Brain Injuries, Mental Health, PTSD and Substance Abuse Explain Criminal Behavior

Observations You can explain dysfunctional criminal behavior by looking at the data on traumatic brain injuries, mental health, PTSD and substance abuse. Author Leonard Adam Sipes, Jr. Retired. Thirty-five years of public relations for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

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Observations You can explain dysfunctional criminal behavior by looking at the data on traumatic brain injuries, mental health, PTSD and substance abuse. Author Leonard Adam Sipes, Jr. Retired. Thirty-five years of public relations for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

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from https://www.crimeinamerica.net

Judges Called ‘Last Line of Defense’ for Mentally Ill in Justice System

The lack of adequate alternatives to jail or prison to help mentally troubled individuals who run afoul of the law is a “horrible American tragedy,” judges and prosecutors from around the country were told at a New York University School of Law conference.

When police and prosecutors are unable to act, judges must be the “last line of defense” for mentally troubled individuals who run afoul of the law.

That was one of the conclusions at a conference of leading prosecutors and jurists at New York University’s School of Law examining the plight of the seriously mentally ill who are trapped in the justice system.

The use of jails and prisons as frontline treatment facilities for individuals with serious mental illness—for lack of adequate alternatives—is a “horrible American tragedy,”  Judge Steven Leifman of the Eleventh Judicial Circuit Court of Florida said.

Christina Klineman, a Superior Court Judge in Indianapolis, added that if local authorities fail to provide diversion programs that police or prosecutors can use, judges should still try to find ways of ensuring the mentally ill are kept out of jail.

They are “the last line of defense” for protecting the mentally ill, she said.

The two judges spoke during a panel Friday at NYU’s Tenth Annual Conference on the administration of criminal law. They joined other speakers, including advocates, in calling for greater attention to diversion programs for the mentally ill.

“The criminal justice system should be the last resort for the mentally ill, not the first,”  Leifman said, arguing that the lack of alternatives too often places the burden of care on prosecutors, judges and police officers, who lack the proper resources, training and funding to help mentally ill patients. 

Participants in the conference cited studies showing that 40 percent of individuals with a mental illness will come in contact with the criminal justice system at some point in their lives—usually because family members call 911, not knowing what else to do. 

Police receive 250 million calls each year, but only 25 percent of those calls are connected with an actual crime, said Rebecca Neuster of the Vera Institute of Justice. Ten percent of those calls are made because someone with a mental illness is experiencing a manic episode.

See also: Why Jail is No Place for the Mentally Troubled.

But when the police become involved, the individual is handed over to the justice system.

According to Ronal Serpas, a professor of Criminology at Loyola University of New Orleans, if police officers had an alternative to arrest, they would take it.

But all they have to offer mentally ill patients “is the back of their car,” Serpas said.

That, he added, was a solution for no one.

The police role as first responders puts them in a difficult position, but at the same time makes it critical for officers to know where to take people suffering from mental illness other than jail, said Travis Parker, senior project associate at Policy Research Associates.

“Officers need an answer to the question: ‘divert the mentally ill to what?'”

He noted that in some cities, police have been given iPads to contact mental health professionals, instead of taking troubled individuals to jail.

See also: How iPads Changed a Police Force’s Response to Mental Illness.

Once an individual with mental illness is arraigned, however, prosecutors can step in to ensure mentally ill defendants are diverted to counseling and social services, the panel was told.

“Public safety is not defined by convictions and arrests — people need to feel safe and secure, they need housing and a job—and the criminal justice system removes that for so many people,” said Vermont Attorney General T.J Donovan,  who argued prosecutors should use “restraint” in deciding whether to seek convictions.

Klineman brought up the case of a homeless man urinating in the street and raised the question, “what do I sentence him to?”

“If I put him on probation, I set him up for failure and we have more problems. If I release him, he doesn’t get any help,” Klineman said.

In Florida’s Miami-Dade County, home to the largest percentage of people with serious mental illnesses, decarcerating jails and providing an alternative for the mentally ill is a top priority for court officials.

