One in four Americans is living with a mental illness each year. That number is much higher in the prison system, said Kevin St. Jacques, senior manager of Recovery and Integrative Care at Sound Mental Health (SMH).
St. Jacques said his job is to help reintegrate people from the criminal justice system into the community.
Headquartered in Capitol Hill, SMH has 80 different programs that served a total of 17,500 patients last year.
Its Recovery and Integrative Care program includes the Forensics program, which serves 3,000 people with mental illnesses who have been in jail or are on their way.
“What we discovered was if you can work with people before they come out of an institution — be it prison or be it jail or even Western State Hospital — and help them prepare and assess their needs, the likelihood of success is higher,” said Declan Wynne, director of Recovery and Integrative Care.
Different routes for help
Journalist and author Peter Earley spent time embedding himself in the prison system in Miami, looking at how inmates with mental illness were treated. His findings and his experiences with his son’s mental illness became the book “Crazy.”
Earley’s son has bipolar disorder. When his son had breakdowns and was arrested, Earley found he couldn’t help him. “The law wanted to punish him” because he broke into a house to take a bubble bath,” he said.
Earley, who spent time in Seattle at SMH in May, said, while SMH is helpful, it’s not enough.
If a person has a psychotic breakdown in Washington state, they are three times more likely to go to jail than to receive help, he said. In Washington, two-thirds of people who meet criteria and need to be treated, can’t find an available bed, leaving them to wait hours or sometimes days, Earley explained.
Most states have laws based on the danger a person can cause to himself or others or their state of deterioration, Earley said.
“When you don’t have enough services,” he said, “it becomes an excuse to not help people, and only someone who acts out and is violent gets help — and then it’s often too late.”
His son wasn’t dangerous, Earley said: “I had to wait for him to get dangerous, and that’s a bad way to go.”
The right to refuse treatment is something people don’t understand, Wynne said.
“We cannot control the behaviors of some of our consumers, and we are not the police or the Department of Corrections,” Wynne said. “We are here to treat, but we can only treat within limitations.”
There are a few routes for a mentally ill person who is arrested in Seattle. They can go to a diversion court instead of criminal court. There are mental health, veteran and drug diversion courts. People can also go to the Crisis Resolution Center, where they stay one to two weeks until they stabilize and get connected with a treatment agency. Some people still go to jail, but they can get services while they’re in jail too, St. Jacques said.
For a criminal to be diverted from court into a mental health program, they need to have committed a misdemeanor or low-violence crime, Wynne said.
No crimes are specific to mentally ill people. Often, they commit nuisance crimes, like urinating outside, St. Jacques said. SMH’s Forensics programs reach individuals who commit all types of crimes, but SMH offers programs focused specifically on serious crimes like attempted murder and sexual assault. The recidivism rate for that program is 13 percent, he said.
“The population we’re working with,” St. Jacques said, “they’re committing crimes as a way to have their needs met — whether they have a chemical-dependency issue and they’re trying to get a fix so they commit a crime to do that, or the voices in their head are telling them to do something. The city gets that they don’t just commit crimes on a whim.”
The mentally ill do not generally commit the major, violent crimes, St. Jacques said. Instead, they’re more likely to be the victim of a crime.
Even though people may not get mental health treatment until they commit a crime, they’re using that “to their advantage to trap as many people as we can to get them to the appropriate services,” St. Jacques said.
Of the 3,000 people in the Forensics program at SMH, St. Jacques estimates that 90 percent have childhood trauma. This often pushes them to leave home young and live on the streets, where drugs are available to cope and crimes are committed.
“The mania, the voices in their head, the depression, the anxiety, the PTSD — it’s not addressed,” St. Jacques said. “It’s not what they’re interested in dealing with. [They think,] ‘I’m just trying to make it day to day. I’ll worry about the voices later.’“
Mentally ill behind bars
Earley said he was shocked by how inappropriate the prison system was for people with mental health and how many people there had a mental illness.
“[Prisons have] always been a dumping ground for people who have problems,” he said.
