Multnomah County Commissioner Lisa Naito is on a mission. It's not to win re-election or to award a fat contract.
It's to do something she believes will truly make a difference in the county and across the nation: Naito wants to remove mentally ill offenders from the criminal justice system and place them where they can be cared for as people — not punished as criminals.

"Our jails and prisons aren't mental health facilities," Naito said. "Obviously, there are people engaging in criminal activities who also have mental illnesses, but for nonviolent mentally ill people, jail is not the appropriate place to be."

Too often, Naito said, the mentally ill are incarcerated because their behavior doesn't seem to fit any other label but criminal. Naito said that in Oregon, the population of nonviolent mentally ill prison inmates began to rise in the 1980s, when many patients were released from state mental institutions. In the absence of appropriate treatment and surroundings, their behavior landed them in jail. This scenario was repeated in many places around the country, she said.

"We didn't de-institutionalize the mentally ill from state institutions about 20 years ago," Naito said. "What we did was trans-institutionalize them into local jails. And it's not just Oregon — it's a nationwide issue. Sheriffs across the country are realizing that they have become the main provider of mental health services in their communities."

The idea behind de-institutionalization, she said, was the belief that local, community-based mental health care facilities are healthier for patients than large, impersonal, restrictive state hospitals.

"Think One Flew Over the Cuckoo's Nest," she said.

The problem was, she continued, that the movement was inadequately funded — forcing jails to become a sort of care provider of last resort. Ironically, she said, local governments have ended up spending far more in incarceration costs than they would have in developing a community-based care system.

"The problem is that the money didn't follow into the communities," she said. "You had people who were basically on their own. They just get caught in this jail-to-street, jail-to-street cycle."

So Naito's mission has widened in scope. Last week, she addressed a gathering of Oregon county government officials in Pendleton, where she spoke about the need to advance the growing movement to separate mental health services from the criminal justice system. She chairs the National Association of Counties' Public Safety Committee, where she has made the issue a top priority.

She also chairs the same committee at the state level — for the Oregon Association of Counties — and has combined forces with the chair of the Human Services Committee to help keep young people with mental illness from entering the criminal justice system in the first place.

A big part of the problem, Naito said, is that most law enforcement officers lack the appropriate training needed to interact with a mentally ill person who may be behaving oddly or even violently.

"Crisis training would help officers and responders better identify people who are having mental health issues and are not really a threat," she said. "Learning to 'talk people down,' for example. Talking works far better than confrontation."

Multnomah County is setting up mobile response teams who can assist officers in the field, so they won't have to arrest and jail someone who is having a mental health crisis. A system being tried out with in Dallas, Texas, automatically alerts officers when they come in contact with someone who has a history of mental illness. Naito said that she's interested in implementing a similar system here.

"The idea would be to divert that person to a hospital right away, rather than ever having them go to jail," Naito said.
Another piece of the puzzle isbettercollaboration between the county's mental health services and the criminal justice system. If a mentally ill inmate is, in fact, a danger to others and needs to stay incarcerated, the county can provide him or her with mental health services in the jail itself.

In terms of the legal side of the criminal justice system, she said, it's frankly unrealistic to expect a mentally ill defendant to show up for a court date. And when a court date is missed, an arrest warrant is issued, the legal stakes are raised and the county ends up spending a whole lot more money than it would otherwise. Naito's answer? A simple phone reminder system that dials up mentally ill defendants and reminds them to get to court.

In the end, she said, the idea is to transition mentally ill people out of the criminal justice system and back into mainstream society to the greatest extent possible. While many won't ever live completely normal lives, they can still live happier lives than they would in jail — and at far less cost to taxpayers, Naito said.

Part of this effort lies in making sure that there are places for people to stay when they get out of jail and that they get help in securing the resources available to them — Social Security benefits, for example, which are suspended when a beneficiary is incarcerated. Likewise, Naito said, getting people quickly into a treatment program is essential.

"We want to establish continuity of care," she said, "so that people can avoid that repeating crisis situation that ends them up in jail."

Naito is hopeful that her efforts — and those of her counterparts in counties around the country — will bear fruit. Ultimately, the goal is a better quality of life for the mentally ill and county governments that can free up resources for more productive ends than incarceration — making for a happier, healthier society.

"What I'm hearing as I travel is positive," she said. "More and more people are realizing that this is something we need to do."