How hospice became big business. A new investigation in The New Yorker reveals an industry that at times puts profits before patients.
Guest Host: Laura Knoy
President Barack Obama and some members of Congress are pushing for reforms in our criminal justice system. In particular, there’s bipartisan support to give judges more discretion in sentencing, but some say an even bigger problem is the fact that our jails and prisons are crowded with many people who don’t belong there in the first place. They pose no threat to public safety, but suffer from untreated mental illness. In some communities police, attorneys, judges and mental health service groups are working to change this: Join us to discuss new efforts to help people with mentally illness stay out of jail and get into treatment.
- Pete Earley Author of thirteen books. His best-seller: "Crazy: A Father's Search Through America's Mental Health Madness," was a finalist for a Pulitzer Prize in 2007. He is a former Washington Post reporter. His the father of an adult son diagnosed with bipolar disorder.
- Evelyn Lundberg Stratton Attorney, Vorys, Sater, Seymour and Pease former, justice Ohio Supreme Court
- Dr. Fred Osher Director of health systems and services policy, Council of State Governments Justice Center,
- Tom van Hemert Coordinator, Crisis Intervention Team, Thomas Jefferson Area, Virginia
Listen: What Schizophrenia Sounds Like
This audio file from the National Empowerment Center is used as a training tool for crisis response teams to better understand what those with mental illnesses hear in their minds. Courtesy of Tom van Hemert, coordinator of the Crisis Intervention Team in the Thomas Jefferson Area of Virginia.
MS. LAURA KNOYThanks for joining us. I'm Laura Knoy of New Hampshire Public Radio sitting in for Diane Rehm. Diane's on vacation. She'll be back next week. About 2 million Americans who suffer from mental illness are behind bars. Not because they are a threat to public safety, but because they aren't able to get the mental health services they need.
MS. LAURA KNOYJoining me talk about new efforts to help people with mental illness avoid incarceration and get treatment, Pete Earley, author and father of an adult son diagnosed with bipolar disorder, Tom van Hemert, coordinator of a crisis intervention team in the Thomas Jefferson area in Virginia. They join us in studio. Joining us by phone from Hudson, Ohio, Evelyn Lundberg Stratton, former Ohio Supreme Court justice, and by phone from New York City, Fred Osher of the Council of State Governments Justice Center. All of you, thank you so much for being with us. I appreciate it.
MR. PETE EARLEYThank you.
MR. TOM VAN HEMERTThank you.
DR. FRED OSHERThank you.
KNOYWe'll also hear from our listeners throughout the hour, call us at 800-433-8850. Email is firstname.lastname@example.org. Find us on Facebook or Twitter. Again, the number, 1-800-433-8850. And Fred Osher at the Council of State Governments, I did want to start with you for the big picture. What percent of people in jails and prisons suffer from mental illness, Fred?
OSHERWell, thank you, Laura. It's an overrepresentation of our population and that admitted to jails, 17 percent of individuals meet criteria for a serious mental illness. Breaking that down, that's a little over 14.5 percent of the men and 31 percent of the women. And that's four to eight times higher the rates -- the prevalence rates within the general population.
KNOYSo 17 percent of people, roughly, in prisons and jails, Fred, suffer from mental illness.
OSHERYes. Serious mental illnesses, those that are associated with disabling conditions. And as you had mentioned at the outset, there are about 2 million arrests each year, oftentimes for nonviolent misdemeanor offenses for individuals that might not require jail stays, but rather should have an opportunity to be linked to treatments within the community, assuming they pose no risk to public safety.
KNOYWell, and let's talk about that a little bit with you and everybody. Why are they, Fred, behind bars? I mean, what are some typical crimes that land people in jail?
OSHERWell, there may be offense related to their homeless condition, panhandling, shoplifting. There are also misdemeanor offenses related to some of the burglaries and more serious offenses. I do want to say that, you know, individuals with mental illness also do commit crimes for which segregation and punishment and accountability is appropriate, but we do want to insure that those individuals that don't require that, that don't pose a risk to public safety are given opportunities to be diverted to programs in the community to access the care that they need.
KNOYWell, and Pete, you wrote a bestselling book, as I said, about the experiences that your son, who suffers from bipolar disorder, had with that and your son did get involved in the criminal justice system. What happened?
EARLEYWell, we had two encounters, both preventable and both very tragic. The first time my son was sick, he was in college, which is very typical. These illnesses appear then. I rushed him to an emergency room in Fairfax County. He was, I considered, suicidal. We sat there for four hours. Finally, a doctor came in and basically said, look, you've been sitting here four hours. Nobody's in danger. Your son doesn't believe he's sick.
EARLEYHe thinks pills are poison. We can't do anything to treat him. He has a right to be crazy. You bring him back when he tries to hurt you or someone else. He slipped out of the house 48 hours later. He broke into a stranger's house. Luckily, no one was home. He broke in to take a bubble bath and he was arrested and charged with two felonies. So all of a sudden, he's now in the criminal justice system.
