“..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 […]
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.
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.
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.
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.
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. […]
Efforts to close facilities like the Rikers Island jail complex in New York won’t work unless authorities find alternative ways to deal with seriously mentally ill individuals who run afoul of the justice system, New York’s former chief judge told conference-goers last week.
Efforts to close down Rikers Island, America’s largest jail complex, need to begin with finding effective alternative treatment for mentally ill individuals who are confined behind bars because there are no other places for them to go, according to New York’s former chief judge.
“These people are not in Rikers because they’re hardened criminals,” said Jonathan Lippman. “They’re there because they have a problem, (and) they don’t need to be brutalized by a penal colony that is a relic of the past.
“Instead of tough or soft on crime, let’s be smart.”
Lippman, who served as Chief Judge of the New York State Court of Appeals between 2009 and 2015, spoke at an October 4 forum on the future of the Rikers Island facility, which authorities have promised to close within 10 years.
He was chair of the Independent Commission that produced the April 2017 report recommending the closure of Rikers.
The forum, entitled “Closing in on Closing Rikers,” was held at Baruch College of the City University of New York, and examined viable alternatives to prison for the mentally ill that have enjoyed success in other states.
At Rikers, 19% of the inmates have been diagnosed with a serious mental illness.
“We’re not getting at that population yet, but if we’re going to close Rikers we have to do so,” said Cheryl Roberts, Executive Director of The Greenburger Center for Social and Criminal Justice, a nonprofit organization advocating for justice reform that co-sponsored this event.
Working with the New York Daily News and the Metro Area Industrial Foundation, The Greenburger Center invited behavioral health care expert Leon Evans, President and CEO of the Center for Health Care Services in San Antonio, Texas; and Miami-Dade County Mental Health Court Judge Steven Leifman—both of whom have pioneered strategies aimed at finding alternatives to incarceration (ATI) for the seriously mentally ill.
Leifman told the group he is still horrified by the memory of his visit years ago to a mental health hospital in Miami-Dade County while he was an intern for a prominent Miami legislator.
“I walked into a hellhole,” he said, recalling the sight of one teenager strapped to a bed and given thorazine which made him overweight. The teenager, it turned out, was not there for psychiatric treatment; he was autistic.
In another part of the hospital, he witnessed six naked men being hosed off by a guard as if they were animals.
But today, he pointed out, the mental health system’s failure to provide adequate care for troubled individuals has only shifted the burden to jails and prisons.
“(Some) 40% of all people with mental illnesses in this country at some point in their life will come into contact with the criminal justice system,” said Leifman, who has been one of the country’s most influential advocates of ATI.
Other participants in the forum included New York City Council Speaker Melissa Mark-Viverito, an outspoken advocate for local and national criminal justice reform.
“Looking at the way we look at incarceration, and having the punishment fit the crime, is critically important,” said Speaker Mark-Viverito.
In support of this idea, to date, Speaker Viverito and the New York City Council have contributed over $6 million to ATI initiatives, and recently passed the Criminal Justice Reform Act which decriminalized non-violent, low-level offences and replaced them with a summons.
The Act is a boon for the homeless and mentally ill that frequent New York City streets and subways.
“When you think about incarcerating someone for public urination, it’s unpleasant, but does that really make sense?” asked Speaker Viverito, who believes that authorities have to re-envision their approach to non-violent offenders who are apprehended for minor crimes—if they are ever to reach their goal of permanently closing Rikers.
According to the National Alliance on Mental Illness, more than two million people are arrested and booked into jails each year. A 2010 survey by the Treatment Advocacy Center found that people with mental illness are nine times more likely to be incarcerated than hospitalized, and 18 times more likely to find a bed in the criminal justice system than at any state and civil hospital.
These statistics are reflected in Rikers where, according to a 2015 New York Times article, a total of 4,000 men and women with diagnosed mental illnesses are incarcerated at any given time.
This number represents more than all the adult patients in New York State psychiatric hospitals combined.
But the problem is nationwide, according to Judge Liefman.
“On any given day, there are approximately 360,000 people with serious mental illnesses in jails and prisons and another 760,000 under correctional supervision,” he said.
“This is a shameful American tragedy and it must and can be reversed.”
To demonstrate what can be done to achieve this goal, Leifman discussed the Eleventh Judicial Circuit Criminal Mental Health Project, which he implemented in Florida in 2000. The project seeks to steer people with mental illness that have committed low-level offences away from incarceration and towards community-based care.
“Anybody that gets arrested on a misdemeanor in dade county, within three days they are evaluated and transferred from jail to one of our public or private crisis stabilization units,” said Leifman.
“Because they are on a criminal hold, we can reset the case to a few weeks, give them an opportunity to stabilize, have a team go see them, and offer them an opportunity to come into the program.”
If the person is accepted into the program, they can be in from three months to a year, depending on their illness and charges. While there, they are helped to find housing, clothes, benefits, and are assigned a peer counselor and case management assistance to lower their chances of reoffending.
Leifman said that, as a result of this program, recidivism rates in arrests of the mentally ill have, to date, fallen from 70% to 20%.
This focus on treatment and diversion over arrest and incarceration is believed by the criminal justice community to be the best option for improving what is considered a broken and costly system.
According to a 2014 report from The Hamilton Project at the Brookings Institution, the U.S. spends $80 billion on incarceration costs every year. By relying on the criminal justice system to provide services, taxpayers are losing money by putting away people who come out worse than when they went in, Liefman observed.
“It’s gotten so bad that our communities are now having to choose between building a new jail and a new school or hospital,” he said.
