The moment a 911 call is made relationships become crucial for mentally ill people who are on the brink of interfacing with the criminal justice system. Los Angeles County receives one mental illness related call every three minutes. The nature of these calls may include concerned citizens observing a person’s erratic behavior in a public space, or family members alarmed by the behaviors of a loved one. What may be needed is an ambulance, but what arrives is a patrol car.
For people with severe mental illness interacting with law enforcement can be a terrifying experience. Regular policing techniques can quickly escalate a frightened mentally ill person resulting in physical resistance, violence and legal charges.
The Los Angeles Sheriff’s Department has implemented a Mental Evaluation Team (MET). It consists of trained deputy sheriffs and mental health workers, who work hand in hand evaluating mental health calls, deescalating crises, making appropriate referrals and following-up with mentally ill citizens. Clients are routed to appropriate services and stay out of the criminal justice system. Here is a brief video of a similar program that was implemented in Portland, Oregon after a police altercation with a mentally ill citizen turned deadly. It goes to show that relationships between first responders and persons with severe mental illness matter.
Mental Health Courts:
People with mental illness show improved outcomes when their criminal infractions are addressed in a mental health court. The goal is to keep defendants out of jail by providing resources that will reduce recidivism. In exchange for a guilty plea, defendants receive mental health, substance abuse and social services. Compliance is closely monitored by the court. Judge Wendy Lindley’s Mental Health Court in Santa Ana has served as model of excellence. A key to its success is the judge’s investment in clients and her dynamic leadership in the courtroom. Relationship between the legal system and persons with severe mental illness matters.
Forensic Diversion Programs:
Mental health care provided within correctional facilities is often dismal. After visiting “the Forgotten Floor” of Miami-Dade County Jail where mentally ill inmates were kept in abhorrent conditions, Judge Steven Leifman, became an advocate for mentally ill offenders. His goal was to offer those arrested for small crimes alternatives to incarceration. Miami-Dade County now pilots one of the nation’s most extensive Forensic Diversion Programs. These programs link community resources with forensically related programming. Forensic Diversion Programs offer residential services for psychiatric and medical treatment as well as housing assistance and job training. They not only benefit the individual receiving those services, but also the community at large by improving public health and public safety; and by reducing the costs associated with housing mentally ill offenders in correctional facilities. Forensic Diversion Programs are an excellent example of how the relationships between different service agencies, the courts and the community matter.
Jails and prisons in California are notoriously overcrowded. Mentally ill offenders are incarcerated for longer periods of time compared to their non-mentally ill peers. Erratic behaviors that accompany untreated severe mental illness often lead to additional infractions and more time incarcerated. Untreated mental illness, therefore, contributes at least in part, to California’s overcrowding issues. Placing mentally ill offenders into more appropriate programs such as the forensic diversion programs may be a partial answer to this dilemma. Funding for forensic diversion programs has not received much support in our communities. Public health, particularly public mental health does not attract much voter support, which instead focuses on enhancing public safety and law enforcement. Changing the relationship our culture has with punishment as opposed to rehabilitation matters.
Relationships become crucial as issues increase in complexity. The relationship between state and county government determines who provides funding for the care of mentally ill offenders. The relationship between elected officials and voters decides which fiscal policies become reality for securing and implementing effective programs. Public opinion about the need for mental health care and an understanding as to the cost savings brought about by alternative approaches to incarceration is a large part of obtaining voter approved funds for these programs.
It is disquieting that in the United States, prison systems serve as de-facto psychiatric facilities. Fourteen percent of male and 31% of female inmates suffer from a severe mental illness. Many of the nation’s largest mental health facilities are county jails such as Reiker’s Island in New York, and Twin Towers in Los Angeles. Mentally ill inmates are placed on long wait-lists for sub-par mental health care. In most cases these mentally ill inmates, having received less than ideal mental health services during their incarceration, will rejoin our communities, where they are more likely to re-offend than their non-mentally ill peers.
Probation and Parole:
Currently there are 5.5 million offenders in the parole/probation system nationwide. As stated above, mentally ill offenders on parole or probation are more likely to re-offend upon release. Relationships between the parole and probation officers and those newly released prove to be key in reducing recidivism. A 2008 study by Bonta, Rugge and colleagues shows that time spent discussing criminogenic was directly related to reduced recidivism when compared just monitoring probationers. A therapeutic approach compared to an authoritarian style of interacting with probationers also contributed to reduced risk for re-arrest. Probation officers with reduced caseloads were able to provide their clients with more meaningful attention and counsel. Relationship with probation officers was the most important aspect of reducing recidivism in mentally ill probationers.
Relationships between institutions and the public matter. Relationships between institutions and the communities they serve matter. To improve these relationships will ultimately reduce the number of mentally ill offenders in the criminal justice system only if we consider not just the micro-level (between practitioner and patient, lawyer and client, parole officer and parolee) but also and especially macro-level.
Towards this goal we should:
- Focus on creating mental health law enforcement teams that can foster relationships between the mental ill and community services.
- Create comprehensive mental health courts committed to furthering those relationships.
- Dedicate resources to the creation of Forensic Diversion Programs to reduce the number of non-violent offenders overcrowding jails, and to address factors underlying the frequent contact of mentally ill citizens with the criminal justice system.
- Reduce wait lists of those in prison seeking psychiatric care by properly staffing these institutions with mental health professionals. This will ultimately reduce the problematic behaviors that result from untreated mental illness, and ensure timely release of mentally ill prisoners.
- Reduce the caseloads in prisons and community supervision systems, so that providers have ample time to foster relationships with their clients and reduce their chances of re-offending.
- Appeal to policy makers and politicians to reframe the debate about public safety to by bringing into awareness the benefits public health initiatives can have on communities.
- Educate the public about how increased funding for mental health services will provide cost-savings and safer communities in the long-term.
Anyone who is interested in the terrific talks presented at the Elyn Saks Spring Symposium can find the video and power point slides here.