EARLEYTwo years later, when his probation ends, we were fortunate enough to get him on probation, he stopped taking his medication and I called a mobile response team. I said, my son's slipping again. This is what happened -- whoa, wait a minute. You can't judge him on what happened. Wait until he's dangerous. The night I called that team, I said, my son is violent. And they said, wait a minute, is he dangerous or violent?
EARLEYAnd I said violent. And, oh, we don't come if they're violent. You call the police. And two police officers came and shot him with a taser and took him away. Both of these were preventable incidents had we had a better jail diversion and a better mental health system.
KNOYWell, that's heart-breaking and it seems like this -- almost this push-pull of events that happened to you. You know, he would have trouble, but not enough to get him involved in the criminal justice system. It had to get terrible before you could get help.
EARLEYAnd this is pretty, you know, in the last nine years, I've been to every state but Mississippi and Hawaii. I've toured all these programs. I've spoken about mental health. And what you see is we have a Band-aid system. We wait until there's a tragedy. In Fairfax, Virginia, where I live, we've waited until a woman was -- died in the jail after being repeatedly tasered to finally say, hey, maybe we need crisis intervention team training. Maybe we need jail diversion.
EARLEYAnd that's a real tragedy, but this is what happens. In fact, crisis intervention team training originated out of Memphis after a white police officer shot to death a black man who had a mental illness. So tragedy leads to programs, unfortunately.
KNOYWell, and so that leads perfectly into you, Tom van Hemert. You are coordinator for a crisis intervention team in Virginia. What is a crisis intervention team and how common are they?
VAN HEMERTA CIT, a crisis intervention team, is a collaboration of the mental health and the law enforcement and medical systems all working together with a purpose to help somebody, when safe, when appropriate, to keep them out of the criminal justice system and get them the proper services that are available in the community. And CIT, since 1985, when Major Sam Cochran and Dr. DuPont first implemented CIT, has grown exponentially throughout the United States.
VAN HEMERTSo 10 years ago, we were the second CIT program in Virginia and now there's over 30 CIT programs in Virginia. So tremendous amount of support is coming in there. And Fred brings up a tremendous point about 17 percent of the inmate population have a serious mental illness and so it comes down to training. And so one out of five people that are being arrested have a serious mental illness and so what we've been doing is a training, which is basically a 40-hour training, that provides officers information, resources and understanding and knowledge of what it's like to have a mental illness and learning new techniques on how to deescalate a crisis situation to help that person be safe, keep the community safe and that officer safe.
KNOYWell, and we'll definitely get into, a little bit later, about how some of that training works with police officers 'cause they're so often the front lines of this. But just give us an example, if you could, please, Tom, of how this crisis intervention approach works. You know, someone calls, you know, for example Pete calls and says, my son's having a crisis. He's violent, but not dangerous, however you draw that line. So what do you guys do?
VAN HEMERTIt's all about approach and communication and working with that person and understanding somebody with a mental illness, that alters their perception, their behaviors, their actions. And it also -- you have to slow down the process so the last thing you want to do is escalate the situation and so we're teaching officers on better ways to deescalate the situation, give that person room, give them space, let them vent and then also, you know, developing better resources for them so the alternative isn't incarceration.
VAN HEMERTIn Virginia, we've been developing crisis assessment centers and that's where they can take somebody into the hospital and that officer can relieve custody of that person with another security officer and then they can be properly evaluated and get the treatment services. And so it's quicker, faster and better for everybody.
KNOYWell, and Evelyn Lundberg Stratton, I want to bring you in, too, especially drawing on your experience as a former justice on the Ohio State Supreme Court. I'm struck by the numbers that Fred and our other guests are giving us. One out of five people arrested have a mental illness. I wonder what you saw in terms of that trend during your time on the court.
MS. EVELYN LUNDBERG STRATTONWell, I first encountered it when I was a trial judge. I grew up as a missionary kid in Thailand, came here when I was 18, never had any real exposure to mental illness of any sort until I became a trial judge. And then, so many of the people that were before me had serious mental health issues, but I foolishly thought, well, if I can put them in jail, they'll get some treatment, not understanding that that was probably one of the worst things I could do because we're not equipped to be mental health hospitals.
MS. EVELYN LUNDBERG STRATTONSo I became very, very interested in the issue. I got involved in community correction reform work and then, when I joined the Supreme Court seven years later, I decided I wanted to try to do something. And I'd heard about a project called a Mental Health Court. Two judges in Ohio, six in the country, were doing it and it was a different way of trying to deal with an arrest involving a person with mental illness.
MS. EVELYN LUNDBERG STRATTONIn a regular situation, you can say to someone, I'm going to give you two weeks, six months, three years, whatever and put you on probation. You need to go get mental health treatment 'cause you've never been properly diagnosed. You need drug and alcohol. You need a house. You need a job. And they go right back under the bridge and they're arrested again. So they cycle in an out. They're what we call frequent user of the system. Sometimes about 10 percent of those people used 70 percent of the resources in the community, dealing with crises.
