Jails are the new asylum. Mental health struggles (be it addiction, dissociation, mania, or anything else) are completely misunderstood and over-criminalized. Symptoms can be a sign of trauma, addiction, or stressful environments, and the complexity of human psychology scares people. Society tucks us away for no one to see, or it isolates us to make the struggle harder and the wound of trauma and addiction deeper.
Mental health isn’t a single problem with a consolidated solution and a punny acronym. It is a complex and human-centered approach that requires widespread organization, oversight, and high standards. So a huge organized system of care needs to be tailored to each patient and individual need.
Today, 40% of adults with mental health issues will come in contact with the criminal justice system, most being charged with low-level offenses tied to a crisis situation and their mental health. Jails and prisons now house more patients with mental health concerns than hospitals, and these patients are often sentenced more harshly for the same crime as a neurotypical defendant. The Washington Posts’ police shooting database finds one quarter of those killed by police officers had some kind of mental health condition, which doesn’t count those injured at the hands of officers.
At the same time, mental health patients tend to be the victims of violent crimes, not the perpetrators. People with mental health issues are over-represented in incarcerated populations in the same way that people of color are.
California sees some of the highest rates of houseless residents in the United States. A third of California’s homeless have a documented mental health issue. In Kern County, I can see our unhoused population isn’t a result of being outpriced in the housing market like in larger cities. Unhoused residents in Kern County often suffer from psychiatric illnesses and addiction. More than just transitional and temporary housing, these residents need ongoing, multi-pronged therapy and care. It is not a one size fits all approach, it is not a simple solution.
As Bruno Amato mentions in his recent diary, 10 percent of the unhoused in CA-23, my district, are veterans. They are dealing with physical and psychological trauma, and we are tucking them away in transitional navigation centers. I do not know much about their needs but I know personally that trauma, like any other psychological injury or condition, is deep-rooted and cannot be simply medicated away.
People have struggled for so long from antiquated policies that try to “solve” mental illness through perfect packages of legislation, and we are suffering from the neurotypical group-think idea that mental health and criminality have the same solution.
A Brief History of Mental Health Policy
If you want to look at mental health policy, you have to start with crime and punishment. The historical roots of our nation’s mental health policy and criminal justice system were both originally built to punish and extinguish what is perceived as sin from society. From the beginning, it began as the way to punish slaves that were slowly being freed, then the wider definition of people of color, homosexuals, hysterical women, the list goes on. However from the start, prisons and jails worked as long-term housing for people with mental health concerns. In the distant past, mental illness was a crime and a sin to be policed.
Over time, institutionalization started as a humane approach to deal with the variety of mental health issues, but a full season of American Horror Story can show us what the institutional environments did to patients and plot lines.
It was JFK’s Community Mental Health Act of 1963 that sought to be the federal solution to the mental health “problem.” CMHA proposed community mental health clinics instead of relying on the asylums and the churches to treat patients. Despite calling it “deinstitutionalizing,” patients were taken out of the asylums and emergency-hospital environment in favor of regional community clinics: institutionalized under a different name. The law allowed patients to be involuntarily committed by family members, or taken when seeking emergency care during a crisis. In the end, the majority of proposed community centers weren’t funded, and existing ones were often defunded to cut costs when the law was criticized for being super expensive.
Side note: The sad irony of the CMHA is that JFK’s own sister was lobotomized (before he was president) and basically institutionalized her whole life afterward, only brought out as a prop for the family campaigns. Coming from a wealthy family, the Kennedy’s were able to afford to secretly put her away until her death in 2005. I imagine JFK wanted to let all families of patients afford this care, but empathy for the patient was literally lobotomized away. This was a simple solution to put away people that neurotypical society doesn’t want to see. This was the same time, the 1930s-60s, where phrenology was still considered science and so were neural surgeries like the lobotomy.
Governor Reagan signed the Lanternman-Petris-Short Act in 1967 (LPSA) four years after JFK’s CMHA. It ended the indefinite involuntary psychiatric hold along with defining other rights of a psychiatric patient. It meant that patients could not be institutionalized without end, and it created the California 5150 hold, the involuntary 3-day hold, that still sets the precedent for mental health institutionalization in the country.
While this set national precedent and pretty much helped accelerate Reagan to the presidency, the proposed community health centers weren’t funded and mental health patients were left homeless and evicted by their caregivers who didn’t have the resources, eventually they were funneled into the criminal justice system.
In the style of Reagan, California’s governors on both sides continued decentralization of the behavioral health system through budgetary realignments directly led to the out of control increase in houselessness for patients with mental health concerns. Counties looked to cut costs and increase caseloads for behavioral health workers, with no organized services or standards from the state.
The 1991 Realignment (unofficial name) under California Republican Governor Pete Wilson decentralized the implementation of in- and outpatient mental health programs like drug rehabilitation, crisis interventions, and institutionalization by putting the onus on counties. Three years laters he would sign the California Three Strikes Law. which meant repeat felonious offenders, including those addicted to methamphetamine, were immediately sentenced to life in prison.
Again in 2011 under Democratic Governor Jerry Brown, the legislature used the budgetary process to shift the responsibility of the mental health “problem” to local jurisdictions with no organization from the state or standard. Sounds kind of like the early disorganization in tracking the coronavirus we faced early on before a vaccine.
California’s AB109 of 2011 meant realignment for nonviolent and nonsexual offenders who would now be controlled at the county level. California voter-initiative Prop 47 of 2014 meant offenders of nonviolent and nonsexual crimes were given misdemeanor citations without drug rehabilitation or group therapy for those who need it. While well-intentioned, AB 109, Prop 47, and the following Prop 57 (parole consideration for nonviolent offenders from 2016) were short-sighted actions to immediately reduce the number of incarcerated people, but they did not address the economic circumstances or addiction struggles of formerly incarcerated people.
TLDR: As we collectively became more aware of over-incarceration, people wanted a quick solution to the flooding of jails and prisons. Under these criminal justice realignment laws, county jails were forced to deal with all nonviolent crimes including those committed because of addiction or a mental health crisis. Sheriffs and local police departments became the primary response for these types of cases. Soon, local jails and state prisons became mental health and rehabilitation facilities, with the best opioids and the most overdose deaths.
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