This excellent Mother Jones piece by Samantha Michaels pinpoints one of the worst ongoing atrocities in our criminal-justice system–the indefinite pre-trial incarceration of young mentally ill defendants. This broken system cries out for restorative, enlightened oversight at the federal level.
By the time he turned 15, Jesus G. was hearing voices and having suicidal thoughts. It was early 2013, and he’d been living at the Central Juvenile Hall in Los Angeles for more than a year, though he’d never been tried or found guilty of a crime.
In late 2011, Jesus’ younger brother accused him of molesting him, but Jesus denied the allegations. The clock stopped on his case months after that, when a doctor decided that, due to his hallucinations and immaturity, he wouldn’t understand what was happening in court.
As with adults, when a kid like Jesus is declared incompetent to stand trial, the state can detain him while trying to improve his mental functioning and knowledge of court procedures. But while California law limits the amount of time adults can be confined—often in hospitals—during this process, no such cap exists for children, who are regularly held in juvenile hall instead. As the months passed, Jesus and his attorneys wondered when he would ever get out.
In California and across much of the country, children with cognitive problems routinely languish in custody for months or years while judges determine whether they’ll be able to pick up the skills needed for a fair trial. Most states don’t have comprehensive programs to help these kids become “competent,” as the courts call it, referring to someone who has the ability to assist their attorney with their defense and possesses a solid understanding of the charges and proceedings against them. In one egregious case, according to a legal director at the National Juvenile Defender Center, children were asked to watch episodes of Law & Order to prepare for their trials.
According to California Assembly member Mark Stone, about 300 of the estimated 7,000 wards in California’s juvenile justice system last year were not getting the help they needed to become competent for trial. Now, lawmakers in Sacramento are considering a bill that would limit how long kids are detained after a judge finds them mentally unfit. And it would spell out the services they can receive to get up to speed. Gov. Jerry Brown vetoed a similar bill last year after critics protested that dangerous, emotionally unstable teens might be let loose.
But this year Stone hopes a compromise will be more palatable: In his new bill, most kids could be detained six months while trying to become mentally competent, but those accused of certain violent crimes could be held for 18 months. Some advocates say a year and a half is still far too long to hold a child without trial, but others say it’s a step in the right direction for a system that often feels haphazard at best and an absolute mess at worst.
Before he got to juvenile hall, Jesus was struggling at home. He’d recently moved to California with his mom and told adults at school he was depressed and wanted to die; he tried cutting his wrist because he claimed his stepdad abused him. At age 14, after he was locked up, a medical examiner found he was functioning in some ways like a six-year-old. “For him to understand the reality of what’s transpiring and understand the process, what people are doing with him and what he needs to do in his own defense…those are going to be difficult things for him,” the doctor told the court.
The fight for better juvenile competency laws has roots back in the 1990s. Across the country, a jump in homicides led to a superpredator panic, and delinquent teens were depicted as dangerous criminals. New laws made it easier for them to be transferred to the adult system, where a third strike could land them in prison for life.
By then, courts already had procedures for dealing with adults who weren’t mentally fit for trial, and many states started to apply the same standards to children. But that hasn’t worked out well, says Thomas Grisso, a psychologist in Massachusetts and a leading expert on these issues. Like adults, kids can struggle to understand court proceedings because of a mental illness or an intellectual disability. But many kids aren’t ready for trial simply because they’re immature. Their brains haven’t developed fully, or they haven’t picked up the average knowledge an adult would have about courts, Grisso says, so they require different types of services to get up to speed.
California does have a separate competency law for juveniles, and back in 2007 it was the first state to acknowledge that immaturity could make someone unfit for court. But since then it has lagged behind. “California ended up with one foot moving forward and the other one stuck in the mud,” says Janet Warren, a psychiatry professor at the University of Virginia who helped develop procedures in her state for juvenile competency that are now hailed as a model.
National guidelines written by Grisso and his colleague Kimberly Larson encourage lawmakers to keep kids in the least restrictive environment possible while they study to become competent—ideally at home. In California, however, “juvenile halls have become an unfortunate default holding place for incompetent youth,” public defenders in Los Angeles wrote in an amicus brief, noting that the state doesn’t use residential group homes enough. And California has no hospital beds for these kids, says Jim Salio, president of the Chief Probation Officers of California. “Because there’s no other place to house them, we end up with these minors in juvenile hall. They really should be in some other place.”
Experts recognize that locking them up can worsen their mental health problems, make them less likely to graduate high school, and boost their odds of committing crimes later. In 1972, the Supreme Court ruled it was unconstitutional to detain anyone indefinitely during treatment for competency problems; a person could not be “held more than the reasonable period of time,” the justices wrote. But what’s reasonable? In California, Salio says, some teens are held two or three years.
According to a study in Virginia, most kids can develop the skills needed for trial within three months by studying court procedures with an expert and receiving treatment for any mental health problems if needed. After six months, if a child has not become competent, it’s unlikely he ever will.