MS. EVELYN LUNDBERG STRATTONIn the Mental Health Court, the judge calls the team together and says, listen, we need to deal with this person as a whole. We've got to get him diagnosed. We need a home so they can stay because it doesn't do any good to treat them and put them under the bridge. We need to figure out where we have resources for treatment. And the judge becomes a convener in pulling the community together and CIT is a crucial part of that because you want to try to get them not arrested in the beginning, rather than arrested.
MS. EVELYN LUNDBERG STRATTONSo the CIT crisis person becomes a very important part of that team concept.
KNOYSo you're almost acting like a social worker, Evelyn.
STRATTONA lot of judges would -- were very resistant at first to this because of that label and then they were like, hey, they're already in our court. They're already our problem. If we don’t do something, we're going to see them again and again and again and use up all our resources and not have any better outcomes. So judges have really stepped up to the plate and taken some leadership in this.
KNOYAll right. Well, coming up, we'll learn more about crisis intervention training, also about the Mental Health Courts that Evelyn talks about and we'll take you questions and comments about mental illness and the criminal justice system. So stay with us.
KNOYWelcome back. I'm Laura Know sitting in for Diane Rehm. We're talking this hour about new efforts to help people with mental illness avoid incarceration. Let's hear from you, 1-800-433-8850. Send us an email, email@example.com. Find us on Facebook, send us a Tweet. Our guests are Pete Earley, author of 13 books, including his best-seller, "Crazy: A Father's Search Through America's Mental Health Madness." Also with us in studio, Tom van Hemert, coordinator of the Crisis Intervention Team in the Thomas Jefferson Area in Virginia. By phone, Evelyn Lundberg Stratton, an attorney in private practice and a former Ohio Supreme Court Justice.
KNOYAnd Fred Osher, director for health systems and service policy for the Council of State Governments Justice Center. One more time, you can join us with your questions and comments and perhaps personal experiences with this issue. 1-800-433-8850. And all of you, before we go to our callers, Pete, I wanted to also hear from you on this idea of a Crisis Intervention Team and how that might have helped your struggles with your own son.
EARLEYWell, thank you very much. I just explained a few minutes ago how, when my son became violent, the police were called. They showed up and they get very authoritative, in your face, I'm in charge and ended up tasering him twice and hauling him away, which is of course what I didn't want. Several years...
KNOYThat must have been heartbreaking for you to see, by the way.
EARLEYIt was. Yeah. Because you're calling -- and I was just lucky that he didn't get shot. I mean, he ran from the police and he got tasered. And as we know now, that could have been fatal. And he had not done anything wrong. It was his illness that was causing this. Two years passed. My son again goes off his medication. This time he checks himself into a safe house. He gets up in the middle of the night. He is psychotic. He takes off his clothes, because he thinks that will make him invisible, and he walks out on the street in the middle of the night. But listen to what happened. A CIT-trained officer picked him up. And that officer said to him -- treated him with respect. Did not approach him with the in-your-face, I'm-a-cop attitude.
EARLEYAnd he -- my son said, "Listen, I haven't broken any laws. I know I'm sick. Don't handcuff me. That's when I ran last time. I'm not a criminal." And the guy used his discretion. He said, "Well, you don't seem like you're that violent or upset. Just get in the back of the police car." And he treated him with respect and my son actually thanked him when they got to the hospital. And just that -- treating a person with respect and listening to them, what a difference between getting tasered and then getting taken to a place where he could get help.
KNOYAlthough your son...
EARLEYNow that's CIT training.
KNOYYour son had the wherewithal, too, though. He played a role to say, "Look, you know."
EARLEYWell, this is important because a lot of people think, if somebody is psychotic, they're completely out of control. And that's not necessarily true. You can -- I know people who are hearing voices who are driving cars, who are walking around. You may think there's an alien in someone's body, but that doesn't mean that you're foaming at the mouth and all these negative images we have of people with mental illness. I spent three months with the homeless. One of the fellows I spent with, he'd talk to you perfectly about everything until he talked about the mazers (sp?) which the CIA were sending into his brain. So we have this misconception that if you have a serious mental illness that you're constantly psychotic. And it's just not true.
KNOYWell and, Tom, as part of the training that you do with police officers, you try to give them a sense of what it is like to have voices in your head. How does that help officers better respond to these crisis situations?
VAN HEMERTWe do an exercise called, hearing voices. And it was produced by Dr. Pat Deegan, who is a clinical psychologist down in Florida. And she also has auditory schizophrenia. And she put together this recording of sounds and voices of what somebody might hear with auditory schizophrenia. And so for 45 minutes, the officers listen to this recording.
KNOYWow, 45 minutes.
VAN HEMERTAnd it's extremely exhausting, negative, anxiety rising and it is almost painful. And during that time, while they're listening to this, they are required to follow simple exercises that I lead them in: reading, writing, word-find exercises, simple math exercises.