“There’s something wrong with a society that is more willing to incarcerate its (population) than it is to treat it.”
For Judge Lippman, Rikers Island is a symbol of the misguided idea that mass incarceration has any rehabilitative function.
“Whether you’re there for three days, three weeks, or three years, you wind up in a much worse place than when you came in,” said Lippman, who agrees that diversion and treatment are the best course of action.
“It’s not just about punishing people, but it’s what the outcomes are for people coming into the criminal justice system and the impact on society.”
In addition, through research for his report recommending the closure of Rikers, Lippman found that by closing the prison, and focusing on smaller, more up-to-date facilities, New York would save over $1 billion annually.
The first step, in his mind, is lowering the prison population from 10,000 to 5,000, and the mentally ill are a key population.
“We need programs to focus on mental health in particular,” he said. “Programs that identify people with mental health problems before they get into the system.”
He cited programs such as Crisis Intervention Training (CIT), which police departments around the country, including New York, Texas, and Florida, have begun implementing with some success.
Focusing on de escalation, conflict resolution, and training to identify the symptoms of mental illness, CIT enables officers to decide if diversion is a necessary response to any situation.
“From 2008, when we started CIT, we had 117,000 arrests in Dade County,” noted Leifman. “This year , it was 56,000. Our jail audit went in half,”
According to Evans of San Antonio’s Center for Health Care Services, CIT-trained officers working with his program’s “one-stop shop” for treating the mentally ill and others in crisis were able to decrease the county jail population by 22%.
“Treatment does work,” said Evans, whose center offers psychiatric care, substance use services, and general healthcare. However, he stresses that the success of these kinds of programs depends on collaboration.
While first serving as the Director of Community Services for the Texas Department of Mental Health and Mental Retardation, Evans became aware of all the people in the prison system of Texas who shouldn’t be there.
He immediately began working on an idea for a diversion program that would break the pattern of criminalizing the mentally ill in his county. However, in trying to get various departments and elected officials together, Evans experienced a lot of push back.
“Almost everybody said, ‘that’s a great plan, but not with my money,’” said Evans. “So, I went to the county judge.”
Working alongside the then newly appointed County Judge Nelson Wolff, Evans utilized this political muscle to help convene a health summit. Gathering together hospital executives, lawmakers, law enforcement officials, and business representatives, he built support for a more pragmatic and beneficial mental health system; one that meant less money spent on criminal justice, less-crowded hospitals, and homeless-free streets.
As a result, since the program’s implementation in 2002, Evans reported that recidivism rates for the mentally ill in his county currently stand at 6.6%, versus the national average for felons after release of 43% as reported by the Pew Research Center, and that taxpayers in San Antonio and Bexar County have saved more than $50 million over the last five years.
It is an example of cooperation and cohesion that he insists is necessary to emptying out jails and prisons like Rikers around the country.
“Be brave enough to talk about what doesn’t work, collect the data,” said Evans. “It’s not about who’s doing good or who’s doing better, it’s about improvement.”
According to Leifman, thanks to benefits like the passing of Kendra’s Law and access to extended Medicaid, New York is, in some ways, ahead of the game.
“We just got the law changed to be able to expand our AOT, which is an amazing pool for (the mentally ill) population,” said Leifman. “That’s one of the things you already have with Kendra’s Law.”
Effective since November of 1999, Kendra’s law grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Coupled with mental health courts, which offer early screening in the court system, the law is a powerful tool in identifying and diverting the mentally ill out of the criminal justice system and into developing ATI programs such as the Greenberger Center’s own Hope House.
Scheduled to open in the Bronx in 2018, Hope House will be an assisted outpatient treatment center offering care and services comparable to the programs developed by Leifman and Evans.
The access to extended Medicaid allows prisoners to apply for insurance coverage while incarcerated and access said coverage upon release, the often impoverished mentally ill will have access to the funds needed to maintain medications and care.
Participants in the forum agreed that though many steps have been taken in the right direction, there is no one solution to the problem of Rikers, and no quick fixes in a system that still suffers from a “tough on crime” policy that stubbornly fails to acknowledge the data and science fueling the effort for change.
Joking that his program is an “overnight 17-year success,” Evans pointed out that achieving change and cooperation required the aid of a County Judge willing to bring together the community and make everyone work towards a solution.
He warned that what worked in one county in one state may not succeed elsewhere.
“Change is hard,” said Evans. “There’s so much politics involved, there’s so much money involved, and nobody wants the spotlight on them.”
Speaker Viverito agreed.
“Yes, we’re starting to see some sort of conversation and change of view and perspective on a national level,” she said. “But it’s still very challenging to get people to think that incarceration is not the only solution to the problem.”
Though the Criminal Justice Reform Act passed, and seemed a simple solution to ebbing the tide of New York’s incarcerated, it, nonetheless, met with controversy and resistance.
“People thought that we were having the city run amuck,” said Viverito.
“Bringing the mental health challenges to the forefront and making sure it’s not a conversation that is held behind closed doors will take us a long way to dealing with the issue,” said Viverito.
Isidoro Rodriguez is a New York-based contributor to The Crime Report. He welcomes readers’ comments.
More than 80 inmates tried to hang themselves so far this year, and 138 attempted drug overdoses, at a time when the Arizona Department of Corrections is under fire over allegedly inadequate health care. The state still has no mental health director, according to a report by the Phoenix public radio station.
Hundreds of people in Arizona prisons are hurting themselves and trying to take their own lives.
New data from the Arizona Department of Corrections (ADC) show inmates are harming themselves at an alarmingly increasing rate.
