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.
The fact is that Big Marijuana has been ready for some time. Now it is on the cusp of near-universal legalization in America. And that spells trouble, especially among the mentally ill, as we shall see.
But not just for the mentally ill. As we shall see.
Here is a quick annotation of what I mean by “trouble”:
To legalize, in our consumer-dominated society, is to legitimize. To legitimize is to strip away any considerations of risk—any considerations whatsoever, except price.
To legitimize, in short, is to commodify.
Consumers are paying for this particular commodity—this exciting new product being rolled out, or rolled up—in various ways. Some pay with their credit cards. Some pay with cash. Some pay with their sanity. Some pay with their lives.
As of September, twenty-nine states—three-fifths the total—and the District of Columbia have moved to legalize cannabis1 “Cannabis” is essentially the same as “marijuana,” a Latino variation. use under varying conditions. With a few exceptions on either side, only the Great Plains states, parts of the Midwest, and the Deep South have resisted legalization. The rules are complex in those states where it is approved. Many states, for instance, restrict it to medical use, as a relief for chronic pain.
Yet few players in what is now being called, without irony, “the industry” doubt that most if not all of these holdouts will eventually fall into line. And that the rules will relax. Some already are being flouted with impunity.
This is what happens when a “substance” becomes a commodity. Money begins to talk; and money, big money, is drowning out the rest of the conversation surrounding Big Marijuana.
The volume went all the way up to eleven when hip and youthful Colorado (2014) and then massive California (2016) became the fifth and sixth states to legalize pot for recreational use. California is expected to be issuing licenses for pot shops by January 1, 2018. Canada—Canada!—is working on legislation. The money people are lining up, clutching their open checkbooks.
They will be writing checks in the aggregate billions.
The “commodity” cachet of cannabis is being reinforced by such impeccably establishment periodicals as Forbes, which in May was pleased to advise its elite readers concerning “The Top 5 Financial Leaders in the Cannabis Industry.”
As the reporter Tristan Green wrote last July in the online magazine Finance: “It’s difficult to determine exactly how much money there is in the cannabis industry. A report from Forbes states that North American sales totaled $6.7 billion in 2016. Investors looking for an emerging industry that’s worth billions, doesn’t have stiff competition from major international companies, and is as close to a ‘sure thing’ as possible need look no further than cannabis. The Motley Fool expects a 300 percent increase in cannabis revenues, in the US alone, over the next five years. That figure could increase exponentially if more US States legalize cannabis for adult recreational use.”
I suppose I should say here that I don’t oppose marijuana use because I think it’s immoral. As a young Chicago journalist in the 1970s, I found it commonplace among the people I knew and liked. In my beloved adopted state, Vermont, I sometimes wonder whether the blue haze over the Green Mountains is mist or smoke. Yet I have never judged anyone on the basis of race, color, or tokes. Hell, I toked up myself. Once. It made me hungry for a pizza. I lost interest after that. In grass, not in pizza. Yet I was never “against” it. It was none of my business.
I’ve lately changed my mind. I have come to believe that marijuana poses a critical societal threat. Not to our morals, but to our public health—particularly the health of the mentally ill among us.
And the bedrock reason that it poses a critical threat? Commodification.
By this, I don’t mean to say simply that legalizing pot makes it easier to obtain. While that is certainly true, the deeper threat is more insidious, and more troubling. The deeper threat is increased potency. The cannabis on the market today is mind-altering on a scale far higher than the weed puffed by the counter-culture in the 1960s and 70s.
Cannabis’s main psychoactive component is tetrahydrocannabinol, commonly known as THC. You will find a variation of “cannabis” inside that name. Cannabinol is a chemical that interacts with receptors in the brain that are associated with pleasure. It is an adversary of dopamine, the neurotransmitter that controls (among other things) reward-motivated behavior. An overflow of dopamine, triggered by stress, trauma, or—oh—too much THC in the system—can produce psychosis.
(Because no two highly complex neurological systems are identical, some people—me, for example—are not as affected by THC as others.)