KNOYSomething they could easily do normally.
VAN HEMERTHands down. And with that, they completely fail. And so they now are getting a better understanding and empathy and respect for the pain and suffering that somebody might have with that.
KNOYWell, you brought along a little bit of that training tape. Now we won't play the whole 45 minutes, obviously. But let's just hear a little bit of it to give us a sense of, what's that like?
KNOYWow. Pete Earley, that's terrifying. Yeah, I, you know, those of us who love someone with mental illness suffer in a sense that we feel badly, we want to help, and often society doesn't let us help our loved ones. But the people who really suffer are the people who have these severe mental illnesses. My son -- the hardest thing for him, why he kept going off his medicine, was accepting that his brain was broken and realizing that he needed help. Because society tells you that you're less of a person if you have a broken brain.
KNOYRight. You should be strong. You should be tough. You shouldn't need a pill to make yourself okay.
EARLEYExactly. You're right.
KNOYAll right. Well, lots of questions and comments from our listeners. Again, you can join us. 1-800-433-8850. Send us an email, firstname.lastname@example.org. And let's go to New Harmony, Ind. Nathan is on the air. Hi, Nathan. Go ahead.
NATHANGood morning. It's a good subject. My question is, has the trend away from state hospitals led to an increase in folks with serious mental illnesses being incarcerated?
KNOYYeah, it's a great question, Nathan. And I think I'll turn to you Fred, with the Council of State Governments, first. People do say that the deinstitutionalization trend that we saw in the, you know, '70s and '80s, led to jails and prisons becoming the de facto replacement for these institutions. What do you think, Fred?
OSHERYeah, a great question from the listener. And it is certainly the case that our state hospital population has shrunk from a high in the '60s of close to 600,000 to close to 50,000 now. It is the case that many people that need access to that level of care, have a difficult time finding it. And so while there is not a direct correlation between deinstitutionalization and the (word?) increase in population, there is a relationship. And I think what's most important is that the institutions provided a range of services for these individuals and supports and housing and food and clothing, that was supposed to follow them back into the community and the funds were supposed to go there.
OSHERBut there, unfortunately, wasn't that sort of availability of resources to support individuals within these community settings. We wouldn't want the only solution to be an expansion of our state hospitals. We understand that individuals with the appropriate supports and services can live successfully in our communities and proceed on their recovery paths.
KNOYHow well do you see states, you know, getting a grip on this -- on the fact that you hear complaints from corrections officials all the time, you know, help us out with this problem. How much do you see states, right now, Fred, finally saying "Okay, maybe the prisons and jails aren't the best place to provide mental health treatment"?
OSHERYou know, Laura, that is a movement that we are aware of at this point in time. And there is a lot of traction towards alternatives to incarceration for people that don't pose a public safety risk. There is, at the county level -- where the front door to the criminal justice system are our jails -- interest on the part of county officials to reduce the number of individuals with mental illness, related to the high costs associated with them and the terrible outcomes that are associated with that approach.
OSHERThere has been a coalition of forces that have been brought together -- the Justice Center working along with the National Association of Counties, the American Psychiatric Association Foundation, National Alliance for the Mentally Ill, and federal partners such as the Bureau of Justice Assistance -- to sponsor what we call a Stepping Up initiative, where we're calling on all counties to sign resolutions, to target the high numbers of individuals with mental illness in their jails and to employ many of the innovations that you're hearing about on this program, including the specialized police-based responses, specialty courts, support on reentry, to achieve the ultimate goal of reducing the numbers.
OSHERAnd we believe the dialog is in a place, the partners and their constituents are at the ready, and we have a really important moment in time to assist the alternatives to incarceration for so many people, like Pete's son, that don't need to be there, but rather need to be connected to their services.
KNOYWell and, Evelyn, we keep talking about people incarcerated with mental illness, even though they pose no threat to public safety. How do judges determine whether that person isn't a threat to public safety. For example, I'm thinking about, you know, Pete's son, and he broke into someone's house and started taking a bath. And, no, he didn't intend to hurt anybody. But if it was my house, I'd be darned scared that, you know, your son had broken in. So, Evelyn, how do we make that determination, in the interest of public safety as well?
STRATTONWe do it a couple of different ways. I've been very involved in the Stepping Up program that Dr. Osher talked about where we try to identify when they first come into jail, when they're first arrested, when they're first in pretrial, do they have a history of mental health issues. And then we're encouraging the development of a tool called the Risk-Needs-Response model, where we look at the risk assessment. If they're under their -- taking their medication, if they're under treatment, do these symptoms go away? Are they fine to get back into the community. Why do we need to keep them in jail twice as long as we keep anyone else we arrest for the same crime? Why do we need to do some of these things?