Numbers collected by ADC show a dramatic uptick in self-harm among inmates in the past year. Total incidents increased by almost 70 percent.
In fiscal year 2017, more than 80 inmates tried to hang themselves, and 138 tried to overdose on illegal drugs.
The number of inmates using blunt-force trauma — which can include inserting objects in the body and banging the head against a wall — has almost tripled in a single year.
The surge in self-harm reports comes as ADC is attempting to settle a lawsuit over poor health-care conditions in state prisons.
But reports generated for that settlement show ADC and its private contractor Corizon are still understaffing critical health-care positions.
The latest numbers from August show the state prison in Douglas, AZ has no medical director and just one psych associate.
The state prison in Phoenix is designated for seriously mentally ill people. The facility has no psychiatric director, no mental health director and less than half of the psych technicians specified by the contract with Corizon.
There is also no state director of mental health.
EDITOR’S NOTE: This story has been updated to specify that the numbers reported by ADC are incidents of self-harm, not necessarily individual inmates.
David Fathi, an attorney for the inmates in the settlement, said there may be other factors at play but the staffing shortages cannot be helping.
“This is behavior that we often see with mentally ill people in particular whose mental illness is not being effectively treated,” Fathi said.
Incidents of cutting increased by nearly 50 percent. Fathi said that while not all cutting incidents are life-threatening, they should be taken seriously.
“This is potentially lethal behavior. Some incidents of self-harm result in serious injury or even death,” Fathi said. “And that can happen even if the person doesn’t intend to cause death. Any kind of self-harm behavior has to be treated extremely seriously.”
Fathi called the numbers extraordinary and said the increase in self-harm events “cries out for some sort of investigation.”
In a written response to questions about the increase, ADC spokesman Andrew Wilder said “personnel work very hard to identify, intervene and prevent inmates from committing acts of self-harm.”
He said ADC will begin a mental-health training program for correctional officers this month.
But Wilder’s statement downplayed the seriousness of the self-harm numbers, saying they should not “be construed as all being suicide attempts, as they certainly are not.”
“More commonly, these self-harm behaviors involve scratching, biting, ingesting/inserting objects, banging one’s head or hitting one’s self, etc., where there is no intention to commit suicide,” Wilder said
Wilder said the state “has put into place a mental-health transitional watch program aimed at assisting inmates as they come off of a watch and transition back into a general population environment. The goal is to reduce incidents of self-harm behaviors. The department is already in the process of expanding the program.”
According to ADC, there have already been 142 incidents of self-harm in Arizona prisons in fiscal year 2018, putting it on track to be the worst year on record.
Jimmy Jenkins is a 2017 John Jay/Measures for Justice Reporting Fellow. This is a slightly abridged version of a story broadcast earlier this week by KJZZ in Phoenix as part of his fellowship project. Readers’ comments are welcome.
The term has been used as media shorthand for any defense in which the accused blames the consumption or use of some substance for his or her actions. It’s long past time to replace it with a more nuanced description, writes a former New York prosecutor.
“The devil made me do it.”
You might not be surprised to hear a defendant in a criminal case make that claim. But what about, “Junk food made me do it?” Or cough medicine? Or caffeine?
Although not especially common, these kinds of arguments are still made in criminal cases. In fact, there’s even a name for such claims—the so-called “Twinkie defense.”
The phrase “Twinkie defense” was coined by the media in 1978 in coverage of the trial of Dan White, who was charged with murder for the shooting deaths of San Francisco Mayor George Moscone and Supervisor Harvey Milk. However, the Twinkie defense is really a myth.
As explained in the San Francisco Gate, the defense presented evidence that White suffered from mental illness, including depression. A psychiatrist testified that White’s excessive consumption of junk food—including Twinkies—exacerbated his symptoms and was proof of his depressed state.
But the defense never claimed that eating snack cakes put White in a sugar-induced frenzy that drove him to kill Moscone and Milk—it was the press that pushed that angle. Rather, the actual defense in the case was that White suffered from “diminished capacity” and acted “in the heat of passion.”
The jury apparently bought this argument and convicted White of voluntary manslaughter instead of murder.
Despite the truth, the term “Twinkie defense” has become stuck in the public’s imagination and the media’s vocabulary, essentially being used as shorthand for any defense in which the accused blames the consumption or use of some substance for his or her actions.
Since 1978, variations of the Twinkie defense continue to be made, expanding beyond junk food to include other substances.
For example, Matthew Phelps, an aspiring pastor in North Carolina, was recently accused of stabbing his wife Lauren to death. He says that he woke up to find her covered in blood on the floor but couldn’t remember what happened that night. Although Phelps believes that he attacked his wife, he claims that the cough medicine he took to help him sleep caused him to black out. On Sept. 25, 2017, Phelps was indicted on first degree murder charges.
Blaming cough medicine seems to be a fairly popular version of the Twinkie defense.
In 2011, Dr. Louis Chen was accused of murdering his partner Eric Cooper and their two-year-old son. His defense: cough-syrup induced psychosis. That is, his attorneys argued that at the time of the murders, Chen was suffering from mental health issues such as depression and paranoia, which were exacerbated by his use of over-the-counter cough medicine. (Chen ultimately pleaded guilty.)
Also in 2011, James McVay broke into the house of Maybelle Schein and stabbed her to death. He pleaded guilty but mentally ill to murder charges. At sentencing, the defense said that the night before the murder, McVay had mixed alcohol with cough syrup, which caused him to suffer hallucinations. In addition, the defense claimed that McVay suffered from mental illness as well as alcohol and drug abuse issues.