Authorities there created the Criminal Mental Health Project to provide community-based treatment and support services to defendants suffering from serious mental illness and substance abuse disorders.

The program provides two types of services: pre-booking diversion training for law enforcement officers, and post-booking diversion to help individuals in jail and awaiting adjudication. 

Justin Volpe, a young man who suffered from paranoia and substance abuse, said he was able to avoid prison though the program. His sentence was tossed out, and instead he was offered a job by the courts.

“That’s what people need,” Volpe told the conference. “I went from having no insight of my mental illness to working with other people in same situation. I assist people in community and get them help. I also have opportunity to train law enforcement and share my recovery story.”

In fact, Volpe was able to train the police officer who first arrested him. The officer told Volpe, “I’m surprised you’re still alive.”

Volpe takes participants in the program to out to lunch, or coffee, or even to play basketball.

“People don’t need another person telling them about their court dates and doctors appointments- giving them a list of things to do,” he said. “I give them a person-to-person feel,” he said.

Laura Usher, senior manager at the National Alliance on Mental Illness, commented that Volpe’s point was critical.

“The only way to treat someone with a mental illness… is like a person,” she said. 

Megan Hadley is a reporter for The Crime Report. Readers’ comments are welcome.

from https://thecrimereport.org

Cops, Violence, Stress and PTSD

Police Motorcycles Observations If society wants us to have compassion and understanding for people in high crime communities affected by violence, or those vicariously experiencing school shootings, why doesn’t the same apply to police officers? If the close proximity to violence affects students or residents, how could it not impact cops? The data below says it […]

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Police Motorcycles Observations If society wants us to have compassion and understanding for people in high crime communities affected by violence, or those vicariously experiencing school shootings, why doesn’t the same apply to police officers? If the close proximity to violence affects students or residents, how could it not impact cops? The data below says it […]

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from https://www.crimeinamerica.net

Why Jail is No Place for the Mentally Troubled

For lack of alternatives, thousands of mentally ill individuals are trapped in the justice system. In a conversation with TCR, Alisa Roth, author of “Insane: America’s Criminal Treatment of Mental Illness,” says change will only happen when we reexamine our attitudes towards mental illness.

In her career as a journalist, Alisa Roth has written about people in what she calls “forgotten communities,” such as immigrants and the poor. But when she began focusing on the mentally ill trapped in the U.S. justice system, after a friend’s brother was locked up, Roth discovered what she came to realize was the most forgotten community of all.

“I can’t think of a group that’s more reviled and more misunderstood,” she told TCR. In a discussion with staff writer Isidoro Rodriguez about her new book, “Insane: America’s Criminal Treatment of Mental Illness,” Roth, a former Soros Justice Fellow, describes how jails and prisons have become the nation’s principal institutions for treating mentally troubled individuals, and suggests that strategies for developing more humane, treatment-oriented alternatives have to begin at the state and local levels.

The Crime Report: What was the catalyst for writing this book?

insane

Courtesy Basic Books

Alisa Roth: I can’t think of a group that’s more reviled and more misunderstood than people with mental illness who are in the criminal justice system. We talk about the issue of race in the criminal justice system, we talk about the issue of poverty in the criminal justice system, but we don’t talk about mental illness. These three intersect and overlap, but we can’t think about global reform without addressing the mental health question.

As I mention in the book, I have a friend whose brother developed a severe mental illness and committed a horrible crime. As I was thinking about this whole system, it kept coming back to him. If we as a society can allow him to see an alternative outcome, and not spend the rest of his life in prison, we can allow that for other people who have done less morally or criminally complicated things.

TCR: Through the process of this book, what hurdles did you have to overcome?

AR: I chose two of the most closed systems to look into. The criminal justice system is extremely closed in terms of access, in terms of data, and in terms of information. Likewise, the mental health care system is bureaucratic and complicated. So just figuring out where treatment is being provided, and who should be providing that treatment is difficult.

