Bruce Herdman, chief of medical operations for the Philadelphia Department of Prisons, sometimes describes the county jails this way: "This is the largest psychiatric hospital in the state of Pennsylvania."
Forty percent of Philadelphia inmates are on psychotropic medications; 17 percent have what's considered a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. At the state level, 29 percent of inmates have a mental illness. People with mental illness also stay longer in jail, and are more likely to return.
So, on Tuesday, state officials will announce a multiyear initiative aimed at safely reducing the number of people with mental illness in Pennsylvania jails -- a problem that has so far been intractable in the face of criminal-justice reform efforts.
The Stepping Up Initiative, led by the Council of State Governments (CSG) Justice Center with support from the state Departments of Corrections and Human Services, aims to gather comprehensive data on how people with mental illness interact with the criminal justice system, then develop an evidence-based approach to addressing whatever's landing them there.
"I've been talking about and frustrated with these issues for well over a decade," said Pennsylvania Corrections Secretary John Wetzel, who manages a state prison population that, on any given day, is likely to include more than 14,000 people with mental illness. "This process is really the brightest glimmer of hope I've seen, where it actually appears that we have a shot at coming up with some way to finally have an impact on this population."
It's a county-by-county effort, though a handful of states, including Ohio and California, have also launched statewide Stepping Up initiatives.
The next step is enlisting county commissioners to pass resolutions committing to addressing this challenge. Thirteen Pennsylvania counties, including Chester, have done so already.
"The premise behind Stepping Up is: We've got to get serious about tackling this crisis of mental illness in jails. It's not a new problem; it's been around for decades," said Richard Cho, director of behavioral health at the CSG Justice Center. "There have been some promising efforts, but none of it's been taken to scale."
To that end, CSG wants counties to collect detailed data on their populations, then use that to create an action plan. That might include changes to policing practices that would prioritize treatment over arrest when appropriate; more support for programs designed to divert people from prison, such as mental health courts; and increased resources for community-based behavioral health services.
Wetzel said that in many counties, that will reflect a fundamental change. Though many screen for mental health issues at admission, it's "hit or miss" right now, he said.
To start, the state and CSG have partnered with Dauphin County, which includes Harrisburg, as a demonstration project.
Dauphin County District Attorney Ed Marsico said he's as curious as anyone about what the data will reveal. His office has been running a diversion program for mentally ill people in Dauphin County jails for years.
"We've been doing pretty good at that, I think, over the years -- but we're not sure," he said.
Obtaining data will be the first step to understanding what's working, and what more can be done.
"One of the goals is, we'd like to move it up earlier in the system. Instead of [diversion once a person's already in jail], we'd like to step that up to, when the cop has contact with an individual with mental health concerns before they even get to the jail, that we can divert them."
Philadelphia is not currently part of the Stepping Up Initiative. However, it's been a year since a coalition including the courts, the District Attorney's Office, and the Defender Association launched a collaborative effort to reduce the county jail population, backed by a $3.5 million grant from the MacArthur Foundation. Addressing the needs of inmates with mental health concerns was part of that plan.
But, Herdman said, as the overall county jail population has decreased to around 6,500, the proportion of people with serious mental illness has grown.
The typical Philadelphia jail inmate with serious mental illness has already been in and out of the county system seven times before.
Still, there are incremental improvements.
An interagency team is beginning to address the backlog of about 130 people who are in limbo in Philadelphia jails because they have been deemed incompetent to stand trial but are awaiting an open bed at the Norristown State Hospital. Some, typically nonviolent offenders, are now being placed in community-based treatment programs while they await trial, Herdman said.
And, as part of the MacArthur collaboration, the city will soon launch an effort to divert people with behavioral-health issues picked up on low-level probation violations into community-based care, said Julie Wertheimer, chief of staff for criminal justice at the Philadelphia Managing Director's Office. A similar program, diverting people with probation detainers to substance-abuse treatment, is already underway.
Inside the jail, a new program provides short-term "bridge" prescriptions to newly admitted inmates who previously received medication at the jail or ho were recently prescribed medication in the community.
"We know these people well, because they've been here a number of times," Herdman said. Now, about 30 percent of people flagged as likely to need medication are receiving it by their second day in prison. "That way, we can decrease their suffering -- and decrease the chance of an altercation or them ending up in segregation," he said.
Once six months' worth of data is collected, a study will be conducted; the expectation is a decline in the overall number of incidents in the jail system.
In July, Herdman expects to launch a program for inmates with mental illness who are serving short sentences: It would connect them with medical assistance before they leave the jail, and would make sure they have an appointment set up with a behavioral health care provider. That's possible thanks to Medicaid expansion, launched in Pennsylvania in 2015.
"Getting people connected effectively [to community-based care] has not been a strong suit of any jurisdiction in Pennsylvania, but now that we can assure that people have insurance, things are improving a lot," Herdman said.
For now, though, the flow of people with mental health challenges into state prisons continues more or less unabated.
"Our numbers are getting worse," Wetzel said. "It's a combination of more folks coming in -- three decades of overusing incarceration as a response to crime -- but, also, we're probably doing a better job of identifying folks, whereas before they would just slip through the cracks."
About this Project
The Inquirer is one of 15 news organizations in the Philadelphia Reentry Reporting Collaborative, a solutions-oriented focus on issues facing people coming out of prison. The piece is part of an occasional series — across the region and across platforms — on the challenges of reentry and what can be done about them.