Jeff Wiehe, writing for the Fort Wayne Journal Gazette, has a pretty good article about the struggles taking care of the mentally ill at the Allen County Jail. One of the basic problems is that when you do not treat the mentally ill up front, there is a strong likelihood that they won’t comply with society’s norms and will, consequently, end up in jail. Jails become the mental treatment centers of last resort.
The article doesn’t specify costs, but my strong suspicion is that it costs more to treat mental illness in jail than it would elsewhere. But, lawmakers get beaten around politically for spending money on “do gooder” crap like mental illness. We don’t even much care for government spending our money to help people with real diseases, let alone mental illness which – I suspect – a lot of us see as more a sign of weakness than as a valid illness. It’s not true, of course, that mental illnesses aren’t real. It’s just that, when we see a broken leg, we know what we’re dealing with. A sick brain is a lot more subtle.
But jails, we’ll let our politicians spend at least some money on jails. Punishment, as opposed to treatment, is something we can get behind. I’m not sure why we’re generally happier with tax dollars spent on retribution, but there it is. Unfortunately, that means that the treatment provided ends up being a lot more slapdash. The mentally ill are mixed in with people who are actually bad. And, once the confinement ends, the treatment usually does to. The person, still unable to conform to societal norms, re-offends in some way or another. Rinse. Repeat.
I don’t know what the right answer is. I don’t think we’re spending our money wisely by using jail as a proxy for mental institutions. But, on the other side of things, it’s hard for me to escape the notion that segments of our population can present a huge, sucking vortex of need into which we could throw every available resource without seriously diminishing the demand. Guess I’m a little cynical.
The other thing you aren’t considering is that a semi-happy, healthy person is more valuable to society than a mentally-ill person. That person can be more productive, boost the economy, and benefit the community. So its a double whammy against our budgets to put them into jail versus up-front treatment.
Keep in mind too that some of the most brilliant minds of our history were also mentally ill. So, you might also be locking up the next cure for cancer, the next great Van Gogh, or the next leap in the understanding of our universe.
The issue is that,being an “internal” affliction, people are generally skeptical about someone with symptoms. Because its internal, people can push it aside and think “ah, they are faking it.” I guarantee that if folks with mental illness were bleeding out of their hands everywhere they went, they’d be rushed to the hospital immediately.
We have created a society that doesn’t reward caring and nurturing. (Why else would a money manager make 10000x more than a fireman, a school teacher, or a nurse?) Add to that a genuine fear of the mentally ill, and the suspicion that they are faking it, and taking care of them up front falls really far down people’s priority list. “Lock ’em up so we don’t have to see them…” instead.
Also: re your last paragraph. I’ve been thinking about this a LOT lately, wrt the health care debate. Science says that we should really be ignoring people who have physical or mental weakness. By healing them and perpetuating their genes, we are just hurting future generations and our species. (At least until we develop sophisticated enough genetics treatments to eradicate all disease at the genetic level.)
I don’t have a good answer. Morally, we shouldn’t just let people die when we can develop the means to heal them. We could debate sterilization in people with genetic disorders, but I don’t think we’d get far. :) Fiscally, we can’t help everyone, nor can we necessarily trust that people who say they need help really need it.
The only partial solution I can come up with is right to the point of your post: Help people at the earliest and cheapest point possible to stretch the budgets as best we can and to make them more productive sooner. Perhaps if we really practiced that, then a lot more of society would be out of prison and be useful again, generating more tax revenue to help out more people, etc, etc.
Dangit, I can’t let this post go. :) Just wanted to point out that this relates to a lot more than just mental health. If we educated kids better, then less would go to prison and be a drain on society. If we spent more effort on the inner city, getting real jobs in there, less people would be addicted to drugs. If we dropped farm subsidies and re-made our agricultural base maybe a fresh salad would cost less than a Whopper and society would be healthier, live longer, and be happier.
People need to be able to better understand the long term effects and true costs of our immediate actions. And we’re notoriously bad at that.