The jury imposed the death penalty, but McVay committed suicide in 2014.
Similarly, Shane Tilley stabbed a friend to death while high on cough medicine. At trial, a doctor testified that he suffered from a schizoaffective disorder. He was found not guilty by reason of insanity and sent to a treatment facility.
Modern versions of the Twinkie defense aren’t limited to cough medicine.
Kenneth Sands, a bus driver in Washington, claimed that consuming too much caffeine compelled him to sexually molest five women. He argued that he suffered from a bi-polar disorder and that too much caffeine caused a psychotic episode, driving him to act out of character. He was sentenced to five months’ prison.
Monosodium glutamate (MSG) was blamed for James Huberty’s 1984 rampage in a San Ysidro McDonald’s, which left 21 people dead and 15 wounded. Huberty, who had a long history of mental illness, was killed by the police who responded to the scene.
Huberty’s widow and children unsuccessfully sued his former employer and McDonald’s, claiming that the MSG in its food, which Huberty regularly ate, and several heavy metals he was exposed to as a welder “combined to cause the violent outburst.”
These kinds of claims may seem like self-serving, desperate attempts to avoid responsibility for horrible acts of violence. But there may be some validity to them.
For instance, many cough medicines contains the ingredient dextromethorphan (DXM). When taken in high doses, DXM can cause mania and hallucinations, and result in assault, suicide and homicide, says one study. Because cough syrup containing DXM is easy to get, it has become a popular recreational drug among teenagers.
In addition, a study published in Injury Prevention in 2012 found a “significant and strong association” between soda consumption and violence in Boston teens. Specifically, the researchers found that adolescents who drank more than five cans of non-diet soft drinks per week were significantly more likely to have carried a weapon and to have been violent with peers, family members and dates.
So is it so crazy to believe there may be similar connections between the use or consumption of other substances and violent crimes?
It’s important to note that aside from asserting some form of the Twinkie defense, there’s another common thread to these cases: nearly all of the defendants had underlying mental health issues. In fact, the defense in such cases is typically that the consumption of a particular substance combined with the mental health issues to result in violent behavior.
Thus, the substances in questions aren’t solely blamed for the resulting crimes. In other words, no one is claiming that if you eat a Twinkie or take some cough medicine, you’ll snap and murder anyone who happens to be near you.
In reality, the Twinkie defense is a form of diminished capacity defense. When a defendant argues diminished capacity, she’s claiming that a mental condition, emotional distress or other factor prevented her from fully understanding the nature of the crime she committed.
The purpose of this argument is not to exonerate the defendant but to negate the element of intent and thus result in a conviction for a lesser crime, i.e., manslaughter instead of murder.
In short, no one has ever really blamed bright yellow, cream-filled snack cakes for a murder. But defendants have blamed other substances, combined with underlying mental health issues, for their violent actions and as a plea for leniency.
As long as defendants continue to make such arguments, it’s unlikely that the term “Twinkie defense” will disappear, despite the truth of its origins. If nothing else, the persistent use of this term shows the power of the media and its influence on the criminal justice system.
Robin L. Barton, a legal journalist based in Brooklyn, NY, is a former assistant district attorney in the Manhattan District Attorney’s Office and a regular blogger for The Crime Report. She welcomes readers’ comments.
A new book argues that mental health authorities’ failure to address the public safety challenge posed by individuals with serious mental illness unfairly shifts the burden to police and the courts. DJ Jaffe, the author, explains why in a conversation with The Crime Report.
Most experts acknowledge that the seriously mentally ill are a formidable challenge to the resources of the justice system. DJ Jaffe, executive director of MentalIllness Policy Org, a nonpartisan think tank, argues that mental health authorities’ failure to address the issue has placed the burden unfairly on police and the courts.
In Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, Jaffe says that it’s long past time for the nation to make this a priority. In a conversation with TCR’s Isidoro Rodriguez, Jaffe explains why he wrote the book, how the mental health “industry” has helped to distort public opinion about mental illness, and why he thinks Republicans are “better” on the issue than Democrats.
The Crime Report: What was your motivation for writing this book?
DJ Jaffe: About 20-30 years ago I became guardian to my wife’s sister-in-law, who had schizophrenia. We didn’t know she had schizophrenia. She was an adorable teenage girl living in Wisconsin with her old-world mom and they were getting into fights. We thought it was just a culture clash between an American teen and an old-world mom and that we would bring her to live with us and everything would be fine.
We would listen to her saying that people were planting transmitters in her head or the buildings in New York were going to fall on her. We’d hear her screaming in her room at the voice only she could hear. Eventually we called the police [who] took her to a hospital. Back then, the hospital would take people who were seriously mentally ill; so she got in and was stabilized after maybe a month. But she would come out and it would keep happening, and we didn’t know what was wrong with her because they wouldn’t tell us. Eventually, in passing, a nurse told us she was schizophrenic. So, we looked it up. We were shocked by our ignorance. I started volunteering for a local group dealing with the issue, and started raising money for them. [The experience] made me realize how messed up the system was.
TCR: In your book, you discuss ways in which the mental health industry has skewed public opinion about the seriously mentally ill in this country. What part do the media play in this?
DJ: The media repeat all of the myths: The mentally ill are no more violent than others, everyone recovers, prevention works. The media, for instance, will continually emphasize the success of “peer support.” One person with a mental illness talking to another person with mental illness. There’s no data showing this has led to improvement by any meaningful metric, but this story is everywhere. It’s very tough for the media, I think, because they’re relying on so-called experts.