During his year-plus at juvenile hall, Jesus continued his schooling but received no services to prepare him for trial, his attorneys told the court, including no ongoing treatment to deal with his hallucinations, depression, and suicidal thoughts. The probation office explained a committee focused on competency programming was still “in the planning stages” and that Jesus probably couldn’t start until the following year.
Albert C., a 15-year-old accused of assault and gun possession, was also locked up in Los Angeles after a judge found him unfit for trial. His programming, according to an amicus brief, involved just 90 minutes a week of going over worksheets with court vocabulary, followed by a quiz. The person who administered the worksheets hadn’t graduated from college or received much training. “He was essentially warehoused for a year with no therapeutic services or treatment,” wrote the Pacific Juvenile Defender Center and local public defenders, noting that doctors recommended he take medicine for attention deficit hyperactivity disorder.
It doesn’t have to be that way. In Virginia, most kids with cognitive problems stay at home while they prepare for their trials. The state has hundreds of trained forensic evaluators who meet with them there a few times a week, typically over three to four months, using an individualized curriculum with interactive animated software, flashcards, workbooks, coloring books, board games, verbal conversation, and role playing. Florida, Louisiana, and Maryland also have comprehensive, state-wide programs for incompetent kids. But some states like California face pressure to spend their money on more hospital beds for the growing number of incompetent adults left languishing in jails. “To put juvenile competence as a financial burden on top of that makes me pessimistic about a lot of states suddenly getting on board,” Grisso says.
Virginia experts counter that it’s cheaper to do it their way. Warren estimates children in her state become fit for trial at a cost of about $5,000 each, while it takes $200 a day to detain a kid in juvenile hall and $600 a day to keep someone in a psychiatric facility. In other words, a few months of treatment and education could cost three and a half times more in juvie than at a kid’s home.
Jesus and Albert both fought their pretrial detention. Neither kid had much luck. Jesus was held in juvenile hall for about 16 months before he was finally released. Albert stayed for about a year until a judge declared him competent and he pleaded guilty to his crimes. In his case, a judge ruled that although local protocols suggested kids shouldn’t be held for more than about four months during competency treatment, that didn’t carry the force of law in California.
Last year, the California Legislature passed a bill that would have put a six-month cap into law, with support from the Chief Probation Officers of California, but the governor vetoed it amid concerns that kids with aggressive behavior would get out of custody too soon. Assembly member Stone tried to put more teeth into the bill this year, with a six-month cap for most kids and an 18-month cap for those accused of certain violent crimes, including murder and rape as well as certain acts of sexual abuse, like the ones Jesus was accused of.
The new bill would lay out the types of services that courts could consider for incompetent kids, things like therapy and medication instead of just workbooks with court vocabulary. And it would encourage courts to look for options besides juvenile hall while still considering public safety, and require them to dismiss the cases of incompetent kids who are only accused of misdemeanors. Lawmakers have until Friday to vote on the proposal.
In the meantime, children are waiting. Dale Major, an attorney in San Francisco, says one of his teen clients has spent about three years locked up without trial, spread out over multiple arrests, after being declared incompetent because of post-traumatic stress disorder, paranoia, attention deficit disorder, and developmental immaturity. “Even though he’s in juvenile court, he’s now 18, sitting in a county jail, getting no services,” he says. “The kid has had no childhood.”
Suicide has been a persistent problem in Montana — and it’s getting worse. Now, some who have lost loved ones are mobilizing to stop the deaths.
WOLF POINT, Mont. — Mourners in this small town in northeast Montana, where a strip of appliance shops and bars are dwarfed by vast ranches, packed into a church this month to pray for Michael Lee.
A week earlier, Michael, a 13-year-old who dreamed of playing for the NFL, had killed himself in his family’s red clapboard home. At the funeral on Aug. 3, a row of Michael’s middle-school football teammates sat behind his relatives and friends, wearing maroon jerseys and white armbands with “R.I.P.” handwritten on them. A handful of strangers were there, too; the funeral announcement said anyone affected by suicide was welcome.
That seems to include just about everybody in the state these days.
The church was silent as Colleen Timmins-Lee, Michael’s stepmother and a state trooper, rose to speak, trembling.
“If you or someone you know that you even think might be going through this, then please, please get them the help they need,” she said through tears. “Please, please just reach out and just tell one person and try to prevent another tragedy like this.”
For those who sat in the pews wiping their eyes, or who stood by the entrance of the church, where a table was covered in pamphlets on suicide prevention, the message was both urgent and familiar. Montana has the highest suicide rate of any state in the country, and while people here don’t often speak openly about sadness or loneliness, many have firsthand experience with loss.
That already included Michael’s family. Just over two years ago, his mother, Kimberley Evans, also died of suicide.
Afterward, Michael struggled. He saw counselors at a children’s mental health clinic in rural Wolf Point, but after it burned down last year, the closest available counselor was 50 miles away. Michael’s stepmother and his father, Frederick Lee, a patrol officer with the Montana Department of Transportation, couldn’t afford time off to take him there, and they said the counselors Michael had seen told them that he had improved.
Now, weeks after their son’s funeral, they were left wondering what else they could have done — and what Montana can do — to stop this from happening.
