Mental Illness Behind Bars

00:07 Tess Terrible: If someone is having a mental health crisis and 911 is called, police officers act as the first responders. Jails have become housing units for the severely mentally ill. The system is cyclical, recidivism rates are high and law enforcement is acting not only as judge and jury but as caretaker.

00:31 Justin Volpe: I had told the officers and the people in the jail that I needed to get to a hospital, and even though they gave medication on that floor, it’s not just medication that makes people feel better. It’s the whole environment. And as far as that wasn’t the place for anybody. The system is wrong for the sense that you have to get arrested first to be able to get some kind of help or some incentive to wanna turn your life around. You shouldn’t have to get arrested to have to try to get help for mental health or a drug problem.

01:07 Tess Terrible: This is The Pursuit, a podcast about government action and individual liberty. I’m Tess Terrible.

01:16 Justin Volpe: My name is Justin Volpe and I’m a jail diversion peer liaison, certified recovery peer specialist. Well, I was originally born in New Jersey. I came to Miami when I was 19 years old, and I’ve lived here ever since. I had a bad drug and mental health problem. I was diagnosed at a young age, and I got caught up in the system, and that’s how I came across this program. I always lived in a very unstable life at that time, and then I ended up… Actually I ended up being arrested in April 2007, which led me to be incarcerated on the ninth floor of the Dade County Jail, that would be a forgotten floor.

01:58 Tess Terrible: To understand the country’s mental health crisis and where we are now, we have to look back at the history of state institutions. This is Alisa Roth. She is a reporter and the author of Insane: America’S Criminal Treatment Of Mental Illness.

02:16 Alisa Roth: We have always put people with mental illness into jail and prison. We can go back to even before we were a country and see that jail or prisons were the default answer to our mental health crisis. Even Benjamin Franklin was talking about people with mental illness. Of course he calls it something else, but people with mental illness wandering around the Pennsylvania colony with no place to go, and that was why he proposed building what became the first psychiatric unit in the country. But over the last 40 years, as mass incarceration has developed in this country, we see that more and more people with mental illness have ended up locked up in our jails and prisons. And at the same time, we’ve really moved away from the use of psychiatric hospitals and asylums, which has, of course, reduced the number of people who end up in the hospital for mental illness, or who end up in the hospital with mental illness for longer than very brief stretches. That number has gone down.

03:34 Alisa Roth: You’ll remember that at the height of institutionalization, which was around 1950, there were about a half a million people who were living in institutions, which sounds like a lot of people, it is a lot of people, but even then the vast majority of people with mental illness were living in the community. Whether or not they were getting treatment, they were living in the community. So when the institutions started to get shut down, it’s happened in the ’50s, ’60s, it continues today, but we’re really pretty getting pretty close to that zero mark, at this point, yes, there were people… Yes, people were released out of the institutions, and yes, some of them did end up in the criminal justice system, but by best estimates, it was a very small increase in the population of incarcerated people with mental illness that resulted from institutionalization.

04:36 Tess Terrible: In the ’50s and ’60s, the United States made a pretty deliberate move away from state institutions. State asylums were expensive. Like state prisons are today, state mental institutions were overcrowded and underfunded, and they could not provide proper mental health treatment. They became notorious for poor living conditions and patient abuse. When left untreated, individuals with severe mental illness can unfortunately end up living on the streets. They’re often picked up on minor charges, drug possession, or other petty misdemeanors. Charges that shouldn’t be met with hefty jail sentences, but all too often these individuals get caught up in the criminal justice system. This is Ayesha Delany-​Brumsey. She’s part of the Stepping Up Initiative.

05:27 Ayesha Delany-​Brumsey: Estimates really vary, but it’s been found that between 31% of women and 16% of men in jail have a serious mental health condition, and that’s compared to about 5% of people who are not incarcerated, so it’s a huge over-​representation of people with serious mental illness in the justice system. And that’s just in jail. We know that it’s not just that they’re over-​represented. We know that they also are more entangled in the system, they’re likely to stay longer in jail than their peers, they’re less likely to be let out on bail, or on community-​based supervision pre-​trial, and they’re more likely to have their probation and parole revoked and return to jail and prison compared to people without mental health conditions. There is a significant number of people with serious mental illness in jails, but also that once in, it becomes very difficult for people.

