Is This A Good Time To Talk About Mental Health?

In this Thursday, June 26, 2014, photo William, a 62-year-old inmate sits on his bottom bunk and works a word puzzle inside the Cook County Jail’s Division 2 Dorm 2 in Chicago. William, says he’s been jailed nine or 10 times for theft to support a drug habit and doubts that being jailed will end the cycle. Too many judges dismiss mental illness as a factor in crimes, says the inmate, diagnosed with depression, anxiety and symptoms of bipolar disorder. “You come back to the streets and all the facilities are closed with maybe one or two that are still open and they have an overload. And sometimes they get you and sometimes they don’t,” he says. “Once we leave here, we’re back on doom street.” (AP Photo/Charles Rex Arbogast)

Experts warn against connecting mental illness, shootings

Mental health initiatives, or at least the concept of them, are brought up quite a bit in the wake of tragedies like the events in Parkland. Florida’s own Senator Marco Rubio has brought it up since the Parkland shooting, as have Governor Scott and President Donald Trump.

Peter Earley is one of the country’s foremost advocates for mental health and the improvement of mental health treatment. He sits on the Interdepartmental Serious Mental Illness Coordinating Committee, but he spoke only for himself in this interview.

Mr. Earley was eager to spread the word about the state of mental health care in America and within Florida, but he made it clear from the get-go that he was not thrilled with the circumstances behind our interview.

“I’m the father of a son with a serious mental illness. Like all advocates, I’m kind of caught in a frustrating position. Because all of us want better mental healthcare.

“Everybody brings this up around the shootings, and the shootings, if you look at a 2016 really thorough report from the American Psychiatric Association, the shootings are not representative of all people with mental illness.“

That 2016 report from the American Psychiatric Association offers two bullet points in the first couple of pages that serve as a counterpoint to the idea that mental health initiatives will reduce mass shootings.

  • “The overall contribution of people with serious mental illness to violent crimes is only about 3%. When these crimes are examined in detail, an even smaller percentage of them are found to involve firearms.
  • “Laws intended to reduce gun violence that focus on a population representing less than 3% of all gun violence will be extremely low yield, ineffective, and wasteful of scarce resources. Perpetrators of mass shootings are unlikely to have a history of involuntary psychiatric hospitalization. Thus, databases intended to restrict access to guns and established by guns laws that broadly target people with mental illness will not capture this group of individuals.”

Considering that the National Institute of Mental Health estimates that 4.2% of adults in 2016 had a serious mental illness, being respnosible for 3% of violent crimes suggests that people with a serious mental illness are no more likely than anybody else to commit a violent crime.

This is a major problem, because much of the conversation surrounding mental health in this country is based in the idea that the mentally ill are dangerous individuals. Mr. Earley brought this up: “This is my dilemma: I want to talk about better mental healthcare and how we’re trying to achieve that, but I want people to understand that blaming people with mental illness is statistically just not accurate.”

“What’s going to happen is, when people like President Trump get up there and they talk about mental illness and shooters, they just increase the stigma.”

The stigma of mental illness helps contribute to the number of people who never get their problems treated. It doesn’t take much to realize how prevalent that stigma can be.

This attachment to violence goes beyond stigmatizing the mentally ill. The majority of emergency treatment for the mentally ill is based on a person being a direct danger to themselves or others.

“The whole idea is to change our system. Right now we have a system who waits until stage 4: You have to hit rock bottom, you have to be dangerous before we offer you any kind of help. We’re trying to flip that on its head.”

(AP Photo/J. Scott Applewhite, File)

A Supreme Court ruling in 1975 is at the center of this. The finding in O’Connor v Donaldson was that a state cannot constitutionally hold an individual unless that person is considered dangerous.

Peter’s own experience with the system paints a bleak picture. “My son was psychotic, I took him to the emergency room, they said to bring him back when he tries to hurt or kill somebody.”

“When I became a judge nearly two decades ago, I had no idea I would become the gatekeeper to the largest psychiatric facility in the State of Florida.”