Then there’s the whole health care aspect. People are not allowed to, or are unwilling to, share information about treatment. And there’s the stigma question in both systems. There is still shame attached to having a mental illness or having a family member with mental illness. We march for breast cancer or AIDS, but we don’t want to talk about mental illness and we don’t want to admit it. So, getting people to open up and say “yes, I do have this issue” or “yes, my child does have this issue and these are the struggles we are going through,” is very difficult. I am very grateful to all the people who were willing to share their stories with me.

TCR: How did dealing with this affect you, and how do you move forward after seeing what you have seen?

AR: I feel a great responsibility and duty to share these stories and spread them. I have the means to tell the world about these horrible situations, whether it’s the really awful abuses or just the day-to-day low-level abuses of being locked up with a mental illness. So, I feel privileged to share that.

Keeping that in mind was a way to mitigate the awfulness of it, but it’s traumatic reporting. I had a lot of nightmares about jail and prisons. I have a lot of friends who work in this universe, so it was great to be able to compare notes and talk about what we have seen. It is traumatizing and exhausting, but I kept thinking that I got to walk out of there at the end of the day, and I needed to take advantage of that to tell the world about how bad the problem is.

TCR: One of the subjects in your book is the practice of solitary, and you note that it is still in effect despite being considered a form of torture by the United Nations. Why do you think it is still being practiced in the U.S.?

AR: There are a lot of pieces that go into this answer. Unfortunately, we have abandoned the notion of reform and rehabilitation in our criminal justice system. We’ve moved back to the punitive notion. In some measure we think that people who are locked up in jail or prison deserve what they get. There is a dehumanizing aspect to the whole criminal justice system, and solitary confinement is part of that. If we don’t think of somebody as a full human being, then it becomes easier to do something really awful to them. If you think of this person as your brother, or our uncle, or your husband, it’s much harder to lock them in a box 23/7.

There’s also the fact that so many of us don’t know what goes on in the criminal justice system. The system as a whole is so abstract for such a large portion of our population, that we just don’t think or know about it. People have no idea that there are tens of thousands of people locked in solitary confinement on any given day. In a lot of places and for a very long time it’s just been how it’s done. It’s a very easy solution to put someone who is being unruly or difficult out of sight and out of mind. I think it speaks to a larger issue: We take people with mental illness, we lock them away, someplace we don’t need to see them. If we put them in jail or prison we don’t need to see them or step over them on our way to Starbucks in the morning. Solitary confinement is a reflection of that. But it makes everything so much worse.

Alisa Roth

Alisa Roth. Photo by Matthew Spence

TCR: Your book also criticizes the dangerous mistakes made by judges, and attorneys, who have no experience with the mentally ill. One example is your story of Jamie Wallace, a young boy suffering from mental illness and multiple physical disabilities, who eventually killed himself in prison due, in part, to a judge’s inability to understand his circumstances. How do we increase awareness and understanding of mental illness so that we may better avoid tragedies such as this?

AR: As awareness of the problem of large numbers of the mentally ill in the criminal justice system grows, judges and attorneys are more attuned to it. It’s not that people don’t know it’s there, but it’s as much as about changing attitudes as anything else. I talk to a lot of judges and I’ve said “Hey, in a lot of cases you’re being asked to make what’s effectively a medical decision and you’re not a doctor; you’re a judge. ‘

The best answer I heard, and it makes sense to me to a degree, is the judge who that’s what he does all the time. He takes the best information he can get and makes a decision based on that. So, he’s not making a medical judgement, per se; he’s taking the information that the psychiatrist, the therapist, and the attorneys give him and using that to make a decision. Jamie Wallace’s case was particularly egregious. He was so young, so sick, and had a developmental disability on top of it. I found it heartbreaking to think that the judge couldn’t see a way to understand. And the judge was playing very much by the rules.