What the media should do is talk more often with police and criminal justice about these issues. Ten times as many people with mental illness are incarcerated as are hospitalized. The police have much more experience. The police and sheriffs can’t do what the mental health system does, which is when they get a call, say that the person is too ill, or has “high needs”—we can’t do anything for them. The police and sheriffs don’t have that option: they have to go in. They are much more realistic and want to help because it puts their lives in danger as well ….when the seriously mentally ill go untreated. All the progress that’s come out has been the result of the criminal justice system speaking up after tragedies: Kendra’s Law in New York, Laura’s Law in California, the reform of the Baker Act in Florida.
TCR: What can police do to get this sense of urgency and understanding out to the public?
DJ: This is where I’m trying to focus my efforts. The criminal justice system has not gotten involved at the political level in changing things. When there’s an incident where an officer shoots someone, the answer is always, “we’re going to train police better.” But the answer really is we have to get the mental health system to not turn these people over to police. That should be the answer.
And the danger goes the other way. A large amount of line-of-duty deaths are on mental illness- related calls. So, what they really need to do is get involved politically. Sheriffs around the country are outraged because they’re running the largest mental hospitals. The largest mental hospitals are [today] the Rikers Island [jail complex] in New York, the Los Angeles County Jail, and Cook County Jail. My effort is to get police and sheriffs involved in political change. Now, whenever there is a high-profile instance of violence, the reaction is to form a joint task force of police and mental health people. The police assume the mental health people know more, so when they start proposing solutions, the criminal justice system doesn’t know enough to say those will hurt.
For instance, if you ask any officer, any sheriff, what we have to do to solve the mental health problem, they are going to instantly say, we need more hospitals because we can’t get people in, we need them to hold people longer so they’re really stabilized, we need easier civil commitment processes, and we need to be able to keep people on medication when they’re outside the hospital. Brilliant solutions. [But] if you ask a person in the mental health industry the same thing they will say we have to reduce stigma, we have to do more public education, and we have to train police better. All these things are totally irrelevant to solving the problem.
TCR: In your book you do write that stigma is one of the hurdles to solving this problem.
DJ: I don’t believe there is stigma to being mentally ill. It’s a no-fault biologically based illness, so there’s no stigma to having it and we should stop teaching that. But the system has diverted attention away from the sickest individuals, the small minority who commit violence. In public service announcements you won’t see homeless and psychotic people eating out of dumpsters. They won’t admit that some people need hospitals or some people don’t recover. The whole stigma movement is premised on diverting attention from those [individuals] the police and sheriffs are called to intervene with.
That takes attention away from the solutions. The mental health industry’s response to high-profile acts of violence is to tell the media: “That’s stigmatizing, don’t report on that, the mentally ill are no more violent than others.” What I say, is that our response should be to propose solutions to that very real violence that did occur and hope the media reports on it.
TCR: Why is there, seemingly, so much resistance to serious and practical reform?
DJ: You’d have to ask the people who are doing it. I’m not being coy. We all want to feel that we’re helping, so we often default to easier things. There are also financial incentives to do the easier job. Taking care of people with serious mental illness is exceedingly difficult and time-consuming, and people aren’t paid enough to do it. But, why, for instance, are they saying that we should put more money into prevention when there is no way to prevent it? My mind boggles. We don’t even deal with seriously mentally ill adults.
There are worthy social services today that focus on the issues of “trauma” or “at-risk” individuals. Trauma is not a mental illness, everyone loses a loved one, or experiences [personal stress] like losing a job. That’s not mental illness. We’re wrapping all these social services in the mental health narrative and diverting funds that should go to help the seriously mentally ill.
TCR: In your book, you note the success of mental health courts. Is that a sign of progress?
DJ: Mental health courts are, again, an example of turning this problem over to the criminal justice system. As long as the mental health system isn’t doing its job, mental health courts are needed. The fascinating thing about them is what they do. If a prosecutor or district attorney believes a person who has been charged with a low-level crime has a mental illness, they may divert him or her to a mental health court. The mental health court will say, if you accept treatment for X amount of time, we will drop your charges and the person comes back every week to see if he’s still complying. Basically, you have somebody who has committed a crime—often because the mental health system didn’t treat them—deferred to a court, which then tells the mental health system to treat them. It’s a long, unnecessary round trip. The mental health system should just treat them.
Now, there is no single solution. But something I strongly support is assisted outpatient treatment. Basically, it’s the same thing as a mental health court, except it happens before the crime is committed, after the person already has a history of multiple instances of homelessness, arrest, incarceration, or hospitalization due to being off medication. If the person has that history, then the court, with all due-process protections, can order the person to six months of mandated and monitored treatment while he or she continues to live in the community. It doesn’t involve criminal justice, it doesn’t involve locking someone up or in-patient commitment, it’s less expensive, less restrictive, more humane. We should make more use of that.
TCR: However, according to your book, one of the main groups resisting solutions like assisted outpatient treatment and mental health courts are civil rights activists, who claim that such methods encroach on people’s rights.
DJ: I just don’t understand the opposition. It’s an anti-science, anti-common sense, anti-public and anti-patient position. Being psychotic is not a civil right to be protected; it’s an illness to be treated. They fail to understand that. People with mental illness lack the maturity of their faculties. They have an inability to exercise free will. We shouldn’t protect the civil rights of a person who thinks the devil planted a transmitter in his head and he has to shoot first or the devil will get him. We should be helping such people regain their ability to exercise free will.
TCR: In addition to being anti-patient, you point out that many today are also anti-medication.