In many ways, prisons are even worse for people than no care at all, he said. Often, jails will not give prisoners their medication or will insist on giving them a cheaper kind. In Miami, Earley said, he saw cells that were made for two people with six inmates in them.
People with mental illnesses spend up to three times longer in jail, Earley said, which ends up costing even more.
“Nobody wants to let you out,” he said.
Earley’s research focused on people with serious mental illnesses, schizophrenia and bipolar disorder — the illness his son has.
“They’re the sickest of the sick,” he said.
When speaking with Earley, Wynne said he was taken aback by the number of resources and the energy Seattle puts into diversion programs. “There is a lot more openness to talking about it here, and a lot more openness to try to problem solve it here,” he said.
What needs to happen with mentally ill people who commit crimes is treatment, Earley said. Mentally ill people need help with housing, education, job training and building a social life. This includes veterans with PTSD, he said.
“If you provide wrap-around services, most of them can recover,” Earley said. “They can manage their illness,
instead of having their illness manage them.”
The police officers Earley worked with in Miami did not have training to work with people who had mental illnesses, he said.
In Seattle, a major component of the collaboration between SMH and the Seattle Police Department (SPD) is Crisis Intervention Training (CIT). SMH staff work with SPD during the 40-hour training to help police officers handle mentally ill people.
“The truth of the matter is, even though all officers are issued a gun, what they use more than anything is their mouth,” St. Jacques said.
Not all officers are required to take the CIT training — that’s up to the police chiefs, St. Jacques said, but the goal is to train every officer.
“Obviously, we don’t want our cops out there being social workers,” he said. “Good, bad or indifferent, the criminal justice system seems to be the place where the homeless individuals first get connected into the system. SPD recognizes, that and they now have the tools to get them routed correctly.”
Continuing the fight
Even though SMH programs have been successful, the agency is working with limited funding. One of its programs, which helps with the transitioning the most dangerous mentally ill out of the prison system and into the community, has been working with the same budget for the last 14 years, Wynne said.
For their clinicians to be financially stable, they need to take on large caseloads, which means they spend less time with each patient.
“As far as we have come, the more we have walked down that road, the more we as an agency are expected to do on a shoestring,” Wynne said.
More money could help recidivism rates drop even lower, said SMH communications director Steve McLean said. Nationally recidivism rates are around 46 percent, Wynne said, while the recidivism rate in the SMH Forensic’s program is about 20 percent.
Rent costs in Seattle are a huge hinderance to the mentally ill, St. Jacques said. Even though SMH partners with the Low Income Housing Institute to get people affordable housing, there needs to be more. SMH now has 1,500 units of housing primarily for mentally ill clients with a criminal history.
While the institutions in Seattle are making strides to get mentally ill criminals the proper resources and programs, people in Seattle aren’t always so understanding, Wynne said.
Earley said, when people see someone homeless and “crazy” in the street, they want to blame them and believe they chose that life.
“If we really believe it’s an illness...then we have to believe it might happen to us or someone we love, and people don’t want to believe that,” he said. “It happened to someone I love — it happened to my son.”
It was a difficult journey, Earley said of his son’s struggle with his bipolar disorder. He had three breakdowns while Earley worked on his book, culminating in a run-in with the police where he was Tased. But this story is “happily ever after,” Earley said: His son received treatment, lives independently, has two jobs and is a peer for other people with mental illnesses.
“This is not the fault of the person who get’s it,” Earley said. “You don’t get schizophrenia because you’re a bad person, or bipolar because you’re evil — they’re genetically based illnesses.”
Earley has been touring and giving speeches about his experiences with his son and in the prison system because he wants to keep attention on the problem. He is now working with actress Glenn Close’s sister, Jesse, who has the same mental illness as his son. Together, they’re writing a book; some of the book’s proceeds will help the Closes’ Bring Change 2 Mind foundation.
“When high-profile individuals begin to talk about these issues in real ways that are very accessible and quite frankly courageous, I think you’re going to see a shift in that area, and that’s why we invest heavily in those partners,” McLean said. “It doesn’t benefit SMH specifically, but it does rise the tide, so to speak. We’re stakeholders in this, as well.”
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