mere 160. During that time, there has also been a significant decrease in the availability of psychiatric beds at local hospitals.
To be sure, many people with mental illness have benefited from advancements in treatment and are living independently, leading full and productive lives. Others are more marginal and depend on a fragmented and, in recent years, chronically underfunded system of mental health services. As a result of this underfunding, individuals end up on the streets, face arrest for nuisance crimes and spend time in jail instead of receiving needed treatment.
Law enforcement has made great strides and benefited from increased funding and training to improve their understanding and response to people with mental illness. We need to provide the same emphasis and opportunities to court personnel and to other players in the corrections system. Lack of appropriate assessment and understanding of how to manage people who have mental illness and who are accused of crimes, combined with limited treatment options has resulted in high recidivism rates for individuals who commit low level offenses and probation violations.
National studies indicate people with mental illness are charged, convicted and sentenced more severely, and spend more time in jail than others accused of similar crimes who do not have mental illness. These cases clog the court system, increase the stigma and shame that people with mental illness already carry — and cost taxpayers a lot of money.
Better solutions exist. Mental health courts are a key to reducing the likelihood that individuals with mental illness will reoffend. In mental health courts, all court personnel receive training designed to promote positive outcomes for individuals with mental illness. Through careful assessment and screening, court personnel identify individuals who can safely be held accountable for their actions. Public safety is ensured because participants must adhere to individualized treatment plans which are carefully monitored through frequent judicial reviews and court appearances. As a result, the chronic cycle of incarceration is interrupted.
Currently, only 10 of New Hampshire’s 33 Circuit (District) and Superior Courts have a mental health court. Because counties and local municipalities fund prosecutors as well as special programs, there is a wide discrepancy in regions where mental health courts are located. Some counties have seen significant savings as mental health courts are successful at reducing use of county correctional facilities.
For this reason, many mental health courts have focused exclusively on misdemeanor crimes. It is important that similar programs be offered for felony convictions as well. For instance, the NH Department of Corrections indicates that 77 percent of the women at the Goffstown prison have experienced serious life threatening trauma from physical or sexual assaults. Trauma often results in post-traumatic stress disorder, severe depression, substance use and other debilitating disorders. At the men’s prison in Concord, forty-five percent report having a mental health disorder.
A bill making its way through the Legislature encourages the establishment of mental health courts statewide. Although it does not provide funding, it establishes guidelines for how mental health courts should operate including following the best practices established nationally which have demonstrated the most effective and positive outcomes.
To be sure, individuals who commit violent crimes should go to jail. But we need to stop incarcerating those with mental illness simply because treatment options are few. We need to stop clogging our courts and corrections systems with people who need treatment, not confinement. Instead we must carefully screen and assess individuals with mental illness who can be safely monitored in the community with treatment and supports. We must recognize that the community is safer and tax payer dollars are more wisely spent if we invest in effective community programs that will address the needs of individuals with mental illness and/or substance use disorders. Only then will we stem the tide of people ending up in the judicial system.
Kenneth Norton is executive director of the National Alliance on Mental Illness-New Hampshire. Tina L. Nadeau is chief justice of the New Hampshire Superior Courts.