DJ: In general, both the civil libertarians and the anti-psychiatry movement fail to differentiate between serious mental illness and people who need their mental wellness improved or have minor issues. So, a lot of what they say is true about those with minor mental health issues, but it’s not true about the seriously mentally ill. There are people with minor mental health issues who can get by without medications, but most of the seriously mentally ill, mainly those who are bipolar or suffering from schizophrenia, need medications in order to access other support.
While [they are] psychotic, no programs will accept them. However, it is true that medications have side effects, and those side effects can be devastating. No one’s denying that, and we need more research on it, but as a kind and compassionate society we have to help those who need help the most. What these groups are focused on are those who need help the least, and they are using them as the poster children for what we should be doing. There is clear evidence, mainly from deinstitutionalization, that medications help people. They got them out of the hospitals.
TCR: Most mental health facilities exist in prisons, and most incarcerated individuals who are mentally ill wind up worse when they come back out—and end up incarcerated again. How can we stop this revolving door?
DJ: One positive solution is community monitoring of people coming out of jails. One of the proposals that I make in the book is that there should be mandatory evaluation. We’re spending millions on outreach. We’re going to grammar schools and giving speeches and training people to identify the asymptomatic, but we know who the most seriously mentally ill are and who we should help: the ones who are most prone to homelessness, arrest, incarceration, or violence. There should be mandatory evaluation of everyone coming out of prisons or jails who used mental health services or needed [those] services while they were there, to see what they need to stay safe in the community. But we’re just releasing them and saying “time served.”
TCR: In one chapter, you advocate changing the Health Insurance Portability and Accountability Act (HIPAA). Why?
DJ: HIPAA is a patient confidentiality law and, depending on the state, once your child turns a certain age he or she is entitled to confidentiality. This means the parents can’t know what’s happening. How this plays out, frequently, is parents provide housing for a mentally ill kid or have placed him in a program that’s providing housing—and the kid goes missing. If the parent calls the program, the program can’t tell them the kid is missing. If they’re missing from their own house, and the parents call the hospitals, the hospital won’t tell them if they’re there.
This just happened recently to the former president of the New York State [organization of] chiefs of police who has a mentally ill kid who went missing from the program. Even though he’s a police chief, he still could not find out if his daughter was in a hospital when he called around. When your relative gets out, you’re not allowed know the diagnoses, what medications they’re on, what outpatient program they’re supposed to go to. [That means] parents can’t arrange transportation, can’t see that prescriptions are filled, or that appointments are kept.
The typical media story is “why didn’t the parents do anything?” People don’t realize that we have all the responsibility but none of the authority. If you’re providing housing, case management, and transportation services out of love, you should be able to get the same info that those that provide those services for money get. If I were an insurance company providing medications, I would be able to get that info.
TCR: One of the most surprising details of your book is that you strongly believe that this new administration will make positive steps towards change. Why?
DJ: On this issue, Republicans are a lot better. Democrats are willing to throw money at mental health, but aren’t willing to admit the politically incorrect things that are necessary to admit to help the seriously ill. Democrats won’t admit that some mentally ill are more violent than others, that not everyone recovers, that they are more violent than others, that some need hospitals, that involuntary commitment can be a good thing.
Republicans see this as a quality- of-life thing. They see homeless people eating out of dumpsters, they see jails fill up, and want to know why we’re not helping those people. The legislation aimed at helping the seriously mentally ill is mainly coming from republicans. I hate to admit it, I’m a Democrat, but we’ve been basically useless. We throw $100 million at children’s issues, and serious mental illness, schizophrenia and bipolar disorder, are mainly adult illnesses.
Suicide is a huge one. It’s exceedingly rare. We’re throwing a lot of resources at it that haven’t reduced suicide in any way, shape, or form, and we’re throwing them at kids who are the least likely to commit suicide. It’s primarily an adult illness. But kids are a sympathetic population and so they get greater resources. And that sympathetic population plays an important part in who gets served by government.
Isidoro Rodriguez is a contributing writer to The Crime Report. Readers’ comments are welcome.
Police around the country are learning how to step back from confrontations that can lead to tragedy. But additional reforms are needed to help divert individuals with serious and untreated mental illness from the justice system.
On December 19, 2013, a man stood on the ledge of a bridge in Spokane, Wash., threatening to jump. Responding officers knew that if they tried to grab him, he would step off the ledge and fall into the river below.
Instead, they spent almost 90 minutes listening and talking to him, in the hopes of calming him down. Their efforts at empathy worked. The man eventually allowed himself to be taken into custody. He was placed in an ambulance, and driven to a nearby hospital. The officer who talked him down rode to the hospital with him.
That story was retold by Frank Straub, currently Director of Strategic Studies for the Police Foundation, who was the police chief in Spokane when the incident occurred.
As he described it in a recent interview with TCR, responding officers lowered tension by turning off sirens and flashing lights that might have antagonized a person in acute distress. They approached the man slowly, instead of running to him, and kept a distance so that he didn’t feel threatened or crowded.
“It demonstrated that we were truly there to help this person, to help his family, to get him connected to services,” said Straub.
The patient, empathetic approach allowed the officers to obtain the man’s name, and gave them time to contact his mental health provider who, once involved in the conversation, was able to give cues on what and what not to say.
In hindsight, the steps Spokane officers used to talk the man off the ledge seem obvious. But many police departments around the country have only gradually begun to grapple with a problem that has challenged law enforcement, as well as courts and prisons, for decades: dealing with the justice-involved mentally ill.
According to a 2015 assessment by the National Institute of Mental Health, 18.5% of the U.S. population suffers from a mental illness in a given year. Of that number, 4% of the country’s population—roughly 9.8 million people—suffer from a serious mental illness, most commonly schizophrenia and treatment-resistant forms of bipolar disorder.