Over the long history of pot consumption, the THC level in cannabis plants averaged out to something under ten percent. This relatively benign percentage held through the years of love-beads and “Power to the People.”
That was then. In recent years, researchers have found that the THC in legalized-sale states is three times that percentage. This means that today’s puff produces a higher high—but also a threefold increase in the likelihood of psychosis due to interference with dopamine.
And this is not the only change in the plant. Another component of cannabis is cannabidiol, or CBD. This secretion, traditionally only 0.28 of each plant’s makeup, is responsible for marijuana’s cachet as a benefit to patients who suffer extreme pain. Legalization for medical purposes would be meaningless without it. CBD’s presence in the blood system reduces pain and anxiety. It also is found to block the psychotic potential of THC.
Guess what: lately, those same research projects have found that CBD’s average level has fallen from .028 to 0.15 percent.
What has happened to jack up the potency and lower the medical benefits of cannabis? Is it some abrupt shift in the evolution in the plant?
No. As I have heard public-relations people smirk after their company’s product gets a favorable story in a newspaper: “These things don’t happen by accident.”
The changes have happened because of selective breeding. Another name for this is “eugenics.” Marijuana growers are finding that more potent plants fetch more money from wholesalers. Among the leading wholesalers is Tardiv, Inc., of Boulder, Colorado, a startup in 2015 that now calls itself “the cannabis industry’s largest online wholesale marketplace.” (The acceleration of commodified weed can be grasped from the report of one market research firm Arcviewthat the cannabis “industry” generated $2.4 billion in sales in 2014, up 74% from 2013.) Tardiv, which keeps its profits a secret, advertises its mission as “To Make Wholesale Cannabis Trade Efficient, Easy & Secure.”
Secure from what?
Secure from being evaluated on its own demerits, for one thing. Big Marijuana is in its infancy compared to, say, Big Tobacco, Big Pharma, and Big Guns. Yet it is learning quickly from its elders.
Learning to turn liabilities into assets, for example: higher wholesale prices mean more cost to the consumer. But with this commodity, that’s not a problem. Higher bucks connote a higher high, not to mention the fantasy of elite consumption. And anyway, many smokers develop a tolerance for THC over time, and actually require ever-larger jolts. In this sense, marijuana is its own gateway drug.
Here some other adaptive skills that Big Marijuana has absorbed.
All of these strategies are important. None, perhaps, is as important as the manipulation of language to (further) neutralize activist opposition on public-health grounds. Big Marijuana has scrubbed its jargon clean of any usage that might summon thoughts of the product’s potential menace to human well-being and sanity, and replaced that usage with the antiseptic jargon of Corpspeak: “We connect investors and entrepreneurs to the deals and information they need to make the most of this emerging market.” “Cannabis, meet capital.” “Quality Products that Pave the Way for Mainstream Acceptance.”
And get this, for appropriation of the gilt-edged idiom of politesse:
“Snoop Dogg is one of the most revered figures in music, entertainment and more recently, a business pioneer in the cannabis sector. Over a respected career that stretches 25 years, his repertoire has turned him into a cultural icon across mediums. Snoop and business partner Ted Chung recently launched online media platform MERRY JANE, the definitive cultural destination for news and original content.” https://www.canopygrowth.com/
A capitalist juggernaut has formed and is rolling. Armed with its vast arsenal of persuasion; outfitted in the fine-woven haberdashery of Success; anointed with further legitimacy-by-association bequeathed by “progressive” billionaires such as George Soros and former Facebook chairman Steve Parker; dripping second-hand stardust from celebrity investors such as Roseanne Barr, Whoopi Goldberg, Melissa Etheridge, the inevitable Willie Nelson, and others, Big Pharma seems poised to overrun the rusting Maginot Line of social checks and balances: federal and state governments, regulators, educators, medical doctors and psychiatrists. It seems guaranteed to take its place among the rest of the ethically impervious Bigs: a massive Goliath striding forward, its path clear of natural enemies.
