by BJW Nashe
Most violent crimes are not committed by mentally ill individuals. Yet the percentage of violent crimes they do commit is worth paying attention to since they are for the most part predictable, and thus preventable. For instance, specialists estimate that 10 per cent of U.S. homicides are committed by people afflicted with some form of mental disorder. It is not unreasonable to think that an effective mental health system could bring that figure down to 2 per cent or 1 per cent or even lower.
Yet, as a nation, we seem incapable or unwilling to make this commitment. Any clear assessment of our current public mental health policies might, ironically, be enough to drive us all crazy. At both the national and state level, our approach to this important issue is a maddening case study of misguided priorities, apathy, and confusion. In terms of dealing with mental illness, we as a society are on the verge of total failure.
When heavily armed psychotics such as Jared Loughner, James Holmes, and Adam Lanza show up at a political rally, movie theater, or elementary school to commit mass murder and mayhem, we hear the inevitable outcry over our need to “fix our broken mental health system.” A broken system is no small matter; a system in complete disarray is even worse. Take a close look at the current state of mental health services in America, and you’ll find that for most people, there is hardly any system at all. The shocking incidents at Sandy Hook Elementary School and Virginia Tech are only extreme manifestations of a widespread crisis in mental healthcare. In fact, given the scope of this crisis, coupled with lax gun laws in many states, it’s surprising that we haven’t seen even more mass shootings. And in addition to the horror of violent crime, this crisis impacts us all in the form of increased homelessness and substance abuse, overcrowding in jails and prisons, increased police brutality, and bewildered and frightened family members.
In a powerful article in the current issue of Mother Jones, “Schizophrenic. Killer. My Cousin,” journalist Mac McClellan takes a long, hard look at the issue. As the title of her piece indicates, McClellan has personal experience to draw upon. Her cousin Houston, afflicted with schizophrenia as a young junior college student in Santa Rosa, California, ended up slaying his father Mark one night in November 2011, stabbing him 60 times with four different knives, and nearly beheading him during the attack. Houston’s symptoms are common features of our ongoing narrative of schizophrenia: telepathic communications, alien voices, wireless connections, invisible friends, paranoid delusions of sex ring conspiracies, and suspicions that family members were trying to poison him.
The obvious question is how could this tragedy, and others like it, have been averted? Why are seriously ill individuals such as Houston — as well as Loughner, Holmes, and Lanza — left to their own devices? Why is there no intervention or treatment that could have prevented their devastating crimes?
The answers to these questions are complex, but they can be broken down into two general areas of concern: deinstitutionalization and austerity politics.
DeInstitutionalization
In her article, McClellan draws attention to just how difficult it is in many states, including California, to force someone suffering from mental illness into treatment. Recent laws have tended to err on the side of individual rights over collective safety. Even a person such as Houston, who is talking to the aliens, cannot be confined against his will unless he presents a clear danger to himself or to others. Basically, the sick individual needs to be threatening suicide or waving knives at people before police will take them into custody. In principle, this makes sense. We as a society are not interested in having people who are “acting strangely” simply rounded up and locked away willy-nilly. This would be a clear violation of civil rights. On the other hand, at the more practical level, family members and friends who see a loved one headed for disaster are often frustrated by the unwillingness of the authorities to intervene before it is too late. There seems to be no way to defuse this ticking time bomb.
Furthermore, there is a general trend away from institutionalization. McClellan points out:
“In the 1950s, more than a half a million people lived in US mental institutions—1 in 300 Americans. By the late ’70s, only 160,000 did, due to a concerted effort on the part of psychiatrists, philanthropists, and politicians to deinstitutionalize the mentally ill. Today there’s one psychiatric bed per 7,100 Americans.”
In many ways, the motives for deinstitutionalization were sound. Mental institutions were hardly bastions of humanitarian treatment. The One Flew Over the Cuckoo’s Nest scenario of sadistic doctors and nurses, strait-jackets, and electro-shock therapy struck a raw nerve in many Americans. The most extreme examples of institutional abuse came to light when Americans learned of the MKUltra program, where asylums became de facto laboratories, with the mentally ill treated as human guinea pigs in secret government research projects. Distrust of institutions was probably at an all-time high during the late 1970s.