STRATTONSo a lot of it involves use of the mental health court. But that can only reach a small population of the most seriously ill. We are trying very hard to educate judges to understand mental illnesses, to understand the treatment options, to understand that these people generally are not violent. They may have symptoms that we can interpret that way but not really that's what they're about. And if we deal with their illness upon release rather than just release them and let them cycle back through, then we start reducing the jail population, which is the Stepping Up program, and consequently the prison population as well.
STRATTONSo it's a united effort between judges, the community, CIT, leading research institutes, funders, groups like CSG and the National Association of County Organizations -- people who all are coming together to try to change the paradigm and put treatment back in the community instead of in the jails and prisons.
KNOYLet's take another call. This is Jane in East Lansing, Mich. Hi, Jane, you're on "The Diane Rehm Show." Welcome.
JANEYes, thank you. Thank you.
KNOYGo ahead, Jane.
JANEI was calling -- yes. I was calling today because the former Supreme Court judge was talking about mental health court. And we have a very new program in the Michigan area that I had a personal experience with about a year-and-a-half ago, when my son, who is bipolar, was arrested for a (word?) of something that was very, very small. But he cycled through this court. And I was so impressed with the team that was put together, with the thoroughness of the background information that they collected, with their interviews with my son. And then, further along, with Judge Boyd (sp?) , so sat, you know, sat in the seat and evaluated these young people and put them on the right road. It was just a very positive experience.
KNOYWow. So the mental health court really helped you and your son and your family get on the right path, Jane.
JANEIt really did. He -- there was a system set up so that my son was being seen regularly by a parole officer specifically identified with this court. There were also individuals who had degrees in social work and psychology, who were available to him if something were to happen. He also had to, as in regular experience (word?) , he had to go and do drops. And it was all coordinately seamlessly through this court.
KNOYJane, thanks a lot for calling in. And I'm Laura Knoy. You're listening to "The Diane Rehm Show." Again, if you'd like to join us, call 1-800-433-8850. Send us an email to email@example.com. Follow us on Facebook or send us a Tweet. And, Fred, to you, you know, and Jane talked about the mental health court and how wonderful it was for her son. All those people, she said, who helped her through the various steps of the process. Who typically pays for all that help?
OSHERYou know, the help oftentimes is funded through the traditional insurance sources and public funding that comes from the federal government in the form of a block grant. The important part is to identify the individual in need and link them to those services. We also know that increasingly people have access to Medicaid as an insurer. And that can provide an important source of fuel for programs to develop responses that are effective, enable those individuals to get the services that they need. It is the case that funding is an issue in many communities.
OSHERAnd there has been a reduction in overall funding to communities in the last several years, and that it's important that we have a very healthy and robust community mental health system as the ultimate prevention for individuals with mental illness being in contact with criminal justice.
KNOYSo part of it, Fred, is private pay, people with insurance.
KNOYPart of it is community mental health centers where people can get help for free or at a reduced cost.
OSHERYeah, absolutely. And, you know, there are -- that was a part of the vision of the institutionalization, that there would be community mental health centers in all counties, all communities. It hasn't spread as far and as wide as we'd like. But we're seeing, you know, an increased awareness of mental health as a principal condition that keeps people from being productive and also, sometimes, as the focus of this show, get them involved in the criminal justice system. And more and more counties around the country are taking up the call to action to address this and provide the alternatives that are appropriate at this point in time.
KNOYWell, Pete, I wonder what you think about the costs? I have friends who struggled with this with their kids and it is not cheap.
EARLEYWell, I think what we have to realize, Laura, is that we're already paying the cost. When it comes to jails and prisons, we can prove Bear County, Texas, San Antonio, saves $10 million a year. It's gone from wanting to build a new jail because of overcrowding to having 800 beds empty by implementing CIT, mental health courts and a drop-off center. So we're paying the cost. And I want to go back real quickly to a point that the judge made. When I did my research in Miami, the jail there, there were 97 people. These are people with schizophrenia, people who used to be -- would have been locked up in a warehouse in a state hospital. Now they're in our community. But they weren't getting treatment.
EARLEYThey were responsible, in five years, for 2,200 arrests, 27,000 days in jail, 13,000 visits to crisis centers. They cost that community $13 million a year. So my point is, not helping people get better through these systems is costing us money. Would you rather pay for an 85 percent recovery rate through these systems or an 85 percent recidivism rate, which is what happens with folks who have mental illnesses.
KNOYWow. So that's a lot of police time, court time, and all those expenses add up.
EARLEYYeah, we're paying. Yeah. So do you want a bang for your buck or do you just want to keep this cycle going over and over and over?
KNOYHow easy or hard is it for parents, like you, who struggle with this with their kids to get help from private insurance, for example? I mean, how open are they to paying for x-number of days' treatment?
EARLEYWell, because of parity, which was passed recently...
KNOYMental Health Parity.
