When a combat veteran experiences an acute trauma response, we do not start by asking whether he is dangerous or immoral. We ask what he has endured. We ask what injuries, visible and invisible, he carries with him. We recognize that his brain and nervous system may still be operating in survival mode. We know, instinctively and clinically, that discipline alone will not heal trauma. Punishment is not treatment.
Yet across the United States, we routinely respond to people with severe mental illness as if jail were therapy and confinement were care.
This did not happen overnight, nor did it arise from malice. Beginning in the mid-twentieth century, the nation closed large public psychiatric hospitals, many of them antiquated and rightly criticized for failing to meet modern standards of dignity and care. The intention was humane: to replace institutional warehousing with community-based mental health services.
But something essential was lost.
Those community systems were never built at the scale required. They were never adequately coordinated. And they were never meaningfully connected to the people most likely to need them, those cycling through courts, jails, prisons, probation, and parole. What we dismantled was a system. What we replaced it with was a patchwork.
I saw this shift firsthand. More than thirty years ago, as a young prosecutor walking through county jails, roughly 15 percent of the incarcerated population lived with serious mental illness. Today, in county jails across the country, that figure commonly exceeds 50 percent. This is not because mental illness suddenly became more prevalent. It is because the criminal justice system quietly absorbed responsibility for care that medicine and public health no longer had the capacity, or infrastructure, to provide.
What we are left with is a system operating by default rather than by design.
Judges are now asked to manage psychiatric crises with tools never intended for that purpose. Courts exist to preside over jury trials and impose punishment, not to diagnose psychosis or stabilize trauma. Sentencing still centers on culpability, while clinical need is often secondary. Jails and prisons are expected to hold together people suffering from psychosis, trauma-driven behavior, traumatic brain injury, or addiction, conditions that require sustained medical care, not short-term confinement.
To New Jersey’s credit, legislative leadership has begun to confront this reality. Senate Majority Leader Teresa Ruiz has expanded diversion, and that progress matters. Essex County’s
partnership with Silver Lake Hospital in Newark is groundbreaking. Chairman of the Senate Judiciary Committee, Senator Brian Stack, has consistently underscored the essential role of clinical care in supporting court-involved persons and strengthening the justice system.
But diversion alone cannot address every challenge. What happens when diversion is not appropriate? What happens at sentencing, in custody, and under probation or parole?
The uncomfortable truth is that we still lack a coherent, clinically grounded, and operationally workable framework for integrating psychiatric care across the criminal justice continuum. Our Governor Mikie Sherrill and state legislative, medical, and psychiatric leaders across New Jersey understand that clinical care is not ancillary to justice. It is foundational to it.
At this point, the science is settled. Trauma is not a character flaw or a failure of will. It is an injury to the brain and nervous system that shapes how a person perceives threat and safety. Hypervigilance, impulsivity, and catastrophic thinking are not moral choices. They are survival responses. Punishment does not reset that system. In many cases, it reinforces it.
We know what works. Evidence-based treatments such as Cognitive Behavioral Therapy, paired with accurate psychiatric diagnosis and appropriate medication management, can interrupt trauma-driven behavior. But treatment only works if people can actually access it. Systems must be built.
That requires bringing physicians, psychiatrists, judges, lawyers, and correctional leaders together to establish clear clinical and legal standards for integrating mental health care into sentencing, custody, probation, and parole. That work must also be tested where it actually operates, in courtrooms, jails, and correctional settings, not left on paper. None of this is radical. It is overdue.
On April 2 at Saint Peter’s University in Jersey City, the New Jersey Reentry Corporation will host its Annual Reentry Conference, Trauma, bringing together David Brooks, Dr. Jill Bolte Taylor, Dr. Petros Levounis, and Dr. Elie Aoun to align medicine, law, and lived experience.
If we want safer communities and a justice system that deserves public trust, we have to rebuild the connection between psychiatric care and criminal justice. Accountability still matters. But so does understanding behavior well enough to interrupt it. There was a time when this country recognized severe mental illness as a shared public responsibility. Reclaiming that understanding will require humility, coordination, and the willingness to build systems that heal rather than simply punish.
When medicine and justice work together, accountability takes on greater meaning, and public safety becomes more real.