Voices from the inside: It’s time to Decriminalize Mental Illness

The “criminalization” of mental illness is the end result of decades of failed mental health policy. Jails and prisons are the new asylums. Law enforcement is now on the front line of mental illness crisis response. Mental illness is one of the drivers of incarceration in the Whatcom County Jail. See the Vera Institute of Justice, Report to Whatcom County Stakeholders on Jail Reduction Strategies (November 2017). The county’s incarceration of the mentally ill is not unique. It is part of a national shame. Strategies to reduce the jail population by diverting those with serious mental illness into the health care system should be a priority. Unfortunately, there are—at this time—very few options in Whatcom County for true diversion out of jail for those suffering serious mental illness.

It is a given that for any serious health crisis, such as a heart condition, cancer or a traumatic brain injury—we seek medical treatment. Why then, when someone suffers mental illness, do we expect law enforcement officers, correction officers, prosecutors, defense attorneys and judges to fix this community health problem? As citizens, we need to explore ways to provide community-based care to those suffering mental illness before they intersect with law enforcement. We need to be part of a transparent discussion on creation and funding of a state-of-the art local mental health system to which the justice system can safely divert those whose alleged criminogenic behavior arises primarily from mental illness.

Barriers to mental health treatment: Stigma

Before moving forward with a community-based, healthcare model for the treatment of mental illness, the stigma of mental illness needs to be confronted. A person is NOT their mental illness. They are us, our parents, spouses, children, siblings, friends and neighbors. Their condition is not a moral failing. The scientific and medical community still does not know what causes schizophrenia and bipolar disorder (among other mental illnesses), but these diseases occur world-wide and appear to be biologically based. Hearing voices is not the fault of the person who hears them. There should be no shame in being a person with a mental illness—only shame in failing to provide ethical, humane treatment in the health care system, rather than the justice system. We should stop separating the mind from the body—mental illness is every bit a medical problem as cancer or any other chronic disease.

How we got here: A brief history of mental illness “treatment” in the United States and the mental health policies that led to Connor Leib’s tragic death in Whatcom County

When this country was founded, there were no services for the mentally ill, so they were simply dropped off at the local jail. Some towns contracted with local individuals to care for mentally ill people who could not care for themselves and lacked family or friends to do so. Unregulated and underfunded, this system resulted in widespread abuse including “confinement in cages, stalls and pens—chained, naked, beaten with rods, and whipped into obedience.” Dorothea Dix, a Memorial (1841).

Ms. Dix—the nation’s first mental health advocate—visited a jail in Boston in winter. She saw 14 men segregated from the rest of the inmates. They had no heat. They had no blankets. They had almost no clothes and they were freezing. She met with the jailer to ask why he was allowing these men to freeze to death. He told her that they were just a bunch of lunatics—the label used at that time for those with mental illness. He said they had not committed any crimes, and he had no money to house them.

Community-based mental health care becomes the 19th Century standard of care

Dorothea Dix pushed states across the country to build small 120-bed asylums and move those with mental illness out of the jails and into these asylums for humane treatment. The people transferred from jail into these facilities began to make progress. Incredibly, just the act of removing them from the horrible conditions in the jails actually helped them recover.

The rise and fall of the regional mega state mental hospitals

States then decided it would be cheaper to build fewer—but massive—regional state hospitals, rather than the smaller community based asylums—which were then repurposed or closed. At their peak, these larger regional state hospitals housed close to 600,000 patients. In time, they became known as houses of horror and human experimentation facilities.

For example, an early treatment for people with mental illness was insulin shock therapy. Doctors found that certain patients had slightly elevated blood sugar and supposed that if they cured their diabetes, they might cure the mental illness. Instead, patients died.

Doctors then theorized that they might use electricity to “shock” people out of their mental illnesses. They put the patients in a “treatment room,” tied them to a bed, attached electrodes to their heads, placed a tongue depressor in their mouth and then plugged the electroshock machine into an outlet to electrocute them.