The move away from institutional confinement was also spurred on by the development of a whole range of new drugs and “psych meds.” This led many to envision a new life of freedom for the mentally ill, who, though heavily medicated, would be able to subsist free from harm in the general population. In addition to the new and effective drugs, a key part of the deinstitutionalization plan involved “community mental health centers” that would be established to help the mentally ill integrate into society. It all sounds fine in theory. The only problem was, as the big asylums were shut down, and the new drugs were doled out, the community mental health centers failed to materialize. The funding never came through and the concept slipped off the high priority list. In actual practice, deinstitutionalization became a way of simply turning mentally ill individuals loose to fend for themselves.
Austerity Politics
Mental healthcare costs taxpayers money. In a political climate where “government spending” is often considered to be public enemy number one, funding for treatment and prevention of mental illness has been slashed dramatically. McClellan’s piece clearly spells out how the politics of austerity has in recent decades resulted in severe budget cuts that have decimated the type of programs needed to help individuals such as her cousin Houston. At this point, even for those who willingly seek help, the lack of available resources is daunting. There is simply no room at the inn. There are jails and prisons, however, and there are city streets and public parks. And these are the places where the mentally ill tend to end up these days.
In addition to California, where her cousin Houston lives, McClellan also has relevant personal experience with the state of Ohio. As recently as the 1990s, Ohio had a state mental health system that was a model for the nation. More than any other state, Ohio had worked hard to make deinstitutionalization succeed, by utilizing active case management, independent-living initiatives, employment-support programs, educational support, and home-based services for children. One of McClellan’s relatives, her Aunt Terri, was diagnosed as schizophrenic as a young woman, and would most likely have been a lost cause were it not for Ohio’s mental health services. After repeated hospitalizations, she was successfully treated and placed on a proper medication regimen. A non-profit outpatient services provider called Pathways was able to help her transition into her own living arrangement in a mobile home trailer park. Pathways was able to provide a network of support for Terri in her daily life. Today, the same hospitals that treated Aunt Terri no longer exist. The network of services and support that helped her get a foothold in the community have been gutted. It’s a tragic development that is unfortunately emblematic of a nation-wide trend.
McClellan points out that Ohio’s mental health department was already in political peril by the late 2000s. The 2008-09 recession and subsequent Tea Party austerity movement drove the nail in the coffin. Out of the 10 states that cut the most from mental-health budgets between 2009 and 2011, Ohio ranked sixth. Republican Governor Kasich’s 2012-13 budget slashed local government funds by a billion dollars and continued downsizing of community mental-health programs.
Ohio is not alone. Collectively, states have cut $4.35 billion in public mental-health spending since 2009. California in particular seems to be the place where we can see the full effects of the unfolding crisis. McClellan sums up the situation in her cousin Houston’s home state as follows:
“Ah, California. No. 1 in the amount of mental-health funding cut from 2009 to 2011, No. 7 in cuts as a percentage. Home to one of the largest jail/psych facilities in the nation, the LA County Jail. Where visitors can’t believe how many bat-shit-crazy homeless we’ve got. Where deinstitutionalization was pioneered under Gov. Ronald Reagan with the 1967 Lanterman-Petris-Short Act, which made it vastly more difficult to commit people, and where the rate of mentally ill in the criminal-justice system doubled just one year after it took effect. Where, often, the severely mentally ill live in jail for three to six months because they’re waiting for a bed to open up in a psychiatric facility. California: where, says Torrey, the psychiatrist who warns about ‘predictable’ violence like my cousin’s, ‘they led the way in [deinstitutionalization], and they’ve led the way downhill. They’re certainly leading the way in consequences.’”
The Consequences of the Crisis
It’s important to be mindful of the fact that the term “mentally ill” refers to a significant number of people within the U.S. population. McClellan points out that according to the National Institute of Mental Health, the term “mentally ill” applies to a whopping 25% of the adult population, because it includes everything from depression to Attention Deficit Disorder (ADD). The term “seriously mentally ill” is used to describe severe functional impairments such as major depression, schizophrenia, and bipolar disorder. This narrows the pool down to roughly 6% of the population. Still, that amounts to some 2.4 million individuals. With that many people adversely affected by the mental health system failure, the impact is felt throughout the general population. Slashed budgets, closed hospitals, and discontinued services all carry serious consequences. Initial short-term savings may in fact end up costing us even more money in the long-term. Some have estimated that instead of spending $2,000 to $3,000 in treatment for a given individual, we are currently wasting $50,000 in prison costs.