And yet a resistance remains in place. Across the country, determined local activists have dug in against the onslaught. They are armed with the flimsy-seeming small-bore weapons of medical research, demographic statistics, personal testimonies, and legal savvy. Their most valuable weapon, in the end, may prove to be what William Faulkner called “man’s puny, inexhaustible voice.” They are determined to prevail.
In some ensuing blogs, we will meet some of these Davids, and we will see what they have in their slingshots.
If neurochemistry can be thought to have a cruel side, it is evidenced in anosognosia. This loathsome side-effect of severe mental illness accompanies about fifty percent of all cases. As the link explains, it renders its victims incapable of understanding that they are afflicted, and prompts them to strongly resist doctors’ efforts to medicate them and, in cases of active psychosis, commit them to hospital treatment.
My family is acquainted with anosognosia and its lethal power.
Our younger son Kevin almost certainly was a victim of this ride-along predator, and it cost him his life. He accepted psychiatric treatment and medications for most of the three years after he was diagnosed with schizophrenia, yet never acknowledged the disease itself, insisting that it was merely a “condition.” Near the end, after he had been re-diagnosed with schizoaffective disorder he renounced medication of any kind. He hid the pills that we continued to insist he take, and committed suicide just days before his twenty-first birthday.
Kevin’s older brother Dean, stricken a few years after his sibling’s death, has been more fortunate. An enlightened psychiatrist observed Dean’s own resistance to intervention, and turned it to my son’s advantage: In brief, “Report to a clinician for a monthly antipsychotic injection, or be legally hospitalized when the inevitable psychosis erupts.” Dean has taken this carrot/stick choice seriously, and has significantly improved from his psychotic depths.
Now comes medical science (via the pharmaceutical industry) with a product designed to defeat anosognosia. The Food and Drug Administration has approved the digital modification of a popular oral medication, Abilify® (Aripiprazole, manufactured by Bristol-Myers Squibb). As explained in this New York Times story, each pill will be equipped with a digitalized sensor that can transmit electronic data to doctors and family members, reporting whether and when the patient took the medication.
The device will surely be welcomed by parents who have exhausted themselves begging in vain for their children to accept professional intervention, and watched helplessly as their children have refused, and deteriorated into deep psychosis, and sometimes, as with Kevin, death.
My own instinct (naturally) is to celebrate this promising solution to a scourge that would be called “evil” if there were sentience behind it. Yet reason tells me that celebration is premature.
An obvious roadblock to the product’s success is that those who most need it may not take it. If anosognosia leads SMI sufferers to resist acknowledging their illness, why would it not lead them to reject a medication that treats a “nonexistent” illness? (It should be noted that the digitalized medication will also be marketed to older sufferers of various discomforts who tend to forget taking their meds.)
Another barrier is popular distrust–legitimate distrust, to an overwhelming extent–of Big Pharma itself. The distrust has been earned.
Bristol-Myers Squibb is a part of a massive industry that has recently been rated as the second-most hated in America. (The top pariah varies from website to website. The far-flung electronic communications industry is often the No. 1 contender, or nolo contenderer.) Pharmaceutical companies raked in a composite global revenue of more than one trillion dollars in 2014. This ongoing bonanza has made them virtually impervious to the restraints of the law. In 2012, for instance, GlaxoSmithKline paid the U.S. Department of Justice three billion dollars in a false-claims settlement, the largest in the long and bloated history of penalties assessed Big Pharma. Bristol-Myers Squibb’s history of producing Abilify® has been tainted with lawsuits: the watchdog organization drugwatch reports that as of September, 365 actions were pending against the company. Most of them charged that Abilify’s® side-effects include compulsive tendencies toward gambling, eating, shopping and sex.
Big Pharma’s excesses are making headline news, and disrupting America’s social fabric, to this very day. The October 30 issue of the New Yorker carries a bold and searing investigative essay by the writer Patrick Radden Keefe. Keefe’s immersive journalism meticulously lays out the chain of greed, recklessness and “ruthless marketing” that led to our present opioid crisis. Keefe trains his sharp lens on the family of multi-generational philanthropists and drug entrepreneurs, the Sackler family, private owners of Purdue Pharma, which has built them a net worth of thirteen billion dollars, and which is responsible for the prescription painkiller OxyContin. OxyContin’s active ingredient, as most people now know (many of them through catastrophic experience) is oxycodone, a chemical similar to heroin.
