Georgia puts its mentally ill in prison instead of psychiatric hospitals or community-based facilities.

The systemic failure of Georgia's community mental health system is overcrowding state prisons and county jails, creating a new form of institutional care for the chronically mentally ill because they can't get help anywhere else.

At least 15 percent of inmates incarcerated in state prisons and held in county jails have been diagnosed with a serious mental illness, a state judicial task force reports. Many of them serve time in county jails or state prisons only to be released, stop taking the medications they need to stay well and get picked up again for mostly nonviolent crimes.

The recidivism now rampant in the failed system costs taxpayers millions, says Georgia Supreme Court Chief Justice Leah Sears, who heads the task force. The problem is deeper and more widespread than task members thought, according to Sears.

"We have to break the cycle," she said. "We have to start linking these defendants with the services they need or, as we now know, we will keep seeing them over and over again."

Georgia is not alone. As many as half of all prisoners nationwide exhibit symptoms of mental illness, the U.S. Justice Department reported recently. Other states also report that 15 percent to 20 percent of inmates have serious, chronic mental conditions, such as schizophrenia, bipolar disorders and major depression, treatment for which requires medication and monitoring. Many of them are also dealing with alcohol and/or drug addiction.

But the problem in Georgia may be more acute than in other states, Sears and her task force members believe. In the last 20 years, Georgia's prisons have added 35,000 beds, and county jails have expanded to take in 23,000 more inmates. Meanwhile, the number of psychiatric beds in the state hospital system has declined, wards are overcrowded and the quality of care is so suspect that the Justice Department is investigating whether patients' civil rights are being violated.

"Deinstitutionalization," the movement to get patients out of state hospitals, has been around for about 40 years. But Georgia, like other states, has failed to ensure that severely mentally ill patients have access to the treatment they need in communities where they live. Little of the savings from scaling back care at hospitals was transferred to provide an adequate level of spending on community services, which 180,000 Georgians now depend on for basic mental health care.

The $500 million that the state now spends annually on community mental health care is simply inadequate for the intensive level of help this chronically ill population needs. In other states with better records than Georgia in caring for the mentally ill, spending is targeted at case management, using not just psychiatrists and nurses but also mental health social workers. Treatment teams are established to help patients find decent housing, hold a job and get the array of social services they need to stay well. It is not a cheap system.

Local judges, prosecutors and law enforcement officials would do well to set up similar teams in their communities to break the recidivism cycle, the chief justice said. "We need much more collaboration between the criminal justice system and the mental health system," Sears said. "Mental illness is not a crime. But these citizens are falling through the big holes in the safety net."

Judges in a handful of superior court districts around Georgia have created "mental health courts" to tackle the issue head-on, she said. The first to do so was Judge Stephen Goss of Dougherty County Superior Court, who holds a separate mental health docket in Albany one morning every week.

The key to the court's success — the Dougherty circuit has cut the recidivism rate for mentally ill defendants by about 40 percent in the five years it has been operating — is in working with mental health professionals and prosecutors to find defendants who agree to undergo intensive treatment. At any given time there are about 50 defendants in the program, Doss said, many of whom are getting the care they need for the first time in their lives. The program relies on a coordinating nurse and licensed mental health counselors provided by the local community service board serving the Albany region.

"Most of the defendants we work with have multiple prior convictions," he said. "For the most part they are for nonviolent crimes, thefts, bad checks, a lot of what we would consider 'quality of life' crimes. They have been in and out of the system — the hospitals and the courts — for years." Most program participants also have a substance abuse problem, he said.

Defendants agree to remain under supervision as long as the court deems necessary — on average about 12 to 18 months. They also are required to attend periodic court hearings so the judge is kept up to date on their treatment. If they violate the terms of the agreement, they go back to jail.

Goss' court has become a model for others in Georgia. He routinely gets inquiries from judges, corrections officials and jailers from around the country concerned about the same issue.

"There are lots of anecdotal stories, wonderful stories, about how we have helped a person find a stable place to live and get the care they need," he said. "But each community has its own resources, or lack of them, so what works in one jurisdiction might not work as well in another."

That's where the state must play a more significant role.

Even if local judges and prosecutors adopt the model, innovative options like mental health courts will be successful only if the state agrees to make mental health care a higher budget priority. At a minimum, the state should consider a mental health budget at least equal to the annual corrections budget. Failure to upgrade mental health care means those same prisons will keep filling up with people whose only major crime is being mentally ill.

— Mike King, for the editorial board