Earlier this month, a nonprofit released a report on the state of mental health in America, and it was pretty damming. According to their research, the number of people with serious mental health issues that are incarcerated is ten times higher than the number of people with serious mental health issues that are in treatment centers.

So how did we get to this point? As America has spent more money on prisons and jails, less has gone towards mental health services, so treatment centers can’t house as many patients as they once could. It has also become more acceptable to send mentally ill defendants to prison rather than treatment centers since the 1950s.

Given that prisons are not well-equipped to deal with mentally ill inmates, many leave prison even worse than they were before their incarceration. They are more likely to be beaten or raped in prison than other inmates, and they are kept for longer because they are often too unstable to charge with specific crimes.

One consequence of the Affordable Care Act is that insurance companies are required to cover more mental health issues than before, making cost less of a factor for many. Advocates are pushing for a slate of reforms that include reforming both mental health laws and prison treatment laws.

At a time when Cook County in Chicago, Shelby County in Memphis, and Polk County in Des Moines all have more inmates with serious mental issues than all the state hospitals in their respective states, real change for this pervasive and ingrained problem needs to come from local and state governments’ sustained efforts.

This story was cross-posted on OurTime.org.