In the days since the Parkland shootings, untreated mentally ill Willard H. Broyles of Hamilton, Ala., came towards police with a knife and was shot by an officer. In Escambia, Fla., untreated, mentally ill Dale Brown fired a gun at sheriffs. And at Central Michigan University, untreated, mentally ill James Eric Davis killed his parents inside a dorm room. Crimes caused by leaving people with serious mental illness untreated are common and often preventable.
It is therefore good news that earlier this month, President Trump signed an executive order establishing the Federal Interagency Council on Crime Prevention and Improving Reentry comprised of top White House and Cabinet officials. The order reiterates his previously stated position that crime and incarceration can be reduced by improving the nation's mental health system. The Interagency Council can prove him correct by focusing community mental health funds on treating the most seriously mentally ill and increasing the number of psychiatric hospital beds.
“Today’s community mental health programs tend to serve the least symptomatic and highest functioning, rather than the seriously mentally ill who are most likely to become incarcerated without treatment. ”
Those two reforms will lower the crime and incarceration associated with leaving people with serious mental illness untreated, which can lead to savings for taxpayers.
Today’s community mental health programs tend to serve the least symptomatic and highest functioning, rather than the seriously mentally ill who are most likely to become incarcerated without treatment. Combined with the lack of housing and lack of psychiatric hospital beds, this has forced many seriously mentally ill people into the criminal justice system.
While researching Insane Consequences, I calculated that there are almost 400,000 seriously mentally ill people who are incarcerated and 750,000 on probation or parole. Most were arrested for minor crimes that escalated, but 26,000 mentally ill individuals are incarcerated for murder. These are not the result of serious mental illness, but they are the result of letting serious mental illness go untreated. Nationally, 35 percent of those who are most seriously mentally ill go untreated. That’s a problem that redounds to the criminal justice system and needs fixing.
The Interagency Council should encourage greater use of Assisted Outpatient Treatment. AOT allows courts to order the subset of the seriously mentally ill who go off treatment and are frequently arrested to stay in mandated and monitored treatment while they continue to live in the community. AOT has reduced arrest and incarceration in the 70 percent range and cut cost of care to taxpayers by half. The council should recommend that all involuntarily committed patients and mentally ill prisoners be evaluated for enrollment in AOT prior to discharging them as those two groups are the most likely to needlessly deteriorate if not provided treatment. The Interagency Council should allow Medicaid funds to be used for the court costs of AOT and require states to have active programs as a quid pro quo for receiving federal mental health block grants. It should also incentivize states to expand clubhouse programs, assertive community treatment teams, housing, and other community programs that willingly serve the seriously ill.
The council’s other recommendation should be to expand the number of psychiatric hospital beds available for the seriously mentally ill who cannot succeed in the community. The nonprofit Treatment Advocacy Center calculated that we are short at least 100,000 beds for them. The council should recommend eliminating the IMD Exclusion, a provision of Medicaid that prevents states from using Medicaid funds for long-term psychiatric hospitalization of adults. It is close to insane that Medicaid does not allow funds to be used for those who need help the most and may become arrested without it. Trump alluded to eliminating the IMD Exclusion for substance abusers, but it must be done for the seriously mentally ill as well. Likewise, Medicare’s 190-day cap on psychiatric hospitalization should also be eliminated.
But even if hospital beds are created, some mentally ill are too sick to recognize their need for hospitalization. Current law frequently prevents hospitalizing them until after they become “danger to self or others.” The Interagency Council should do what Attorney General Jeff Sessions recently called for: make involuntary commitment easier while preserving due process protections. That would also lower the use of incarceration.
Trump took the first step in fixing problems in the mental health system when he appointed Dr. Elinore McCance-Katz as Assistant Secretary of Mental Health and Substance Use Disorders. She has taken numerous steps to end mission-creep and focus existing government mental health funds on the most seriously ill. The Interagency Council should help her and the president by proposing more mental health reforms that are focused on keeping patients, the public, and police safer.
This piece originally appeared at the Washington Examiner
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DJ Jaffe is Executive Director of Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.
This piece originally appeared in Washington Examiner