08/18/2014 01:53 pm ET Updated Oct 18, 2014

The Criminalization of Persons With Mental Illness: Time for a New Welcoming

Several years ago I received a call from friend, colleague and NSU Forensic Psychology Professor Lenore E. Walker. Lenore, best known as the mother of the Battered Woman Syndrome and theories behind the Cycle of Violence, asked if I would develop an inter-disciplinary course for a new graduate program (e.g., law, psychology and criminal justice). The topic: mental health courts, therapeutic justice and applied behavioral health strategies. "Of course," I replied. As new proposals for curriculum certifications go, it would take many months for approval. By the time the program was ready, I was not. In the interim, a new policy rush to explore the causation and perpetuation of mass incarceration in America had begun. Clearly the scope of the course needed to be expanded. This will serve as the first example of a welcoming.

Coming from a mental health perspective, my view of the enormity and urgency of the problem of mass incarceration in America can be likened to a dual disorder. Meaning, one simply cannot talk about fixing mass incarceration without an authentic policy strategy to respond to the inappropriate criminalization of persons with mental illness. With beliefs consistent with Dr. King, from a historic, cultural and civil rights perspective deserves to stand on equal footing along with other forms of social injustice in America.

The criminalization of persons with serious mental illnesses and substance abuse disorders persists due to a nefarious set of conditions. Which includes century's old prejudice, stigma and stereotypic beliefs, failed governmental health care policies and ill-equipped community-based treatment systems. For those we serve in mental health court, the experience can be summed up in extremes. Extreme treatment and psycho-service needs, extreme shame and suffering; extreme cycling in and out of hospitals, jails and streets; and extreme joy when people are feeling better with access to individualized treatment and holistic care. Simply put, mass incarceration is an acute co-occurring criminal justice and health care problem. My concern, that like the title of a recent ACLU report, "Out of Sight Out of Mind," about Colorado's use of long-term solitary confinement and warehousing of inmates with serious mental illness in its prisons. Failure to meaningfully include comprehensive mental health policy recommendations within the mass incarceration research agenda will ultimately become its own barrier to success.

Which brings me to Malcolm Gladwell. In updating my course, I stumbled upon YouTube videos essayist and author Malcom Gladwell. Here, Mr. Gladwell was addressing the Equal Justice Benefit dinner in 2007, to mark the 50th anniversary of the Minnesota Council on Crime and Justice. Gladwell is there to announce the launch of a new Council social justice initiative. The Council identified nine areas of reform:

  • Changes in the juvenile justice system (e.g., development of modern gang, criminalization of youth and shift to punitive justice model)
  • The prosecution of the "War on Drugs"
  • Changes in criminal sentencing (e.g., mandatory sentencing policies)
  • Changes in mental health system (e.g., deinstitutionalization, lack of community access to mental health and chemical dependency treatment, and a growing recognition of that role that mental illness plays among the prison population)
  • Changes in education, (e.g., fewer neighborhood schools, emphasis on testing, and relevant education for a new economy)
  • Changes in family and community structure (e.g., growing poverty, single-parent families, increase in the number of families with incarcerated parents, shifts in relationship with community policing)
  • Changes in government aid and welfare (e.g., leading to inter-generational poverty)
  • Changes in influence of the media (e.g., fostering of culture of fear)
  • Changes in technology (e.g., 24-hour news cycle and online blogs and forums)

I included Gladwell's presentation in my course, because I wanted my students to appreciate the relationship between bold leadership and transformational change. Gladwell's remarks were authentic and timeless. Essentially that system change comes hard. Particularly in the civil rights arena. Gladwell suggested a roadmap for success which included three essential elements: 1) a sense of urgency, 2) a connective strategy and 3) a welcoming. He braided many examples of case studies, into his remark. He eloquently spoke about using "lessons of culture and history to confront the social problems that face us, the need for cross-pollination and new collaborations in leadership." As he noted, "fresh air from the outside." Yet, it was his closing remarks to the audience that I most related to. That was the assertion that when it came to developing strategy versus the welcoming, "it was the welcoming that mattered most."

As a former member of The President's New Freedom Commission on Mental Health, assembled in 2002, I recall our Interim Report to the President. It was drafted by the chair of the commission, Michael F. Hogan, and in part reads, "Our review for this interim report leads us to the united belief that America's mental health service delivery system is in shambles." A bold statement which emphasized that nothing short of transforming our system of national mental health care would cure the problem.

The policy work and rehabilitative agenda set out by the Minnesota Council on Crime and Justice in 2007 was more than correct -- it was welcoming. The council respectfully integrated and included the criminalization of persons with mental illnesses, as an essential part of its criminal justice fix. The founcil's work would be echoed in the release of The Pew Center's report "One in 100: Behind Bars in America 2008" and major justice, public health and human rights policy organizations in the U.S. Clearly, it is time for a new welcoming of mental health care in America. Perhaps the fresh air will follow.