Los Angeles chooses mental health treatment over jail

by Dr. Terry A. Kupers

The supervisors voted against constructing a new mental health jail to replace Men’s Central Jail, which is slated for demolition, and decided instead to funnel the funds into a new hospital facility overseen by the Los Angeles County Department of Mental Health.

Jail is simply no place for individuals suffering from serious mental illness, even if the jail has a mental health tag. The historic vote by the L.A. supervisors could be the first step in reversing a decades-long pattern of criminalizing mental illness.

People struggling with mental illness do not do well in jail. They are too often victimized, or their tenuous control over some of their unfortunate inclinations get them in disciplinary trouble. A central tenet of modern psychology is that punishments for wrong behavior do not help improve behaviors. Rewarding desired behaviors leads to improvements.

But jails are built on the idea of punishment. Prisoners get “tickets” for breaking rules, and indeed, prisoners with serious mental illness break rules and are punished with time in segregation or solitary confinement — and the time in solitary exacerbates their mental illness and makes their prognosis and recidivism rates dire.

Diversion involves the assignment of individuals charged with crimes to mental health treatment and substance abuse recovery programs in the community. According to outcome studies, diversion works — and it is proven safe. Typically, a Behavioral Health Court offers defendants a chance to avoid jail if they will adhere to an assigned treatment or recovery program. Those who follow through on their assigned treatment are far less likely to return to jail, and more likely to find stable housing, to stay clean and sober and to find work.

In the 1960s, progressives pushed to discharge individuals suffering from mental illness from the asylums — places where strong tranquilizers and electroconvulsive shock were known to make zombies of them, as illustrated in Ken Kesey’s novel, “One Flew Over the Cuckoo’s Nest.” The plan was to return mental patients to the community, where federally funded community mental health centers would provide the services needed to keep them afloat. Mental health clinics, halfway houses, day treatment programs, services for children with emotional problems, vocational training and supported housing would make it possible for them to attain a much better quality of life than they had in the asylums. But then the funds dried up.

The federal Community Mental Health Centers Act that President Kennedy signed in 1963 provided only five or eight years of funding. Local government was supposed to pick up the tab from there. But state funding for public mental health plummeted. The people who should have benefited from well-funded community mental health centers fell through the cracks.

Our communities don’t have the capacity to meet the demand for mental health services for all those in need, leaving jails and prisons to serve as de facto asylums.

Many were unemployable, resorted to illicit substances and alcohol, became homeless, and eventually found their way into the jails and prisons. A 2014 study by the National Sheriffs’ Association and Treatment Advocacy Center found there are 10 times as many individuals with serious mental illness in our jails and prisons as there are in our psychiatric hospitals.

What if, instead of building a new mental health jail, the counties were to put an equivalent amount of public funds into community-based treatment programs? One way to move forward with that plan would be to identify the mental health programs in the community with proven efficacy, and then increase the budgets for those programs so they could accept many more clients who would otherwise be in jail.

Just about everyone believes public mental health funding must be increased. The question is whether we are going to fund mental health treatment behind bars, where recidivism rates are notoriously high, or in the community, where individuals with mental illness and substance abuse problems can be given a fair chance to succeed.

Dr. Terry Allen Kupers, forensic psychiatrist and professor at the Wright Institute in Berkeley, is the author of “Prison Madness” (Jossey-Bass, 1999) and “Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It” (University of California Press, 2017).

Originally published in SF Chronicle.

Read the full article here.

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