The result of the Law of Unintended Consequences is that sometimes fixing one problem creates another one. In the 20th century, mental health hospitals were designed to improve on the insane asylum model of the previous century. Unfortunately, supply exceeded demand, and the result was increased neglect of the patients. A movement known as deinstitutionalization began in the 1970s and 80s. It was to replace the long-stay psychiatric hospitals with a home or halfway house environment. The concept was that this would provide more personal attention to their needs with a goal of integrating the mentally ill into regular society.

As lofty and noble as this goal sounds, moving these people into society had profound repercussions. Those with mental illness are two and a half times more likely to be victims of a crime such as murder, rape, and assault. They also suffer from severe health issues, evidenced by the fact that the average lifespan of a mentally ill person is twenty-years fewer years than the national average. Unfortunately, these individuals also find themselves on the wrong side of the law. Over 20 percent of those in prison today suffer from mental health problems. The sad truth is that the prisons and jails in the United States have become the de facto mental health institutions of our country.

Incarceration facilities are not designed to be care facilities, but now they must adapt. It is just this situation that has created the Stepping Up Initiative, an effort between the Council of State Governments Justice Center (CSGJC), the National Association of Counties (NAC) and the American Psychiatric Association Foundation. The goal is to put local law enforcement and local government leaders in contact with resources and organizations that can help inmates who suffer from mental health illnesses get the assistance they need to prevent them from re-offending.

Lycoming County is officially participating with Stepping Up. At the ceremony making this announcement at the County Commissioners meeting last month, several speakers highlighted steps that are already in motion. Keith Wagner, Lycoming and Clinton Mental Health and Intellectual Disabilities Department Administrator, noted that there are now two mental health professionals who provide mental health first aid training and suicide prevention training to community members. Lycoming County Warden Kevin DeParlos remarked how valuable it is to now have a position for a full-time, masters level, mental health professional at the county prison. Deputy Warden of Inmate Services, Chris Ebner, has worked with the courts to implement an in-house mental health and substance abuse screening for all those booked into the county prison. Warden DeParlos remarked that there are times when those with mental problems must be put in restraint chairs, so they do not harm themselves.

It is obvious that these individuals with severe mental problems should not be in jail, but the result of deinstitutionalization is that there are just two state hospitals in the state of Pennsylvania, one in Norristown outside of Philadelphia and the other in Torrence near Pittsburgh. The Torrance Hospital has just 100 beds, and it covers 37 counties, including Lycoming. This is why the Stepping Up Initiative is so important.

Another important step that the county has taken in last year is to use grant money to hire a coordinator for the Crisis Intervention Team. The purpose of the coordinator is to provide training to local law enforcement and emergency responders to help them de-escalate scenarios involving people with mental illnesses.

What is impressive about this multi-faceted program is the coordination between the various aspects of the county’s institutions — the courts, the prison, and county government. The county commissioners were sincerely excited about the initiative when it was presented to them. Commissioner Mirabito noted that county jails spend two to three times more on adults with mental illnesses, and they also have a much higher rate of recidivism than those without mental illnesses.

Judge Nancy Butts also echoed her full-fledged support on behalf of the county’s judges of the Court of Common Pleas, applauding this cross-system collaborative approach. She noted the seeds go back as far as 1998 when Lycoming County was just the fifth county in the state to adopt a drug treatment court, which is where the mental issue problem was first identified. Judge Butts noted that in 2008, a mental health treatment court was appropriate and needed, which like the drug treatment court is also headed up by her.

There are no perfect programs in an imperfect world, but it seems that with all the urgency combined with research and data and cooperative effort that is being put together in the Stepping Up Initiative, the Law of Unintended Consequences might not happen this time.