Keefe reports that “Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.”
Chapter 15, “Antipsychotics,” in my book NO ONE CARES ABOUT CRAZY PEOPLE, covers the era of Big Pharma from the introduction of Thorazine in 1954 through our present time. The saga is one of proliferating medications, global expansion of companies, almost inconceivable profits, false claims, hidden or downplayed side-effects, and a corporate culture whose manifest amorality was damningly characterized by a former insider, quoted in the chapter, as fulfilling “the criteria for crime in U.S. law.”
Given the details that I have amassed, in this essay and in NO ONE CARES, covering the nearly 70 years of depredations that make up the worst of Big Pharma, it may seem surprising that I do not, out of hand, dismiss the introduction of digitalized Abilify. And the entire universe of antipsychotic pharmaceuticals along with it.
The reason I do not is at once simple and complex: many of them work. Or work for some patients, if not others. Or work in spite of their problematic side effects. Or work until they don’t work. Our vexed universe of care for the seriously mentally ill, even at its best, remains enshrouded in mystery, incomplete science, and human failing.
I believe that until the day that an infallible cure arrives, the advocates of intervention (including conditional support for new products such as digital Abilify, and strong support for laws that ease intervention’s barriers) must acknowledge that we take our stands in a world of risks. Some of the risks we advocate might result in more harm than good, or in harm, period.
But I also believe this: that the biggest risk of all is doing nothing. For this way lies madness.
Ray Weaver is a singer/songwriter whose daughter is afflicted. With his permission I am reposting his recent message on the private Facebook site CCAC. Never have I seen the many griefs and agonies of a parent expressed so compactly and so bursting with truth.
Ray’s words remind us, among many other things, that far too many Americans remain uneducated about the nature of serious mental illness. It is a genetic brain disease, beyond the control of the sufferer. Yet its effects can be stabilized by medications, therapy, and a loving environment.
Thank you, Ray, and peace to you and to her.
When you have a sick child, there is never a day off. Never. Every day. Waiting for the phone to ring. Trips to the hospital. Fear. Fear. Fear. Sadness. Regret. And yeah, anger. At them. At yourself. At the fucking world. My daughter tried to kill my own mother. Demons. She tried to stab them out to save mom-mom’s life. And so, my own family, my own sisters have washed their hands of her, and, because they cannot understand the sickness, the illness, they have turned their backs on me as well,
While in Providence to give a talk to the powerful advocacy group, the Mental Health Association of Rhode Island I stopped in for an interview with Molly O’Brien, a young and talented host for the innovative public-affairs webcast GoLocalProv. Here is the clip:
I have posted several blogs about the unconscionable jailhouse ordeal of Tyler West, the 18-year-old mental-illness sufferer who has been held in the Muskegon (MI) County Jail since February (!) while awaiting trial on a felony charge of breaking and entering. (He committed this offense early this year, walking into a neighbor’s house and falling asleep on a sofa while in a psychotic state.) Last week Tyler was beaten up by a violent inmate in a cell. It was the second beating he has endured.
Tyler has suffered unthinkably: deprivation of his medications for periods, stints in solitary confinement for no discernable reasons, and the one previous beating by an inmate. I cannot recall a case in which so much punitive state power and so much negligence for well being has ever been visited upon an ill and essentially peaceful young man. His adoptive parents, Dan and Kimberlee West, have held themselves together with remarkable fortitude as they have pleaded again and again for humane treatment and public recognition of Tyler’s torment.
The futility of finding help for Tyler–legal or through mass-media sources–rivals his ordeal itself in surreality. Together with many of you who read this blog, I have alerted media outlets in Michigan and an NPR program dedicated to investigative reporting. I am–we are–met with silence.
