The Cost of Failing is the result of two years of reporting.
In 2023, Spotlight PA and the Pittsburgh Institute for Nonprofit Journalism published an investigation that found symptoms of serious mental illness have become criminalized in Pennsylvania. The newsrooms reported that people facing charges for behavior tied to their condition often languish in jail awaiting a competency evaluation, an assessment that determines if a person has the mental capacity to aid in their own defense.
After the investigation was published, reporter Danielle Ohl sought to understand why so many of these people ended up entangled in the justice system rather than receiving care.
This involved examining the history of mental health treatment in Pennsylvania, the experiences of local and state administrators responsible for providing care, and the outcomes for people seeking that support.
The new investigation found that over nearly four decades, Pennsylvania has failed to build a community-based mental health system despite knowing the consequences.
Cuts former Gov. Tom Corbett made in 2013 to community mental health services were never fully restored. Since 2017, county mental health services have lost $150 million in spending and reached about 85,000 fewer people.
Gov. Josh Shapiro, who took office in 2023, approved $40 million for mental health services in his first two budgets. And he is proposing an additional $20 million in 2025.
But the infusion does not make up for inflation or the 2013 cut. An analysis of data from 37 jails shows serious mental health needs growing alongside the rate of incarcerated individuals who are on suicide watch and in need of psychiatric medication.
Spotlight PA reviewed numerous different types of records, including:
Federal lawsuits filed by psychiatric patients and subsequent court rulings.
State grant applications to the U.S. Substance Abuse and Mental Health Services Administration.
State reports on the mental health system from both 1987 and 2022.
Pennsylvania’s published plans for the deinstitutionalization of the mental health system from 2005, 2011, 2013, and 2016.
Budgets for the Department of Human Services from 1991 through 2025.
Spotlight PA also filed two identical records requests for community and jail spending on mental health with all 67 counties in Pennsylvania.
To supplement the records received from the counties, Spotlight PA asked DHS for the annual income and expense reports that each local mental health administration files with the state. These records show how counties individually spent mental health funding from the state.
There are 48 mental health administrations because some counties collaborate to provide these services as “joinders.” Spotlight PA received income and expense reports for all 48, for each fiscal year from 2016 through 2024. Prior reports were not available.
The counties on the whole did not provide enough information to draw broad conclusions about spending on mental health services in jails. So Spotlight PA turned to PrimeCare, a company that provides contract medical services to most jails in the state.
PrimeCare gave the newsroom 10 years of data on those services, as well as aggregate statistics showing the number of incarcerated people assessed for mental illness and the category of severity they fell into.
These requests altogether produced hundreds of pages of documents. Spotlight PA partnered with the Lehigh Valley Justice Institute to review them; analyze the data contained; and assess mental health needs in Pennsylvania communities and in jails. Data scientists Eli Laurin, Timothy Loftus, and Vidush Bhardwaj, and Director of Operations Victoria Wrigley conducted this review and analysis.
Read more about their methodology here.
Through additional requests under the Right-to-Know Law, Spotlight PA obtained more documents from DHS including:
Spreadsheets showing mental health allocations from the state to the counties between fiscal year 2001 and the present, including through the CHIPP program.
Annual reports showing patient populations and demographics at Pennsylvania State Hospitals between 2004 and 2022.
A spreadsheet showing the demographic information, state hospital admission and discharge dates, and current living situations of patients who left state hospitals through the CHIPP program.
Alongside these records, Spotlight PA conducted dozens of interviews, speaking with people with direct lived experience navigating the mental health system, including patients and their families; service providers; advocacy organizations such as the National Alliance on Mental Illness and Disability Rights Pennsylvania; and current and former state and local officials.
Several of these people reached out to Spotlight PA following the publication of the 2023 competency investigation.
Among them was a mother who became the narrative center of the story. To protect the identities of the mother and her son, the story uses the pseudonyms Sue and Robert. A pseudonym for a cousin of Robert’s was used for the same reason.
The recreation of Sue and Robert’s experiences is based on several in-depth interviews with Sue, as well as other people with knowledge of the events described in this story.
Spotlight PA also obtained several documents related to Robert’s criminal charges and time in jail that allowed the newsroom to verify the details of Sue’s memory.
Spotlight PA reached out to former Govs. Tom Wolf and Tom Corbett with findings from the investigation. Wolf declined to comment through a spokesperson. Corbett provided comment through a spokesperson, which is included in the story.
Spotlight PA also reached out to Gov. Josh Shapiro and DHS with findings from the investigation. Shapiro spokesperson Manuel Bonder deferred to responses provided by DHS, which are included in the story where relevant.