Jamie Wallace was failed by the system at every level, over and over again. A forensic psychiatrist who read about him said he should never have been declared competent or even been standing in that courtroom. The judge made an awful decision, but he also made a mistake in letting him even be in that courtroom that day. You have to wonder how it would have been different if he had been wealthier, or his parents had been more educated, or if he had been in a different state.

TCR: Jamie Wallace’s story is an example of the mistakes that can be made as a result of the disorganized bureaucracy of the criminal justice system. At a time when so many are pushing for better training within that system to fix the problem, and others are fighting to keep the mentally ill out of that system entirely, which do you feel is the better option?

AR: In an ideal world, we would be able to keep everybody with a serious mental illness out of the criminal justice system. In an ideal world, we’d be able to keep a lot of people without a mental illness out of the criminal justice system. We lock up a lot of people very easily. I think that diversion is absolutely critical, but in order to make wide scale diversion possible, we can’t just look at this little tiny piece of the problem. We have to remember that we are operating in a very large ecosystem, not just of criminal justice but also of mental healthcare. We need to see wide-scale reform of both these systems so that people aren’t getting to the point where they’re so sick.

You see people in jail and prison who are sicker than a lot of people you see in psychiatric hospitals. We need to be catching the diseases earlier and treating them earlier. It’s great to train the cops to not arrest people, but if you don’t have some place for the cops to take them that’s not jail, they’re still going to wind up in jail. That’s what happened in San Antonio when they created their crisis center system. [They realized] you can train cops as much as you want, but they’re still going to take people to jail if there’s no other option. The other part of it is, as long as we are going to have people that end up in the criminal justice system, we have to make sure that when they’re there, they’re getting the treatment that they need and not just being warehoused in prisons.

TCR:A popular talking point now is de-institutionalization, starting when the majority of state-run mental health hospitals were closed during the 1960s. However, your book insists that there were other, more important, causes for the problem. Can you expand on that?

AR: De-institutionalization is a fabulous talking point. It has this very neat narrative: Dorothy Dix found people locked up in jail; realized this was not the place for them; they weren’t getting the treatment they needed; wardens were saying they couldn’t handle this; she pushed for the creation of the asylum system; everything was great until it all went to hell and we had to open up the doors and let everyone out. Then, without treatment, people were ending up in the criminal justice system. And it has a very neat solution: if this is how we got there, then all we have to do is treat the mental illness and we’ll get people out of the criminal justice system.

Unfortunately, it’s way more complicated than that. Even when you look at the heyday of institutionalization, during the middle of the last century, there were a lot of people in institutions, but it was not the majority. There were still a lot of people living at home or elsewhere, or getting treatment in the community. The population in institutions tended to be older, white, female, and very heavy on people with a diagnosis of schizophrenia. The people now locked in the criminal justice system are overwhelmingly young, male, and not white.

I think we also have to look at the story of mass incarceration. We’ve started locking up way more people than we ever did…and when you cast such a big net, of course you’re going to pull in a lot of people with mental illness. When you break it down even further and look at co-occurring substance use disorders, a very large majority of people with mental illness in the criminal justice system have a co-occurring substance use disorder. So, if we’re arresting tons of people for drug possession, drug use, drug selling, drug dealing, it makes perfect sense that we’ll pick up people with mental illness.

Using policing tactics such as “broken windows” and “stop and frisk,” allowed us to lock up huge amounts of people [and] made it easier to arrest people with mental illness. I think that the story of mental illness in the criminal justice system is as much a story of mass incarceration as it is of de-institutionalization. The one piece of the story that is important, even if we don’t quite tell it right, is that we do have a severe lack of mental health care in the community and we have made it extremely difficult to get treatment for mental illness. But it’s not that everybody was getting treatment in a hospital and now they can’t get it, we just don’t have that and we’ve never had it.

TCR: How can we get people to start viewing mental illness seriously?