06:19 Ayesha Delany-​Brumsey: But I think it’s helpful to start with the understanding that incarceration rates really began to grow to unprecedented levels in the 1970s. And that happened across the board, both for people with mental health conditions and people without. And the reasons for that increase are really complex but we know that some of what drove those increasing rates are things like mandatory minimum sentences, “three strikes and you’re out” laws. Increased enforcement for drug charges and increased punishment for drug charges. And that last piece, that piece about increased enforcement for drug charges is particularly relevant to the question of how we came to where we are now with the over-​incarceration of people with mental health conditions.

07:03 Tess Terrible: Once someone gets caught up in the criminal justice system, anyone, it’s difficult to get out of it, but it is especially difficult for individuals suffering from mental illnesses. When researching her book, Alisa Roth visited the Los Angeles County jail. It has one of the biggest mental health units in the country.

07:25 Alisa Roth: We see that people in general get caught up in the system, and once you’ve been caught in the system, it’s very hard to not get caught up over and over again. But for people with mental illness, particularly those who are being picked up on the low level quality of life offenses, it’s really a repeat cycle. So the person might get picked up for, let’s say, disorderly conduct, which as you know, is really broadly defined. And somebody with mental illness who’s dealing with, say, psychosis or mania can very easily be picked up on disorderly conduct ’cause it could be screaming at somebody who’s not there, or just screaming, or any number of things. The Los Angeles County jail has thousands of people who are held in separate Mental Health Units, so separate from the rest of the jail population. These are people who are put into single cells because it’s been determined that they’re too sick to safely live with another person in their cell. And in many cases, these people are very clearly very, very sick.

08:47 Alisa Roth: So I walked around with a corrections officer in the LA County Jail who was trying to get people to come out of their cells. We encountered a man who you couldn’t even see. He was wrapped in a blanket on his bed, and so you saw just this pile of blankets, but he had smeared the walls of his cell with feces. Almost… And this wasn’t somebody who hadn’t made it to the toilet. This was a very clear intentional act. It’s worth noting that when I’ve talked to psychiatrists who work in the civilian world, they almost never see that kind of behavior, whereas when you talk to psychiatrists in corrections offices, those people who work in jails and prisons, it’s something that they see very very often. There was another person I saw in the LA County Jail who officers brought out, said, “Do you wanna see something?” This guy just tore a piece out of his arm. And they brought a man out, he was on his way to the hospital unit, and had literally ripped a square piece out of his flesh with his own hands.

10:10 Alisa Roth: As you may know, suicide is the leading cause of death in jails and one of the leading causes in prison. And there are a number of reasons for that, but certainly the fact that we have large numbers of people with mental illness in jail and in prison contributes to that. I think that in some circumstances at least, the conditions that people with mental illness are already dealing with really exacerbate the suicide problem. So there’s a young man whose case I looked at in Alabama, for example, who had a long history of self-​harm or trying to hurt himself, but he was also being held in absolutely horrific conditions. He was being held in solitary confinement with effectively no mental healthcare at all. He had no meaningful activity, was having trouble getting visits from his father. He would get punished when he tried to hurt himself. He would be punished by being denied visits with his father and his brother. And he ended up killing himself in prison. And you see this often. If the person were being cared for in a hospital, the ways that they would be taken care of, and even just the environment that they would be taken care of in would contribute to their getting better rather than getting worse.

12:11 Tess Terrible: Judge Steve Leifman of the 11th Judicial Circuit of Miami, Florida, started to recognize this problem in his courtroom. He decided to do something about it. Judge Leifman created the 11th Judicial Circuit Criminal Health Project in 2000. It’s a program that helps people with mental illnesses who have committed low level offenses take part in community-​based programs rather than be incarcerated.

12:38 Judge Steve Leifman: They’re screened right away. If there’s an indication of a serious mental illness, they’re seen by a psychiatrist usually, that day. And if they meet criteria for involuntary commitment on a misdemeanor, instead of ordering all of these very expensive competency evaluations, so we just toss them back to the street, what we do is within three days of the arrest, we actually have them physically transported to one of our locked crisis stabilization units. And all this happens usually within three days on arrest on the misdemeanor. And we reset the case for about two weeks, which is what they really need to begin to stabilize. And then as they’re stabilizing, we send a representative from our program. I have an amazing staff of about 25 people now. And they’re all trained in motivational techniques and they talk to the individual like a real person. And then they say, “Look, we wanna help you. We don’t wanna keep you in jail. We wanna help you get into recovery. And if you agree to go into our program, which is voluntary, we’re not gonna re-​book you, we’re gonna take you, we’re gonna pick you back up,” and the Department of Corrections picks them back up. And instead of taking them back to jail, takes them directly to the court room.

