Let’s all grin at Alex like we swallowed the canary because we know we have the right question.
Who are America’s front-line mental health workers?
The second line are the homeless shelter personnel and sworn staffs of our jails and prisons. Good to see Nicholas Kristof of The Times call our attention to these facts (below).
Kristof could not have known this but his piece was timed exquisitely with the sick, sad news out of Mattapan that a 14 year-old shot and killed his 9 year-old brother. As more details come out about the 14 year-old’s past behavior, it looks like an excellent bet that the kid is mentally ill.
I remember former Boston commissioner Mickey Roache telling me s story about a situation he responded to while assigned to District 4 in the South End. On a sweltering July afternoon a very large woman wrapped in a very large fur coat and jammed herself into a comparatively narrow telephone booth. (You remember telephone booths: glass and metal sidewalk structures to which low-level gangsters reported for their executions in the 1960′ and 1970’s). Anyway, Sgt. Roache finally talked the lady out of the booth and into accepting a ride to the old D-4 stationhouse. There, the sergeant called Mass. Mental Health and he asked them what they wanted to do; clearly sticking this mentally ill woman in a dreary D-4 cell was among the least therapeutic of options. The doctor on the other end of the line said, “Sergeant, do your job.”
Over the past 50 years the police have been told by many in society to “do your job.” Mentally ill people putting themselves in danger on the street? Mentally ill people putting others (see second paragraph above) in danger? Do your job!
I think other players take themselves off the hook when a person’s mental health issues land him or her in the criminal justice process. And, since police are the only government agency making house calls 24/7, such behavior will come to the attention of the police at some point. Once they can call the behavior a “crime” everyone can hang up the phone, literally as well as figuratively.
Massachusetts was a national leader from the 60’s on in the deinstitutionalization movement in mental health treatment. No one should have been forced to live in the conditions in a Danvers State Hospital (how people can buy condos there now is beyond me) or in a Fernald School for Children. Community-based treatment integrated with the rest of society was to be the humane, new mode. Then NIMBY emerged as at the rallying cry in all but the poorest communities. The street replaced the dungeon.
I for one do not see this changing any time soon. The paradigm has deep foundations. Granted, the mental health agencies are more responsive than in Sgt. Roache’s day. But only marginally. That’s not a knock on the good people trying to do the right thing. We as a country just don’t invest much in taking care of the emotionally and mentally disabled. The overwhelming majority of the mentally ill in America still get what treatment they get from the cops, corrections officers and shelter staff.
Inside a Mental Hospital Called Jail
FEB. 8, 2014, Nicholas Kristof, NY Times
CHICAGO — THE largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire.
Just one thing: It’s a jail. The only way to get treatment is to be arrested.
Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incarceration. And as more humane and cost-effective ways of treating mental illness have been cut back, we increasingly resort to the law-enforcement toolbox: jails and prisons.
More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.
In the jail here, some prisoners sit on their beds all day long, lost in their delusions, oblivious to their surroundings, hearing voices, sometimes talking back to them. The first person to say that this system is barbaric is their jailer.
“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart, told me as he showed me the jail, on a day when 60 percent of the jail’s intake reported that they had been diagnosed with mental illness. Dart says the system is abhorrent and senseless, as well as an astronomically expensive way to treat mental illness — but that he has no choice but to accept schizophrenic, bipolar, depressive and psychotic prisoners delivered by local police forces.
Launch media viewerThe Cook County sheriff, Thomas Dart, center, talks with inmates Russell, right, and Compton. Russell, 46, has been diagnosed with severe depression. John Gress for The New York Times
People are not officially incarcerated because of psychiatric ailments, but that’s the unintended effect. Sheriff Dart says that although some mentally ill people commit serious crimes, the great majority are brought in for offenses that flow from mental illness.
One 47-year-old man I spoke to, George, (I’m not permitted to use last names for legal reasons) is bipolar, hears voices and abuses drugs and alcohol. He said he had been arrested five times since October for petty offenses. The current offense is criminal trespass for refusing to leave a Laundromat.
The sheriff says such examples are common and asks: “How will we be viewed, 20, 30, 50 years from now? We’ll be looked on as the ones who locked up all the mentally ill people.
“It really is one of those things so rich with irony: The same society that abhorred the idea that we lock people up in mental hospitals, now we lock people up in jails.”
A few data snapshots:
• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.
• Mentally ill inmates are often preyed upon while incarcerated, or disciplined because of trouble following rules. They are much more likely than other prisoners, for example, to be injured in a fight in jail, the Justice Department says.
Launch media viewerThe Cook County Jail has become a de facto mental health hospital, the county’s sheriff says. John Gress for The New York Times
• Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.
In the 1800s, Dorothea Dix led a campaign against the imprisonment of the mentally ill, leading to far-reaching reforms and the establishment of mental hospitals. Now we as a society have, in effect, returned to the 1800s.
Among those jailed here is Russell, 46, who is being held for burglarizing a garage. He has been diagnosed with severe depression and said that he self-medicates with alcohol and drugs. Most of his adult life has been spent behind bars for one offense after another, and he said he became aware of his mental health problems when he was being clubbed by a thug with a baseball bat and realized that he was enjoying it.
“I just want to be normal,” he said as we spoke in a large dormitory room for inmates with psychiatric problems. “I want to have a job. I’ve never had a job. I want to be able to say hi to a co-worker.” He stopped, and there were tears in his eyes.
In 1955, there was one bed in a psychiatric ward for every 300 Americans; now there is one for every 3,000 Americans, the 2010 study said. So while more effective pharmacological treatments are theoretically available, they are often very difficult to access for people who are only borderline functional.
“Some people come here to get medication,” says Ardell Hall, a superintendent of a women’s unit at the jail. “They commit a crime to get in.”
India, a 42-year-old woman, suffers from manic depression and post-traumatic stress disorder. She said she tried at various times to get psychiatric care but found it almost impossible, so she self-medicates when on the outside with heroin — and has spent almost all of her adult life in jails and prisons on a succession of nonviolent offenses relating to drugs and shoplifting.
Launch media viewer
India, 42, suffers from manic depression and post-traumatic stress disorder. She has spent almost all of her adult life in jails and prisons. John Gress for The New York Times
TAXPAYERS spend as much as $300 or $400 a day supporting patients with psychiatric disorders while they are in jail, partly because the mentally ill require medication and extra supervision and care.
“Fiscally, this is the stupidest thing I’ve seen government do,” Dart says. It would be far cheaper, he adds, to manage the mentally ill with a case worker on the outside than to spend such sums incarcerating them.
Cook County has implemented an exemplary system for mental health support for inmates. While in jail, they often stabilize. Then they are released, go off their medications and the cycle repeats.
One woman in the jail, Kristen, said she had been diagnosed with depression and anxiety disorders. On the outside, her prescription medication cost $100 a month, so she skipped it.
“When I’m not on my medicine on a regular basis, I don’t make decisions well,” she said, explaining her long arrest record for theft and narcotics offenses. I asked her if access to medicine would keep her out of jail, and she said: “I don’t know if that’s necessarily true, to be totally honest. But it would help.”
As Sheriff Dart puts it: “We’ve systematically shut down all the mental health facilities, so the mentally ill have nowhere else to go. We’ve become the de facto mental health hospital.”
Do we really want to go back two centuries? Doesn’t that seem not only inhumane but also deluded — on our part?
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A version of this op-ed appears in print on February 9, 2014, on page SR1 of the New York edition with the headline: Inside a Mental Hospital Called Jail. Order Reprints|Today’s Paper|Subscribe