Criminal Justice System Now Providing Mental Health and Welfare Services

 

On a recent trip to San Francisco I read with some interest a front-page article in the San Francisco Chronicle about an assault on a professor at Johns Hopkins by a homeless man (AStreet attack stuns visiting doctors,@ May 23, 2003).  It brought close to home the realities of street life these days in virtually every American city.  The irony was that the victim was attending the annual meeting of the American Psychiatric Association, a group involved in the treatment of serious mental illnesses suffered by people like the homeless man who was the perpetrator of this attack.  Marcie Goin, the president-elect of the APA, noted that AThose who need psychiatric care don=t have it readily available.@

Although the violence exhibited by the homeless man is rare, it nevertheless illustrates a trend that began back in the 1970s, at the start of what was called the Adeinstitutionalization of mental patients@ movement.   This movement, begun by people in and out of the mental health profession, sought to end what amounted to Awarehousing@ of mental patients in what were often called Adungeons@ and Asnake pits@ The end result of this movement was the closing down of many of these institutions and the release of former mental patients into communities all over the country.  While many were helped by this move, growing numbers since then have suffered even more as the dollars that were supposed to be saved from such closures all too often never made it to the communities for out-patient treatment.

One result is that, throughout the intervening years, the criminal justice system, especially local jails and state prisons, have come to be relied upon to manage the problem.  And Amanage@ is about all they can possibly do, as the criminal justice system is not equipped to handle such problems.  But handle it they must, as an estimated one-fourth to one-third of those in jail or prison on any given day suffer one or more forms of mental illness.  The perpetrator in the above-referenced assault had a history of being in the criminal justice system for psychiatric evaluations.  He was being held on two felony counts of assault and battery.  During his first court appearance the next day it was determined that he could not understand what was going on.

It was also reported that the nation=s mental health system is suffering severe cutbacks during this time of fiscal crises in virtually every state (brought about in large part because of increased expenditures on Ahomeland security@ and the Awar on terrorism@ and the recent invasion on Iraq, plus looming tax cuts).  A representative of the APA noted that these cutbacks will negatively affect more than 27 million people with mental health problems.  One of the few programs in San Francisco, a residential treatment facility, faces a $1.9 million cut, which would result in the loss of 20 of their 36 beds and its entire day treatment program serving 80 people.

Similarly, cutbacks are looming here in Las Vegas and in other parts of the state as the budget crisis hits close to home as far as the treatment of mental illness is concerned.  But not to worry, as there seems to be a perpetual deep pocket in our criminal justice system. The Las Vegas Metropolitan Police Department is currently seeking huge increases in funding. 

Thus, all over the country during the past 30 years, millions of mental patients have been deprived of needed care and whenever this happens the criminal justice system is there to Amanage@ the problem.  If I’ve heard it once, I’ve heard it thousands of times that someone who should be on medication in an out-patient program or housed within a community program, has been picked up by the police, usually for some minor offense like disturbing the peace, vagrancy, trespassing, and the like.  A study I helped conduct on jail overcrowding in Clark County in the 1980s found that the offense responsible for most of the increases in the local jail was the charge of Avagrancy.@  It is like this all over the country.