Of that 4%, more than two million go untreated. This last group is where most problems occur.
But any way you look at it, the relationship between the seriously mentally ill and law enforcement is a difficult one.
“When people ask, ‘Are the mentally ill more violent?’ they are usually asking about this group, the most seriously mentally ill,” said DJ Jaffe, founder of MentalIllnessPolicy.org, a think tank providing information about the care and treatment of people with serious mental illness.
Prone to criminality, as well as violence against themselves and others, the untreated mentally ill have been responsible for the deaths of 115 law enforcement officers since 2009, says Jaffe.
Adversely, of the 608 people killed by police this year, mental illness played a role in 144 of those deaths, as recorded by the Washington Post’s “Fatal Force” database.
However, in the last five years, departments across the country have begun to address the contentious nature of this relationship with new and extensive training methods that teach officers how to deal with individuals in mental health crisis and, hopefully, avoid violence.
“There has been a greater appreciation for the need for officers to be well versed in how to deal with people in crisis,” said Straub.
According to a 2016 report by the National Alliance on Mental Illness, CIT has been adopted by more than 35 states, with statewide initiatives in effect in Ohio, Georgia, Florida, Utah, and Kentucky.
Teaming with representatives from the mental health community, as well as experienced members of law enforcement, officers in the programs are trained to recognize the signs of a variety of mental illnesses and respond accordingly.
Where once law enforcement may have taken a confrontational approach to any tense interaction with the seriously mentally ill, today the officers learn to identify an observable pattern of mentally ill behavior and, in response, calm things down.
For Straub, the success of this training is exemplified by his own experience as chief of police in Spokane, where, after requiring that all 300 of his officers attend 40 hours of CIT, use-of-force incidents were reduced by 22% in 2014.
Susan Rahr, Executive Director of the Washington State Criminal Justice Training Commission and a former sheriff of Kings County in Washington State, is hoping to get similar results with a statewide law enforcement training program.
“What we’re trying to reinforce is [the need to] do everything else possible before you resort to deadly force,” said Rahr in a recent interview with TCR.
Like Straub, Rahr insists that officers must constantly attempt to position themselves so that they have the opportunity to calm a suspect down and de-escalate the situation.
At the Kings County Police Academy, she points out, 90% of that de-escalation practice is rooted in proper patrol tactics: not rushing into a situation and exposing yourself to a suspect’s gun or knife; maintaining distance between yourself and the suspect; and creating the time needed to assess the best course of action.
While Straub and Rahr agree that practical CIT practices represent some of the largest positive changes to law enforcement’s handling of the mentally in nearly 30 years, both admit that these methods alone are not enough to solve the problem that the seriously mentally ill represent.
The Larger Problem
Rahr argues that all elements of the justice system must work together to deal with persons in psychological crisis, from the moment they are pacified and taken into custody to treating their needs through courts and counseling.
“If there’s no place to take them except jail, we really haven’t gotten much better,” she said.
Most of the players in the criminal justice community agree.
The unavailability of hospital beds, the lack of treatment alternatives, and misallocation of federal funding are among the factors that ensure the seriously mentally ill wind up back on the street without access to the medications and treatments they need to stay out of harm’s way, according to mental health advocates.
“The big picture, over the last forty years, has to do with deinstitutionalization,” said Cheryl Roberts, Executive Director of the Greenburger Center for Social and Criminal Justice, a nonprofit organization advocating for justice reform, in an interview with TCR.
A byproduct of the Social Security Act of 1965, de-institutionalization was brought about by a provision called the “IMD exclusion,” which prohibits federal Medicaid payments for treatment in “Institutions of Mental Disease” larger than 16 beds.
Thus, states were incentivized to move patients out of state mental hospitals and into communities with no prior planning or resources to meet their needs. As a result, homelessness increased and, soon after, criminality ensued that was promptly followed by incarceration.
Today, such policies have led to the fact that the largest mental health facilities in the nation are, effectively, jails.
“We’ve really, over the last 40 years, had this trans-institutionalization from mental institutions, and other situations, into jails or prisons,” says Roberts, who stresses that most mentally ill offenders return from incarceration in worse condition than when they entered.
Even if a person is lucky enough to receive some medical attention and behavioral health care while incarcerated and, in some cases, even be stabilized, Roberts points out that when they come out there are often no adequate services available for them.
Members of both the mental health and criminal justice communities agree that incarceration of the mentally ill is not a solution and only “wastes taxpayer’s money.”
And it is the police who bear the brunt of the failure to develop a nationwide system of dealing with the serious mentally ill—and who are most often blamed when encounters go tragically wrong.
“The institution of policing is not designed for mental health treatment,” said Rahr.
“We inherit the failures of all the other systems and then when things don’t go well, the frontline officers become the target of people’s blame and anger.”
In response to these issues, there have been initiatives such as Stepping Up, which asks communities to come together to develop an action plan for achieving measurable impact in criminal justice systems across the country; and efforts by Pew Charitable Trusts, to help states develop alternatives to prison or jail for the mentally ill.
Steering the Mentally Ill Into Treatment
Called “diversion work,” the goal is to ensure that community health providers have the capacity to handle folks who are mentally ill and provide them with regimented treatment.
“Having this population go in, get more ill, and come back out is not serving anyone’s interests,” said Roberts.
It is this understanding of a general need for diversion alternatives to prison that lead her and the Greenburger Center to develop “Hope House on Cratona Park,” a first-of-its kind diversion option for people with serious mental illness who have been accused of felony level crimes.