Kimberlee West herself updates the story in the message below, which I reprint with permission from the Circle of Comfort and Assistance Community website.
Please read it, and the letter she sent to the Muskegon County sheriff, and follow your conscience.
Wish with all of my being, I had nothing to post. Unfortunately, that is not the case. Our son Tyler was assaulted again, last week in jail. Tomorrow I will email another letter to Sheriff Poulin. Also I will bring forensic psych report into jail medical and to CMH. It is overwhelming. It is hard to carry on, when it has been one fire after another for the last 3 years. So hard to work like this. Ty has had struggles, but, this is a completely different matter. Admire all of you, who have been doing this year after year. This may be a ridiculous question because I already know the answer. How do ya all do it!? Hope one day we will have real choices! We told the sheriff several months prior, “Ty can’t protect himself”. Please do not place him with violent offenders. They are NEVER proactive! They mentioned placing him in security. What does that mean? Isolation!? The last week it has been hard to have a real conversation with Ty. He seems scared. He will barely talk to us. He fears he will be a snitch. Then someone else will get him. We found out during his video visit. We also noticed he had lost weight. Just wanted to reach through that computer and hug him, never letting go. Daddys and Mommys, if your kids and adult children are with you physically, hug them like there is no tomorrow. It is precious to have them near you! Even if you have rough days. Prayers ya all! Ty has a target on his back. Below is the letter to the sheriff. Hope I get it right?
Hello Sheriff Poulin,
We appreciate your quick response last time we emailed.
This is to inform you as of 10-31-2017, Tyler Daniel West,#131395, continues to be in your care at the Muskegon County Jail. We are Dan & Kimberlee West we are his parents, guardians and advocates. Should anything else happen to our son we hold you responsible for the damage/ or loss of life. We seek, for Ty to be moved to the appropriate pod. He was assaulted last week. Tyler is not violent. He has black eye and his neck, snapped back. He does not know how to fight. The last week he has has had a flat affect. Currently he does not feel safe? He is now a target in this unit. He is not street smart.
Ty was also, assaulted March 11, 2017. Ty has traumatic brain injury as he has sustained, several serious concussions. Tyler has Healthwest,(CMH) Dan Scanlan is his liason. Ty cannot protect himself, which means he is a danger to himself. Should he not be, in either a disabilities, medical/mental or handicap pod? His previous pod, he was safe. Tyler is autistic, and has a neurocognitive disability. He also has a Serious Mental Illness. He has intrusive auditory command hallucinations. Sensory integration disorder and ADHD. We will also send his recent Psychiatric report, from Dr. Harris. Tyler is only 18.
We thank you for your help and hope you have compassion to do the right thing for Ty.
Unless a national petition sponsored by an Arkansas social-justice group succeeds (see the bottom of this blog), the life of a hopelessly insane man will be extinguished by the Arkansas Department of Corrections on November 9, less than two weeks away at this writing.
Jack Greene was convicted of murder in 1991. Greene’s lifelong history of suffering abuse, organic brain damage, psychotic disorder, and intellectual impairment amount to traditional grounds for being spared the death penalty. That history cries out for psychiatric attention and, yes, perhaps lifelong confinement. But not death. Yet, as this essay by Jessica Brand of Injustice Today reveals, Greene’s legal representation has been spectacularly clueless and negligent. The jury in his capital murder trial never received evidence of the manifold damages to his brain.
Jack Greene is the embodiment of what can (and often does) happen when a state criminal-justice system loses its fundamental sense of justice. But he is also a maimed human being who does not deserve to die for the violence impelled by a deformed brain.
Please sign the petition below, and repost this–and help in the effort to ward off what Brand rightly calls “a stain on our country’s moral conscience.”
Commentary: “It Is So Loud Inside My Head”
The words of a mentally ill man the state of Arkansas hopes to execute on November 9th
“It is so loud inside my head. It feels like electrical impulses are going through my head all the time. If you took that pen and tapped it on the table I can feel it all the way down my spinal column. It is so loud inside my head.”
