Smart Justice: Texas Needs More Effective Alternatives Than Jail to Treat Mentally Ill

For decades, a best practice of health care systems reform has been to reduce higher-cost emergency health care by promoting more cost-effective primary care aimed at prevention and early intervention of illness and disease. It is time to eliminate the stigma of mental illness and understand it for what it is, a physiological disorder in the brain, and apply the same best practice to improve Texas’ mental health care.

Across the vast majority of our state, access to community and preventive mental health services is limited. Consequently, too many Texans with behavioral health problems do not receive the help they need until hospital emergency departments, child protective services, social services agencies or the criminal justice system intervene with services that are often more costly and less effective.

The Meadows Mental Health Policy Institute partnered with the Texas Conference of Urban Counties to study outcomes of the Texas mental health system. Counties representing more than half of Texas’ population provided data on jail related costs, including large and small counties (21 total). Using county-level prevalence estimates, they determined the relationship between the number of people with serious mental illness and the cost of housing and treating individuals with mental illness in county jails. Their conservative estimates of the local burden of unmet mental health needs add up to a heavy price tag for our communities:

• $450 million in jail costs for individuals with mental illness.
• $230 million in juvenile justice costs for youth with serious emotional disturbances.
• $940 million in psychiatric emergency department costs.
• $445 million in alcohol and substance abuse emergency department costs.

When you consider that one-half of all mental illnesses begin by age 14, and that adults with untreated mental health conditions are eight times more likely to be incarcerated than the general population, earlier screening and intervention need to be part of a comprehensive, integrated primary and behavioral health care system in Texas.

Each year, 175,000 Texas children suffer from severe mental health needs. Of those, 50 percent will drop out of high school and face double the risk for substance use. Despite the availability of Medicaid, the stigma and lack of public education surrounding mental illness is a barrier that prevents families from seeking early care. As a result, many Texas children in need receive their first mental health services through foster care, juvenile justice or special education. Research has consistently documented that approximately 70 percent of youth in the juvenile justice system have a diagnosable mental health disorder; of those youth, over 60 percent also suffer a substance abuse disorder; and 27 percent have serious disorders that require immediate and significant treatment.

Untreated mental health disorders in children will follow them into adulthood with potentially greater consequences and cost to our communities. It is estimated that 34 percent of the inmate population in Texas have mental health disorders. Youth and adults in our criminal justice system are not the only concern. Texas is home to 17 million veterans. Approximately eight percent experience severe mental health and substance abuse needs and approximately three percent suffer severe and persistent mental illness in a given year, putting veterans with inadequate access to care at higher risk of contact with the criminal justice system.

The concept of Smart Justice is to divert the treatment of mental illness away from our criminal justice system by ensuring Texas has a comprehensive, integrated primary and behavioral health care system to prevent, screen and intervene early through lower-cost and more effective programs. To do that, we need to de-stigmatize mental illness and join in supporting our state and community leaders and organizations who are working on this issue in your community.