“When it comes to depression and suicide in our community,” Lee said, “it’s out of control.”
A GROWING CRISIS
Suicide has been a persistent problem in Montana — and it’s getting worse. The state saw 25.9 suicides for every 100,000 residents in 2016, nearly double the national average, according to Centers for Disease Control and Prevention data that is age-adjusted. Since 1999, that rate has risen 38 percent, even faster than the 30 percent national rise in suicides.
The challenges Montana faces are many. It’s sparsely populated — the fourth-largest state by area, it’s 44th in population, with just over a million people — and it has less than a quarter of the mental-health care providers required to serve its residents, according to the Health Resources and Services Administration. A strong gun culture and high rate of heavy alcohol consumption fuel the problem, as does lack of daylight in the winter and high altitude, which have both been linked to depression. And then there’s the stigma associated with reaching out for help, which many Montanans see as a sign of weakness.
“We have a perfect storm when it comes to suicide,” said Karl Rosston, suicide prevention coordinator for Montana’s Department of Public Health and Human Services. “We have a lot of factors that are all happening at the same time.”
Then, last year, came another blow: Facing a projected $227 million budget shortfall, Montana’s Republican-led legislature and Democratic governor made cuts to the state’s health department, including to mental health funding. As a result, more than 100 mental health professionals were laid off across the state and 10 rural health care programs were forced to close because they couldn’t afford to pay their employees, according to the Behavioral Health Alliance of Montana, an advocacy group for the state’s mental health providers.
Now, some who have lost loved ones to suicide — frustrated by the budget cuts and driven by the state’s urgent needs — are mobilizing to do whatever they can to stop the deaths. They are veterans and Native Americans, social workers and public health officials. They’re studying suicide prevention and opening clinics and speaking to students. But they still fear that, in many cases, their efforts will not be enough.
‘ONE IS TOO MANY’
When Ryan Ranalli was growing up in Helena, Montana’s capital, there was at least one suicide in his high school each year. Later, after he joined the military and served in Iraq as an Army infantry squad leader, he lost more friends to suicide. More than 200 Montana veterans killed themselves from 2013 to 2016, representing nearly a fifth of the state’s suicides in that time, according to the state Office of Vital Statistics.
“It’s one of those things, especially if you’re a male, not to ask for help,” Ranalli, 39, said. “People I served with, they don’t want to reach out and say ‘Hey, I’m having some problems, and I need to talk to somebody.’”
For Ranalli, the problems started in 2005 after several Army buddies in his unit were killed in Iraq, some by a bomb, others in a firefight. The same year, on his second deployment there, Ranalli was hit by a roadside bomb, ending his dream of a long Army career. He returned home with a traumatic brain injury, stuck in a cycle of nightmares, flashbacks, anger, depression and anxiety. The following year, two more friends died while fighting in Iraq. By 2012, Ranalli was overwhelmed by survivor’s guilt and frustration over his inability to rejoin the Army. One night, his wife found him in their garage, blackout drunk and attempting suicide.
“I felt like a burden,” he said. “I’ve seen what [suicide] does to families, but at the time, you just don’t think about it.”
Ranalli’s wife convinced him to get help, but it eventually became clear that the treatment he needed wasn’t available in Helena. There was a traveling VA clinic that came through once a month, but nothing permanent, so he underwent months of treatment out of state, in San Diego.
After his health improved and he returned home, Ranalli decided to channel his frustration with Montana’s mental health care shortfalls into action. He worked on a letter-writing campaign for a permanent veterans mental health clinic in his hometown, and this spring, the Helena Vet Center held its grand opening. So far, it’s provided over 1,055 mental health visits to nearly 150 veterans and family members. Ranalli is one of them; he receives treatment there for post-traumatic stress disorder.
In the fall, Ranalli, who has six children, plans to begin speaking about suicide prevention in local schools.
“To me, one is too many,” he said, “whether it’s a vet or a high school student.”
‘YOU LOSE A LOT’
At 19, Laurencia Starblanket, a member of the Salish Tribe, has already lost more than half a dozen close friends and relatives to suicide.
Nearly a decade ago, Starblanket’s aunt killed herself. Soon after, Starblanket’s grieving mother became addicted to pills, then heroin and methamphetamine, which has landed her in prison on and off.
Then Starblanket lost three friends, two cousins she called brothers and an uncle she considered a father figure — all died by suicide, all within the past two years.
“It’s hard. You lose a lot. A lot comes out of you,” said Starblanket, who lives in Arlee, a windswept town of about 600 on the Flathead Indian Reservation in the shadow of the Rocky Mountains. “After my [uncle] passed, I was just numb. I didn’t want to go to school. I didn’t want to do anything. I just laid in bed.”
A little over a year ago, after her cousin died, Starblanket started drinking for the first time and soon began considering suicide herself. Her family sent her to Canada to spend time with relatives, and when she returned home, she decided to go to school to study tribal governance so she could address the high suicide rate among Native Americans.
This year, after Starblanket came home, her younger sister attempted suicide. That only doubled Starblanket’s resolve. This summer, she worked as a camp counselor at a suicide prevention program at the Tribal Health Department in St. Ignatius, Montana.