13:47 Judge Steve Leifman: And usually, not in all cases, but in almost all of the cases, if they successfully complete all the terms and conditions, the charges get dropped and we monitor them. And even once their charges are dropped, we will continue to monitor them for up to a year. We keep data on every single mental health call that my two largest agencies out of the 36, which would be the city of Miami and Miami-​Dade County, make. Over the last eight years combined, those two departments handled, I think it was 92,000, 427,000 mental health calls. And out of those 92,000, 427,000 calls, they only made 152 arrests. Our jail audit dropped from about 7,300 to about 4,000. It enabled us to close one of our three main jails and an actual savings of $12 million a year. It’s been closed now six years. So that’s like $72 million in real savings to the county, something else we discovered that we had not anticipated.

14:48 Judge Steve Leifman: And it makes so much sense when you think about it. There’s so many people that have these very serious illnesses that end up in the criminal justice system. By the time they get arrested, they have clinical depression on top of their serious mental illness. They just have given up; they don’t care anymore. And then when they get to the court room, one of our eight peer specialist are waiting for them. Our peers are people with lived experiences with mental illnesses. All four of them are graduates of our program and they’re waiting in court with food, with clothes, with their medication. And the peers play a huge part.

15:27 Tess Terrible: This is Walter, he works as a peer specialist. He is also a veteran and he suffers from mental illness.

15:34 Walter Thompson: So, I’m a retired United States Army. I had 20 years active duty. I retired in 2005, got diagnosed with PTSD. I’ve been living with debt. And started back working, helping people out that have the same problems that I have with my mental illness. I constantly work on myself because that’s the example. Because you don’t want them go through it. As I’ve been looking at it, we treat the illness. We treat the illness and the illness is not a death sentence for them. And exactly how I wanted it to be a death sentence for me, I don’t want it to be a death sentence for them. And what it is it’s when we get ‘em in there, and I see ‘em there, and we look at what’s going on with ‘em, you want to help them as much as possible to be normal. I actually teach that, you know, who said it’s about normal. And I teach them to be their normal, and their normal is not in jail. It’s not letting the mental illness get to you; it’s controlling what it is and living your life.

16:42 Walter Thompson: It gives me great satisfaction to see one of ‘em graduate our program and do different things in their life. That is a big thing for me when I see that because somebody helped them. And I know this could be me, or one of the other peers, or whoever it is, but it’s helped them, but they mostly helped themself. And then when I’m seeing them take control of their life, they’re the ones no longer coming back through the jail system itself.

17:10 Tess Terrible: You used the word death sentence. Why did you use that phrase?

17:16 Walter Thompson: Because I wanted to die. I wanted to die. And concerning about what was going on with me. And all of a sudden you got a mental illness, and people look at you some way, and you want to escape. And sometimes when you look at that and you just want to die with it. I know I did. I said, “Well, this is going on with us, this and that, and this is happening. Then if I die, I ain’t gotta worry about it.” And a lot of people will look at that, “Okay, well, you’re not gonna get a job, you’re not gonna get this.” So all you can do is just take your medication and just sit around and just depend on people. No. That’s not how life… It goes on. You can use what you have and be successful in your life. So you’re gonna get rid of that death sentence on you, and I had to do the same thing.

18:13 Tess Terrible: This is Leah Reed, she is also a peer specialist.

18:17 Leah Reed: So, I see my work as working with the most vulnerable people in our justice system, which is people with mental illness. And it’s just a lot of supporting them and giving them hope that there’s a light at the end of the tunnel. That, as someone who also suffers from mental illness, that you can be a productive member of society. You don’t have to rely on illegal substances, or hurting yourself, or committing crimes to get through life and to recovery. And that’s pretty much what I do. I also do some clerical stuff for my team because I support my clients and I also support the team that I work with that helps make the program happen. The problems that my clients are having, I have them too, like taking your medication every day. That can be a struggle for me even as a semi-​well person.

19:14 Leah Reed: So while I’m telling these people, “You need to take your medication every day.” It makes me look at myself and I have to practice what I preach. If I’m telling my clients that they need to have hope, that things get better, you just have to fix through it, and saying I need to do it myself. And it gives me a motivation to keep going every day, just knowing that I’m helping people, and I’m going through some of the same struggle as them so maybe that’ll help me forge a better connection with them so that they don’t feel like they’re alone.

19:49 Tess Terrible: A lot of things need to happen to keep individuals with severe mental illnesses out of jail. But it starts with tackling the stigma about mental health. I talk to all of our guests about this.

