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Freeing the Media's Coverage of Incarceration and the Mentally Ill

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When the papers of record write and opine about mental illness, they invariably focus on incarceration. In so doing, they often reinforce stereotypes about the mentally ill by propagating the notion that a significant percentage of those with mental disorders commit crimes.

A more nuanced argument, written by Terry Smerling, appeared in the L.A. Times on May 5.

Like Nicholas Kristof, who wrote about this issue in the New York Times in February, Smerling has compassion for the mentally ill. He wants to help.

But unlike Kristof, Smerling has decades of experience in dealing with people with mental illness.

A judge on the Los Angeles County Superior Court, "with more than 31 years on the criminal bench," Smerling argued that the L.A. County Board of Supervisors, which is considering whether or not to fund an expansion of jail facilities, should fund a diversion program to treat the mentally ill in a therapeutic setting. He urged the Board of Supervisors to do this rather than spend $2.3 billion on "building 3,000 new mental health jail beds."

As he pointed out, "extended incarceration...is not only damaging to the mentally ill; it is extraordinarily expensive."

I agree with Smerling. He is right that the mentally ill do not do well in prison. I have seen this up close at Patton State Hospital, a prison for the criminally insane, where I gave a talk some years ago. And he is also right that it will save money to divert the mentally ill who have committed truly nonviolent crimes like drug possession into treatment programs.

But I do not agree with other aspects of his piece. For instance, he wrote that mentally ill inmates "cycle in and out of lockups, often for petty violations relating to their mental illness."

While "cycle," the "c" word, may not be as radioactive to the mentally ill as "apartheid," the "a" word, is to supporters of Israel, I take issue with its usage here. "Cycling" suggests not only that the mentally ill are doomed to repeat their crimes or end up on the street; it also suggests that the mentally ill cannot hold down jobs and cannot be responsible.

It would be helpful if op-ed writers and commentators elsewhere would recognize that most of the mentally ill do not in fact "cycle" in and out of incarceration, addiction and homelessness. As I have written before, the vast majority of the mentally ill blend in to society and hold down jobs in fields as varied as law, medicine, business, academia and journalism.

I also question a statistic cited by Smerling, who wrote that "nearly 20 percent" of those in jail are mentally ill.

I have given talks at a number of prisons over the years, and as I wrote before, most of the inmates I encountered were young men who had committed murder. They had been in and around gangs and claimed that they had killed their enemies so that they would not be killed.

These young men were hoping to rehabilitate themselves in new neighborhoods, away from gangs. They were not necessarily hard-core criminals, but they were not mentally ill either. They were survivors, and most of them were seeking a second chance.

While that "nearly 20 percent" statistic strikes me as being somewhat high, given that the mentally ill, with no substance abuse problems, commit only 3 percent to 4 percent of violent crime, it is far more plausible than Kristof's assertion that "more than half of prisoners in the United States have a mental health problem."

As I wrote at the time, many of those prisoners with supposed mental health problems are not mentally ill at all. Forensic psychiatrists will tell you that many of those prisoners are psychopaths or have been diagnosed with anti-social personality disorder.

Psychopaths and those with anti-social personality disorder show no remorse for their violent acts, which makes them very different from most of the mentally ill, who, like me, tend to feel guilt and remorse over nearly every innocuous thing they do.

Kristof also wrote that "some 40 percent" of people with serious mental illness have been arrested at some point in their lives.

I questioned that stat in two columns, pointing out that some of those people who have been "arrested" may have simply been picked up by police after family members or psychiatrists reported them missing.

As I also wrote at the time: "Given that we live in an age when so many people, particularly men, still refuse to admit that they are in therapy, when so many patients still exit unseen out of a back door when they finish their therapy session, how are we to know that surveys about mental illness are answered honestly?"

I am glad that mental illness is being discussed more openly these days, a tribute, I would like to think, to those of us who have been writing and talking about our condition for years. But this is a very complicated issue, and the language used can sometimes backfire and perpetuate stigma.

As then-Senator Barack Obama said, "words matter." That is particularly true in discussions of mental illness, a subject that should never be reduced to simplistic tag lines and clichés, however well-intentioned.