Those are Jack Greene’s words. He is the 62-year-old man that the state of Arkansas hopes to execute on November 9th for the 1991 killing of Sidney Burnett. Greene suffers from crippling psychiatric deficits, a possible intellectual disability, and a mental illness so severe that there are questions about his competency. He received such grossly inadequate representation at trial that the jury that sentenced him to death never heard of his devastating mental illness — a refrain all too familiar in capital cases. The state is aware of the glaring problems in Greene’s case, but it still hopes to execute him next month.
[t]he prolong and repeated injuries on me . . . by staff of the Ark. Dept. of Corrections with the deliberate permanent destruction of such vital bodily functioning organs that’s caused injuries so severe and traumaticly [sic] inflicted to my brain, head, left inner ear, etc. . . . for all of which is so painfully torturing and inhumane I can no longer humanly function properly and live with.
He believes that his ex-attorney, the prison warden, a nurse, and a prison guard have conspired together (in that “chronological order”) to destroy “these vital functioning organs,” and that they are also preventing him from being extradited to North Carolina, where he could receive adequate medical care. He thinks his looming execution is part of this conspiracy.
Doctors believe Greene has organic brain damage. He has had a serious head injury in the past, and neuropsychological testing reveals damage to his frontal lobes. Several experts who have examined him have diagnosed him with a psychotic disorder, and his current lawyers are certain he is not competent to be executed. He also might be intellectually disabled, a status that, like incompetence, would render him categorically ineligible for the death penalty.
Then there is the trauma and the familial mental illness visible in many of Greene’s relatives. Greene’s father killed himself when Greene was an infant. His mother would later overdose on pain pills, and his brother later shot himself. Greene’s grandfather physically abused him and his siblings, sometimes rubbing salt in the wounds he caused. Greene lived in a house with no running water, electricity, or plumbing. At eleven, his grandfather handed him over to a notorious state-run training school for boys. While there, Greene was sexually and physically abused.
The evidence described above is the type that often causes juries to spare someone’s life, according to the findings of the Capital Jury Project. But at Greene’s sentencing trial, his attorney did not put on a mental-health expert and he presented no other mental-health evidence, although the signs of his illness were readily apparent. Instead, to convince the jury to spare Greene’s life, his lawyer presented a measly 46 pages of testimony, 33 of which were read from a cold, emotionless, transcript from a prior proceeding.
What happened next is equally disturbing. During post-conviction proceedings, an expert found that Greene might be intellectually disabled but stated that he needed to do additional testing to confirm. Greene, insistent that his lawyers were conspiring to torture him, asked the district court to withdraw the claim. He accused the Federal Defender’s Office of “making [him] out to be some kind of incompetent retard to get their office appointed to [his] case and try and cover up crimes of inhumane injuries maim and torture.” The judge found Greene competent to abandon this potentially life-saving claim and withdrew it. No court has ever heard it.
Perhaps the most shocking thing in Mr. Greene’s case is that, with a little more than two weeks until the scheduled execution, he has yet to receive a hearing to determine whether he is competent for execution under U.S. Supreme Court precedent that bars the execution of persons who lack a rational understanding of the punishment they are to receive. Arkansas’s unusual statute gives the Director of the Department of Correction sole discretion in making competency determinations. This means that the same person who is in charge of carrying out Mr. Greene’s execution also gets to determine –without a fair and independent court hearing — if he is competent for execution.
If the state has its way, Jack Greene will join a group of four other men executed by Arkansas in 2017, a group that to a man suffered from the most debilitating illnesses and trauma and received the worst lawyers. Ledell Lee, who might have been intellectually disabled, had lawyers who tried to withdraw from his case, citing a “gross [ethical] conflict,” a drunk lawyer, a mentally ill lawyer, but never, until it was too late, a competent lawyer. Marcel Wayne Williams had a mother who pimped him out for sex at ten and who tortured him by pouring boiling water on him and covering him with tar; Kenneth Williams may well have been intellectually disabled; and Jack Jones suffered from extreme physical abuse, was brutally raped by strangers, and suffered from bipolar disorder. Juries never heard these stories because of ineffective lawyering.
