Sheriff Drew Alexander, of Ohio’s Summit County, put his foot down this week: He announced a new policy, under which violent, mentally ill arrestees must be treated at a hospital or mental health clinic before being referred to the county jail.

“We’re not going to be a dumping ground anymore for these people,” Sheriff Alexander said. He knows of no other county in the U.S. with a similar policy.

This recent move is the latest in Ohio’s decades-long battle to better help mentally ill offenders who cycle in and out of the state’s jails and prisons. “We are the gatekeepers of a lot of persons who are mentally ill, and that’s not something we relish,” Reginald Wilkinson, director the Ohio Department of Corrections, told FRONTLINE in 2004 for our film The New Asylums.

Nearly 22 percent of Summit County’s inmates are being treated with psychotropic drugs. The county’s mental health providers have expressed concern over the impact of the sheriff’s proposal, but Summit County jail officials say they expect only two or three people per week will be brought to hospitals or mental health centers for evaluation.

NPR recently estimated that at least 350,000 people with mental illnesses are in U.S. prisons and jails. Experts point to tougher sentencing laws implemented in the 1980s and 1990s, combined with deinstitutionalization — the process of closing down mental hospitals that began in the 1950s — as the primary factors driving the rise in the mentally ill prison population.

In Ohio, it’s possible that a person could receive better mental health care in prison than on the outside. “I’ve actually had a judge mention to me before that ‘We hate to do this, but we know the person will get treated if we send this person to prison,’” Reginald Wilkinson told us.

Sheriff Alexander’s new policy, aiming to treat the violent, mentally ill before they’re incarcerated, comes after a review of of his jail by the National Institute of Corrections. It’s not surprising, however; Alexander has been a vocal critic of locking up the mentally ill for years. His new move is likely in part a response to the death of mentally ill inmate Mark D. McCullaugh Jr., who was killed in 2006 during a struggle with deputies in the Summit County lockup. One deputy was found not guilty of murder in the case, and charges were dropped against the others involved.

But Sheriff Alexander is not the only one reviewing and responding to the complicated issue of incarcerating mentally ill offenders.

A recent Sheriff’s Department report out of Los Angeles County found that deputies tend to use more force against mentally ill inmates than the rest of the population. This is not surprising: In The New Asylums, we heard that trained force is sometimes deemed necessary to protect the rest of the prison population, and the inmate himself. “You do have to use force on them…” one corrections officer told FRONTLINE. “Once they reach that level, they’re out of control, then they need to be secured.”

But Peter Eliasberg, legal director of the ACLU of Southern California, says that the real problem in L.A. County is a lack of training when it comes to using force. “You have to be on guard that some of them behave differently and they often do things that if they didn’t have mental illness, it would be a real true sign of aggression,” he said. “But if you’re sensitive that this is an inmate with mental illness, you realize it’s not a deliberate attempt to incite.”

The ACLU recently sued the department for “failing to root out deputy brutality inside the county’s jails,” after the Los Angeles Times reported on allegations that a rookie deputy was forced to beat a mentally ill inmate.

And in Massachusetts, the Department of Correction and the Disability Law Center recently came to an agreement to better care for inmates with severe mental illnesses, five years after advocates filed a federal lawsuit following a spate of inmate suicides between 2005-07. The agreement, which awaits a judge’s approval, “calls for the Department of Correction to maintain two new units at high-level security prisons as alternatives to disciplinary segregation for prisoners with mental illness.”

Being in segregation or solitary confinement can be particularly problematic for people with a mental illness. “The mentally ill in isolation [usually] simply fall apart. They have no support; they have no sensory stimulus; their hallucinations get worse. And you can just watch them fall apart,” Fred Cohen, a prison mental health consultant, told us for The New Asylums. “They’re being punished for their illness.”

In 2009, five years after The New Asylums, FRONTLINE producers Karen O’Connor and Miri Navasky went back to Ohio, and found that many of the people they profiled had been released — and then re-arrested, in some cases more than once. These arrests often occurred when a person stopped taking his medication, a constant struggle for former inmates learning to live on their own. Watch The Released for an intimate look at this transition, and learn more about efforts to stop the cycle in and out of jail, such as mental health court or a residential treatment facility that address mental health issues.

Both films feature unforgettable men, struggling with their mental illnesses in and out of prison. There’s Bennie Anthony, who was diagnosed with schizophrenia in 1974. He’s been in and out of jail for a variety of offenses for over 30 years. Jerry Tharp, who has been diagnosed with psychosis, borderline personality disorder and major mood depressive disorder, wants nothing more than to remain in prison for the rest of his life because of the stability it gives him. And he just might: After each of his releases, he went on to commit violent crimes.