The people who are driven through the gates of Patton State Hospital, processed and clad in the khaki uniform, come from many walks of life, but all have two things in common: a diagnosis of severe mental illness and a criminal history. At one point these intersected, leading to incarceration.
Patients who are admitted to a forensic hospital do not come voluntarily. They are sent by the courts, having been diagnosed with severe mental illness that renders them incompetent to participate in the court process, too dangerous to parole after their prison term, or that prevented them from understanding their actions at the time of the crime.
Some have long histories with the legal system, while others are surprised by how their middle class life trajectory led them to involuntary incarceration in a psychiatric facility.
Working as a psychologist in this setting, I listen to a lot of their life-stories, and a common narrative weaves through them.
It is the narrative of the criminalization of mental illness.
Aspects of this narrative contain variables that are either person-specific or societal in origin.
The former includes a familial predisposition to mental illness, histories of emotional, physical and sexual abuse, neglect, trauma, and substance abuse. These of course don’t occur in isolation from the larger cultural environment, but are specific to a person’s central life-experiences.
In addition to these person-specific factors there are societal variables. These are present in our culture and contribute to the proliferation of untreated mental illness. They include:
o lack of awareness about symptoms of mental illness;
o poor detection of early warning signs by parents, teachers or counselors;
o lack of access to long-term care;
o fear of stigma, as well as
o prior contact with law enforcement who are ill equipped of addressing the needs of the mentally ill.
Aside from my frustration about being confronted time and again with stories that may have had different outcomes, had we, as a culture been more receptive to their suffering, I remain hopeful these barriers to detection and treatment can be more constructively addressed. Physicians, teachers, counselors, clergy, politicians, to name a few, can play a pivotal role in raising awareness of the struggles of those with mental illness.
Strategies to break down those societal barriers to care and recovery may include:
o public service announcements about the warning signs of severe mental illness;
o education of teachers, counselors and physicians on how to recognize prodromal symptoms;
o outreach to law enforcement agencies;
o parity of insurance coverage for those with mental illness and of course
o funding priorities for community mental health clinics.
Let’s be mindful about how each of us may be able to contribute towards this goal of addressing mental illness before it results in criminal behavior. In the future, I hope that the stories of those with severe mental illness residing in our communities need not end with a seat on a bus leading behind the gates of a correctional facility.