COMMENTARY

Michigan court administrator offers road map for handling mentally ill

12/21/2017

DETROIT — Milton Mack spent years as a chief probate judge in Wayne County, watching as Michigan turned its prisons into ghastly expensive and failing institutions for the mentally ill.

“The system is broken,” he said last week. “In nearly every state, jails and prisons are now the primary institutions for housing persons with medical illness” — with disastrous results.

Costs have skyrocketed. Mentally ill prisoners sometimes fail to get treatment at all — and even when they do, “jails and prisons are not therapeutic environments.”

On top of that, many of those locked up tend to “remain incarcerated much longer than other inmates, largely because many find it hard to follow and understand jail and prison rules.”

They often don’t understand what they did wrong in the first place, and when released, they are among the most likely to soon reoffend and find themselves in prison again.

But today, Mr. Mack, now Michigan’s State Court Administrator, has developed a serious proposal to fix things — and it would both offer better treatment for many mentally ill inmates and potentially save the state hundreds of millions of dollars annually.

After working on it for a year, he presented a policy paper, “Decriminalization of Mental Illness: Fixing a Broken System” to the national Conference of State Court Administrators last month at their annual meeting in Arizona.

They gave it, he told me, unanimous approval.

For years, experts on criminality and mental health have tried to push what they call the “sequential intercept plan,” which sets standards for how the criminal justice system should interact when people with serious mental illness get in trouble.

These intercept standards, which cover everything from a mentally ill person’s first contact with law enforcement to what happens after they serve their time, are necessary and valuable, and work to save lives, Mr. Mack believes.

But he takes it a step beyond. In order to fix what nearly everyone agrees is a badly broken system, he wants mental health codes modified to allow the courts to order “timely treatment for persons with mental illness,” which he calls an “intercept zero” solution, before they get into trouble with the law.

“The idea is to permit the court to intervene early in the course of a person’s mental illness in order to treat it.”

Mr. Mack is mindful of the need for safeguards, and as a probate judge was cautious about declaring somebody incompetent just because officials or family members said so.

But he firmly believes that changing the standard to allow more court-ordered treatment will provide huge advantages to everyone from the patient to the state budget — and has figures to back it up.

“In Michigan, though the total number of prisoners is declining, the number of prisoners with serious mental illness has increased,” dramatically, to nearly a fourth of the prison population.

The average state prisoner costs taxpayers $35,253 a year to house and guard, “while those with the most severe mental illness annually cost $95,233 per inmate to house and treat.”

How much do taxpayers spend on average for mentally ill adults who are not locked up but are getting treatment? A mere $5,741.

The difference is staggering — and based on a lifetime of experience and a few pilot projects, Mr. Mack estimates that around a fourth of Michigan’s 40,000 prisoners could be released.

“That would mean saving hundreds of millions,” he said. Once, Michigan did have a system of mental hospitals, some of which were closed by Gov. John Engler in the early 1990s.

But while Mr. Engler is often blamed for the influx of mentally ill into the prison system, the forces that created the current nightmare were set in motion much earlier.

As the longtime probate judge details in his study. “The Community Mental Health Act of 1963 created a financial incentive for states to close state-funded mental hospitals while promising to fund community-based outpatient treatment and community mental health centers to replace the services provided by hospitals.”

But that funding never happened.

The old-fashioned mental hospitals closed. Congress eliminated funds for hospitalizing people with mental diseases in state hospitals. State legislatures enacted new mental health codes that made it much harder for courts to order people into mental institutions even if such hospitals existed.

As a result patients who often had nowhere to go and no real ability to support themselves were released.

Speaker of the House Tom Leonard (R., DeWitt) is a strong believer in using mental health treatment to keep people out of prison when possible.

He is keenly interested in Mr. Mack’s report, as are some other lawmakers. Whether that translates into action isn’t clear.

Next year, after all, is an election year. Mr. Leonard is campaigning for the Republican nomination for attorney general. Being the man who fought to release mentally ill criminals from prison may not be seen as a winning political strategy.

But what is clear is that the system is failing the taxpayers, the public, and Michigan’s mentally ill citizens.

And one of the state’s foremost authorities on the problem has drawn a road map that would allow our leaders to save money, solve a major problem, and do the right thing.

Jack Lessenberry, the head of the journalism faculty at Wayne State University in Detroit and The Blade’s ombudsman, writes on issues and people in Michigan. Contact Jack Lessenberry at omblade@aol.com