20:02 Walter Thompson: I know is, it’s one thing that I appreciate the awareness that we’re now giving to mental illness. I appreciate the time that people have started seeing this, that we are helping our people out because we’re obviously the ones that need help there. I appreciate that someone is actually coming talking to people and getting that word out there for people to understand and maybe can hear our stories and realize that they help people that are having the same problems we have and that maybe they can get them help. Because help is there, help is there, but we just have to get that word out more. And having these podcasts and them having people come down talk to us that is showing that there are some people there are people in this world that truly want to help the mental illness, and I appreciate that and I love that what’s happening because it puts me more out there to help my fellow men.

20:56 Leah Reed: It’s not something that you can see it’s not like someone missing a leg or maybe someone who has cancer. And you sometimes you can see that reminds them of chemotherapy. It’s a very invisible illness that a lot of people don’t believe in and I wanna really dispel that notion that it’s not real. It’s very real, there’s a lot of people that suffer from it, the family members probably suffer from it, and it’s important to have empathy and sympathy for these people because It’s like any other illness, it just needs to be treated.

21:31 Tess Terrible: This is Ayesha.

21:33 Ayesha Delany-​Brumsey: Jail does not change a person’s life for the better, if what we’re asking of jail is to make sure that someone doesn’t return to jail again, we’re asking too much of jail. If you’re going to incarcerate someone, you have to ask yourself what are you looking for out of that incarceration? And I think that’s what communities are doing now. They’re saying this level of incarceration has not made us safer, it has not made individuals more healthy, it has not helped their families, and it has not helped our communities.

22:08 Tess Terrible: Since being in jail, Justin now works as a peer specialist in the 11th Circuit program, and he’s a good friend of Judge Steve Leifman.

22:17 Justin Volpe: A lot of our laws are outdated, and there’s so much stigma around mental health and drugs is that a lot of people think it’s an issue of willpower or of better judgment. But the truth is, is that anybody can suffer from a serious mental health issue. But the people we’re seeing incarcerated and over-​incarcerated are also people of poverty as well. Because if you see somebody’s family that has money for a private attorney and to bail somebody out, they may have access to better opportunities than somebody that does not.

22:52 Justin Volpe: It’s been criminalized, but now so many people are suffering, they wanna decriminalize it. But the problem is that jails are filled up because people are either too poor or too sick to bail out or don’t know the system. People are living week to week, or month-​to-​month and then they get arrested for a small crime due to their addiction or mental health. They’re put so far back, it puts a strain on their families. If they have kids at home, or if they had jobs, they’ve lost those jobs now even if they’ve been in jail a week. And they don’t criminalize it, but there’s no resources, there is no other prevention in place. There’s so much stigma in general of how to get help and accessing help, good community treatment, that all these people slip through the cracks and they end up incarcerated. And that’s why we do a lot of things with our CIT officers here in Miami. We train them. I’ve had the privilege of training over 2,500 of them with our coordinator to… If they spot the signs of somebody with serious mental health issue, they can get them to the hospital instead of jail.

23:57 Tess Terrible: Lastly, this is Judge Leifman.

24:00 Judge Steve Leifman: There’s something wrong with a society that’s willing to spend that kind of money to incarcerate people with illnesses than to treat them because for a fraction of that amount of money, we can rebuild the entire community mental health system in Florida, and provide access to everyone that needed it at a really high quality. And it just doesn’t happen because they’re so worried about incarcerating and not treating and so we have to try to change that mindset. And so it’s just absurd and cruel what we’ve done, and I really think that if people step back a little bit and looked at this larger picture with these better outcomes, they’d be more likely to do the kind of work we’re doing here. But I’m optimistic.

24:50 Tess Terrible: Thanks for listening to the pursuit. If you like the pursuit, please rate and subscribe to us on Apple Podcasts, Spotify, or wherever you get your podcasts. The Pursuit is a project of lib​er​tar​i​an​ism​.org and the Cato Institute. If you’d like to learn more about libertarianism, visit us on the web at lib​er​tar​i​an​ism​.org. As a podcast producer. I’m occasionally pitched some pretty crazy ideas. So it’s without further ado, that I introduce libertarianism.org’s new podcast Pop n Locke. That’s pop, the letter ‘n’ and locke like the philosopher John Locke. If you haven’t listened to it yet, you can check it out on Apple Podcasts, or wherever you get your podcasts. Look out for a new episode, on the first Wednesday of every month.