Judge Steve Leifman was not talking about a specific mental health facility within Miami-Dade County. He was talking about the Miami-Dade County jail. Judge Leifman, as the Chair of the Supreme Court of Florida Task Force on Substance Abuse and Mental Health Issues in the Courts was testifying in the US House of Representatives about his experiences with mentally ill people going through the criminal justice system.

The testimony is available on the House of Representatives’ website, and contains some chilling accounts.

“Of the roughly 100,000 bookings into the jail every year, nearly 20,000 involve people with serious mental illnesses requiring intensive psychiatric treatment while incarcerated.” Leifman goes on to point out that the “vast majority of these individuals are charged with minor misdemeanor and low level felony offenses that are a direct result of their psychiatric illnesses. Roughly three-quarters of this population also meets criteria for a co-occurring substance use disorder, which complicates treatment needs.”

Note that the judge’s description of the problem does not include references to firearms, or even violence.

The harsh assessment of the capacity of the criminal justice system to deal with the mentally ill only got worse when talk turned to the judge’s home state of Florida.

“Several years ago, the Florida Mental Health Institute at the University of South Florida completed an analysis examining arrest, incarceration, acute care, and inpatient service utilization rates among a group of 97 individuals in Miami-Dade County identified to be frequent recidivists to the criminal justice an acute care systems. Nearly every individual was diagnosed with schizophrenia, and the vast majority of individuals were homeless at the time of arrest. Over a five year period, these individuals accounted for nearly 2,200 arrests, 27,000 days in jail, and 13,000 days in crisis units, state hospitals, and emergency rooms. The cost to the community was conservatively estimated at $13 million with no demonstrable return on investment in terms of reducing recidivism or promoting recovery. Comprising just five percent of all individuals served by problem-solving courts targeting people with mental illnesses, these individuals accounted for nearly one quarter of all referrals and utilized the vast majority of available resources.”

Thirteen million dollars for ninety-seven people.

“Individuals ordered into forensic commitment have historically been one of the fastest growing segments of the publicly funded mental health marketplace in Florida….Florida currently spends more than $210 million annually – one third of all adult mental health dollars and two thirds of all state mental health hospital dollars – on 1,700 beds serving roughly 3,000 individuals under forensic commitment.”

The Miami-Dade County judge painted the overall picture later in his testimony.

“The justice system was never intended to serve as the safety net for the public mental health system and is ill-equipped to do so. Jails and prisons across the United States have been forced to house an increasing number of individuals who are unable to access critically needed care in the community.”

Student survivors from Marjory Stoneman Douglas High School walk through the halls of the state capitol to challenge lawmakers on gun control reform, in Tallahassee, Fla., Wednesday, Feb. 21, 2018. The students split into several groups to talk with lawmakers and other state leaders about gun control, the legislative process, and mental health issues. (AP Photo/Gerald Herbert)

This all speaks to Peter Earley’s dilemma. America, perhaps especially Florida, needs to have an earnest discussion about mental health and what can be done to improve the quality of treatment for mental illness. However, making that conversation about guns and violence will not improve anything.

When people make the mental health discussion one of danger and mass murder, it discourages others from getting treatment for mental health issues. This is problematic, as the National institute of Mental Health estimates that one in six adults in America lives with a mental illness of some kind, and one in twenty five lives with a serious mental illness “resulting in serious functional impairment”.

Peter had a theory why mental health discussion seems to become most prominent after shootings. “What concerns me is, this is just used as a dodge, people want to talk about mental health when they don’t want to talk about guns.”

The optimist might believe that there is an opportunity in these misconceptions; that if mental health initiatives come out of this discussion, the ends may justify the means. The APA’s report warns against that.

  • “Gun restriction laws focusing on people with mental illness perpetuate the myth that mental illness leads to violence, as well as the misperception that gun violence and mental illness are strongly linked. Stigma represents a major barrier to access and treatment of mental illness, which in turn increases the public health burden.”

Mr. Earley had a sense of urgency in his voice toward the end of his interview.

“Our latest science shows there’s genetic links, and environmental links. It’s not the fault of the person who gets them. It’s an illness. We treat these people like they’ve done something wrong.”

Thanks to Peter Earley, author of CRAZY: A Father’s Search Through America’s Mental Health Madness