“Ever since seeing my sister in a hospital bed because she wanted to kill herself,” Starblanket said, “I look at it as: I want to save someone else’s little sister.”
‘WE LITERALLY DON’T HAVE THE CAPACITY’
The mental health clinics serving Montana’s wide-flung communities were already struggling to meet the state’s growing needs. Then, over the course of 2017, the Department of Public Health and Human Services was hit with about $95 million in cuts, which resulted in the loss of at least as much money from federal matching funds, according to the Montana Budget & Policy Center, a nonprofit that analyzes budget issues and advocates for government investment in health care, education and the environment.
State officials declined to say how much of the health department cuts directly affected mental health services. But two cuts hit mental health care providers particularly hard. The state reduced the Medicaid reimbursement rate by 2.99 percent, which meant that clinics received less money when they treated low-income patients. And the state slashed Medicaid reimbursements for case managers by more than half, so that clinics receive $8.19 across the board, rather than $17.38 for children and $18.22 for adults, for every 15 minutes that case managers spend with their clients.
In response to the funding reductions, the Sunburst Community Services Foundation, a Montana nonprofit that offers mental health care as well as arts and education programs, cut anything that could be considered extra, from office supplies to training. Yet the organization is still losing about $60,000 a month and may close two of its six locations.
“They’re my people and I really care about them, but it’s like a fool’s errand,” Megan Bailey, a licensed clinical social worker who leads Sunburst’s program development, said of their clients. “We literally don’t have the capacity to hold this up any longer.”
Gov. Steve Bullock has said mental health is a priority for his administration. His office has released figures showing that mental health funding in the state has increased by millions of dollars since 2011, two years before he took office, even with the recent cuts. Still, Montana’s mental health budget lagged behind states with a comparable population from 2009 to 2015, according to data compiled by the National Alliance on Mental Illness.
Following a public backlash, including a lawsuit by the Montana Health Care Association, Bullock announced plans in July to restore funding for Medicaid reimbursements and partially restore Medicaid case manager funds. Those plans, including details on restoration amounts, will be made public by Sept. 1, the governor’s office said.
“Governor Bullock remains committed to fighting for Montanans and the essential services they deserve,” the governor’s office said in a statement. “He will again propose a budget that invests in mental health and ensures vulnerable Montanans have the health care they need. He will continue to engage in statewide partnerships to implement evidence-based programs aimed at reducing suicide in Montana.”
But struggling mental health care providers say that it may be too little, too late, and it would take years to reopen shuttered clinics and regain the community’s trust. In the meantime, Montana’s suicide toll continues to rise.
‘WE CAN’T WAIT FOR FUNDING’
Libby, Montana, is tucked between the Kaniksu and Kootenai National Forests, surrounded by mountain ranges crisscrossed with trails roamed by moose and bears. Reader’s Digest named it the state’s most charming small town this year.
But beneath the natural beauty is a growing frustration.
Libby is in Lincoln County, which has a population of nearly 20,000 but just one behavioral health employee, Amy Fantozzi, a graduate student who oversees the county’s contracts with medical providers who do mental health assessments.
The town had a clinic run by the nonprofit Western Montana Mental Health Center, the largest service provider in the region, which had 12 clinics serving 15,000 clients across 15 counties. But after the cuts were announced last year, the center laid off more than 60 case managers and shut down three clinics, including the one in Libby. That left hundreds of patients without access to therapy, medication and a case manager to check on them.
Now, when those patients are in crisis, their only option is the emergency room at Lincoln County’s lone hospital. Once they check in, Fantozzi gets a call, and she must decide whether to spend $100 of her $18,500 annual budget on a mental health assessment. Depending on the results, she could then spend an additional $300 to have the patient evaluated and involuntarily committed at the nearest mental institution 90 miles away.
There have yet to be any publicly reported deaths by suicide as a result of the local clinic’s closure, but county officials fear the current system of mental health triage won’t hold up.
“Right now it just feels like a Band-Aid on every patient,” said Jennifer McCully, 32, Lincoln County’s public health manager. “Is it going to work this time? Maybe, but we probably will see them again.”
On a recent Thursday morning, more than a dozen Lincoln County health officials, law enforcement officers, teachers, community leaders and medical providers gathered around a horseshoe of folding tables at Libby’s high school to discuss how to fill the gap left by the budget cuts. One idea was to create a list of people who may be at risk of suicide and deploy volunteers to check on them regularly.
“We can’t wait for funding,” said Liz Erickson, who provides faith-based counseling through the Libby Christian Church. “We cannot wait for the grant. We cannot wait for that help. We just have to start the dang thing ourselves.”
‘WE CAN’T GO BACK’
In Wolf Point, Michael Lee’s father and stepmother are grieving for their son, who would have started high school this fall. They are also urging everyone they know to reach out to those who may need help.
But they are well aware of Montana’s many challenges when it comes to suicide prevention, which Frederick Lee said made the recent mental health funding cuts all the more infuriating. “They’re cutting back things we need,” he said.
