On April 23, 2026, the Schizophrenia Policy Action Network is hosting an event called “Navigating the Justice System for Our Community,” which will commemorate the opening of the country’s first-ever National Mental Illness Justice Center.
There has never been a better time to move forward with such an initiative. Two million people with a mental illness are booked into American jails and prisons every year. It is easier to find oneself incarcerated than it is to find a free bed in a psychiatric hospital. Specifically, while the United States had half a million psychiatric beds in the 1940s and 1950s, today we have only 40,000.
Only the very sickest in our community receive care, while those with devastating cases of psychosis are commonly left to deteriorate underneath bridges and on park benches, even in inclement weather, as I did in 2006-2007. I understand this problem well because of the four years of my life I spent homeless, including 13 months living outside in a churchyard.
Unfortunately, even in my deplorable state, psychiatric intervention did not happen until I was more profoundly ill. This psychiatric treatment would save my life. I just wish it had been offered sooner.
The following are important goals of the National Mental Illness Justice Center.
Addressing the Justice System and Behavioral Health Intersection
One of the most misleading aspects of our mental health system in the United States is the classification of schizophrenia and bipolar disorder as “behavioral health” conditions, implying that a person’s erratic and sometimes even violent behavior results from their own choices. At the same time, we would never consider other brain diseases like Alzheimer’s disease and Parkinson’s disease as “behavioral health conditions,” but instead medical diagnoses.
It would be cruel for a person agitated due to Alzheimer’s to be incarcerated for aggressive behavior. Modern medications for psychosis can greatly reduce violent behavior and agitation, as well as lead to a great reduction in psychotic symptoms, improved insight, and cognition. We must use them early to avoid agitation and violence.
Access to Treatment and Care Within Carceral Settings
When I was first picked up by police for homeless, disorderly behavior, which happened while I was acutely psychotic, I was never assessed for a mental illness or brain disorder. Looking back, this very brief incarceration was a golden opportunity for the justice system to work in my favor, for my eventual recovery. I could have been deemed very sick and transferred to a psychiatric hospital for treatment, including medication. Instead, on my release after a few days in jail, I walked back to the churchyard where I had been living as a homeless person to resume sleeping outside and deteriorating.
Because so many mentally ill homeless people are struggling with brain disorders, and because it is so hard to find a bed in a psychiatric hospital, jails and prisons become the default places where those with severe illness can finally receive help. But ironically, while inmates are offered treatment for illnesses including diabetes, cancer, and high blood pressure, mental illnesses often remain undiagnosed and untreated, even for those who are severely ill.
Finally, for those inmates who are receiving treatment, the very oldest and cheapest antipsychotics are often the only ones provided. For example, many jails and prisons only offer one antipsychotic medication: haloperidol. Haloperidol is a medication from the 1960s often associated with devastating side effects, such as Parkinson’s side effects and extreme restlessness. These side effects can sometimes be irreversible, and can greatly decrease a person’s quality of life and chance for longstanding recovery, to avoid further incarceration or hospitalization.
Prevention, Diversion, and Early Intervention
I should never have ended up in jail, but offered treatment. When I was incarcerated in 2006, I had had no contact at all with my parents for four years, extremely paranoid that they would stop me from making a worldwide impact. I was also paranoid of old friends, people at my church, and my former university professors. I was delusional, thinking I would raise billions for improving healthcare in rural communities in Africa (in reality, I raised several thousand dollars for Africa). Nine months prior to my incarceration, I had begun hearing voices in my head, seeing things that weren’t there, and experiencing painful tactile hallucinations.
Psychiatry Essential Reads
So why was I not hospitalized earlier, when it could have prevented my incarceration?
The reality in the United States is that a person must become gravely ill before receiving life-saving mandated help. My parents knew from 2002 on that I badly needed treatment, but they could do nothing except wait as I refused their intervention and sank to a point of looking for food in garbage cans, sleeping outside, and eventually screaming back at the voices in my mind.
If people with mental illness were offered or mandated treatment early, and for many, involuntary treatment is the only way, hundreds of thousands of people would avoid ever ending up incarcerated.
Understanding and Incorporating the Lived Experience
The final objective of the Mental Illness Justice Center is to utilize what we know from those who have been incarcerated and either had a detrimental experience or experienced the system working as it should.
Eric Smith, a Texas Commissioner, tells his story of success following his arrest and brief incarceration, as it led to his eventual hospitalization and treatment. He was a high school dropout. But following treatment, he returned to college and finished his master’s degree.
Crystal Fox shares the story of her son’s suicide in jail, while being denied medication and treatment for severe psychosis. Her story shines light on the worst of the system of justice in the United States.
Conclusion
Psychiatric treatment, including involuntary hospitalization, can prevent vulnerable individuals from ending up incarcerated. Personally, I wish an earlier mandated hospitalization had saved me from ever ending up in jail for a few days. But there is hope. I did eventually receive the help I needed, and I am truly thankful.
It is my wish that this new National Mental Illness Justice Center will provide a pathway to true justice for millions of suffering Americans.