EARLEYYeah, Mental Health Parity. And the National Alliance on Mental Illness has really been helpful in this area, you can usually get that kind of care. It's not -- oftentimes, it's not the insurance company that is the problem, it's actually getting access to care, getting access to doctors and getting your person -- your loved one to those doctors, making them realize they need care when they're psychotic. So it's a combination of all these things. And the insurance company, obviously, can be a real factor. But it's more access into the system. You have to get in crisis to get help.
KNOYAll right. Coming up, more of your calls and questions for our guests on mental illness and the criminal justice system. We'll be right back.
KNOYWelcome back. I'm Laura Knoy, sitting in for Diane Rehm. We're looking at new efforts to help people with mental illness avoid incarceration. Our guests are Pete Earley, author of 13 books, including his bestseller "Crazy: A Father's Search Through America's Mental Health Madness." Also with us in studio, Tom van Hemert, coordinator of a crisis intervention team in the Thomas Jefferson Area in Virginia. Joining us by phone, Evelyn Lundberg Stratton, an attorney in private practice and a former justice on the Ohio State Supreme Court, and Fred Osher, he's director of health systems and services policy for the Council of State Governments Justice Center.
KNOYAgain, you can join us with your questions and comments and personal experiences with this issue, 800-433-8850, firstname.lastname@example.org is the email. And with us now from Little Rock, Arkansas, is Mattie. Hi Mattie, you're on the Diane Rehm Show. Welcome.
MATTIEHi, thank you. I think that the mental health court is a great idea. But it also is a Band-Aid, and what it does is people have to qualify, first of all, by their competency to get into the court. So they have a pretty group there to start out with. But it's not an 85 percent success rate. It's more like a 15 percent success rate. And what it does, the person has to plead guilty to whatever crime they were arrested for or whatever number of them, and that way, if they go out, and they are not in compliant, they are put into jail, and it's like shooting fish in a barrel because they -- they didn't take them out for another review the next week, and then they -- but they hold them in jail while that's going on.
MATTIEAnd they need facilities for the mentally ill. I don't care how many nice ways there are to try to connect them with services in their community, these people are not going to continue doing it. They are going to recycle and recycle and recycle. They're going to fail. They need to be in sometimes locked facilities for a number of time, not to be warehoused, but that's where they should be treated.
KNOYOkay, Mattie, two points you bring up. Yeah, and I want to talk about both of those points. So thank you very much for calling. First to you, Evelyn. She's less excited about the mental health courts. There's a lot of sort of ins and outs there.
MS. EVELYN LUNDBERGWell, I'm not quite sure where she is getting her statistics, but we encourage what we call pretrial diversion wherever possible. Rather than convicting them, if their crimes are low-level enough, which many of them are, we actually put them in programs before any conviction to try to get them help. There's also a dynamic that occurs with -- when a judge is involved, where somehow the person responds much more to a symbol of authority in terms of learning to understand their illness, learning to understand treatment and compliance.
MS. EVELYN LUNDBERGAnd in Ohio, all our programs are voluntary. We say to the defendant, okay, you can serve your six months, fine. That's what the normal sentence is for this crime. Or you can enter our mental program, on a volunteer basis, for two years, and we will put you on probation and work with you and try to put a team around you to change your behavior and to help you understand your illness and try to connect you with treatment.
MS. EVELYN LUNDBERGSo I don't know where her 15 percent came from because Ohio, we have a very, very high success rate, and if we didn't do this in a mental health court, then they would simply serve their regular sentence, go out, be rested again and be right back in. So it's been a much more effective system of dealing with it because it brings the whole community together to treat the person. It's not just a court sentencing somebody. It's a community effort to do something.
MS. EVELYN LUNDBERGBut I am in full agreement that we need to go up the scale more, up the post more, and get to them before they need to be arrested. That's really key, and that's what all of our goals are.
KNOYWell, and another point Mattie raises, and I'm going to throw this to you, Pete Earley. This is a very touchy subject, the last point that Mattie made, so I'm glad she called, the idea that some of these people, she says, would be better in those old-fashioned institutions that, you know, that were closed in the '60s and '70s and '80s because they weren't treating people right. They were, you know, locking people up. What do you think? Is it time to bring some of these institutions back for some people? And I know you talk about this in your book.
EARLEYWell, it's not against the law to have mental illness, and you shouldn't get arrested because you have a mental illness, and you shouldn't be thrown in an institution and have somebody stick an ice pick up between your eyelid and scramble your brains and say congratulation, you're cure. The reasons we got rid of state institutions were valid reasons. They were warehouses, they were underfunded, and we never want to go back to that situation.
EARLEYNow what she's referring to is, in closing down all those state institutions, we have failed to provide adequate safety nets, adequate hospitalizations for temporary crisis care. No, people don't need to be locked up and kept out of society. They need to be integrated into society. And we do know, if you look at the Lamp Project in Los Angeles, people who are homeless get housing first, and they get an act team, a team that comes and helps them. They have an 85 percent recovery rate. And that's important, especially of somebody like my son.