Lee hopes to help in any small way he can. He will soon begin a three-year course in a suicide prevention method known as QPR — which teaches participants to question, persuade and refer those thinking of suicide — so that he can train others in northeast Montana. And he plans to leave his job with the Department of Transportation to find work as a deputy in a school. He wants to talk to kids throughout the day and check in on them.
“If we had one more minute to talk to Michael about his depression, if we had one more minute to tell him that we loved him, maybe the depression wouldn’t have taken him,” Lee said, his voice breaking. “But we can’t go back. The problem is we have to go forward.”
Phil McCausland reported from Helena, Libby and St. Ignacius, Montana; Elizabeth Chuck reported from New York; Annie Flanagan reported from Wolf Point, Montana; and Mariana Keller reported from Missoula, Montana.
Below is the text of the talk I delivered to the 2018 conference of Pathways to Hope in San Antonio on Friday. Pathways is an exemplary nonprofit outreach organization that has set new standards for reclaiming and treating victims of mental illness and addiction.
Because of a last-minute scheduling conflict, the venue for my talk was shifted from an auditorium furnished with audio-visual recording equipment to one that lacked same.
In one sense, that is a good thing: people who are curious about what I had to say can find out without having to watch the image of my homely mug flapping its gums for half an hour.
In another, it is not so great.
I’d designed this talk as a forceful message—a call to arms, if you like—not only for the Pathways attendees but as a video document that could be distributed on the Internet to advocacy groups around the country, to access stations in towns and cities, to educational and religious groups, to judges and the law-enforcement community, and to state and federal political leaders with the power of policy-setting over our country’s broken mental-healthcare system.
My talk includes a look into the broken lives of two sufferers whose hellish plight epitomizes the rank obscenity of the ignorance, indifference, and neglect at the extreme edges of our judicial and municipal authorities. These victims’ images and encapsulated stories may be found near the end of my talk.
Finally, my remarks conclude with two proposals that will be difficult to achieve and can be fulfilled only via a sustained and broad-based outpouring of activist passion. One proposal is the enshrinement of mental-illness reform as the predominant civil-rights issue of our time. The other is the establishment of a new Cabinet-level federal department: the Department of Mental Healthcare.
I cannot overstate the urgency I feel for the necessity of these goals, and for our sustained witness of those unfortunate people who exemplify the atrocities in our dealings with the insane. Nor can I overstate the frustration I feel (I seldom mention this) at the societal inertia that enshrouds progress and muffles the voices of reform.
I realize that the remarks below are not for everyone. Except that they are.
TEXT OF MY TALK TO THE PATHWAYS TO HOPE CONFERENCE, AUGUST 24, SAN ANTONIO, TEXAS
My wife Honoree and I would like to thank you members of Pathways to Hope for inviting us to this enlightened and important conference.
We are grateful in particular to your inspirational president, Doug Beach; his associate the Rev. Carol Morehead, and their All-star array of board members. Including your great county judge Nelson Wolff, who has so brightly illuminated your path.
You have reached out to a couple of chilly Yankees from the People’s Democratic Republic of Vermont—and got us down here to enjoy a little sunny weather.
Honoree was actually kind of rattled yesterday when I read her the temperature here. I told her not to worry; it would probably warm up.
I hope you know how special you are. Three years ago Pathways to Hope did not exist. Today, you are a piston in a great city’s emergence as a dynamo of human reclamation: the reclamation of the most helpless and vulnerable and overlooked people among us. I speak of those who have been stricken with mental illness.
And I speak of the families and friends who have interrupted their lives and often their livelihoods to protect them.
Something big is going on here in San Antonio and Bexar County. Has been for a while. At about the time Pathways was getting organized, in December 2016, the Boston Globe had this to say about the civic revolution you were joining:
“San Antonio has done in Texas what Massachusetts has not come close to: making mental health care a community priority, a real system built with creativity, humanity, and sustained commitment. A national model, saving lives and money.”
And you are now a central part of this. Your work embodies what has come to be known as “the San Antonio way.”
Let’s examine what “the San Antonio way” means, for the benefit of those who are not aware of it.
It means a great and rare coming together. A spontaneous combustion of civic will that rebukes our long national apathy toward mental health reform. A galvanizing of public agencies and private businesses and healthcare providers and churches and ordinary people—teachers, volunteers, and victims of mental illness themselves. A drive to finally seize control of our broken care and judicial and enforcement systems that too often intervene in the shattered lives of afflicted people only to make things worse.
San Antonio has said “Enough of this! Let us intervene in these systems and rebuild them from the grass roots up!
And let me be more specific still:
In this city it has meant creating special mental health units within the police force: handpicked officers who are rigorously trained to ease themselves into crisis situations and tamp down psychotic behavior, using words and gestures instead of guns. Incredibly important!
It has meant achieving national prominence in the practice of jail diversion. Gilbert Gonzalez and his Bexar County mental health staff have used jail diversion to identify more than 20,000 people with serious mental illness and divert them from jail into treatment. It has saved Bexar County more than fifty million dollars and counting!