What is happening in Arkansas is a stain on our country’s moral conscience. Under the Eighth Amendment, the death penalty is supposed to be reserved for the worst of the worst, society’s most culpable. The prosecutors’ continued push for death in the face of severe illness and trauma, never heard about by juries, flouts that constitutional promise. And each time a court allows a state to carry out the harshest of punishments on the most impaired and least represented, it mocks the promise of justice. Will a court finally recognize this reality and intervene? Or will Greene become another tragedy in a system that is completely and utterly broken?
Please watch the video below to learn more about Mr. Greene and share his story with friends.
Madeline and Terrie, you tried to put me wise to the special challenges of African-Americans who suffer from mental illness. You reached out to me as I began research on NO ONE CARES ABOUT CRAZY PEOPLE.
You provided me with sources. You tried to educate me. I promised you that I would look deeply into this topic in my book. But in the end, I did not look deeply enough.
Recognition of this truth arrived, appropriately enough, on Mental Health Day, October 10. It arrived in the form of a young woman in Cleveland, an African-American service-staff employee at the Intercontinental Hotel. It arrived just minutes after I’d finished addressing an exemplary civic group on—well, on the topic of education. Education about mental illness. How important this kind of education is.
It took a three-minute conversation with this soft-spoken young woman to make me realize that my own education has been incomplete.
This is a rich irony—or a well-deserved comeuppance, depending on your point of view. I wrote NO ONE CARES essentially as an effort at education. After schizophrenia invaded my family and attacked both my sons, triggering the suicide of one of them, my wife and I realized that we’d become citizens of a “sub-nation”: the largely opaque nation of the afflicted and their families. Years later, when I recovered my willpower, I decided to write the book as an attempt to widen public understanding (and my own) about the nature and the reach of serious mental illness. That, and to illuminate the gross deficiencies in the American systems of mental health-care, criminal justice, and political willpower in addressing the problem.
As I’d hoped, writing the book educated me—but incompletely, as I now understand.
It is not as though the book ignores the particular ordeal of mentally ill black Americans. At least the public symptoms of that ordeal. It covers the epidemic of fatal shootings, by police, of unarmed and psychotic black men on the street. It portrays the overcrowding of the nation’s jails by juveniles, mostly black, who have been charged with crimes but not yet tried; and the violence visited on them by wardens and guards.
All of this is important. Yet in merely evoking these familiar abuses, I failed to cross an elusive border: the border that defines the daily realities of a sub-nation within a sub-nation. The lives of African-Americans struggling with mental illness amounts to unknown territory—unknown, at least, to most white Americans, of which I am one.
I was ushered across that border in Cleveland on Mental Health Day.
My guide, the young service staff member, approached me just minutes after I had finished speaking at the annual luncheon of the Centers for Families and Children at the Intercontinental. (I am withholding her name. It’s a sad possibility that in these hair-trigger times, her employment could be jeopardized by the very fact that she spoke up to me about a racially charged public issue.)
The Centers deserves a moment of illumination here. It is a sterling civic institution. A nonprofit with an annual budget of $55 million, it reaches out to the poor, the hungry, the under-educated, the sick, and the troubled—some twenty-five thousand clients—in a city striving to overcome chronic post-industrial poverty entrenched racial tensions. The racial stress is burned into the city’s history along lines of segregation in its housing patterns: most of its black and poor population is concentrated in the near East Side, and most of its white population farther west. Cleveland’s incidents of fatal police gunplay in recent years, highlighted by the shooting of the 12-year-old Tamir Rice in 2014, have deepened black Cleveland’s distrust, bordering on paranoia, toward the mostly white police department.
Amidst these overwhelming challenges of poverty and racial unease, the Centers for Families and Children persists as a national model of enlightened civic service and hope. Its board chairman, the lawyer and businessman David E. Weiss, ranks among the most socially engaged civic leaders in the country. Its new director, Elizabeth Newman, has re-ignited its six hundred volunteers with her own passionate sense of mission: to help people find job opportunities and early-education conduits for their children, provide food for hungry families, dispatch pharmacists to households to help manage nutrition and medications, find treatment for substance abuse, and summon emergency services in crisis situations.