EARLEYWhat we're missing is, and some states are building state hospitals but not for long term. They're for short term, for people who are very, very sick, to stop the repetitive process. In Virginia today, if you get sent to a hospital, the average stay is less than five days, and if you are really, really sick, and you get into a state hospital, it can take months to get in, and maybe you'll stay 30 days. So we don't have stabilization centers, where people who are very, very, very sick.
EARLEYBut I would argue that instead -- the hospitals are gone, but what this person is calling for is already happening. They're all getting locked up in jail. So, you know, no, let's not go back to the old system, but let's create enough hospital beds in our country that people can get help and then move seamlessly back into the community.
KNOYCrisis beds, where people in the midst of a mental health crisis can get the professional help that they need.
KNOYInstead of hanging out in the ER, which is what sometimes happens.
EARLEYYeah, psychiatric boarding, where, you know, it's just in Seattle, and people are there 24 hours being, you know, handcuffed to a gurney. And, you know, you asked me about access. Fairfax County is one of the richest counties in the United States, but if you have a breakdown like my son, it takes seven days to get in to see a licensed therapist, six weeks to get a case manager and up to 18 years to get housing if you're very sick.
KNOYEven with mental health courts?
KNOYIt doesn't move the process along more quickly?
EARLEYWhoa, wait a minute. Fairfax County has dragged its feet. It doesn't have a mental health court. And Virginia has dragged its feet on mental health courts because of this whole idea that we don't want to be social workers. And it's a hot issue in a lot of jurisdictions, especially conservative states.
KNOYWell, and that's something that Evelyn talked about earlier, too, the resistance. Let's go back to our listeners, and Bonnie joins us from Rochester, New York. Hi Bonnie, you're on "The Diane Rehm Show," welcome.
BONNIEYeah, hi, how are you doing? Yeah, I retired -- I'm retired now. I was a social worker for over 30 years, and I primarily worked in a public sector with persons being, you know, leaving institutions. And most of my experience was with people with disabilities, but, you know, there's a lot of overlapping. I think what's so frustrating to folks like me and the people who are calling in, too, is the public sector needs a role, really required role, as they had when, you know, the years that I was working.
BONNIEAnd that role meant that they -- you know, we're talking about a right to services here. We're talking about bottom line, who is going to be responsible. Well, the people, who we always pay taxes -- the use of public services to include all these things. And so what happens in my experience, we have this -- what I think was really, I found, an extremely good model, and that was we had -- first of all, we had an interdisciplinary team that reached out, and we did it with kind of -- it was funded through this state money, but it was, you know, county-based largely, and there was an interdisciplinary team that went into inner-city area, went into suburbs...
KNOYThis is in New York, Bonnie, where you're -- that you're talking about, right?
KNOYWhen you said in my state, in New York?
BONNIEYeah, right, that's the only state I - so it was also a full interdisciplinary team, which you cannot beat that. I don't want to take time to go through all the details, but...
KNOYSure. Well, Bonnie, yeah, and let me jump in, if I could, for a minute, please, and turn to Fred, again Council of State Governments. So what's your sense, Fred, of, you know, the range of expertise, the range of attention that different states have when it comes to paying attention this issue of mental illness, overburdening our courts, our jails, our prisons? Which states seem to be doing a better job with this versus others?
OSHERWell, I first wanted to support the caller's assumption that there are ways, and we know ways, in which we can support individuals within community and that I also want to iterate Pete's point, that we've come a long way in our understanding of the brain and the effective strategies to help individuals with serious mental illnesses move forward in their recovery. And if we put that together in a package of services, including supportive housing, wraparound care, and interdisciplinary models that were referred to, we can really be effective in keeping people, our loved ones, within our communities and in these settings.
OSHERAnd that states around the country have taken, you know, various steps to assure that is available and possible and that there obviously are different levels of expenditure. Increasingly, the public dollars of the state are a smaller part of the pie, as we are looking at some of the private insurance and federal insurance program to support the services that people need to stay out. And I also just want to amplify Mr. Earley's point. We are spending moneys. Our counties are spending $60, $70 billion a year to warehouse individuals within a jail facility, which was never meant and/or intended for treatment, and we get very little return on that investment.
OSHERSo there are dollars, new dollars that are flowing into states that can be used to provide the services. There are existing dollars that could be repurposed so that we can get the outcomes that we all care and value.
KNOYWell Bonnie, thank you again for the call. Here's an email from Julie (PH) in Indianapolis. She says, my local school district has worked with our local police department to ensure that they are specifically trained to safely deal with students with mental health issues. I hope that this builds a positive relationship between those students and the police so that if they end up interacting outside of school, it will end more positively.
KNOYJulie says, I do worry that there are not enough specially trained officers. She says, what can we do as citizens to encourage our police departments to invest in more training to deal with those with mental health issues? Julie, it's a great question, thank you. And I'll turn to you, Tom, on this to first of all answer her question, and then I have another question for you.
