Jails and prisons have become default psychiatric institutions

The largest psychiatric institutions in the state and nation are not hospitals—they are jails and prisons. Far more people in California with mental illness are behind bars than in hospital beds. Over 30 percent of California prisoners currently receive treatment for a serious mental disorder, an increase of 150 percent in nearly two decades.

“We’re going to end up with an incarceration system that’s mainly dealing with people that have serious mental health problems,” said Democratic state Sen. Jim Beall of San Jose. “It’s our own fault, in a way, for not having a good mental health system.”

Mental health courts provide one possible response to this crisis. Public defenders, prosecutors, judges and social service providers work together to connect certain defendants with services and treatment, with a goal of keeping them out of jail.

Judge Stephen Manley started one of the nation’s first such courts in Santa Clara County more than two decades ago. The model has expanded around California, but still serves only serve a fraction of the need.

“Everyone wants to tell me, ‘It’s so complex, we can’t solve it,’” he said. “And I say, ‘No, you can. Get together and figure out what you can do.’”