Mentally Ill and Incarcerated

I am brother Cornell West, this is Chris Hages, I'm brothers of Clemente. Hey, what's up, this is Chuck D. Public Enemy Prophecy Rage, and this is News. Hey everybody, this is Manny Faces, producer and host of NewsP. Welcome and thanks for listening. So if I asked you to name the largest mental health facility in New York City, what would you say? Bellevue, Manhattan Psychiatric, Metropolitan Center for Mental Health, how about Rikers? Yeah, that'd be perfect, of course, you see, the largest mental health facilities in the United States are jails and prisons. With 1 in 7 federal and state prisoners of 14%, and 1 in 4 jail inmates are 26%, suffering serious psychological distress. In every county that operates its own jail and psychiatric facility, more people are incarcerated than receive treatment at a hospital. How much more, there are 10 times more people with a serious mental illness currently incarcerated than within state hospitals. So on any given day, for example, Rikers Island holds more men and women with mental illness than all of New York's psychiatric hospitals combined. And surprise, surprise, studies show the incarcerated mentally ill rarely get the help they so desperately need, and instead get worse. Zachaling the shocking truth for us on this episode is Leah Pope, Senior Research Fellow at the Nonprofit Vera Institute. John Snook, Executive Director of the Treatment Advocacy Center, and Homer Ventors, Physician, Epidemiologist, and Senior Health Justice Fellow, a community-oriented correctional health services. Ventors is the former Chief Medical Officer of New York City Jails, and is the author of the new book Life and Death in Rikers Island. Notting just absolutely devastating verses to all of this is New York-based hip-hop fusion artist, DJ, songwriter, educator, and one of newsbeats artists and residents, Liquid, aka, Fagrim. Now, as always, be sure to rate and review us if you dig what we're doing because every little bit of love helps. Once again, my name is Manny Faces on behalf of the entire newsbeat team, and more creative studios, we thank you for listening, sharing, and showing love. This is mentally ill and incarcerated. I think it's become a common refrain that our jails are our de facto mental health institutions in this country. It's definitely true because you go into any jail, and you're more likely to find someone with mental illness than you are in the community. This is what checking into America's largest mental health institution looks like. It's not an official role, but when 30% of people being shuttled around from cell to cell and locked away in this jail, I thought to have psychiatric problems that by default is what it's become. It's now thought there are more than three times the number of psychiatric patients incarcerated in America than are in hospitals. I think the criminalization of mental illness has a lot of underpinnings, and there are many explanations. One, certainly, is the history of institutionalization in this country, the fact that we close the massive numbers of psychiatric hospitals in this country and really never builds up the community treatment capacity that's required. But there are also other explanations. Police in this country often have too few resources to deal with people who are experiencing a mental health crisis. People are routinely picked up for misdemeanors and end up in cycles of criminal justice involvement. And so, we have a history of the criminal justice system kind of repeatedly failing people with mental illnesses. But I think it's also important to highlight that it's not just the criminal justice system. We have many other systems that have failed these people, including our mental health system. One of the big issues at the beginning of the United States was that people with mental illness were placed in jails and prisons, because there simply wasn't anywhere else to care for it. Somewhat ironic that that's where we've ended up again. Dorthia Dix really made it a point in Philadelphia and around the country to say we should be doing something more humane, that this is an illness and it should be treated as such. 1841 Here in this cell of the East Cambridge Jail for Women, a wild-eyed lunatic is hiding in the gloom. Bard from the simplest human decencies, she spends her days struggling against the chain that fastens her leg to the wall. Good morning, a young Sunday school teacher named Dorthia Dix catches sight of the mad woman when she visits the jail. Shocked, Dix gives up teaching and embarks on a journey to investigate the plight of the insane. That led to what we're known as the "silums" and if you think about the word "silum" it's gotten something of a negative context recently, but a "silum" is a word means a place that people can go and feel safe. And that was Dorthia Dix's plan was to have facilities that cared for people. After covering more than 10,000 miles by stage, steamboat and rail, she comes to Washington to build the case for reform. It is the mid-1800s and women have little political clout. But Dix works tirelessly out of this boarding house, lobbying Congress to build public hospitals for the disturbed. That lasted for, say, about 75 or 100 years. Then we started to get some really exciting advances with medicine, the Thorazine, and we got our first drugs that seemed like you could really begin to treat serious mental illness and provide people with the opportunity to come out of the institutions, to come out of those "silums" and get care in the community. And that was a real exciting moment because in many places, the "silums" had become what we're known as snake pets and the idea was that people were being taken advantage of. People were being put in there for all sorts of reasons, not related to any sort of illness. And when they were in there, they weren't getting very good treatment. Almost every