Ok, now I’m leaving. :)
The general thought seems to be that it’s not society’s responsibility. And because nobody has figured out how to make money from the mentally ill, private enterprise isn’t interested. Therefore, only those who have families wealthy enough to care for them receive treatment on a consistent basis.
The rest are consigned to the street, where local officials, in response to complaints from potential voters, pass laws against panhandling.
Jesus, Dave, should we just round the poor bastards up and kill them? A final solution? When do we start blowing away recidivist prisoners? Nonconformist activists?
Sure would save on State revenues. Keep the bored populace happy, too.
science definitely does not tell us that we “should” be ignoring the weak, unless you consider eugenics to be a science… in which case, i don’t think “ignoring” is the right word.
I get what Dave’s saying. And I don’t think we need to beat him around for saying it. He’s not *advocating* eugenics here. I don’t think I would say that “science” is telling us anything. Science is basically just a method of observation.
Maybe in a pure state of Nature these genes aren’t being passed along. And the fact is that we’ve overcome nature in a lot of ways that add to our long term expenses, many ways for the good (even given additional expenses) and some for the bad.
I wonder when I hear about a suicide for someone who was bi-polar (which can usually be managed albeit through meds), why didn’t the person’s family members step up and keep better tabs on the person (ie., taking away their firearms from them)?
Sensible jailers and Sheriff’s know how huge this problem is. I remember when the facility on North 6th Street was the “new jail” for the County. Then we wholesale deinstitutionalized all but the most intractably mentally ill, many of the newly freed proving unable to behave acceptably – especially without good outpatient services. The current jail is orders of magnitude larger, and overall population doesn’t explain much of that.
This problem far outstrips poverty and poor education in accounting for drug law violations, too. “Self medication” is pandemic among the mentally ill.
If you want to help, a nice big check to NAMI West Central Indiana (http://www.nami-wci.org/) would be a good step. NAMI trains our Police Crisis Intervention Teams, by the way, and has a good relationship with law enforcement generally.
Jail is easy and available and the people are off the street and not a danger to others,and there is no other facility except the streets. And so many people think insanity is a choice and a result of bad life style.
I watched again recently on rerun the movie ‘A Beautiful mind’, with actor Russell Crowe playing the part of a Nobel Prize winning, lifelong schizophrenic. It gave good insight into what insanity is and perhaps how we could treat it.
This schizophrenic was utimately able to function on a high level by using his intellect and logic to tell him that the people he was seeing and conversing with hadnt aged in all the 30 years they were ‘friends’.But knowing they were not real didnt mean he didnt continue seeing them. His damaged mind remained damaged. This is good insight what an ‘insane mind’ might be..Not aging was not logical,he reasoned, so they cannot be real people..He continued to see them,but ignored them and they, from his point of view, pouted and complained of being ignored and rejected. His mind was never healed.
So he lived his life to outsiders as an eccentric since he was an effective teacher at Princeton. ‘Insanity’ label means to most people that the person would be dangerous. Eccentrics can make good teachers,depending on level of students and nature of eccentricities.So maybe the cure is less important than being able to function..
He could have led a normal life through medication therapy,but he chose not to.The medicine would have made the hallucinations disappear.
This an amazing true life story and points the way to how psychiatry and medicine may evolve in the future
Best quote by Doug:
” I don’t think I would say that “science” is telling us anything. Science is basically just a method of observation.”
But,method of observation’ is key step to defining what is and what isnt..
I’ll second what Roger says here about drug users. Absurd to place people with illnesses in storage and expecting them to be ‘cured’ upon release.
Well yes, Doug, in this post you do sound like a cynic, a cold-blooded one at that.
Regarding the comment about sterilization I think it is important that we are all well aware of the history of forced sterilization of people with mental illnesses in this country. In that spirit I offer the following links: Eugenics ArchiveFrom the Chicago TribuneGeorge Mason University
Further, I think it is also important to be aware of the capacity of people with mental illness to recover.