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The Policing of the Mentally Ill

Part 1 in a series

This is Part 1 in a series of blogs on topics where mental illness and the criminal justice system intersect which, unfortunately, occurs far too often. We recognize that only a series of books could possibly do such topics justice — critical issues that cut to the core of our humanity.

A recent report on the state of mental health in America paints a very bleak picture. Mental illness among youth and adults is increasing, as is suicidality. Nevertheless, many people are still not getting the help they so desperately need and, far too often, our society’s most vulnerable and marginalized members end up in the criminal justice system. In fact, police officers have increasingly found themselves in the position of playing the part of social workers. In a nationwide survey of senior law enforcement officials, 70% stated that the amount of time that they spend responding to issues involving people experiencing mental illness has increased. In the same study, 56% said the increase in calls is due to the inability to refer people with mental illness to treatment and 61% reported more people with mental illness are being released to the community. In Part 1, Open Mind Health explores the history of why so many more people are on the streets and what we need to do to ensure that we don't unjustly criminalize people living with mental illness.

While there have been many public attitudes and policy changes that got us to this point, three significant events occurred between the early 1960s and the early 1980s. In the early sixties, the public tide started turning towards deinstitutionalization. With new psychiatric medications offering greater hope for recovery, the thinking was that many mentally ill patients could be treated with medications in community-based settings. To that end, in 1963 President Kennedy signed the Community Mental Health Construction Act intended to build 1 500 to 2 500 of such centers.

In 1967, California's then-Governor Ronald Reagan signed an act that limited a family's right to commit a mentally ill relative without the right to due process. Of course, this solved many unfair or unnecessary involuntary commitment cases, but it also allowed the release of many people to the community who were not mentally capable of living independently. And while the act reduced the state's institutional expenses, it also led to a massive increase in the number of people who ended up being handled through the criminal justice system instead. Other states soon followed suit with similar involuntary commitment laws.

Fast-forward to 1981, when Ronald Reagan was President, and he repealed a Federal Act that included funding for more community mental health centers and shifted mental health funding to states through block grants compared to the previous method of entitlement programs. While Federal entitlement programs allow people who qualify to get the help they need, the grant process involves the states having to prioritize funding with other competing public needs such as housing, food banks, and economic development. Unfortunately, spending on critical mental health needs got sacrificed.

The United States is now at a point where there are literally millions of people who don’t get the mental health care and treatment that they need. They either can't afford it, refuse treatment, and/or there aren’t enough treatment facilities. There are only 1 892 inpatient 24-hour care treatment centers in the entire country and currently one psychiatric bed for every 3 000 Americans, compared to one bed for every 300 Americans in 1955. Consequently, many people living with mental illness end up living on the streets and repeatedly revolving through the criminal justice system – a system which has neither the proper mental health training nor the resources to adequately help those who are mentally struggling. It is estimated that 37% of prisoners and 44% of jail inmates have a documented history of mental health problems.

So, what is the answer? Well, it's complicated, and there is no easy fix. It's going to take a lot of political and public will to actually make this a priority. First, funding has to be increased and specifically earmarked for mental health priorities. This requires a combination of many more short-term outpatient centers as well as long-term places to care for the severely mentally ill who are a danger to themselves or others and require more intensive monitoring and treatment to ensure that they are protected and cared for humanely. Second, those working on the front lines, such as police, need to have more and better training in how to effectively respond to and deescalate mental health calls including crises and, where necessary, more options to admit people to appropriate health facilities rather than merely defaulting to jails. Third, there needs to be an integrative and holistic approach to recovery which combines medications and therapy and includes teaching practical coping skills and safety planning.

The bottom line is that we grossly fail as a society when millions of people live on the streets due to mental illness and addiction. And a recent study supports that we are missing the mark compared to other wealthy industrialized countries. The United States has the highest suicide rate and the highest number of deaths due to addiction. We also have a relatively low supply of mental health workers, especially psychologists and psychiatrists. Just one-third of U.S. primary care practices have a mental health professional on their team, compared to more than 90% in the Netherlands and Sweden. We can’t blame it on money because we are still the wealthiest nation in the world. The money is there – it just has to be deployed for the right things. And it would be hard to find anything more important than treating our citizens like human beings.

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