American family at some stage will experience or has experienced, the case of mental affliction. We have to offer something more than crowded custodial care in our state institutions. Our task is to prevent these conditions. Our next is to treat them more effectively and sympathetically with patients on the community. Unfortunately, as we close down all those facilities, we didn't do a very good job replacing them with either community care or recognition that the illness requires something more than simply just community care in some instances. When you think about that, that makes sense. Mental illness is like any other illness. Sometimes, you need a period of impatient care in order to get stabilized. We didn't provide that. The lack of that, impatient care, combined with the lack of community care meant that people went into the systems that couldn't say no. And unfortunately, in most instances, what that meant is that people with mental illness ended up in jail's prisons. We know that people with mental illnesses are overrepresented at all stages of the criminal justice system. The latest federal data is from a survey that was fielded in 2011, so the data are actually quite old. It shows that one in four people in jail and one in seven people in prison meet the criteria for serious psychological distress. That's about three to five times higher than you find in the general population. So we know that the numbers are very high. Other studies suggest that around two million people with mental illnesses are entering jails every year. At the same time, the data are pretty problematic. So first, as I mentioned, the data are old. Second, the data are from the federal data are self-report, so that means we're actually don't know if these people have diagnoses from a psychiatrist or a medical professional. We just know that they're reporting symptoms that meet a certain criteria. So it has become a bigger and bigger issue as the problem has really increased. One of the big moments in time was a report that we did about a decade ago now that showed that there are ten times as many people with mental illness in a jail or prison as in the biggest hospital in that state. And so right now, if you look at it today, the biggest mental health providers across the country are the jails in our major cities. So Cook County in Illinois, Twin Towers in LA, and Rikers in New York. Those are effectively our largest mental health facility. [Music] Come with us to Riker's eye, Riker's eye, the biggest jail complex in America. A place haunted by its violent history, 8,000 inmates living in a kind of suspension, a shadow world. Riker's Island is a penal colony. We think of it as the jail system of New York City. There are eight or nine jails on the island itself, hundreds of buildings, all accessed by a single bridge that goes across. It operates both in a modern sense as the place where people are held, awaiting trial, and some people serving in shorter sentences. But in a very classical sense, it operates as a penal colony. What I mean by that is it is hidden and removed from the rest of the community. It's a place of long-standing, well-documented abuse and neglect that leads to injury, massive trauma for people, death, particularly people and their families from highly-policed communities, and it's a place that needs to be closed. For 85 years, Riker's Island has been the city's major lock-up, a troubled jail legions of problems. Now in and about face, Mayor de Blasio said he has decided to shut it down. New York City will close the Riker's Island jail for so long, it will take many years, it will take many tough decisions along the way, but it will happen. The intersection of serious mental illness and criminal justice contact is one that we know quite a bit about because we've worked hard to reduce the pipeline that takes law enforcement contact and results in arrest being held in jail and prosecution with crimes. The outcomes from the health standpoint can be quite serious. We know that people with serious mental illness stay longer in jail in prison because they have a difficult time advocating for themselves, participating in their own legal defense and they also often get substandard care that makes their mental health conditions worse and that prosecutors and judges are fearful, often unreasonably so or without any evidence of having people go back into the community. One of the central problems I see inside jails around the country, particularly county jails, is that the primary response to any behavioral problem behind bars is one of punishment that involves discipline and punishment. For people with mental illness and I see this virtually every time I go into a jail or prison, it involves locking somebody in a room by themselves, isolating them and punishing them. It sometimes also involves beating them, it often involves denying them access to their family, to medications, to things that we know would help them and it certainly involves less engagement and less treatment and more punishment. That central question of are you responding to people with treatment and engagement or with punishment and isolation? Really is kind of the hallmark for me of how these places confer very grave new health risk to people. We look quite closely at the issue of length of stay for people with and without behavioral health problems, after the deaths of Bradley Ballard and Jerome Murdo and we had a city-wide task force. The man's for answers tonight from the family of a mentally ill enemy who died at Rikers Island. 