Mental Health and Criminal Justice: Malign Neglect

By Patricia Obletz, Editor

Ed. Note: Updated 7/25/18 l Adam Trammell lost his life in 2017 in West Milwaukee, Wisconsin, due to police officer ignorance about mentally ill people in crisis. Trammell had appeared naked in the common room of a mental health residence. Someone called 911 instead of a Crisis Assessment Response Team (CART), along with the Fire Department paramedics. Trammel was showering in his own bathroom, unable to hear the police, who then weaponized their tazers and shocked Trammell over and over again, felling his oversized body. He was dead not long after he collapsed.

Adam Trammell might be alive today had the team that knew how to work with people in a mental crisis been called. In Wisconsin, people who have a mental illness and/or substance use disorder are morally and criminally mistreated. This is especially true for black and brown people. Specifically, the men and women driven into poverty by racism, accident and/or illness who are denied rehabilitation services in order to support the Prison Industrial Complex.

“People with untreated mental illness are 16 times more likely to be killed” during a police encounter than people without a mental illness. About one in four fatal law enforcement encounters involves an individual with serious mental illness.”

I escaped the criminal justice system because my skin is white and I had family backup when I preached on street corners in the explosion of my first psychotic break. I escaped at least six months in a public mental health system: my parents sheltered me while a psychiatrist brought me back to reality and then to a tenable balance. I never knew then that I could have been endangered by police called to apprehend me, book me, put me in jail. Kill me.

Ten years after my unexpected bipolar disorder diagnosis, I learned that people who also lived with serious and persistent mental illnesses were mistreated in public mental health systems. This awful knowledge sent me to join activist organizations for mental health in the Buffalo, New York area. It was 1991.

We lobbied New York State Legislators and the public to push into law the NYS Reinvestment Bill, which would put NYS in compliance with President John F. Kennedy’s 1963 Community Mental Health Act 30 years after its passage. We won in 1993. At last, as JFK’s Act mandated 30 years before, public psychiatric dollars saved from closed and downsized state and county mental health hospitals would fund adequate community-based mental health services systems that would meet the mental health needs of every county.

The second US President Bush’s 2008 Great Recession zeroed out or downsized too many community mental health services ’09 budgets in New York State, and no doubt across the country.

Most states diverted the savings from the closing and downsizing public mental health hospitals to general funds. Their disregard for their voters and tax base enabled them to ignore the urgent need for enough community mental health centers to help people recover, learn how to manage their symptoms, and become taxpayers.

The need for criminal justice reform didn’t enter my path until 2007, a few years after I moved to Milwaukee, Wisconsin. My art introduced me to a gallerist with whom I became close, our spirits one, only our skin colors different. I learned what life was still like for black people in America despite the 1964 Civil Rights Law and the 1965 Voting Rights Act.

I learned that Milwaukee, Wisconsin, is the worst place to live for black people in America. This atrocity led me to work with activists for human and civil rights focused on criminal justice as well as mental health reforms: Mental health and often co-occurring substance use illnesses run in every family: 1 in 4 people experience a mental Illness in a given year. In 2014, approximately 20.2 million adults aged 18 or older had a past year substance use disorder (SUD), according to SAMHSA (Substance Abuse and Mental Health Services Administration).

PART I: The Problems with Wrongful Incarceration

The problems with incarcerating the wrong people cross the country: “A Shocking Number of Mentally Ill Americans end up in prison instead of psychiatric hospitals.”

Prisons are the new costly and ineffective mental healthcare system. Every taxpayer needs to know that community-based mental health and substance use disorders services cost tens of thousands of dollars less than incarceration per person, per year:

  • One incarcerated person per year in Wisconsin costs about $30,000.

  • Even the most expensive alternative treatment centers cost about $8,000 per person per year.

In June 2018, the prisoner population in Wisconsin burst the seams of this state’s prison and jail systems, deepening the overcrowding. Out of state prison cells are costlier financially and personally, further limiting family contact, but how many people can the system jam into jails and prisons?*

As noted above, at least 35 percent of people behind bars have a mental illness. At least 75 percent of incarcerated men and women have a substance use disorder.

