The criminal justice system has displaced the mental health system as the main institution for dealing with poor people with psychiatric disabilities in the United States.
Federal cuts to mental health and affordable housing programs are responsible for this shameful reality. During his tenure as President, Ronald Reagan instituted sweeping changes in domestic policy. HUD's low/moderate-income housing budget was cut from $77 billion in 1978 to $18 billion in 1983 and the number of beds available in public mental hospitals dropped by 40% between 1970 and 1984. This divestment has put millions of people on the street, many of whom are mentally ill and whose conditions worsen by having to live on the street. The danger and degradation of homelessness can also create psychiatric disorders such as Post Traumatic Stress Disorder.
Many local governments reacted to the very visible upsurge in those living on the streets with public space restrictions and ordinances that criminalize activities like sitting or lying on sidewalks, panhandling, and sleeping outside. These punitive policies are largely driven by the concerns of business interests, and go hand in hand with the increasing privatization of public spaces and services.
All of this has a particularly dramatic impact on people who have difficulty navigating the complex legal system. Once cited by police, a person who does not go to court or pay the fine ends up with a bench warrant permitting arrest on sight. Arrest records can block access to housing services and benefits urgently needed to help stabilize someone who is homeless and disabled. Whether intentional or not, the bottom-line is that these laws are disenfranchising tens of thousands of mentally ill homeless people.
Been Here Before
Mentally ill people have long been stigmatized by society. Often considered defective, they have been met with pity and repulsion, sometimes with reluctant charity, their "treatment" often horrific. People labeled insane have also been removed from public view, be it in attics, asylums, or jails.
Today, it is common knowledge that Riker's Island Jail in New York City, Cook County Jail in Chicago, and Los Angeles County Jail are the three largest "psychiatric facilities" in the United States even though there is rarely any real treatment occurring in these jails. The situation is so dire at Chicago's Cook's County Jail that the sheriff has threatened to file a lawsuit against the state of Illinois for allowing his jail to become a "dumping ground" for the mentally ill.
It is less known that in every county across the country there are more severely mentally ill persons in the county jail than there are in the psychiatric unit of the county hospital. Nationally, a severely mentally ill person is three times more likely to be in jail or prison than in a state mental hospital. The problem is even worse in states like California, Florida, Texas, and Nevada where a mentally ill person is four to ten times more likely to be in jail or prison than in a state mental hospital.
There is precedent for locking up mentally ill people at the current alarming rates. In the middle of the 19th century, jails were filled with indigent mentally ill people criminalized under so-called poor laws. "Poor laws" were imported from England during colonial times and used to control the movement of the poor and to distinguish those considered "deserving" from those deemed "undeserving" of aid. The "undeserving poor" were punished in jails and workhouses.
Our mental health and criminal justice policies are not all that different from the poor laws of the 1850s: poor mentally ill people are languishing in jails untreated due to discriminatory "quality of life" or "nuisance crime" laws. Instead of increasing treatment and housing options in the community, we are shutting down programs and substituting them with costly jails and prisons. Despite reports ad nauseam about the human, financial, and social toll of this approach, the overriding social policies remain simply getting mentally ill people out of sight.
Taking it to the streets
The voices of those most impacted by these punitive measures -- mentally ill homeless people themselves -- are currently nowhere to be found in policy debates. To better understand the reality of those caught in the vicious cycle of insufficient treatment, homelessness, and jail at the street level, WRAP and our partners conducted surveys with 336 self-identified mentally ill homeless people in seven cities -- San Francisco, Los Angeles, Berkeley, and Oakland, California; Portland, Oregon; Denver, Colorado; Worcester, Massachusetts; and Houston, Texas. We also conducted a small online survey with 48 front-line service providers in San Francisco, Los Angeles, and Portland.
The findings from the two sets of surveys build on other recent data from the Department of Justice and mental health researchers. The findings from the two surveys are very similar and reveal a discriminatory pattern that deserves closer public scrutiny.