VAN HEMERTSo I think it comes down to what is success. You know, you want safety, ultimately, and it comes down to our taxpayer dollars. And so what do you get for return on your dollar with the current systems? And so for us, it's taking a look at saving time, saving money and ultimately reducing recidivism rates.
KNOYAnd saving lives, too.
VAN HEMERTAbsolutely. That's part of the safety. And so -- and we've documented the cost savings for CIT, both working with the school systems and in our general public, so less time that officers have to spend with somebody. Ultimately what we've trained them is to spend more time up front with somebody, at the scene, and then looking at the appropriate resources with that. So within the training, we show them all the different resources that somebody can access, and most of the officers had no idea what services that they could have accessed before.
KNOYWell, sure, they feel like they're probably out there on their own, just dealing with this situation at hand. To Julie's point, though, you know, she says what can we do as citizens to encourage our police departments to invest in this training. How open do you find police departments to bringing in crisis intervention training for mental health problems?
VAN HEMERTIn the beginning, I think people just didn't have an understanding about mental illness. You know, we talked about Fred Osher, about one out of five arrests. Law enforcement officers were not being given the training about what to do, how to recognize somebody in crisis due to a mental illness. And so for the first time with CIT, they now have the knowledge, the skills, the awareness of what to look for, what to do, what not to do, and finding better accesses for that person to keep everybody safe.
VAN HEMERTAnd with that, we've had tremendous success. So some local stats is that in our regional jail, the (unintelligible) regional jail, we reduced the daily inmate population from 525 people per day down to 425.
KNOYWow, that's a big difference.
VAN HEMERTIt is. It's a huge success. And one of the number one reasons was that we've implemented a number of evidence-based practices, one of them being CIT, in keeping people out of the criminal justice system when it's safe, when it's appropriate.
KNOYI'm Laura Knoy, and you're listening to the Diane Rehm Show. A few last questions for all of you. Just looking ahead, Evelyn, I did want to ask you, where do you think this is going to go? I mean, if we had this conversation 10 years from now, would we be seeing a different picture in our prisons and jails, some of the reductions that Tom talked about, which are pretty dramatic? What do you think?
LUNDBERGWell, I think we have made enormous progress. When I started working, we had 100 CIT officers trained. We now have 7,500 trained in Ohio. We have 188 specialized dockets, drug courts, mental health courts, other ones that do this model of social justice sort of thing. But what I'm seeing even more importantly is whether you're Republican, whether you're Democrat, liberal, conservative, no matter what philosophy you have, everybody is realizing that this is an enormous waste of taxpayer dollars with very poor outcomes and dramatically affect lives in ways that are negative instead of positive.
LUNDBERGAnd all these sides, all these foundations, all these groups, Council for State Government has been a huge leader of this, are coming together and saying we have to change the paradigm. The old model of, you know, more time for more crime just doesn't work. You can't just keep adding sentences and sentences and treating people with mental health like they're criminals. We have to change the -- how we deal in criminal justice in the system.
LUNDBERGAnd I've seen a huge change in the 20 years that I've worked in this and especially in the last five years. So I am very optimistic and hopeful.
KNOYWell, and how does this fit in, what do you think, Pete, with the whole bipartisan push now, by the president and many in Congress from both parties, to reform our criminal justice system? How does this issues specifically, of people with mental illness in a criminal justice system, fit into that bigger picture of prison reform?
EARLEYWell, unfortunately, I still think a lot of national leaders don't understand just how important the mental health part is of this. If you look at California, for instance, they're doing a great effort of trying to empty their prisons of people who are not necessarily violent in the community. But if you look at those subgroups, you'll see that mental health arrests are actually growing. They've almost gone up one-third.
EARLEYYes, and so we still don't get it across the country when -- in a lot of these situations, and this is why what we're talking about today is so important. Every community should have crisis intervention trained police officers. They should have alternatives to inappropriate hospitalization and inappropriate bookings. They should have mental health courts that can divert people who are not dangerous into treatment so they don't recycle. They should have re-entry programs.
EARLEYAnd what we have to see, though, is this is a community-wide -- it's not oh, let's fix the police department. It's not let's fix the court system. It's a whole community. It has to do with housing, jobs, availability of services, and when you add all that, a study out of Texas shows that for even $7 -- you'll save $7 for every $1 that you spend. But we just have to get that through our heads and spend the money up front to save money down the line.
KNOYSo do you think that this issue, again of people with mental illness in the criminal justice system, is being left behind by this other criminal justice reform movement?
EARLEYYes, I think it doesn't get the recognition it needs. That's why I'm glad that Fred and other groups are starting this stepping-up program. And I just cite one example. When President Obama held his mental health summit, which was a great step, he left out law enforcement, and he left out jails and prisons. And how can you do that when 17 percent of your population has serious mental illness in jails and prisons?
KNOYAll right, well all of you, thank you so much for being with us. I really appreciate it.
VAN HEMERTThank you.
KNOYI'm Laura Knoy, sitting in for Diane Rehm. Thanks for listening.
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