Do the math: $30,000 v. $8,000 per year per prisoner whose brain chemistry is unbalanced, causing conditions that are treatable.

How did we get to this extreme misuse of tax dollars? Not only were adequate community systems of mental health care deliberately shortchanged – as if governors have no idea that one in four people experience a brain chemistry illness. But, the GOP and the Prison Industrial Complex are in the driver’s seat — in Wisconsin, since 2011. That’s one urgent reason why we must oust the current administration, which expands this obscene development under former WI Gov. Tommy Thompson.

June 11, 2018, every Wisconsin Democrat gubernatorial candidate at the packed Pewaukee public forum promised to reduce the prison population by establishing new and expanded treatment and rehabilitation services. In the July 12th forum, candidate Tony Evers said that Wisconsin must initiate “smart criminal justice,” stressing the need for diversion from jails to community treatment and rehabilitation services. At least 95 percent of men and women in prisons and jails return to society. If people don’t learn how to control their illnesses, they end up back behind bars.

Lashing out at the governor’s wise opposition, the WI attorney general made a sickening attempt to shill for the ravenous prison industry by “calling the Democrat gubernatorial candidates’ plans ‘irresponsible and dangerous.’” What he ignores is that a significant percentage of prisoners have treatable illnesses. He also ignores the cost savings of community-based versus prison-based mental health services.

Another way Wisconsin reached the point of spending more on locking people up than on higher education is that, between 2014 and ’17, Milwaukee County, had the highest known rate of emergency detentions in the U.S. “About 13,000 patient visits to Milwaukee County’s psychiatric emergency room. Of those, roughly two-thirds were brought in on emergency detentions, when they are considered a danger to themselves or others.”

In 2017, additional “CART teams responded to more than 1,200 calls. On about 600 of the calls, a CART team made face-to-face contact. Almost 90 percent of the time, they prevented emergency detention or hospitalization.” This fact saves lives, society and the extravagant cost of incarceration versus treatment.

Institutionalized racism forges the humanitarian disaster that is mass incarceration. Are you aware that a new study concludes that “constant police violence takes massive toll on the mental health of black Americans.” Epigenetics studies (relating to or arising from nongenetic influences on gene expression) tell us that “police” violence since Africans were brought to America as slaves has affected the brain chemistry of many slaves and their descendants.

Don’t Send Weaponized Police Forces to De-escalate Illnesses Unless Armed by Medical Knowledge

Wisconsin and only four other states require police involvement before a mental health patient can be admitted to a mental health hospital. Doctors must call police to have their psychiatric patients involuntarily detained. However, unless licensed mental health clinicians educate police officers about mental health, their ignorance likely will aggravate a person’s active mental illness, perhaps causing death, as was the case for young Adam Trammell. At the very least, law enforcement ignorance could extend the time it takes an individual suffering with a mental illness to recover. It’s horrifying to even think about being confronted by police, handcuffed, possibly tazed when I was engulfed by psychosis.

Mass incarceration studies and current data make clear that incarcerated people are often in custody because of:

  • Ethnic and racial stereotyping: about one in three black males who turn 16 this year will go to prison at some time during their lifetime, according to the federal Bureau of Justice Statistics. One in six Hispanic males and one in 17 white males. Why? Black people are arrested more frequently, usually due to racism that imposes poverty, broken families, lack of opportunity, and physical and mental illnesses.

  • Untreated mental health and substance use disorder: The segregation of mentally ill inmates into separate jail units or isolated in “suicide watch” units further drives personnel costs, increasing personnel to meet the need for direct supervision. Treatment alternatives also enable parents to remain with or nearby their children. They also would be better able financially to support their children.

In 2014, the American Psychiatric Association reported that the most common mental illnesses among prisoners are depression, schizophrenia, and bipolar disorder.”

According to the April 2015 study by the Urban Institute, “an estimated:

  • 56 percent of state prisoners;

  • 45 percent of federal prisoners;

  • 64 percent of jail inmates

“have one or more psychological disorders.”

The article details in depth the issues that affect prisoners, including this:

“Prisoners with mental illnesses are more likely to be held in solitary confinement, be financially exploited, physically and sexually assaulted, commit suicide, or be intentionally self-destructive. In fact, both the size of the population and the seriousness of their psychological disorders are increasing.”