39-year-old Bradley Ballard. He's reportedly put in isolation for a week after he insulted a female guard. Seven days with little or no medication, meds that he needs. It's like Jerome Murdo who died five months after Ballard literally baked to death when equipment malfunctioned and no one noticed. The statement from the new commissioner of correction, the city needs to do better, increased coordination between the security staff, mental health professionals who are supposed to be monitoring mentally ill in it. One of the things we found is that people with behavioral health problems have a harder time getting everything else, even if we focus on getting them their behavioral health care, which is difficult to do. So they may have a hard time making it to court, they may also have a hard time getting their medical care so they may get sick physically. They may also have been through the system multiple times and there aren't good community alternatives for them or it's hard to find placement in community settings so that judges and prosecutors are fearful of diverting them or getting them into a community alternative to jail. The lack of community structures as alternatives is really an important part of undoing mass incarceration. We can reform care in the jail city or as we're doing right now in January, you can change how bail is used. Closing the aperture entry into the jails is one important innovation but we can't forget that these are communities people are coming from that are heavily policed and it really like basic mental health, behavioral health addiction, housing services, employment services and without pouring money into reinvesting those structures that have been destroyed. People will still be bumping up against law enforcement and they'll still be directed one way or the other into the jail setting. This and no, this and no present, no present, no if the patient gets cured, puts the rich in the pickle and the a come slow for the sick and temperamental. I'm often asked that question, how do you fix the system? I somewhat wish that the answer was more complicated than it was. We'd have more of an excuse for how bad the system is if it required really complicated systems to be designed and really difficult to prescribe medications or something like that and unfortunately that's really just not the case. We just simply haven't taken these illness seriously. What we need to do is pretty simple, basically you want a system that provides people a level of care they need before they're in crisis and so what that means is having effective treatment options for people, whether that's through expanding Medicaid to ensure people are getting the treatment they need and just having a continuum of services when someone is starting to deteriorate. Having it not be just a choice of inpatient hospitalization or the streets, having things like group care, living room options, basically just the sort of services you would expect for a chronic severe illness like serious mental illness. My work in particular and the work of the policing program and the substance use of mental health program at Vera has really been focused on this early intervention so we're thinking about in the community what can be done to prevent arrests and criminal justice involvement for people with mental illnesses to begin with, then what can be done at the point of arrest or the point of police contact and then what can be done at these really early stages of court proceedings. First, in terms of thinking about preventing arrests, we obviously need more treatment, we need especially more crisis response solutions that includes things like crisis response centers that have been developed in different places across the country that people can walk in from the community or the law enforcement can drop off. At Vera we've been working on a large national initiative called Serving Safely, which is an effort to improve police and prosecutor responses to people with mental illness. I think most folks don't understand what release from a jail looks like. In lots of communities release from a jail happens in the middle of the night, you know, you can be dropped off at midnight with bus fare. If you have a serious mental illness, the chances of you receiving effective care while you were in jail are very low. And the need for you to have what's known as a warm handoff, that idea of getting you into treatment when you're released from a jail is so vital, but it very rarely happens. And I think law enforcement has done a really good job of starting to step up and saying both we want to make this a more effective moment in time, that we want to start really having effective procedures in place, we want to have Medicaid suspended and so that we're able to get people back onto the Medicaid roles immediately upon release. And we want to make sure that we don't see these people again. At the end of the day, that's what happens too often is people are released without the care they need, something happens and they're immediately back in a jail or a prison. That doesn't help anybody. For me, given my work, the intersection of criminal justice and mental illness I think is one of the most troubling issues in the criminal justice system. I think that it is both under reported, under recognized and has generally failed from a lack of a match. imagination in terms of how to improve the situation. I think we're starting to see real change and communities coming together from both law enforcement and mental health, which is really what we need. We need collaboration to think about how to solve these problems. It's one system is not gonna solve them. I'm optimistic that communities across the country are really starting to collaborate and think about how to turn the tide on this issue. But I think historically, we've really lacked imagination in terms of responding to the problem. And I think most Americans have generally turned away from this issue. It's an out of sight, out of mind issue for many people. As more and more people are reckoning with mental illness in their communities and thinking about criminal justice reform in this country, I think mental illness and criminal justice is going to be an area of future innovation. [MUSIC] [BLANK_AUDIO]