A woman at the market I went to Thanksgiving morning reacted to my banter with a question, "Are you a Marine?" When I told her I had been, she said her son was a Marine. "He got in trouble with the law and had to go in," she remarked.
One of Senator Webb's comments in his address to The Hamilton Project reminded me of this encounter. It is a chance meeting that is not uncommon and I never know how that story is going to turn out. Having spent a lot of time involved in entry level training, I know that the story can go either way. Senator Webb mentioned that he thought the Marine Corps provided a pretty good model on how there can be, on the one hand a disciplined environment, and on the other hand a fair environment. But my experience in that kind of environment informs me that that approach will not necessarily succeed in the manner desired for portions of two of the three classifications in the Webb triage concept. Not all violent criminals are incorrigible, but many are; rarely will discipline and fairness alone evoke civil and rational behavior from the mentally ill. On the one hand, we must still treat the incorrigible with civility; on the other, there is no sustainable good that can come from using the criminal justice system to house the mentally ill.
During the mid-eighties, funding for the mental health care system was slashed. Immediately thereafter, fellows who had been set loose by a system that could no longer provide care began coming up to my recruiting tables on campuses. One in particular became a fixture at the table at San Jose State University where he had been a student at one time. He was the first person I remember meeting who had nicotine yellowed nails and fingertips. I never saw him without a cigarette or tobacco product of some sort. His story involved a stint in the military that had been very brief and now that he had lost another temporary home he wanted to know how to get back in. He promised he could behave himself this time. I would not be surprised if today he is one of the mentally ill who Senator Webb believes are inappropriately incarcerated.
Our prisons are housing the great portion of our nation's mentally ill, according to Webb. The number of mentally ill in prison is calculated at nearly five times the number of people in inpatient mental hospitals. A forensic psychologist has pointed out that, nationwide, jails have become the number one holding stop for the mentally ill. Here Webb sees resources that are dedicated to incarceration being used more effectively in mental health care. An effort must be made to find better ways to treat those who are suffering mental illness. It is not a crime to be mentally ill. It is a crime to live by violence. By waiting until the mentally ill become violent to address their issues is to invite the kind of tragedy seen at Virginia Tech last year.
Plus there is the aspect situations like that discussed in John Grisham's The Innocent Man: Murder and Injustice in a Small Town. It is a compelling story of Ron Williamson's journey from professional baseball prospect to convicted murderer. Though innocent, he was arrested, charged, and sentenced to death largely due to his mental competence. Grisham has stated that these kinds of incidents are happening in this country with increasing frequency. So, not only do you have the mentally ill being incarcerated for crimes that are from despair, there are the innocent mentally ill being put away with no prospect for proper care and treatment.
Like the issue of our treatment of non-violent drug offenders, an alternative can reduce incarceration, improve public safety, and produce social benefits in excess of their costs. But unlike the bumper sticker law enforcement and criminal justice solutions offered by those who just want the problem to go away, we must move in more creative ways of dealing with problems in our society. Again, a national dialogue is required.
With trepidation, I asked that mother I met at the market how her son was doing in the Marines. She grinned broadly and said, "He just loves to go running in those green shorts and boots when he is home, he is so proud. He's 37 now and almost ready to retire, but he may stay in some more." So, yes, the Senator is absolutely correct when he says that a disciplined and fair environment can go a long way towards nurturing growth. Think of what that environment could do for social justice writ large.
This is the third in a series of what will be five posts generated by Senator Webb's address before The Hamilton Project audience.
7 December, 2008 The War on the Impoverished
8 December, 2008 Senator Webb at The Hamilton Project
Next:
The Campaign Against Drug Addicts
Cross posted at Blue Commonwealth
Cross posted at VBDems.org - Blogging our way to Democratic wins in Virginia Beach!
There are clearly some individuals who lack the gene for learning from mistakes. From an early age they develop impulsive anti-social behavior, and seem unable to develop self-control. What to do with them in a civil society? They do not belong in jails (a hopeless dead end), at least not in the early stages, but the hard-line conservative philosophy blames the individual or his slovenly parents, and refuses to pay for "frills" like counselling. Do we have a progressive philosophy and policy based on science, rather than on self-righteous punitive approaches?
However, anything will be better than the punitive approaches.
But I am concerned that you imply that the natural progression is for mentally ill patients to become violent. That is not necessarily true. The mentally ill per se are no more likely to commit violent crimes than is the rest of the population. There is a subset of the mentally ill population, which is more violence-prone. But the entire population of the mentally ill should not be painted with the same brush. For example those suffering from anxiety disorders, obsessive compulsive disorders, depression, and many other mental illness are not substantially at risk of committing violence against others. Obviously, some among the severely depressed can be a threat to themselves, though. Thee also seems to be an erroneous conflation of the mentally ill in general with sociopaths.
The Surgeon General's report suggests http://www.surgeongeneral.gov/... that a dual diagnosis of both acute mental illness (such as schizophrenia) and substance abuse significantly increases the likelihood of violence. But again, this is a combined result of two things.
According to the American Psychiatric Association, the absolute risk of violence among the mentally ill is very small. Additionally, only a small portion of the violence in society can be attributed to the mentally ill.
The NIMH reports that:
"Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia... By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period."
In a study of one thousand individuals, the National Institute of Justice did find a higher incidence of violence in schizophrenics. But substantially more violence resulted from alcohol or drug abuse.
A New England Journal of Medicine study did find that schizophrenics were twice as likely to become assaultive as the non- mentally ill. But the study also said that much can be done to reduce that risk. See the example of the ride along project below. There are many other tactics, treatments, and programs which can help reduce violent episodes.
On the other hand, individuals can become more violent in prisons. And if one tries to wrongfully incarcerate someone who is mentally ill, especially if the arresting officer has had no appropriate training for dealing with the mentally ill, the story possibly changes too.
That is not natural progression either, but rather a strong reaction to being taken into custody when no crime has been committed. If you are stipulating about the mentally ill who find their way into prisons, then the story changes as well. But it is not the natural progression of mental illness per se, but the violent surroundings that can result in stepped up violence among the wrongfully incarcerated. (Note that there are great model programs, such as one instituted here in Blacksburg, in cooperation with the Mental Health Association, the Blacksburg Police and a legal aid group. The program was modeled after a breakthrough program in Memphis in which police had mental health experts and advocates ride along and guide them in handling of difficult cases. This program is effective at reducing wrongful incarceration. I know at least two people involved with this model program.
In addition, using the example of the Virginia Tech shooter as a surrogate for understanding the mentally ill is using a most extreme case. And it would be unfair to the many individuals living lawful, productive lives. Even those on disability for mental illness aren't well served by being swamped into one overarching stereotype of the mentally ill. One activist in the area of mental health advocacy whom I know was particularly concerned that all the work advancing the rights of the mentally disabled would be undone by such characterization after the Va Tech shooting. Indeed, it appears that some of that effort has been undone by misinformation, fear, and alarming opining in the aftermath. As horrendous as that event was, and as inconsolable must be the victims' families, that doesn't justify equating all individuals with mental illness with (well, I really don't want to say his name). We who live in Blacksburg do not take any risk of violence lightly. Anyone who had loved ones on campus at the time, friends trapped in Norris Hall or who sat helpless for hours not knowing who had died and who had not will never, ever trivialize any risk of such violence. Yet it would also be tragic to learn the wrong lessons.
I've been researching Virginia's law enforcement approach to mental health for some weeks now. There have been substantial improvements to the system which I hope to address in a future diary.