Police Encounters With the Mentally Ill
The mentally ill and police encounters have risen dramatically in the last few decades. Mentally ill folks in crisis are increasingly being sent to jails both pre-booking and post-booking rather than to emergency rooms. The police often don’t recognize the red flags of mental illness. Long waits in emergency rooms, lack of insurance for mental illness and declining psychiatric beds all contribute. EMT, police, sheriff, fire fighters responding to domestic abuse do not recognize the subtleties of the different mental illnesses and thus jails are becoming de facto mental institutions. Prison guards are certainly not trained to treat mental illnesses. This applies as well to the homeless who become aggressive to the public.
Deinstitutionalization of the chronic cases between 1960 and 1980 has flooded the streets of medium and large cities with seriously mentally ill patients. Access to psychiatrists is nearly impossible by private insurers, HMO’s and the medically indigent adults who do not qualify for Medicaid has become epidemic. Only Medicare makes psychiatric care readily available.
20% of arrests involve the mentally ill leading to hundreds of thousand in jails on a given day in this country.
A recent article in the New England Journal of Medicine (NEJM 2016;374:170-1703) highlights Miami-Dade county in Florida. For some reason this county has among the highest rates of mental illness in its population, nearly 9%. With the advent of play-acting scenarios and education of police the number of mentally ill folks in Miamie-Dade county DAILY has dropped form 7000 to 4000 daily. Contributing to this improvement are increasing diversion programs to emergency rooms and to short-term psychiatric placement and Board and Care homes. However, those available must at the very least have Medicaid. Florida, however, has opted out of expanded Medicaid programs under the Affordable Care Act.. In Florida this has led to 500,000 people in MIA status and do not qualify for these diversion programs and placement in acute or chronic facilities.
In a New York Times article (April 1, 2014) Albuquerque is one of the worst cities regarding police shootings involving the mentally ill. A case is reported of a psychotic homeless person ending up shot dead. The outrage to this case has led to lawsuits both private and public and criminal as well winding through the courts.
Most suicides are committed by people with either major depression disorder or bipolar disorder (affective disorders) with co-existent substance abuse or personality disorders. Officers confronting such people in crisis must be able to recognize and de-escalate their response.
So, what happens when someone with a pre-existing mental condition is incarcerated for short periods of time or given long sentences (many years) for minor or major felonies.
In 1995 a judge in a law suit found “that the standard of mental health care in California’s overcrowded prison was so low as to be unconstitutional and ordered that mental care for all of California’s prisons be place under independent control.” It was in response to this 1995 finding that the Lindsay Hayes study was mandated and in January of this year found little change.
Particularly alarming as reported in the Guardian in May of 2016 was an alarming increase in suicides at a California Institution for Women (CIT) in San Bernadino County. During an 18-month period from 2014 to 2015 there were four suicides and at least 20 suicide attempts at tha CIW. In comparison three suicides were recorded in the previous 14 years.
In that same 18 month period only nine women were sent for emergency care due to suicide risk. But over 400 cases were placed on suicide watch. Suicide watch consisted of being placed in solitary confinement with no windows until no longer felt to be a suicide risk. Some of the above suicides occurred within days of being released from solitary.
Although suicides in male prisoners far outweigh females the rate for males has gone down because the early release program for males has accelerated faster than for women.
As far as homelessness a unique collaboration between over 30 news outlets including newspapers, TV and radio during the month of June will involve daily reporting of homelessness in San Francisco. This is the first time such a collaboration has switched news from just reporting to advocating solutions to the State Legislature for homelessness (except for editorials). There are about 6000 homeless in San Francisco with attendant a health problems, economic problems and a blight on the city. As I visit the City by the Bay I see homelessness, trash and the smell of urine pervasive in the most visited tourist locations. I no longer recommend out of state or out of country friends to visit San Francisco. They would be better served by visiting Vancouver, B.C.
That is a personal feeling. The deluge on the populace of San Francisco by these news organizations culminating in June 29 observations and advocacy for solutions is well discussed in New York Times article of May of this year.