AR: I think we’re starting to move in that direction, very slowly. We’re seeing more people acknowledging an issue with depression or anxiety. We’re still not seeing a lot of actors come up at the Oscars and mention that they have schizophrenia, but I think it’s becoming more socially acceptable to talk about these things. We know that people can change, and society can change. There was a time that people didn’t talk about HIV or cancer, and now we wave flags for it. We need to get over the fear and stigma [attached to] mental illness in our society. The narrative in the media and in politics that links mental illness and violence is very damaging. And it’s hard to get over that stigma when every time something bad happens somebody is out there pointing a finger at mental illness.

TCR: Are tools such as Crisis Intervention Teams (CIT), deescalation and community policing having a positive effect on the problem?

AR: Like so many things in criminal justice, there is not a ton of data or evidence-based research to show one way or another. The data in places such as Miami or San Antonio show that these things work. Miami says that it’s cut the number of officer-involved shootings. In San Antonio, the system has prevented them from expanding the jail. People who study policing say that CIT is just good policing—-going back to the kind of policing we had before “professionalized” law enforcement. It was the cop walking the beat who knew the people in the community. There’s no reason to run into every situation like it’s a battleground. Police officers always talk about how they see people on the worst day of their lives. That narrative is used sometimes as a reason why you need to be on your guard. But I’ve also heard it used as a reason to be gentle, kind, and thoughtful because they’re there to help.

Getting police to respond in a more thoughtful, more community/medically oriented way, instead of the tough, warrior way, is terrific. The big caveat is that if you don’t have the whole system set up to accommodate this it can only get you so far. You might deescalate a particular situation, but if you don’t have any longer-term solutions, you’re going to be back picking up the same person with no place to go. Often communities think CIT will be a step to solving the problem, but you have to think about how you’re going to divert, what’s the mental health treatment going to be, and how do we make sure we’re not picking people up again next week or next month.

TCR: Does change need to start at a federal level?  And do you see potential for change under the current administration?

AR: The thing about criminal justice is that so much of it happens on such a local level that, on the flip side, a lot of reform can also happen on a local level. If I’m in Manhattan, and get arrested, it could potentially be a different outcome then if I’m in the Bronx or New Jersey. Because it’s so local, I think the federal question is almost irrelevant. Even the laws of involuntary commitment are handled at a local level.  I think with a lot of laws, particularly with HIPAA (the Health Insurance Portability and Accountability Act) and involuntary commitment, it really comes down to a very narrow line of navigating between civil liberties and safety for the person and the public.

We obviously don’t want to go back to the time when somebody could have a child committed to a hospital for not being religious enough or dating the wrong person.  On the other hand, I think we’ve made it so difficult to get somebody hospitalized that we’re in this perpetual crisis management mode.  The way it’s set up now is that you really have to be at a crisis point in order to make involuntary commitment possible.  Likewise, with HIPAA, I don’t want my business broadcast all over the place.  On the other hand, the very nature of mental illness means that the person is not, necessarily, capable of making decisions for himself, or even providing the information that the doctors need.  I’ve heard families talk about managing to get their adult child hospitalized, but then not being able to convince the doctor to talk to them about what has or hasn’t worked in the past.  As with any other illness, the more information the clinician has, the better they can treat the problem.

Isidoro Rodririguez

HIPAA is also widely misunderstood. It’s used as an excuse for stonewalling families and other people trying to get information.  I think the more important question, is how do we figure out how to loosen these laws a little bit to make things easier and more effective without throwing all the civil liberties out with it.  As for the current administration, I think this is a big wildcard.  It doesn’t seem to be a big priority except on those occasions when something awful happens and suddenly there’s talk of bringing back asylums and more mental health care.  Between seeing real change at a local level or at a federal level, I have a little bit of hope that at the local level there is potential for reform.

