When systems fail upstream, the bill always shows up downstream.
Across the country, courts are quietly doing something they were never designed to do: managing mental health crises.
When someone with untreated or under-treated mental illness enters the justice system, the outcome is often predictable. Short jail stays. Court supervision without treatment. Release. A crisis. An emergency room visit. And then, often, right back into the system again.
This is usually framed as a moral failure or a lack of compassion. But that framing misses the real problem entirely. This is a systems failure, not an empathy gap.
How We Got Here
Most communities do not have enough accessible, sustained mental health care. That gap does not disappear. It spills.
When mental health services are unavailable or fragmented:
- Law enforcement becomes the first responder
- Courts become triage
- Emergency rooms become holding zones
None of these systems are designed for long-term treatment, stabilization, or recovery. They are designed to react to crises, not prevent them.
The result is a loop that feels busy but accomplishes very little.
Healthcare Already Learned This Lesson
Healthcare once operated the same way. For decades, the system paid for volume, not outcomes. More visits, more procedures, more billing. Over time, the costs rose, but the results did not.
That is why healthcare has been moving toward value-based care. The idea is simple: we pay for outcomes, not activity. We prevent crises instead of managing them after they explode. Coordinate earlier. And on top of that, measure what actually works.
The justice system, by contrast, remains largely outcome-blind, not caring about the downstream impacts and subsequent damage.
The Economic Reality No One Likes to Name
- Higher downstream healthcare costs
- Increased repeat system contact
- More appeals, resentencing, and administrative churn
- Less public safety per dollar spent
This is not just harmful, but expensive. And persistently so, at that.
Every ER visit, jail stay, court appearance, and transport costs money. The absence of upstream care does not save public funds. It simply shifts costs into the most expensive and broken parts of the system.
The Real Missing Piece: Visibility
The courts are not intentionally malicious. Judges are not indifferent. The main problem is that the system does not reliably surface patterns.
Decisions are made case by case, often without clear feedback about long-term outcomes or downstream cost. When harm accumulates slowly and across systems, it becomes quiet and invisible.
Without visibility, there is no learning loop.
That is why documenting patterns matters. Not to tell judges how to rule, or to shame courts. But to identify where decisions consistently push people into higher-cost, lower-outcome pathways.
Once you can see that, we get to a place where we can finally ask better questions:
- Where would investment upstream prevent harm downstream?
- Which decisions stabilize people, and which ones reliably don’t?
- What outcomes are we actually buying with public dollars?
Those are operational questions, not ideological ones.
This Is a Design Problem, Not Some Moral Mystery
Systems that only react late will always be more expensive and less effective than systems designed to prevent crises. And right now, the American legal system has its fingers in its ears, ignoring the warning sirens.
If fiscal responsibility matters, if public safety matters, if human outcomes matter, then courts cannot remain the last major institution operating without outcome feedback.
Mental health care is not a side issue to justice. It is infrastructure.
And when infrastructure is missing, every system downstream pays the price.
Why This Matters
Treating mental health as an afterthought guarantees crisis-driven decision-making. Treating it as infrastructure opens the door to stability, accountability, and better outcomes for everyone involved.
We already know this works. Healthcare proved it.
The question is whether we are willing to apply the same logic where it is most urgently needed.
