A recent nationwide study of mental health conducted by Mental Health America revealed the shocking news that the state of Washington ranks 48th among the states in terms of highest prevalence of mental illness and lowest rates of access to treatment for its citizens. This combination of high need and inadequate treatment facilities translates into high usage of jails, hospital emergency rooms, and homeless shelters as the default venues for “treatment” of people with mental health issues. Needless to say, these surrogate treatment venues are far more expensive in the aggregate than would be the case if our communities established mental health care centers at the local level that would provide comprehensive treatment and care for these citizens.
Washington is not alone in facing the challenges of a long-neglected, dysfunctional mental health system. The nation as a whole has failed to address properly the care and treatment of people who suffer from disorders of the brain that we refer to as “mental illness.” The result has been an explosion of inmate populations in our jails and prisons. There are 10 times as many mentally ill people in jails and prisons as there are in psychiatric inpatient hospitals and clinics!
Through neglect and indifference, we have criminalized people with mental illnesses, thus denying them the opportunity to become productive citizens. One of the major factors that leads to the criminalization of people with brain disorders has to do with the fundamental nature of mental illness itself. These illnesses are defined by behaviors that are abnormal. Hence, someone exhibiting these “abnormal” behaviors frequently encounters law enforcement personnel and is often booked into jail. What needs to be emphasized here is that mental illnesses and their associated behaviors are not criminal (they are medical conditions), and people who exhibit these behaviors should not be treated as criminals!
For a crime to be committed, there must be both choice and intent. No one chooses to be mentally ill nor is there an intent to violate the law, so their behaviors must not be treated as criminal acts. This is why it is morally imperative for our communities to provide alternatives to incarceration when mental illness drives aberrant behaviors. Confinement in jails or prisons results in the deterioration of their illnesses — often irreversible — and leads to no beneficial outcomes. Punishment does not cure mental illness! So how do we decriminalize mental illness?
Decriminalization requires adherence to five basic principles:
1) Absent choice and intent, mental illness must not be considered criminal acts.
2) Mental illness is a medical condition that is treatable.
3) People with a confirmed diagnosis of mental illness will not enter the criminal justice system.
4) People without a confirmed diagnosis of mental illness will be evaluated by mental health professionals when mental illness is suspected.
5) Only when mental illness is not judged to be a factor when a criminal act is committed will the offender enter the criminal justice system.
While some recent improvements have been made in the Tri-Cities that address some of the needs for mental health care, much more needs to be done. Among the most important of these is the creation of a “no-refusal” community mental health care center that offers a full range of services including crisis triage, case management, therapeutic treatment, medication management, affordable housing options and education/training opportunities.
Creating a comprehensive system of care will result in tremendous benefits to the individual clients and the community at large. Individuals will not be faced with insuperable legal financial obligations, arrests and charges that will impede recovery, and they will be linked to mental healthy professionals during each step of their recovery process.
The community benefits as well since it will greatly reduce the number of expensive emergency room visits, inpatient stays, recidivism, jail and court costs, and it will allow police officers to spend less time with mental illness persons and more time on traditional public safety activities.
The recent tragedies in the Tri-Cities should serve as a wake-up call for all of our citizens. These events have, in virtually all cases, resulted from untreated mental illness and they will continue until our community takes an aggressive role in creating a system of care as outlined above.