I firmly believe that if we put more money into therapy for mental illness, it would save a significant amount of money and many victims in the long run. I’ll outline the problem, and then offer some solutions. Here’s an analogy of our current efforts. You have a daughter you want to be a great cello player or a great basketball player. Instead of buying her a cello or a basketball, and offering her lessons, you take her to visit a nursing home, and then give her a bus ride to Ely. When you see she isn’t making progress, you send her detention. If you shared this strategy with friends, they would say, “Are you nuts? What you’re doing has nothing to do with playing cello or learning basketball.” But this is how we are dealing with mental illness.
The medication for mentally ill people in jail exceeds the costs of feeding everyone in jail. They require more staff time. This doesn’t include the lawsuits. For example: A mentally ill stockbroker was beat to death by other inmates and his family successfully sued the New Jersey county jail for not preventing it.
I took a look at 1 year in Hennipen County. 119 people were found incompetent to stand trial for their crimes. 46 were civilly committed. No resolution was reached on 4 cases. 7 received a stay of commitment, meaning if they stay out of trouble the charges will be dropped. 62 were released with nothing. Think about this. Someone robs your store. You call the police and they are arrested. They are found incompetent to face the charges so they are released with nothing. So what do you think happens next? They keep committing crimes. They call them “gap patients”—not crazy enough to require placement, but just crazy enough to commit crimes. This costs us a lot of money in the long run. For Example: Jack McClellan is a veteran who came to Hennepin County’s mental health system the usual way—he was arrested. (He had committed 2 thefts, 2 trespassing and an indecent exposure crime.) He was found incompetent to face charges, but was not civilly committed because he was not suicidal and not a threat to abuse others. The judge expressed concern that Jack was homeless and it was November in Minnesota. Jack was back in court in February with 4 more trespassing and theft charges, now wearing medical boots because he had frozen his feet. So now we are paying expensive medical bills because we didn’t have a system to address crisis mental illness.
If they go to an emergency room for a psychotic episode, and the physician feels they are not safe enough to release, they stay in the emergency room until an opening occurs. They don’t admit them to the hospital, for fear they will never get rid of them, so they sit behind the curtains, often talking loudly, while crisis medical cases are addressed around them.
Only 15% of law enforcement officers have training in addressing mental illness and most received that training independently. An officer is 2X as likely to get killed in a domestic call than in a drug bust. Often they’re dealing with at least one person with mental illness concerns in domestic arguments.
We need to start looking at the overall cost to the taxpayer, rather than department budgets. When San Antonio combined the costs of social services and corrections they realized that some people cost taxpayers a lot of money. So they gave probation officers smaller caseloads, and the task of helping make sure clients get to counseling sessions. Ultimately, it saved almost $3000 a person, every year.
Some states have Assertive Community Treatment programs which basically employs professionals to help in any way possible to keep clients functioning in the community. These programs ultimately pay for themselves, by saving taxpayers the cost of jail and inpatient placements. Unfortunately, these programs are typically the first to get cut when budgets are tight.
A study in Florida found that offenders who don’t receive mental health help are the most likely to be convicted of felonies. Offenders who attend therapy inconsistently are most likely to be convicted of misdemeanors. Offenders who access mental health services as requested are the least likely to be arrested again.
You can’t counsel people out of a psychotic episode or severe paranoia. They need medication. It works slowly, but it works. For example: I counseled a teenager with schizophrenia who raced home from school every day, hiding behind cars on the way out of fear someone was trying to kill him. After 2 weeks on antipsychotic medication he was telling me that people are following him, but it’s just people doing it for a joke. 2 weeks after that, he acknowledged no one was really following him.
I ask bipolar individuals to keep track of their mood (1 as very depressed and 10 as hyperactive) every waking hour for 10 days. They quickly see how their mood effects their behavior and their soon telling me, “When I’m at a 2 (or for others at an 8), I always get in trouble.” This recognition is important to learning to rein it in so they don’t get in trouble.
Quotes: (more from Mitch Hedberg)
My sister wanted to be an actress. She never made it, but she does live in a trailer, so she got half way. So she's like an actress, who never gets called to the set.
If you go to the grocery store and you stand in front of the lunch meat section for too long, you start to get pissed off at turkeys. You see, turkey ham, turkey pastrami, turkey bologna. Somebody needs to tell the turkeys, "Man, just be yourself!"
Sometimes I wave to people I don't know. But then I worry, “What if they only have one arm? They'll think I’m being cocky.”
My friend came up to me and he said "Hey, you know what I like? Mashed potatoes." It was like, "Dude, you gotta give me time to guess. If you're gonna quiz me, you gotta put a pause in there.
Thanks for listening!
This weekend my brother Charlie and I played some music with Rosetta (mom). Charlie played this, knowing I occasionally like songs that are more existential. It’s a song you can enjoy if you can relax and let yourself get lost in the metaphors. I particularly like the last verse and the point that a strong relationship can keep you going through the hard times. Josh is actor John Ritter’s son. Great song, although I think Charlie does it better.
CORE Professional Services provides a variety of counseling services for couples, for depression, for parenting concerns and psychological assessments on various issues. The CORE sex offender treatment program has demonstrated success. 97% of offenders who have graduated from this program have not been convicted of an offense again, in their 22 years of programming. Frank pointed out in his presentation that CORE sites where they can offer more individual therapy in conjunction with group work they have the greatest success rates (99%), and offenders also graduate the quickest (13 months) from this program. If we had the grants to offer more individual sessions, it would cost tax payers less in the long run and it would save more victims. As a society, we need to get better at considering preventive strategies.
Frank Weber is a forensic psychologist whose award winning forensic and clinical work includes assessment and expert witness testimony for homicide, sexual assault, and physical assault cases. From this real life world comes his first work of fiction Murder Book from North Star Press. “A convincing piece of fiction that pulls you into a heart-breaking human experience with unpredictable and jolting twists.”