  • Repeat offenders: “Inmates who didn’t finish high school are 40 points more likely to repeat (recidivism) than those who finished college.” This fact underlines the critical need to install colleges in the prisons.**

“Repeat offenders use a disproportionate number of criminal justice resources. Post booking, the provision of stabilization treatment instead of jail or prison not only saves money, but also saves critical time used to issue arrest warrants, transport, hold, and identify offenders, assess risks, decide and communicate sentences.”

PART II: The Solutions to Wrongful Incarceration

The added diversion services from jail to treatment resources still haven’t reduced the percentages of Milwaukee County prisoners who experience a mental health or a substance use disorder: to repeat, at least 35 percent and at least 75 percent.

For these reasons, the Milwaukee County Mental Health Task Force 2019 budget testimony urged MKE County to support the following:

  1. additional community-based mental health services;

  2. additional substance use services;

  3. additional mobile crisis teams.

Why? “Post booking stabilization is a sustained effort to remove individuals who live with a mental illness from the criminal justice system immediately after booking. If diversion occurs at this point, and individuals are connected to stable housing and community mental health services, stabilization outcomes will dramatically improve and decrease recidivism.

“Post booking stabilization can be effective and sustainable only if there are adequate community mental health resources available on a relatively short notice at the appropriate level. The continuum of services needed to ensure dedicated resources to support evidence-based effective diversions must be a priority in the 2019 Milwaukee County Budget. This means:

“Crisis services access 24/7, including CART (Crisis Assessment Response Team [911 emergency; (414)933–4444 Non-emergency]), mobile crisis, CRC (Crisis Resource Center) and Crisis line. CART expansion is key to diverting people with a mental illness from the jail. CART prevents situations from escalating.

  1. “A high level of accountability for providers.

  2. “Timely access to a prescriber.**

  3. “Emergency supportive housing to serve as a bridge for those removed from the jail.

  4. “Access to the appropriate community services based on individual needs, such as Comprehensive Community Services (CCS) or Community Support Programs (CSP.)

Why don’t taxpayers demand that prisoners who have treatable illnesses receive treatment instead of prison?

Wisconsin State Representative Evan Goyke’s 2017 “501 Inmate Report” informs us that the Earned Release Program (ERP), a treatment program that addresses Alcohol and Other Drug Abuse needs, requires that an inmate must be found eligible by the sentencing judge, have an AODA need, and not be convicted of certain violent offenses.

$1.8 Million Saves $2.8 Million

“The 2018–2019 state budget increased ERP funding by $1.8 million,” according to the Goyke report, “and that expenditure is projected to save $2.8 million from reduced incarceration…

The 250 new ERP beds are estimated to save $2.8 million because successful completion of the ERP, on average, reduces an inmate’s sentence by 384 days.” Treatment instead of prison helps to keep families together and add taxpayers. More ERP beds are needed.

Indianapolis, Indiana, Reduced Incarceration Rate By 36 Percent

Indianapolis, Indiana, Mayor Joe Hogsett has reduced incarceration by forging a reformed and modern county justice system that:

  • incorporates the use of technology, such as e-filing, courtroom video conferencing;

  • provides appropriate spaces for counsel/client conferences;

  • provides medical, mental health and social services for both diversion and in-house cases;

  • includes flexible courtroom spaces;

  • allocates the appropriate number of beds for inmates, but also for mental health and addiction patients diverted from incarceration.

Wisconsin Department of Corrections must reform the state criminal justice system and return the excessive funding gifted to the Prison Industrial Complex back to education, health and welfare. Other states have been successful by being “Smart on Criminal Justice.”

*Wisconsin State Representative Evan Goyke’s 2017 “501 Inmate Report.”

**For example, Columbia Correctional Institution’s handbook for inmates section D. 2. stipulates that new prescription medications can be delayed up to five days. Some meds take that long or longer to begin to work.

***Daniel Karpowitz documents these positive results in his book, “College In Prison.”

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Last edited by Tyler Schuster. Based on work by patricia obletz.  Page last modified on August 02, 2018

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