Crime and Imprisonment. As we have noted, in the absence of a fully functioning mental health system, mentally ill people are responsible for an estimated 10 per cent of American homicides. Significantly reducing this percentage would in itself justify the expense of a full range of mental health services.
Homicide is just the extreme tip of the iceberg, however. What about lesser crimes and offenses? We don’t need to be sociologists or criminologists to understand that people who are out in public hearing voices or receiving telepathic messages from aliens are likely to wind up in trouble with police. If they somehow avoid being arrested for committing some offense, they still run the risk of simply being picked up for vagrancy and hauled off to jail because there is nowhere else for them to go. Not surprisingly, as mental health services have been slashed from state budgets, we see that the percentage of mentally ill persons in our jails and prisons has skyrocketed. According to McClellan:
“Between 1998 and 2006, the number of mentally ill behind bars more than quadrupled; the share of mentally ill people among the incarcerated was five times higher than in the general population. More recent national prison stats aren’t out yet, but in some county jails, mental-illness rates have increased by nearly 50 percent in the last seven years. It’s not uncommon for individual jails to report that 25 or 30 percent of their inmates are mentally ill, or that their mentally ill population rises year after year.”
Furthermore, consider these alarming statistics: as of 2004, 44.8% of those incarcerated in federal prisons, 56.2% of those incarcerated in state prisons, and 64.2% of those held in local jails were considered to be mentally ill.
Homelessness/Substance Abuse. In the absence of hospitals and housing facilities, the mentally ill are frequently crowded into homeless shelters, or left to fend for themselves, camping on streets or in parks or under freeway overpasses. Up to 30 per cent of the homeless population are thought to be severely mentally ill. That amounts to five times the rate of the general population. Many people afflicted with mental illness self-medicate with drugs and/or alcohol. If you pay a visit to downtown Los Angeles or San Francisco’s Tenderloin, you won’t have to look too hard to see the triple threat of homelessness, substance abuse, and mental illness on full display.
Police Brutality. Mentally ill people who are left untreated run the risk of violent altercations with law enforcement. McClellan states that Houston’s father Mark preferred not to involve the police when his son’s behavior grew increasingly problematic. In hindsight, we can easily claim that this was a mistake. Perhaps Santa Rosa police could have prevented his murder. Mark, however, was evidently well-informed about certain troubling facts. As McClellan puts it:
“The Santa Rosa cops had killed two mentally ill men they’d been called to intervene with in the last six years, one case resulting in a federal civil rights suit. This is not a problem unique to Santa Rosa — or to greater Sonoma County, which in 2009 paid a $1.75 million settlement to the family of a mentally ill 16-year-old whom sheriff’s deputies shot eight times. There’s no comprehensive data yet, but mental illness appears to be a factor in so many arrest-related deaths that the Justice Department has considered adding mental-health status to its national database of such deaths. Just last year, for example, the DOJ found the Portland, Oregon, police department had a ‘pattern or practice of using excessive force…against people with mental illness,’ including eight shootings in 18 months and the beating to death of an unarmed man in 2006.”
No Easy Answers
McClellan’s article is a well-written, fact-driven, personally relevant piece of top-notch journalism, and serves us up a dose of strong medicine regarding our current political climate. Our unfolding mental health crisis will most likely get worse before it gets any better. How many more mass shootings and arrest-related deaths involving our most vulnerable citizens will it take to turn the tide? No one knows. But the first step is admitting the seriousness of the problem at hand. McClellan, as well as other journalists and healthcare professionals, are helping us to understand the problem, and break through the fog of ignorance, confusion, and denial — hopefully before it’s too late. There are no easy answers, no quick fixes for our broken system. Yet, if we are committed to make a difference, and willing to make the necessary investments, there is no reason why we shouldn’t have a functioning mental health system, which would dramatically reduce crime, and ease the burden on our jails and prisons. Ohio at one time was pointing the way forward. We have made the mistake of taking a giant step backward. Now we are paying the price.