And to co-ordinate intervention and help in the crises of the mentally ill. Elizabeth Newman explained this cornerstone service to me in detail:
“The Centers is equipped to support people with serious mental illness, this skill set actually sets us apart in the community. We routinely assist people living with schizophrenia. We have psychiatrists on staff, in addition to relationships with the local/regional hospital systems and emergency rooms. In terms of onset of psychosis, we are outpatient providers but work in partnership with inpatient providers, so it really depends on the level of severity. Another agency in town runs the mobile crisis unit, but we receive referrals and connections to clients directly from that unit.”
Which brings me (in my round-about way) to the topic of this blog.
As mentioned, I had completed my remarks and was standing amidst the departing luncheon attendees when she emerged from the mix of people. She wore the brown uniform of the hotel’s service corps, and her manner was hesitant; yet it was clear that she had something she wanted to say.
What she said was, “Thank you for speaking about schizophrenia.”
I sensed the urgency behind this polite comment and asked her: “Is there a history in your family?”
She hesitated for a moment, as if trying to decide whether she could trust me with an answer, and then:
“My mother. And my brother.”
There is no way to prepare for a response like this, no matter how much you expect it, no matter how often it comes. One rule of thumb is to avoid “condolences.”
I asked her the only questions that seem fitting, and necessary:
“Are they getting treatment? Are they on medications?”
She smiled just a little before answering; and the smile should have told me everything I needed to know. But she spelled it out anyway.
“Black folks don’t like to get treatment. Black folks see it as a white man’s disease.”
While I was digesting this, she added: “Black men don’t like to talk about mental illness. They see it as a sign of weakness.”
And then, as if recognizing the need to explain the obvious to a blockhead (accurate, I suppose, in this instance): “So, no. They aren’t getting any treatment.”
And there it was: a key to the inner realities of a sub-sub-nation. The culturally learned set of attitudes that makes it all the harder for doctors and psychiatrists to intervene in the mental-illness crises of African-Americans. African-American men in particular, who routinely suffer violations of their self-respect, their safety, their very humanity, at the hands (and guns) of those who view them as inherently alien, dangerous, unworthy of inclusion in society.
Which, when you think about it, is exactly the same way that many people view the mentally ill in general.
I left the Intercontinental Hotel in Cleveland as the educated educator. I thought of my friends Madeline McCray and Terrie Williams, and about the exasperation they must have felt at my failure to cross that border. Felt silently, without rebuke, in the way many African-Americans experience the myopia of their white friends.
Back home, I sought to verify the viewpoint of the young service-worker at the Intercontinental in Cleveland. Below are some samples of what I came up with. There are more, many more, as a Google search of “African Americans mental illness” will show.
–That African Americans are 20 percent more likely to experience serious mental health problems than the general population, owing in part to the exceptional stress they experience just living their lives. The problems include major depression, attention deficit hyperactivity disorder, recourse to suicide, and post-traumatic stress disorder (this last because African Americans are especially likely to be victims of violent crime).
–That many black Americans misunderstand what a mental health condition is and don’t talk about it. Many thus believe that a mental health condition is a personal weakness punishment from God.
–That stigma—which knows no color lines—triggers especial reluctance among African Americans to discuss mental health issues and seek treatment.
–That a pervasive deficit of information—education—causes many African Americans to have trouble recognizing the symptoms of mental illness and to underestimating its dangers. Some may think of depression as “the blues” “or something to snap out of.”
This has been far from an easy blog entry for me to write. No one likes to own up to failures of understanding, especially in the fraught arena of of racial relations. As with NO ONE CARES ABOUT CRAZY PEOPLE itself, I at first resisted writing it at all. Then I decided I had to write it because it was the truth. I hope that it is read with an understanding that writers are often fallible—just like ordinary people.