In the wake of the devastating Sandy Hook Elementary School shooting in Connecticut, mental health reform is back in the national spotlight. There are risks associated with mental health reform when it comes to crime prevention. These risks include, but are not limited to, stigma associated with seeking treatment, concerns of involuntary commitment and even preventative detention, employment issues, civil rights violations and other issues.
Reforming our approach to mental health in America must place at the forefront of any reform the idea that people afflicted with mental illness and people suffering from mental illness are people first, just like you or I, but are people who have a condition not of their choosing. Some people are afflicted with mental illness and because of treatment live an otherwise normal life. Others are suffering from mental illness and are desperately in need of treatment. Regardless if someone is suffering from mental illness or not, understanding and compassion are essential.
Mental Illness in Everyday Life
The prevalence of mental illness in our society is staggering. The National Institute of Mental Illness estimates that in the past year 26 percent of the population have suffered from a mental illness in one form or another, and about 45 percent have suffered from mental illness at some point in their life. With this in mind, everyone is affected by mental illness either personally or someone very close to them, i.e. a family member, friend or work colleague. With such a high prevalence compassion and understanding are essential to reform and advocacy.
Before I was even sworn into office as a State Rep, I was asked for help by a family in my community. A mother who has a son with bipolar disorder has been seeking help from anyone who will listen. She doesn't know where to go for help yet she is concerned that her 21-year-old son may harm her or her 12-year-old daughter. She has been instructed to call the police if a threat is imminent but she has had a hard time finding the appropriate help. The problem is that the advice she has been given has been to contact the criminal justice system, yet no one has known where this mother should go to get help in the mental health system. Based on the specific circumstances she told me about, I looked around for the right organization to put her in touch with to get her son help; that was about three weeks ago and we are waiting to see how things will unfold. If things don't work with that organization, we will look for another. The point is we don't just give up and send the son to the criminal justice system without exhausting all available means in the mental health system.
In the late 1950s and early 1960s, the introduction of psychotropic medications made asylums archaic. But when patients felt good with the use of psychotropic medications, many stopped taking their medication. Often, instability resulted in homelessness and, too often, incarceration. Prison and jail are the new asylums.
The Criminal Justice System
Substance abuse is a catalyst for violence in persons afflicted with a mental illness, and by one measure, some 80 percent of persons admitted to prison professed that they were either under the influence of a substance or had been in the 30 days prior to their incarceration. However, absent substance abuse, research shows that rates of violence may reflect factors common to a particular neighborhood rather than symptoms of a psychiatric disorder. Crime in persons afflicted by mental illness is a highly preventable issue.
Mental health concerns in crime prevention are understated and not adequately addressed. When I was working in a major county jail system with over 9,000 inmates (36,000 yearly admissions), we had only four clinical psychologists for that entire inmate population. We had numerous treatment programs operated by social workers but they were always overworked and underpaid. And by underpaid I mean $30,000 a year to live on repaying student loans, car payments and just to live all to try to rehabilitate someone with a lifetime of criminogenic risk factors. Needless to say, people who go into this line of work care about the work more than the money.
There is a political element to reducing recidivism and advocating for mental health care for offenders. I've been called 'pro-inmate' by political opponents. As someone who worked in a jail and a prison my job is not to judge inmates; they have already been judged. My job as a prison administrator was to make sure that when they are released back into society that they are less likely to re-offend, this very often includes mental health care among other things. As someone who worked in a jail and a prison, I also understand all too well the prevalence of mental illness in our criminal justice system.
One of the findings I reported on was something that everyone knew but there was no data on. I found that on a given day in January 2007, of the 9,000 inmates, of the people who were incarcerated only once in jail (i.e., for the first time), I found that just over 10 percent were identified as having a serious mental illness. However, of people who were incarcerated 16 times, more than 50 percent had a serious mental illness at one point during their 16 times in jail (view data). If you don't think this is costly, you are wrong. If you think there are cheaper ways to do things, you are right.
Advocacy and Reform
Any serious discussion of mental health reform must not scare people away from seeking treatment. On Sunday, Dec. 23, 2012 the NBC program Meet the Press, NRA CEO and Executive Vice President Wayne LaPierre repeatedly called people afflicted or suffering from mental illness who may do harm "lunatics." This view is so completely out of touch with what it means to be a person suffering from a mental illness that Mr. LaPierre made his point of view and that of the NRA irrelevant to any mental health advocacy and reform in America.
First, we have to stop referring to the afflicted as "the mentally ill." They are people just like you or I, only they are people who are afflicted with an illness.
Public schools would serve communities well by educating students of the risks and needs of people afflicted with mental illness. Our criminal justice system would well serve communities by increasing the use of mental health courts and drug courts (drug addiction is a health and mental care issue) in place of the traditional court system. Prison and jails need to be adequately staffed with proper mental health professionals and our treatment programs must be measured to make sure they are reducing recidivism.
Insurance companies would serve the public well by offering unfettered mental health care. Mental illness is quite different than a broken arm or even cancer. Both can be treated and almost have a clear sense of when the malady is remedied. While we can use various x-rays and MRIs technologies to detect recurring cancer, mental illness doesn't have such tools. Mental illness is something that can linger for years and can be subject to relapse. Mental illness is seemingly more amorphous, but it is just as real.
Most people are going to ask "how are we going to pay for all this?" That is a fair question. My response is twofold. 1) We can afford anything; we can't afford everything. What we decide to spend our tax dollars on is a reflection of our priorities. 2) When we invest in early detection and prevention, we save later in incarceration, longer term treatment, and other greater related costs. So the question isn't how are we going to afford a reformed mental health care system, it is can politicians afford the political capital associated with pushing for a better system.
Compassion and Understanding
No one asks to be afflicted with mental illness. No one wants to suffer from mental illness. For anyone who has ever worked with or lived with people who are afflicted, it is clear that these are good and otherwise normal people. They are individuals who have bills to pay, who have to get to work on time and who have to raise children and live an otherwise normal life. For those of us who aren't afflicted with a mental illness, we need to do our share by knowing the facts of mental illness, by understanding the complexity of the issues, by not judging the afflicted, and perhaps most importantly, being compassionate towards those who are afflicted. Remember, considering that it is nearly 1 in 2 people who are afflicted over the course of their life, there is a good chance it could be you someday.
Paul Heroux is a State Representative from Massachusetts. He previously worked for a jail and a prison, and he has a Bachelor's in Psychology from USC, a Master's in Criminology from the University of Pennsylvania and a Master's in Public Administration from Harvard. Paul can be reached at firstname.lastname@example.org.