Isidoro Rodriguez, a staff writer for The Crime Report, covers policing and mental health issues. He welcomes comments from readers.

from https://thecrimereport.org

Public Opinion on School Shootings and Violence

Police Vehicle Observations For school shootings and violence, by 56 to 41 percent, Americans think we should change laws related to “school security and mental health system” rather than the “laws on the sales of guns and ammunition.” Author Leonard Adam Sipes, Jr. Thirty-five years of speaking for national and state criminal justice agencies. Interviewed […]

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Police Vehicle Observations For school shootings and violence, by 56 to 41 percent, Americans think we should change laws related to “school security and mental health system” rather than the “laws on the sales of guns and ammunition.” Author Leonard Adam Sipes, Jr. Thirty-five years of speaking for national and state criminal justice agencies. Interviewed […]

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from https://www.crimeinamerica.net

Most Attackers in Mass Violence Showed Red Flags

A new report from the Secret Service National Threat Assessment Center says that most mass attacks in public spaces are preceded by behavior that worried other people. “There’s no such thing as an impulsive act,” says one expert.

The attacks sound numbingly familiar: five shot to death at an airport in Florida, 26 slain at a Texas church, five killed by a gunman rampaging through Northern California. These violent outbursts last year, and others like them, had key things in common. Long before the violence, the people identified as attackers had elicited concerns, red flags that littered their paths to wreaking havoc on unsuspecting strangers. This is a common thread in most of the mass attacks in public spaces last year, the majority of which were preceded by behavior that worried other people, says a new study from the U.S. Secret Service National Threat Assessment Center, reports the Washington Post.

“Regardless of whether these attacks were acts of workplace violence, domestic violence, school-based violence or terrorism, similar themes were observed in the backgrounds of the perpetrators,” the report stated. Every person blamed for a mass attack was a man. All of them “had at least one significant stressor within the last five years, and over half had indications of financial instability in that time frame,” the report found. That included issues with family relationships, being fired or suspended from work and facing unstable living situations. More than half had histories of mental health issues, criminal charges and substance abuse. Nearly half were fueled by some kind of personal grievance. Half of the attackers had patterns of making threats, while a third made specific threats to their eventual targets. “Direct threats should be investigated, because a threat unchecked could escalate into an act of violence,” said Matthew Doherty, who formerly led the National Threat Assessment Center. Doherty, now at Hillard Heintze, a law enforcement and security advisory firm, said, “There’s no such thing as an impulsive act.”

from https://thecrimereport.org

Honesty, School And Mass Shootings

“..our best built certainties are but sand-houses and subject to damage from any wind of doubt that blows.” – “The Great Dark.” Mark Twain. Author Leonard Adam Sipes, Jr. Thirty-five years of speaking for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

“..our best built certainties are but sand-houses and subject to damage from any wind of doubt that blows.” – “The Great Dark.” Mark Twain. Author Leonard Adam Sipes, Jr. Thirty-five years of speaking for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

from https://www.crimeinamerica.net

Homeless, Mentally Ill and Addicted: The Downward Spiral

An outbreak of hepatitis A in a number of states highlights the vulnerability of individuals suffering from both mental illness and substance abuse. Those most at risk —the homeless and formerly incarcerated—deserve “compassionate, evidence-based solutions,” says a TCR columnist.

Several states are in the midst of hepatitis A virus outbreaks. San Diego and the surrounding region are among the hardest hit, but southeast Michigan has more reported cases and more deaths. Utah, Colorado and Kentucky also have experienced outbreaks.

California had 683 cases as of Jan. 23, with 21 deaths. Michigan recorded 715 cases as of Jan. 24, with 24 deaths. Colorado has had 62 cases, and one reported death.

Understanding these outbreaks requires acknowledging the links between homelessness, addiction and mental illness—and it requires more than a single solution.

Hepatitis A is typically a disease spread by human contact with already-infected individuals or pieces of their stool that are too small to see. High-risk groups include the homeless, the incarcerated (and those released from prison) and drug users—all groups that have some overlap. The homeless and the incarcerated also suffer from mental illness and are drug users, a condition known as a dual diagnosis or co-occurring disorders, and the deficiencies of health care in many prison facilities make incarceration a key risk factor.

