At last count, the California state prison system housed 33,777 inmates diagnosed with significant mental illness, including 6,051 with severe conditions such as schizophrenia.
Despite Gov. Jerry Brown's exhortations, one very feisty federal judge, Lawrence Karlton, doesn't seem prepared to give up control over their care any time soon.
Karlton has presided over a suit to improve conditions for mentally ill prisoners since George Deukmejian was governor in 1990. He showed no sympathy last week when Brown's lawyers argued that after spending billions, California exceeds the constitutional standards for the inmates' care.
"During the life of these lawsuits, the prison health care budget has gone from $700 million to $2 billion," Brown told The Bee's Denny Walsh and Sam Stanton earlier this month. "That money is coming out of the university, it's coming out of child care. It's a situation you wouldn't dream anyone would want."
There is history to this story, one Brown knows well. Like Ronald Reagan before him and governors who came after him, Brown made spending and policy decisions during his first two terms in office that turned mentally ill people out of state hospitals, onto the streets and into prisons.
In his third term, Brown has reduced prison population dramatically from a high of more than 170,000 when Arnold Schwarzenegger was in office. But as the prison population has fallen to 119,500, the number of mentally ill inmates has been constant.
For years when the population was growing, the mentally ill accounted for 20 percent of inmates. Now that the overall number is shrinking, the 33,777 mentally ill prisoners make up nearly 30 percent of the prison population.
"As a society," Jeffrey Beard, Brown's corrections chief, told The Bee's editorial board last week, "we just have not done a very good job of dealing with the mentally ill."
Beard, a doctor of psychology, doubts the number will fall any time soon. "It is not necessarily the way I think it should go long term," he said. "But it's a reality, and you have to deal with the reality."
A little history is relevant to that reality. Former state Sen. Nick Petris, who died the other day, provided context in an oral history for the California State Archives.
A Stanford-educated attorney, Petris was one of the most liberal and thoughtful legislators of his time, which spanned nearly 40 years from 1958 until 1996.
The East Bay Democrat also was one of the authors of the Lanterman-Petris-Short Act. Signed in 1967 by Reagan, the act sped the emptying of state hospitals of mentally ill people who had committed no crimes. The act also created the current mental health care system.
In the 1960s, Petris recalled, patients were railroaded into hospitals, given gunny sacks for clothing, had few rights and often died shortly after their arrival.
Petris sought to protect them by requiring that before they could be held involuntarily, psychiatrists would need to determine that they were a danger to themselves or others, or so gravely disabled that they could not tend to their most basic needs.
Soon after the law took effect, Petris noticed the rise in homelessness, and ultimately, incarceration of a different type. He blamed Reagan for cutting spending to care for people who no longer were held in the hospitals, though governors and legislators who came later share in that responsibility.
Petris' goal was to end the "tyrannical and oppressive system of incarcerating people so easily." But the new system "went overboard the other way," he said.
"I was tormented personally," Petris said. "I just didn't know what the right thing to do was. I didn't know whether these horror stories which we started to get were just a drop in the bucket and were inevitable (or) whether a change in the other direction would get us back to where we were before. Nobody wanted to do that."
In a real sense, the state did go back to where it had been. At one point in 1960, there were 36,853 people in state hospitals, nearly equal to the 33,777 mentally ill people in state prison today.
In a 1994 report to Karlton, a court-appointed inspector described the bedlam at the California Medical Facility, the prison in Vacaville: "Severely mentally ill prisoners were in perpetual isolation in locked cells." Mentally ill prisoners were locked in a segregation unit "without blankets, mattress or clothing." Some "covered themselves with feces."
Later in 1994, as the state fought the prisoner-rights attorneys' effort to have Karlton impose the receivership, Kyle McKinsey, then in charge of health care at the Department of Corrections, predicted that costs would skyrocket to $300 million if federal courts seized control of mental health care in prisons.
Karlton took direct oversight of prison mental health care in 1995. McKinsey turned out to be wrong. California spends $400 million a year on mental health care in prisons.
In 1994, Donald Specter, head of the Prison Law Office, explained the point of the lawsuit by saying the state is "under a constitutional obligation to provide mental health care" to inmates who need it.
"However ironic it may seem," Specter told me at the time, "state government isn't similarly required to provide mental health care to you and me."
Specter was back in federal court last week, opposing Brown's effort to get out from under the court order. Karlton is expected to rule on the governor's request within a week from today.
To be sure, there have been changes in the prisons and on the streets. Care for mentally ill inmates has improved. And in 2004, voters approved Proposition 63, which generates $1 billion a year for mental health care for noncriminals.
All too often, however, severely mentally ill people must commit a crime to get care. Witness the 33,777 mentally ill men and women in California prisons today.
Many others get dumped, as happened last month when Sacramento County jailers gave a mentally ill man named Matthew Herrera a paper jumpsuit and flip-flops and released him, only to have him be rearrested 31 hours later for stealing his mother's car. Or when Nevada officials bought a $60 Greyhound bus ticket for James Flavy Coy Brown, and sent him to Sacramento, where he knew no one.
It all comes at a cost. At some point, the bill comes due.
Follow Dan Morain on Twitter @danielmorain.