Or contain the issue within acceptable limits pending the outcome of negotiations.
I can remember years ago when I was in the field things were different. The largest mental facility was the Los Angeles County jail.
That's so awful about Kalief Browder. Jesus.
This reminded me to put the dates I've been subpoenaed to testify against Rowan's brother on my calendar, so thanks, heebie! Rowan is in prison several hours' drive from us now and it does seem to be a more rehabilitative one. I'd like to think there's some mental health work going on there but really don't know.
When the criminal-justice system is your only hope, perverse incentives are also inevitable. In 1976, the Supreme Court ruled in Estelle v. Gamble that prisons are constitutionally required to provide adequate medical care to inmates in their custody. As a result, prisoners are the only group of Americans with a constitutional right to health care. Multiple city and county officials told me they had encountered mentally ill people who committed crimes simply to receive treatment.
If O. Henry were around, he could write a story about a guy tries to get arrested to get mental health treatment and only gets arrested after he finds some Obamacare treatment and a decides to find a job.
I get a bit annoyed when people act like deinstitutionalization was something foisted on the country unilaterally by President Reagan. This article tells more of the story.
I often act like that. I like to unilaterally blame Reagan for stuff I don't know much about.
My parents blame Geraldo Rivera (who did some big expose on state mental hospitals).
My first real job was the tail end of the project tracking the effects of deinstitutionalization. I'm told Kaisch gutted the last remnants of that effort (the tracking, not the deinstitutionalization).
5: I'd thought this was something of an urban myth, until last year. When the Evil Ex had me arrested, there was a guy in my holding cell who outright said that he'd gotten himself arrested for urinating on a highway sign so that he could get treatment for depression.
Maybe he was just bragging about how much pressure his urine stream had? Anybody can hit the pole, but to get the sign takes effort.
12: I confess was insufficiently motivated to inquire into the precise target or the geometry of the problem.
Anyway, to the call for links, Judge Rakoff's NYRB piece made sense to me. It points to a National Academies report which I've not read.
Those have nothing at all to do with how high the average man can urinate.
This "suicide" was a slow-motion murder.
I'm pretty sure that 2 was right until very very recently at the latest, like last year, if it's not still true. How to do mental health in jails to minimize suicide risk is a problem with known solutions, but the solutions involve prison guards ceding authority and counties spending money, so absent intervention from lawsuits and the DOJ* nothing will happen anywhere.
*which is getting pretty aggressive about this issue, at least here.
I was on the outdoor BART platform at West Oakland the other day and a guy on the other side was clearly crazying around. I was actually just sort of relieved he was on the other side. At some point he threw a plastic water bottle over the side with evident glee. A few minutes later I saw a cop on the platform and thought "what, the water bottle hit someone?" It must have. Five more cops showed up. They cuffed him and led him off. I'm sure he'll be one of our clients. Warehousing the mentally ill! What do I even have to say about it anymore? Emoji of person shrugging!
Actually I should read more about deinstitutionalization because I don't know the history and often wonder what the ever living fuck. I have had attorneys say "can you get him into a residential facility for mentally ill people?" and the answer of course, discarded verse of "Send in the Clowns", is "he's already there!"
You could fantasy come back in time with me, Smearcase, as we fantasy murder Reagan. De-institutionalizing the mentally ill and then de-funding the money set aside for their care was probably the greatest single policy victory pure libertarians have had in this country, the fucks.
Ok, it'll be one of those unlikely buddy movies, but with a political assassination. I'm hearing the preview in my head already, complete with comic record scratch.
It really wasn't pure libertarianism on the de-institutionalizing. There really was a huge amount of unnecessary and cruel institutionalization.
Since I'm far too lazy to look into this myself, does anyone know to what extent efforts by reform minded progressives to expose the abuse and poor conditions in mental institutions inadvertently played into the move to close them down? I'm vaguely familiar with the Geraldo Rivera report mentioned in 9, but I don't know how the aftermath played out.
The movement was well underway before Geraldo was ever in front of a TV camera or Ronald Reagan ended his acting career. The Community Mental Health Act was from 1963.
My informed but non-expert understanding is that 22 is definitely correct. There were for real bad institutions housing the mentally ill (as there were in every rich country). The deal to shut them down in the US was the first and still the greatest example of the purported advantages of liberal-libertarian alliance -- "the government is doing really bad things" met "the government shouldn't be doing anything," combined with a heaping dollop of "we can save money, fiscal responsibility" to create political consensus. Then, they got to the part where they shut the old system down including the bad parts but guess what the libertarians said "psych, suckers" and the new supposedly functional replacement system never got built so now the severely mentally ill sleep on streets or are incarcdrated. A good lesson for left-libertarian alliances generally.
See:
http://en.wikipedia.org/wiki/Thomas_Szasz
24 -- yes, and was largely defunded by Reagan, after Carter tried to regularize the system, IIRC. I just googled it and haven't read it but this seemed like a good overview at first glance.
This:
http://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/
http://montanacorruption.org/2015/01/29/aclu-accuses-montana-state-prison-of-illegal-activities/
I wouldn't assume anything about mental health treatment in a prison setting.
and the new supposedly functional replacement system never got built so now the severely mentally ill sleep on streets or are incarcerated.
"And that's my problem how, exactly?"
17
Los Angeles has a jail system that about double, but Cook County just has a larger single-site facility. Rikers Island in NYC is slightly higher than Cook as well, but that's considered a multi-site system...
24: And Titicut Follies was from 1967.
Re: The Great Satan, there's a clip of him working on defunding mental health support in California when he was Governor in the Cockettes documentary.
Everybody who wants to hold elective office should have to spend a month in jail.
28: And that guy is the expert. But it's still very complicated even in the parts covered that excerpt.
32.last: Illinois is leading the way there.
(For people who didn't click through on 29, there's a bunch of really bad shit going on, but one of the jawdroppingest is the prison psychiatrist who thinks that a bunch of the prisoners are faking mental illness, so he discontinues their prescriptions. He's such an expert that he can tell if someone is faking in the couple of minutes he spends with them.)
But it's not all federal either: the states could have provided the funding. They had been already been the ones paying for the long-term institutions, which Medicaid never matches funds for, so it would have made sense. But by and large they all did the same two-step.
Linked from CharleyCarp's link: http://helenavigilante.com/archives/12077
"Depressing" is really inadequate to describe this.
As per 7, there is a fair amount of the history of de-institutionalization in the Atlantic link in the OP, if anyone wants to break form and read the links in the OP.
I'm waiting for a link with information about the history of deinstitutionalizaton and pictures of dinosaurs having sex with cars.
35 - Which was one of Szasz's beliefs, yeah? Lack of gross physical indications like brain lesions for mental illness means mental illness is mostly malingering.
I had always heard that America's largest mental health facility was LA County Jail. Who knew it was Chicago?
Deinstitutionalisation? I though Reagan was supposed to be good at branding policies. The UK equivalent, which has had about the same success, is universally known as "care in the community".
OT, but very much on-blog: Ekranoplan simulator!
36: Right, but the Medicaid rules created a huge incentive not to institutionalize. even now in MA, the state is very careful to make sure that the DPH hospitals with MH beds have more medical beds than psych.
37: What I mean is the states could have provided the needed substitute non-institutional services, and probably gotten a fair amount of Medicaid match, but they didn't, or cut it over time.