Results from the street outreach found:
This closely mirrors the experiences of service providers in various cities:
The human story behind the numbers
The following story comes from Caduceus Outreach Services - a program that used to provide alternative forms of psychiatric treatment, restorative social supports, and healing for homeless people with severe mental illnesses. The story highlights the lived experiences embedded in the statistics above and illustrates the counterproductive policies now in place. The story is by no means unique.
DJ is a 35-year-old African American man. He has been homeless since his early teens when he ran away from a small Southern town to escape physical and sexual abuse. He has been diagnosed with Post Traumatic Stress Disorder and Dissociative Identity Disorder. Until Caduceus was closed due to funding cuts from the San Francisco Department of Health, he was in early outpatient psychiatric treatment and taking medications that prevented the worst of his hallucinations.
To survive financially, he sets up informal street markets, selling found and discarded clothing and other items. He is well known to the police, as he is unafraid of telling them what he thinks when they tell him to move along. He will cite the inequality by which the law is applied and enforced, reminding them that if he were a white woman having a street sale on the sidewalk in front of her home they would not tell him to move along. As a result, he is frequently ticketed for not having a vendor's license or for trespassing, and despite lack of evidence, has been arrested several times for selling stolen property.
Because the streets and parks are dangerous, DJ carries knives for protection when he camps out at night. He has been rousted and searched, arrested for carrying "concealed weapons," as well as ticketed for camping, sleeping on the sidewalk, and trespassing. His arrest record takes up 27 pages, with most charges dropped by the district attorney.
During a police sweep of a homeless encampment, he became so angry that he held up one of his knives and yelled at the police, "Why don't you just shoot me then, you know you want to." He was arrested for assault with a deadly weapon on a peace officer as they claimed that he had advanced on them with a knife and held in the county jail for over a year while his case was negotiated. During this time, DJ received no psychiatric treatment, no medication, lost his place on a housing waiting list, and had his disability benefits application denied because he couldn't attend appointments. The result was time served and three years felony probation, which, if violated, would result in his being sentenced to state prison. The likelihood of DJ, and thousands of other people like him in similar situations, making it through probation without the appropriate supports is next to zero.
When Caduceus was closed in 2011, his support system was eliminated. Despite his desire to continue treatment, there is no other intensive support program that can meet his complex needs.
Ineffective, expensive, and cruel
Money is being spent on jails rather than services. Municipalities, business districts, and downtown tourist centers support "quality of life" or "nuisance crime" laws because they are deemed effective at ridding homeless people from sight and lead to more lucrative and less visibly impoverished downtowns. But they are also an enormously expensive process.
In 2009, a California jail bed ranged from $25,000 to $55,000 per year and a bed for acute mental health services in a psychiatric unit in a California jail cost $1,350 a day. A University of Pennsylvania study from 2002 found that homeless people with mental illness who were placed in permanent housing cost the public $16,282 less per person per year compared to their previous costs for mental health, corrections, Medicaid, and public institutions and shelters. A report issued in 2009 by the Economic Roundtable found that the typical public costs for a homeless person in Los Angeles is 5 times greater than for a similar person in supportive housing ($2,897/month vs. $605/month) largely due to emergency room and criminal justice expenses.
The scale of this issue is enormous and the cruelty, disregard, and medical neglect suffered by poor and homeless mentally ill people like DJ is unacceptable. According to the Bureau of Justice Statistics, as many as 64% of people in jails nationwide have mental health problems. In the 1980s and early 1990s, people with severe mental illness made up 6-7% of the jail population. In the last five years, this percentage has climbed to 16-30%. Nationwide, there are three times as many people with mental illness in jails and prisons as there are in hospitals; 40% of people with severe mental illness have been imprisoned at some point in their lives; 90% of those incarcerated with a mental illness have been incarcerated more than once.
We deal with this national shame as we so often deal with personal shame: we pretend it isn't there; we try to hide it. In this paper, we hope to bring it into daylight. The obvious answer is of course affordable housing and residential treatment, and ongoing outpatient treatment with practical social supports. None of this is on our current national agenda. But as a country we must wake up to the reality that we treat mentally ill homeless people the way they were treated 150 years ago. Ignoring that truth is the real shame.
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