That is just incredible! Cost-efficient—and more importantly, humane! Why is the San Antonio Way not the American Way?
I want to help make that happen!
My tools are limited. I’m a bereaved father and a writer—not a policy-maker or a neuroscientist or the leader of a great movement. Just a writer.
But as Elie Weisel said, “Words can sometimes, in moments of grace, attain the quality of deeds.”
So let me pray for grace, and not mince words.
American mental health care today is in a crisis.
I will speak to you of this crisis, but I also want to speak through you . . . to all those Americans, good and solid citizens, who may not yet have been poked and prodded to see our mental illness crisis for what it really is.
It is a crisis that takes many forms:
It is a landscape . . . a landscape of humiliation and grief and ignorance and shame. A hell on earth for too many of the most helpless, the most dispossessed, the most misunderstood, the most feared, and too often the most brutally confined and punished for the crime of existing while insane.
The crisis is a graveyard . . . a graveyard of hope, where we bury our complacent myths of compassion and loving community. These qualities are just not evident in society’s dealings with the mentally ill.
And all too often, it is a literal graveyard—where we bury the bodies of our brothers and sisters—our sons and our daughters—whose lives have been needlessly sacrificed to the appalling indifference and outright cluelessness of the very institutions designed to protect them.
The crisis is a swampland: an economic swampland whose quicksand drains and drains our national treasury. America spends about as much as any country on mental healthcare. Around $230 billion a year, in federal, state, local and private funds. That is nearly twice the amount spent in 2012.
And we spend it worse than just about any country.
The great advocate and my friend Dj Jaffe lays it on the line: our government, spurred by lobbyists, pours money into treating high-functioning patients and on treatments that lack evidence.
I know that Pathways to Hope reaches out beyond the borders of chronic mental illness to help those with behavioral and addictive issues, and simple bad luck. Yet you take care of the core group, the chronically insane, as well.
But at the national level, Jaffe and others have a point.
The powerful blogger Pete Earley adds that we squander even more money by over-spending on emergency systems: jails and prisons, for example. Meanwhile, state mental hospitals are being closed.
Politicians love to build jails because voters think jails keep them safer. Politicians love to close hospitals because voters think this will save them tax money.
This gets it exactly backwards: housing an inmate with mental illness in jail costs $31,000 annually, while state and community mental health services cost about $10,000.
Folks, America is getting fleeced! And America can’t or won’t see it! And so it goes on: a jail is built. A hospital closes. Fewer beds. less care, treatment, and medication. But more cells. And hundreds of thousands of chronically ill people—bipolar and schizophrenia sufferers—go untreated because the money doesn’t stretch to them.
Now I want to move to an area of spending on mental illness that is even less examined than the squandering of public dollars—but is perhaps even more catastrophic and dangerous to our social fabric down at Ground Zero.
I’m talking about the uncounted millions of dollars sacrificed each year by private households. By families. By parents who have no choice but to empty their bank accounts and their life savings, and often quit their jobs, to protect an afflicted child from going under.
I can’t give you statistics. There are no reliable statistics; not yet.
But I can tell you a couple of stories. Stories that represent hundreds of thousands of similar stories. Stories that I use with permission from the mothers and wives who shared them on a private Facebook site.
“I have no way to go back and detail the cost to me and my family. I can say that the cost was tremendous. The expenses of traveling to the hospitals, the days lost at work because I had to be in the emergency room, or at a treatment team meeting, or in court. These things caused me to lose my job. More than once. So, how do you account for that? Thousands? Tens of thousands? And this is not counting paying for attorneys and doctors, neurologists and neuropsychologists. And medicine! And a locked safe to keep the medicine.
It’s tremendous, just a tremendous reality.”
This mother concludes:
“I retired way early because I am not able to work anymore.”
Here’s another, from the wife of an afflicted husband:
“Many years of paying rent and utilities before finally getting public assistance. Raising his children while his ex-wife recovered from breakdown due to his illness. Full time work cut to very part time, so I could be there for the grandchildren and to advocate endlessly for any kind of help.
Early retirement related to my own stress. Retirement pension a third of what it should have been. Paying for others to clean his apartments. Automobiles totaled at least twice. Expenses to keep him out of jail. Paying others to shovel out his filthy apartments so he doesn’t have his section 8 housing taken away. Vet bills for his dog. Transportation costs numerous times to get him home from yet another place he’s run away to. The long-term financial repercussions have been devastating.”
I think these two examples give us enough to think about. Or should.
So let’s move from the crisis of foolish spending into the crises of our hospitals, our caregivers, and criminal justice system itself.
America harbors two million, three hundred thousand incarcerated citizens at any given time. One-point-three million in state prisons. A little over half are serving time for violent crimes. The rest are in for property theft and drug convictions, and they should be somewhere else. Treatment, supervised community service. More humane, less expensive.
But no: lock ‘em up.
