One night last winter, Sally Judson was arrested for prostitution and disorderly conduct. She was also charged with resisting arrest and possession of drugs and drug paraphernalia. Judson, who has schizophrenia as well as a heroin addiction, is one of hundreds of thousands of Americans clogging the criminal-justice system for drug offenses. Many, like Judson, are also mentally ill, and the system often fails to treat the mental illness and instead ends up just submerging it in the criminal behavior.
But Judson (not her real name) was fortunate to be arrested in Pittsburgh, one of several U.S. cities pioneering a new and promising approach to treating mentally ill offenders that uses a diversion strategy supervised by newly created mental-health courts. After being arrested and placed in the intake area of the jail, Judson was identified as mentally ill by staff of the Allegheny County Office of Behavioral Health, according to the office's Amy Kroll. Two hours later, Judson went for her initial arraignment. "We drew up a service plan, and she was willing to work with us," Kroll says.
Instead of sending her to jail, the judge remanded Judson to a local crisis center followed by 28 days of drug rehab. She responded well to the treatment and afterward was placed in a halfway house. Her ease was removed into a mental-health court, and in lieu of being incarcerated she was put on a structured, three-year probation. The Office of Vocational Rehabilitation helped find her a waitressing job at a local Bob Evans restaurant. On the one occasion Judson relapsed, she was speedily hospitalized.
Once a week, Judson attends a therapy group in which she and other low-level offenders learn techniques to help them avoid patterns of criminal behavior. Her urine is regularly tested for drugs. She sees a therapist who specializes in "co-occurring" disorders such as drug addiction and mental illness. If she abides by the rules, Judson will graduate from mental-health court in the fall of 2009.
"It's very intense supervision," Kroll explains. "Intense treatment. They come back for progress reports. The judge knows everything about them." Absent the interventions, Kroll believes, Judson "would have continued to prostitute. Maybe she'd have ended up dead."
PENNSYLVANIA HAS one of America's largest and fastest-growing prison populations. More than 47,000 people are in the state's prisons, up from about 8,500 in 1980. In the past, the state has failed to develop effective sanctions to channel nonviolent offenders away from prison, and about 20 percent of Pennsylvania's inmates are serving time for drug crimes.
But since April 2007, a Criminal Justice Mental Health Task Force has been pursuing statewide reform recommendations. Five Pennsylvania counties now have mental-health courts, with Pittsburgh's Allegheny County in the lead. These courts supervise mentally ill offenders deemed harmless to the community. In exchange for agreeing to go into treatment, the individual avoids prison as long as he or she sticks to the program. A similar philosophy was pioneered by drug courts in New York, California, and Massachusetts, among other places, which have channeled tens of thousands of people into treatment programs over the past decade, helping them avoid prison.
In Pennsylvania, as in other states that have invested in better ways of interacting with the mentally ill, diversion of mentally ill offenders begins with local law enforcement. Police are specially trained in crisis-intervention methods. Lt. Francis Healy, special adviser to the Philadelphia police commissioner, describes it as "a lot of commonsense talking to people, getting police officers to know what mental illness is--teaching them how important it is to de-escalate." Dispatchers are taught that how they describe a scene determines whether police show up thinking they are going to have to tackle a dangerous felon or instead talk down a disturbed, perhaps psychotic person. …