Based on what the mainstream media and an ever-growing spate of TV crime shows have to say about mental illness, one could easily sketch a sinister profile of the average specimen: He's a murder convict, schizophrenic or perhaps bipolar, who snapped after he went off his meds and brutally killed someone with a baseball bat or an apple corer. Oh, and don't forget the takeaway lesson: Why was he roaming the streets in the first place? He should have been in a hospital somewhere.
"The fact is that the mentally ill are rarely violent and contribute very little to overall violence in the United States," writes psychiatrist Richard A. Friedman in "The Politics of Mental Illness," an outstanding 24-page special report in the July-August issue of the American Prospect. But it's easy to see why this myth needs dispelling: Friedman points to a 2005 study of 70 major newspapers that found that 39 percent of stories about mentally ill people "focused on dangerousness."
The media would be better off reporting on the dangers to which we subject the mentally ill. Our fragmented system isn't terribly effective or humane, and it's not doing much more for its clients-or for the country as a whole-than the shackles and electrodes of a century ago. Today's seriously mentally ill, particularly those who don't have access to high-quality care, often end up bouncing between the criminal justice system, the mean streets, and overfull emergency rooms-deeply unconnected organisms that don't play well together. Subjecting people to this scattershot system takes its toll: According to the American Prospect report, adults with mental illness who rely on public health programs have, on average, a life expectancy that's about 25 years shorter than that of the general population.
We may have shuttered our insane asylums, but other institutions have risen in their stead: jails and prisons. Some 20 percent of adults behind bars have mental health problems-in Washington's Spokane County jails, that's closer to 60 percent, reports Prison Legal News (May 2008)-and, just like the rest of the incarcerated population, many are put away for nonviolent and petty offenses. But being locked up is far from a rehabilitative boon, and in a system in which rewards and punishments are based on behavior, a mentally ill individual's sentence can easily grow longer. The Houston Press (Aug. 21, 2008) profiled the case of Alexander Hatcher, who was arrested for "criminal mischief" in 2006. Hatcher, who is diagnosed with schizophrenia and bipolar disorder, racked up a whopping 53-year sentence for assault and harassment charges he accumulated in jail.
While men like Hatcher, whose history of mental illness should have made him eligible for psychiatric treatment in jail, are swept under the rug of a swelling prison population, dubious new laws are using mental illness as a way to keep sex offenders locked up indefinitely.
The Nation (Dec. 31, 2007) reports that civil commitment laws in 20 states have declared more than 4,000 sex offenders mentally unfit, which keeps them in jail or sends them to psychiatric facilities when their sentences are up. This happens despite the fact that "most psychologists agree that mental illness is not a prerequisite for sexual violence," the Village Voice notes in "To Catch-22 a Predator" (July 16, 2008). Furthermore, attaching the language of mental illness to some of society's most reviled members isn't likely to help erode the misconception that mentally ill people are prone to violence.
There is a growing recognition that the criminal justice system, from arrest to court date to incarceration, simply does not work for many people with mental illness. In cities and counties across the country, mental health courts are springing up to help close the revolving door between jail and street.
Pennsylvania is currently the model state on that front, writes Sasha Abramsky for the American Prospect. Five of its counties have implemented mental health courts, which work intensively with nonviolent offenders to connect them with treatment, employment, and frequent supervision, all with an eye toward keeping them out of jail. Police officers are trained to recognize when they're dealing with mental illness, and in Allegheny County they can take people to a 24-hour crisis center instead of lockup. "Graduates" of these programs also have much lower rates of recidivism: In Allegheny County, it's just 10 percent, compared to the statewide rate of 55 percent.
These programs aren't cheap-Westword reports (May 29, 2008) that a Denver pilot program costs around $12,000 per person-but this up-front investment jibes with the Council for State Government's Consensus Project, which recognizes the potential for long-term cost savings from lower incarceration rates. In Portland, Oregon, mental health advocates eagerly await the start of their own pilot project, says the Portland Mercury (May 1, 2008). "If we actually provided effective, outcome-based treatment on demand for mental health clients in Oregon," mental health advocate Jason Renaud told the Mercury, "you could probably shut down one hospital and two prisons within two years."
The American Prospect puts forth a decidedly wonky but commonsense proposal: Let the new president create a federal Office of Mental Health Policy. It seems ridiculous that one doesn't already exist, given that close to half of all Americans experience some form of mental illness or substance-abuse disorder at one time or another. It's clear that the disjointed, disconnected systems allow "far too many opportunities" for people to slip in and out of well-being.
Writing for High Country News (March 31, 2008), Ray Ring dreams of something a bit more ambitious, and controversial, than mental health courts and new federal agencies. In an unreserved and heartrending essay, Ring leads the readers of the Western politics magazine through the story of his "crazy brother" John, who drifted in and out of treatment, jail, and coherence until he committed suicide at 47. "If I were in charge," Ring writes, "my program for crazy people would include a decent apartment, a good burrito, movies, hikes. And cats and dogs and whores, so the crazy people can touch and be touched physically, without judgment. And a place for hammering things to smithereens, without endangering other people."