Jails and prisons breed psychosis like the Tropics breed mosquitos and grass breeds ticks. The Kaiser Foundation estimates that about eighteen percent of these populations live with serious mental illness. Serious meaning chronic. Incurable. Leaving the victim essentially helpless. I’m talking about schizophrenia. Bipolar affliction. And the rest of that happy little family. That amounts to three hundred eighty-three thousand insane inmates. Or about ten times the number of patients in our dwindling state hospitals.
I think everybody here can recite the following sentence in their sleep: “We are criminalizing mental illness.”
And yet, with the exceptions of certain oases such as San Antonio, we just keep on doing it.
We buy ever more cells, but never enough, and more solitary confinement: in my opinion, the cruelest, most unethical, most psychologically damaging and most worthless form of legalized torture in our criminal-justice system. Think of the descriptive nicknames: “The box.” “The hole.”
Yet jail inmates, most of whom have not been convicted of anything, keep getting shoved into solitary. Why? Because it’s there. A handy space in an over-crowded jail. And why are jails over-crowded? Mainly because of the stream of mentally ill kids who do not belong there. But are crowded out of hospitals.
Time in the box deepens psychosis. In Florida two years ago, a psychotic young man who’d been in solitary for two years tore off his penis with his bare hands.
One in eight jail prisoners in Florida lives in solitary. One in eight! About twelve thousand total. Out of eighty to a hundred thousand American inmates at any given time.
And the circle goes round and round. And solitary confinement goes on and on and on. Why? Because there is no substantial reform movement. So most Americans hardly ever give it a thought.
Solitary confinement is a national disgrace, and it must be abolished!
A couple more stories now. Stories have a moral force that statistics usually lack.
This from a mother whose brain-damaged son did some time in jail:
“First of all, everyone said that he should not be there. Doctors and other staff. It was known that he needed a real neuro psychological environment. To sum up years of suffering: The state knew, the state hospital knew, and no one did anything until I threatened a lawsuit, even then nothing, until I caught the division in a big lie with a brain injury facility.
The lack of training is unbelievable. State hospital employees don’t keep up with new findings, because they are not encouraged to do so. When I did find a good person, I made sure to tell the top administrator. Then that person was actually told not to talk to me anymore. Yes, buck passing and leaving my son to be secluded for years. I truly believe that the disdain is the word that tells our story. I would say to staff, ‘How can you sleep at night?’”
Listen to this message from the mother of a young psychotic son:
“One of the most shocking remarks said to me was when I tried to get our local hospital psych ward to keep our son over the 72-hour hold period. He was psychotic and refusing treatment. The nurse I pleaded with said, ‘You are his mother and he has a right to be crazy if he chooses.’”
This was said by a professional nurse in a hospital psychiatric ward. How many of you have heard variations of this remark?
Here’s another testimony from the mother of a psychotic child:
“The hotline sent two police officers to my house. When I asked them how they would approach the situation, one of the officers said, ‘If I feel threatened, I will shoot him.’ Based on this interaction, my husband and I declined their offer to do a ‘wellness check’ on my son.”
I will close off with two cases that have literally kept me awake at night. Because I cannot square either of them with any vision of an enlightened and just America.
Youknow about Tyler if you‘ve been reading this blog. I’ve written several times about him and his family. Tyler is the adopted son of Kimberlee and Dan West, two of the best and most civic-minded people I know.
Tyler was already suffering from brain-related afflictions when the Wests took him in as a small child. He is a small and dark-skinned and sweet-natured young man, and he has cognitive processing problems, including with language that is spoken to him. Later he was diagnosed with schizophrenia and autism.
These traits made him a target for repeated beatings in his childhood. Yet Tyler remained gentle, and developed talents for music composition and computer programming. He carried a comic doll around with him.
Still, his symptoms of psychosis deepened and he had trouble grasping reality. Two years ago, when Tyler was 16, he disappeared for about eleven hours with a 14-year-old girl. They both denied having sex, and no traces of semen were found. Still, a judged sentenced Tyler to five days in jail on a charge of statutory rape.
This sentence put Tyler in the crosshairs of local law enforcement. I will skip over several harmless misdemeanors and suicide attempts, not to mention futile efforts to have him civilly committed in a hospital or care center. Bed shortage, you see.
But I will tell you that Tyler’s brain continued to decompose. Disaster struck on a February night in 2017, when Tyler, in a mild psychotic state, wandered across his family’s lawn to a neighbor’s house, opened an unlocked door, and fell asleep on a sofa.
The neighbors discovered him and had him arrested on a charge of home invasion.
Tyler West entered the Muskegon County Jail on February 19, 2017, until June 29, 2018. Sixteen months, as his hearing date got postponement after postponement, During that time, he suffered concussions from at least four beatings from violent fellow inmates. He did stretches in solitary, and could be heard beating his head against a wall. He was deprived of regular medication.
Last June, Tyler finally got his sentencing hearing. The judge moved him to quarantine in a reception center for a month. He is now an inmate at the Richard A. Handlon Correctional Facility in Ionia, Michigan. Length of stay, undetermined. But he may be facing an 18-month sex offender class.
The whereabouts of Tyler’s comic doll are not known.
Okay, I have saved the worst for last. I ask you to please brace yourselves.