According to a 2009 National Coalition for the Homeless (NCH) fact sheet, the Substance Abuse and Mental Health Services Administration found that “20 to 25 percent of the homeless population in the United States suffers from some form of severe mental illness,” compared to only six percent of the population as a whole.

A one-year study of people with serious mental illnesses examined by California’s public mental health system found that 15 percent were homeless at least once in the previous 12 months.

In addition, the NCH fact sheet found that “some mentally ill people self-medicate using street drugs, which can lead not only to addictions, but also to disease transmission from injection drug use.”

The Los Angeles Times cites experts who say that 50 percent to 70 percent of homeless people with severe mental illness (SMI) also have problems with alcohol or drugs.

The likelihood of homelessness also is increased when you have a mental illness, an addiction disorder and a disease such as hepatitis A. None of these conditions is going to go away if you are homeless and have no access to health, substance abuse or mental illness services.

If only one of the three gets treatment, the other two remain, and the third may return because they are all connected.

In 2016, Kevin Fischer, executive director of the National Alliance on Mental Illness (NAMI) of Michigan, suggested on Michigan Public Radio that closing all the state mental hospitals in the 1990s by then-Gov. John Engler resulted in an “explosion in homelessness.”

The mentally ill were supposed to be sent home, but many ended up on the streets because the private mental health system and the patients’ families were not prepared to handle them.

Joel John Roberts, CEO of People Assisting The Homeless (PATH) Partners, says many people in the mental health field put the blame on Ronald Reagan, then governor of California, who they say released more than 50 percent of the state’s mental hospital patients and abolished involuntary hospitalization of people with mental illness.

“This started a national trend of de-institutionalization,” Roberts wrote.

Then, as president, Reagan ended funding for federal community mental health centers. No one expected the mentally ill to wander the streets. The feds thought the states would take care of them. The states thought private insurance or family would take care of them.

Somewhere, somehow, they were wrong.

To get these outbreaks under control, and to prevent future outbreaks, we need more support for mental health and substance abuse treatment, and better harm reduction strategies (including clean needle exchanges and safe injection sites).

Some of that funding could come from Medicaid if the Trump administration eliminates the Institutions for Mental Diseases (IMD) Exclusion, which prohibits Medicaid funds going to mental health providers with more than 16 beds. There’s bipartisan agreement that this rule, which dates back to 1965, needs to go. The executive branch can, has, and does issue exemptions for this rule, and Trump has pledged to speed up the process.

But virtually no one thinks the rule needs to remain.

More than money is needed. Sometimes only one co-occurring disorder is apparent. First responders need to be trained to look for and recognize both.

In 2017, the Michigan Department of Health and Human Services (MDHHS) & Michigan Association of CMH Boards wrote, “Supports and services for persons with co-occurring mental health and substance use disorders must be the norm for all agencies across the network.”

The department added this was because “it is more prevalent than addiction-only or mental illness-only among the people served by MDHHS providers. Practitioners in every program at all levels of care must be competent to address comorbidity in mental health and substance abuse treatment.”

Effective treatment, according to the NAMI, requires not only that both be treated—but preferably at the same time. It’s called integrated intervention, and often involves detoxification, inpatient rehabilitation with psychotherapy, supportive housing, maybe medications (either to treat mental illness symptoms or to control addiction) and self-help/support groups.

The Michigan House of Representatives’ bipartisan House C.A.R.E.S. (Community, Access, Resources, Education, and Safety) Task Force’s final report recommended that crisis intervention training (CIT) for first responders should include “information on signs and symptoms of mental illnesses” and “co-occurring substance use disorders.”

It also recommended that trial and pre-trial practices “should assess defendants to determine whether the person has a serious mental illness, co-occurring substance use disorder” and so benefit from “mental health services.” Better and more consistent efforts must be made to screen for mental illness and co-occurring substance disorders during the booking process, the task force said.

But that’s if the individual ends up in the mental health or criminal justice system. There are harm reduction practices that can save lives even if the person with mental health and substance-use disorder remains out of the system.