Located on two adjacent properties in the New York borough of The Bronx, the model would be a pretrial diversion in which a mentally ill defendant, who is competent and obtains the approval of both the judge and district attorney, would be diverted ahead of trial to Hope House via a plea agreement for up to two years of treatment.
According to Roberts, judges and DA’s have been hesitant to divert this population of the mentally ill. They explain that if these individuals were to go to community facilities and decide to leave, the only way to get them back to court would be to arrest them.
This involves going to court, getting a bench warrant, and it taking several days/weeks/months to re-arrest that person.
Therefore, to streamline the process and guarantee security, the Greenburger Center will ask the court to place a bond on this person and hire bond agents to be trained and to be on site 24 hours a day.
However, the issue of bonded release is a red flag for those who consider any form of restriction on a person’s liberty due to inability to pay to be unconstitutional.
According to Cherise Fanno Burdeen, chief executive officer at the Pretrial Justice Institute, which advocates for an end to the cash bail system in this country, the Greenburger Center’s model may be merely shifting the insurance industry’s profit center to what she calls “treatment bonds,” thereby creating a system where a mentally ill person will have access to treatment only if they can afford bail; otherwise they stay in jail.
“People with mental illness take about five times longer to post money bail,” said Burdeen, in an interview with TCR.
“They are often estranged from their families or living on the street and they then end up spending more time in jail due to this money bond issue.”
Yet Roberts insists that, as the Greenburger Center moves forward with its model, they will avoid this issue entirely by advocating for lower money bonds. Judges would be asked to set bonds at $100 or less, and, if necessary, allowing individuals to pay the bond out of pocket or through expected donations.
Set to launch in 2018, Hope House seems to be a perfect model of progressive diversion tactics.It has received support from judges as well as the New York State District Attorneys Association.
Unfortunately, as with any potential reform in the treatment and care of the seriously mentally ill, it all comes down to funding.
“When there’s a gap in services, it’s because of a gap in funding,” said Roberts.
Such innovations have received law enforcement support.
According to Michael Biasotti, a former chief of the New Windsor (NY) Police Department and head of the New York State Chiefs of Police Committee on Untreated Serious Mental Illness, the funding for treatment centers is there.
However, incremental funds rarely make it to the seriously mentally ill, while cutbacks always do.
“There’s tons of funding if it’s used properly,” said Biasotti. “It’s about prioritizing the spending.”
As Biasotti points out, in the medical and law enforcement communities, situations are handled on a triage basis: you deal with most serious problem first. He insists that in the mental health community it is the opposite: Instead of dealing with the most serious issue first, millions of dollars are spent on treating people who are not seriously mentally ill.
In a 2016 article by Psychiatric Times, this sort of misallocation of funds has been connected to the established position of the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency with a budget of roughly $3.6 billion, that has been criticized as spending too much time and money on psychological programs that have little to no effect on the seriously mentally ill.
Thus, while people dealing with bullying, trauma, divorce, or depression have access to mental health plans, the seriously mentally ill are left with next to nothing.
“SAMHSA’s goal has been to increase everyone’s mental health, which is great, but first you need to deal with the ones that are truly suffering and really need the help,” said Biasotti.
Some progress has been made.
In 2016, as part of the 21st Century Cures Act, Senator John Cornyn (R-TX) added a provision that allows Department of Justice funds to be used for assisted outpatient treatment (AOT), under which courts can order somebody with a history of being arrested, violent, incarcerated, homeless, and hospitalized due to untreated mental illness to stay in treatment for at least six months while they continue to live in the community, according to an article by the National Review.
Moving From Response to Prevention
For Biasotti, AOT is the best possible solution. He argues that, while practices such as CIT, and pretrial diversion models such as the Greenburger Center and Hope House, are merely responsive, AOT is preventative.
As a result, according to a report by MentalIllnesspolicy.org, AOT has been shown to reduce violence, arrest, hospitalization, and incarceration of persons suffering from mental illness by 70%, thereby saving taxpayers 50% of the cost of care.
“AOT addresses the problem upstream,” said Biasotti. “It keeps the police from ever coming to your door.”
Endorsed by both the International Association for Chiefs of Police and the National Sheriff’s Association, AOT is considered to be a source of relief for law enforcement officers who, as a whole, agree that the criminal justice system is no place for the mentally ill, and are constantly frustrated by seeing the mentally ill that they bring to hospital psych centers for evaluation back on the street—sometimes hours later as a result of inefficient mental health practices and policies.
While changes to the mental health systems treatment and handling of the seriously mentally ill have occurred in fits and starts, they are, nonetheless, occurring.
Most recently, the Trump administration’s 2017 pick for the new head of SAMHSA, Dr. Elinore McCance-Katz, has attracted significant bipartisan approval.
Her first act? Shifting funds towards a more aggressive treatment of patients with severe psychiatric disorders.
However, the mental health system still has a long way to go in shifting both funds and attention to the small population of the mentally ill that, due to serious mental illness, either cause or experience violence in cities and towns across the country.
“There are officers that are killed by mentally ill people and mentally ill people killed by officers,” said Biasotti.
“The goal is to keep the two from meeting, by keeping the mentally ill person in some treatment protocol that doesn’t bring them to the attention of law enforcement.”
Isidoro Rodriguez is a contributing writer to The Crime Report. He welcomes readers’ comments.
Observations So the bottom line is that we can “manage” the probation population by limiting interactions. But unlike the advocates, I’m not going to tell you that it’s without a risk to public safety. The bottom line is that people caught up in criminal activity tend to continue their offending. The American criminal justice system […]