This is James Mark Rippee. He has lived on the streets of Vacaville, California, for nearly twelve years. He is schizophrenic. Thirty-one years ago, Mark Rippee suffered a motorcycle accident that left him blind, with head trauma, brain loss, and a shattered right leg that is kept in place with a metal rod. He has endured more than fifty surgeries. He is beaten and robbed regularly.
Mark Rippee’s brother and twin sisters cared for him for eighteen years, until they could no longer control his violent behavior. They have since petitioned every service agency available to them for help get Mark into a protected and therapeutic environment. Or at least a legal guardian, someone who would look after his finances and his needs for shelter, and food, and medical care, and safety.
Every agency has told them “No.”
The bedrock answer is that Mark Rippee has his RIGHTS!
He enjoys the “right,” the civil “right,” to refuse care and treatment. And in his disordered, shrunken state of reasoning, he exercises that right.
And that is all the caring agencies need to hear in order to turn their backs on this hopelessly brain-damaged man.
Here is Mark’s brother, Joseph Privatte.
“I have contacted lawyers, Adult Protective Services, The Public Defender, The Public Guardians Office, the police and fire departments, Mission Solano, five hospitals, several case workers, Laurel Creek Mental Health, the Vacaville Homeless Roundtable, the Solano County Health and Social Services Administration, the Vacaville mayor . . .”
..and he goes on. I’ve left out about half the agencies he has contacted.
And now listen to Mark’s sister, CJ Hanson, after she attended a meeting of the Solano County Board of Supervisors. They were seeking to have Mark designated as “gravely disabled” so that he could be involuntarily committed and receive protection from the county.
California law defines “gravely disabled as being unable to provide for one’s basic personal needs for food, clothing, or shelter.
The siblings’ mission failed. The Board of Supervisors, CJ told me in an email, “consider him self-sufficient if he can eat out of dumpster. They consider him self-reliant if he knows to cover himself with newspapers, or to sleep under a bush to try to stay warm. They consider him self-sufficient if he can panhandle.”
CJ wants to get the state to re-define what it means to be Gravely Disabled. “If my brother is not aware or capable of seeking medical attention, then he is not capable of being self-sufficient. The criteria now in use is archaic! It is disgusting! It is inhumane!”
And it is likely to remain in use for the foreseeable future.
I can’t predict the fate of Tyler West or James Mark Rippee. Or the tens of thousands of Tyler Wests and James Mark Rippees who suffer atrocities today because institutions of justice and reclamation have turned their backs. I’ll repeat it: suffer atrocities, in the landscape of ignorance and shame, the graveyard of hope, or the swampland of wasted resources, that make you wonder at times how far we have really progressed from the era of Bedlam Asylum in the London of the Fourteenth Century, where torture, demonic superstition, and shackles ruled the brief lives of the so-called idiots and lunatics and morons trapped inside its filthy cells.
I am tired of wondering. I am tired of passively complaining. I am tired of giving talks around the country that aim to stimulate the passion for reform, yet result generally in kindhearted applause and handshakes.
I am angry and frustrated, and I want action! I have chosen this gathering of Pathways to Hope as the occasion for two specific action proposals that I am willing to fight for, if enough committed people will rally along with me.
Proposal One is my call for the establishment of a federal Cabinet-level department, the Department of Mental Illness!
This Department will have broad powers of oversight and policymaking into federal, state and county levels of criminal justice: establishing and enforcing standards of education in mental illness among judges. Ensuring speedy trials for jail inmates and accountability in sentencing. Demanding accountability from jails in consistent, humane treatment and medication of inmates in psychosis.
And pursuing, with remorseless intent, the agenda of wiping out the great moral blight that continues to infect our jails, our prisons, and our claim as a civilized nation. I am talking about solitary confinement. It destroys minds! It does not rehabilitate! It is bestial! It must go!
That is Proposal One. A Cabinet-level Department of Mental Illness. Here is Proposal Two:
We must recognize mental healthcare for what it so clearly is: the civil rights issue of our time!
I’m not talking about symposia or a holiday or public-service commercials. I am talking about a national movement! Built around a charismatic figurehead. Someone who can ignite and fuel an ongoing national movement. A galvanizing male or female member of Congress, perhaps. A retired statesman. A member of the clergy. A leader from the world of business. Someone from the ranks of Project Hope. Or someone we have not yet heard of.
It is a civil right to live with hope and dignity. Other movements have recognized that and have broken through. Now it is our turn.
The novel was an indictment of cruelties visited upon American migrant farmworkers, traveling west to California to find survival work in the Great Depression.
One of its immortal passages described the shock—the sense of violation—that these starving migrant workers felt as they looked upon acres and acres of rich ripe fruits and vegetables that had been strewn across the land to rot, because the owners did not want to pay decent wages to the migrants for harvesting them.
Here is what Steinbeck wrote:
“There is a crime here that goes beyond denunciation. There is a sorrow here that weeping cannot symbolize. There is a failure here that topples all our successes.”
Do those lines remind you of anything going on today? We have work to do; the work of reclamation. Let’s get to it. Thank you.