The following article appeared in an online series on criminal justice reform by Variety and Rolling Stone, here.
America's Crime Problems Being Fed by a Broken Mental Health System
By John Snook
A homeless woman freezes to death on a city sidewalk. A man with delusions is shot dead by police. A teen in psychosis murders his grandmother. These are all preventable tragedies.America’s mental health treatment system is broken, leaving those most in need to fall through the cracks. An estimated 8.3 million adults in the United States have a severe mental illness. At any given time, 3.9 million go untreated.
With medication and other support services, those with severe mental illness are no more dangerous than anyone else, capable of leading happy, productive lives. Without treatment, their prospects worsen.
Yet the odds are stacked against these individuals. Our health care system actively denies them care, and we criminalize the symptoms of their diseases.
When someone has a heart attack, an ambulance takes them to an emergency room. When someone is in the depths of psychosis, however, police are called and frequently cart that person off to jail.
My organization is dedicated to eliminating barriers to treatment for people with severe mental illnesses—to root out systemic impediments to psychiatric care. It is a daunting challenge.
Families call us every day with heartbreaking stories. Many follow a familiar pattern. A parent notices a young adult child acting differently, growing paranoid and withdrawn. As the illness progresses, the child may hallucinate and become agitated or aggressive.
Troubled by these symptoms, parents reach out to doctors or crisis services seeking help on behalf of their loved one. However, if their child is too ill to understand the need for treatment, they are rebuffed, told that unless that child himself or herself seeks care, treatment is only available once the child becomes dangerous.
And so begins a cataclysmic cycle.
Without treatment, those with severe mental illness experience a host of negative consequences. Many take their own lives. Others face a shortened life span due to a much-increased risk for other chronic health conditions. Ultimately, those with severe mental illness die, on average, 25 years earlier than their peers.
Others are lost to the streets. Conservative estimates suggest that one quarter of the homeless population suffers from a severe mental illness. In 2017, that amounted to 138,435 individuals on any single night. Also common are arrests for so-called “quality of life” crimes like loitering and public urination—behaviors that are triggered by illness, not criminal intent.
As a result, incarceration has become the norm for those with severe mental illness. Forty percent of them are incarcerated at some point in their lives. Two million are booked into jails each year. The Treatment Advocacy Center estimates that 383,000 individuals with severe mental illnesses were incarcerated in 2016, although many belonged in hospitals instead.
But jails are the worst place to provide mental health treatment. Would-be patients are isolated. They deteriorate, are victimized and receive inadequate care. Their symptoms result in additional offenses and time behind bars. A 2018 national investigation revealed that since 2010, more than four hundred people with mental illness have died in our nation’s jails.
Others die before ever reaching a cell. According to our report, “Overlooked in the Undercounted,” at least one in four fatal law enforcement encounters involve an individual with severe mental illness. They are 16 times more likely to be killed in such an encounter than other civilians.
Law enforcement is taking steps to train its officers to defuse such situations whenever possible. But those laudable efforts are responsive measures, not preventative ones. They do nothing to answer the broader question we ignore: Why do we make law enforcement responsible for a public health crisis?
No matter how one looks at the challenges posed by untreated severe mental illnesses — whether from the perspective of would-be patients, family members, first responders or the general public — the status quo is untenable.
Yet opportunities to improve the existing mental health system abound.
First, we can and should increase the availability of psychiatric beds, now at a historic low. Even a modest increase would alleviate inhumane bed waits for people in need of inpatient care.
We must also fund a robust continuum of community support services that prevent the severely ill from reaching a crisis state, and reduce the need for a law enforcement response.
And we must make it easier to intervene on behalf of those in need. Family members and other caregivers are also victimized by the destructive symptoms of these chronic illnesses, and should have a right to seek treatment for their afflicted loved ones.
Untreated mental illness need not be an intractable problem. We can either continue to condemn families to predictable, preventable tragedies or we can provide necessary treatment to those who desperately need it. But first we must finally agree as a nation to take the treatment of severe mental illness seriously.
John Snook is executive director of the Treatment Advocacy Center, a nonprofit that works to eliminate barriers to treatment for people with severe mental illness;
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
, @JohnSnookTAC.