Figuring out how to better help mentally ill before they land in jail


When the call came in to the Selma Police Department, nobody was surprised: An agitated man was smashing rocks against a homeowner’s fence. Neighbors were alarmed.

The mentally ill man was well known to officers, who had jailed him for similar behaviors before. But this time they had options. They called in a triage mental health expert and she found the man a treatment bed that day.

Similar interventions by triage workers teamed with law enforcement are producing uplifting outcomes throughout California. Funded through the Mental Health Wellness Act of 2013, the triage initiative aims to intercept people undergoing a mental health crisis to keep them out of the criminal justice system.

As chairman of the state commission that provides grants for triage teams, I’m incredibly proud of what these mobile clinicians are achieving. But we must do more.

Prisons and jails are often called America’s “new asylums,” and it’s no wonder. The number of mentally ill people who are incarcerated now exceeds the number in state psychiatric hospitals tenfold. And while six out of 10 inmates have a mental health need, only 17 percent receive treatment behind bars.

People struggling with mental illness do not belong in jail, and we must work to prevent so many of our most vulnerable Californians from this inhumane fate.

Fortunately, momentum is building on multiple fronts.

Our commission is immersed in a yearlong project examining how well California is serving adults with mental health needs and how we can better help them before they land in jail.

In addition, hundreds of county officials will gather in Sacramento next month for a state summit to develop comprehensive plans to reduce the number of people with mental illness in jail.

Already, progress is underway in many communities – in part due to the Mental Health Wellness Act. The legislation sought to increase crisis intervention through treatment centers, mobile support teams and triage workers helping law enforcement in the field. Two dozen counties received grants to hire 600 specialists, many of them trained to intervene during emergencies with police.

Most programs are new, so definitive outcome data are scarce. But anecdotal reports are encouraging. In Selma, Police Chief Greg Garner said having triage workers on duty 20 hours per day has been “a godsend.”

In the past, “jail was the default receptacle” for most mentally ill people whose behaviors triggered a police call, Garner said. Now clinicians accompanying officers in the field ensure people get treatment for the illness that drives their conduct.

While the triage approach is new for many law enforcement agencies, others have been practicing variations of it for years. The Los Angeles Police Department has been at it the longest, and its Mental Evaluation Unit is considered a model of best practice.

In 2015, clinicians responded with LAPD officers to more than 4,500 crisis calls for service. About 80 percent of those encounters resulted in a diversion to mental health treatment; only 10 percent led to arrest.

Programs elsewhere demonstrate that treatment outside penal institutions not only costs less but prevents crime. In Florida’s Miami-Dade County, for example, a program funneling mentally ill misdemeanor offenders into treatment reduced the recidivism rate from 75 percent to 20 percent.

As such results show, diverting mentally ill Californians away from jail and into treatment can produce significant fiscal and public safety benefits for our state.

Beyond that, I think we can all agree it’s the right thing to do.

Dr. Victor G. Carrión is chairman of the California Mental Health Services Oversight and Accountability Commission and the John A. Turner, M.D., professor of psychiatry and behavioral sciences at Stanford University School of Medicine. Contact him at