One is providing maintenance drugs (medication-assisted treatment or MAT) such as buprenorphine (brand name Suboxone, also available as an implant, Probuphine, that only needs to be replaced every 90 days) or methadone to addicts to prevent withdrawal, and there are drugs for mental illnesses such as depression, bipolar disorder, schizophrenia, and psychosis.

Another—although hep A isn’t as likely to be spread this way—is providing intravenous drug users with a safe injection space. These spaces are also known as safe consumption sites, fix rooms, drug consumption room (DCR), supervised injecting facilities, and shooting galleries. But they share the following characteristics: a clean facility, with clean needles, the availability of testing supplies to make sure the drug is unadulterated, and a nurse to administer naloxone in case of an overdose.

They not only save lives—no deaths have been reported at any such site around the world, including Canada and Australia—they also save money.

Editor’s Note: San Francisco is set to become the first in the U.S. to introduce safe injection spaces, with two sites scheduled to open in July.

A recent study estimated that such strategies could save an average US city $3.5 million per year and that some could save more (Baltimore: $6 million). The American Medical Association likes the idea, as do the Clinton Foundation and the Johns Hopkins Bloomberg School of Public Health.

Some in the anti-drug camp oppose harm reduction in particular, and substance abuse treatment in general. They prefer incarceration to rehab. Their position on the mentally ill is less clear, but maybe they feel that, too, is the result of a poor personal choice.

Stephen Bitsoli

Stephen Bitsoli

Maybe paying for these sinners to go to dual diagnosis treatment centers seems like rewarding bad behavior. The result: we have a homeless problem, an opioid epidemic, and hepatitis A outbreaks,

Punishment isn’t working, and science and public opinion now believe addiction is like a disease. It’s time to look for compassionate, evidence-based solutions.

Stephen Bitsoli, a Michigan-based freelancer, writes about addiction, politics and related matters for several blogs. He welcomes readers’ comments.

from https://thecrimereport.org

Seattle PD Finds No Fault in Slaying of Deranged Woman

Two white officers shot and killed Charleena Lyles, a 30-year-old African American mother of four, after she called 911 in June to report a burglary at her apartment. A police review found the shooting reasonable. An attorney for the dead woman’s family said, “If her killing was within policy and training, we need changes in policy and training.”

The Seattle Police Department’s Force Review Board has found the controversial fatal shooting of Charleena Lyles by two officers in June to be reasonable, proportional and within policy, reports the Seattle Times. The board’s unanimous vote followed a daylong meeting Tuesday. The findings are subject to final approval from Assistant Chief Lesley Cordner, who presided over the meeting and oversees the department’s Compliance and Professional Standards Bureau. Corey Guilmette, an attorney representing Lyles’ family, said, “We cannot accept that Charleena Lyles’ killing was unavoidable. If her killing was within policy and training, we need changes in policy and training.”

Lyles, a 30-year-old African American mother of four, was shot seven times by two white officers, Steven McNew and Jason Anderson, on June 18 after she called 911 to report a burglary at her Northeast Seattle apartment. Police said Lyles suddenly threatened the officers inside the apartment with one or two knives before they opened fire. The officers found no evidence of a burglary. Lyles had struggled with mental-health issues, according to her family and court records, and the shooting came at a time her life was spinning out of control. The shooting unleashed a storm of public protest, with many seeing it as another example of unnecessary deadly force being used by police against people of color.

from https://thecrimereport.org

Saving Offender Rehabilitation and Reentry Programs

Observations I’m suggesting that we focus almost exclusively on mental health and the co-occurring issue of substance abuse. With budget limitations, we can’t be all things to all people. Are we at the point where we need to completely rethink our approach to programs for offenders? Little will happen until we stabilize people in need. […]

Observations I’m suggesting that we focus almost exclusively on mental health and the co-occurring issue of substance abuse. With budget limitations, we can’t be all things to all people. Are we at the point where we need to completely rethink our approach to programs for offenders? Little will happen until we stabilize people in need. […]

from https://www.crimeinamerica.net