When that didn’t work, they welcomed Dr. Walter Freeman, who traveled the country demonstrating his technique—known as lobotomy—of tying a patient down on a bed, inserting an icepick into a patient’s eye socket and moving it rapidly back and forth to sever connections in the frontal lobe. Lobotomy was performed on the most vulnerable population and permanently disabled countless people. This procedure was still performed until the 1970s, although evidence-based research proved it both barbaric and useless.

The Supreme Court extends constitutional rights to patients in state hospitals for the mentally ill

At the same time, Alabama cut its cigarette tax. The tax was a major source of funding for Brice Hospital for the mentally ill in Tuscaloosa. 100 staff members, including 20 professionals, lost their jobs as a result. On October 23, 1970, the fired staff members filed a lawsuit seeking reinstatement on the grounds that patients in the institutions would receive inadequate treatment. The group added Ricky Wyatt as a plaintiff. Wyatt was a 15-year-old “juvenile delinquent” with no mental illness, placed in the state hospital by the courts in an attempt to improve his behavior. The focus of the litigation shifted from the rights of the employees to the rights of the residents See Wyatt v. Stickney, 325 F. Supp. 781 (M.D. Ala. 1971). This decision took more than three decades to work its way through the federal court system (and all the way to the Supreme Court), making it the longest running mental health lawsuit in United States history, with estimated litigation costs exceeding $15 million.

The case highlighted deplorable conditions in Alabama’s state mental hospitals. They were so inhumane that the editor of the Montgomery newspaper described them as “concentration camps,” similar to those run by the Nazis in Germany during World War II. Both staffing and treatment were woefully inadequate. For example, at Bryce Hospital, just one clinical psychologist, three medical doctors with limited psychiatric training, and two social workers provided direct therapeutic care to 5,200 patients. Wyatt v. Stickney, 325 F. Supp. 781, 783 (M.D. Ala. 1971); See alsoWyatt v. Aderholt, 503 F.2d 1305 (5th Cir 1974) (Partlow State Hospital described as a “warehousing institution… conducive only to the deterioration and the debilitation of the residents.”).

After hearing arguments in the case, U.S. District Court Judge Frank M. Johnson ruled on March 12, 1971, that thousands of Bryce patients who had been committed involuntarily “have a constitutional right to receive such individual treatment as will give each of them a realistic opportunity to be cured or to improve his or her mental condition.” He recognized that these patients had been “involuntarily committed through noncriminal procedures but without the constitutional protections that are afforded defendants in criminal proceedings.” He continued: “Adequate and effective treatment is constitutionally required because, absent treatment, the hospital is transformed ‘into a penitentiary where one could be held indefinitely for no convicted offense’.” Johnson found the entire process of institutionalization unconstitutional: “To deprive any citizens of his or her liberty upon the altruistic theory that the confinement is for humane therapeutic reasons and then fail to provide adequate treatment violates the very fundamentals of due process.”

The Court mandated: (1) A humane psychological and physical environment; (2) Qualified staff in numbers sufficient to administer adequate treatment; and (3) Individualized treatment plans. The Court not only extended these basic constitutional protections to patients in those hospitals, but further outlined another 80 changes to bring these hospitals into compliance with patient constitutional rights. The judge ordered Alabama to make these changes or he would shut down the hospitals. He assumed—incorrectly—that the state of Alabama would not want all of those housed in these institutions to be turned out on the streets. While Alabama began to make changes, the state quickly ran out of funding for state hospitals. The judge began to shut them down.

This decision was eventually appealed to the U.S. Supreme Court and was upheld—making all state hospitals subject to the requirements. Now each state examined their own state mental institutions, and faced a choice: Spend billions of dollars to upgrade the facilities or shut them down and provide community-based treatment.

President Kennedy and the promise and defeat of community-based mental health care

In 1963, in what was his last public bill signing, President Kennedy signed the National Health Act, a $3 billion authorizing act that would have created a national community mental health system. The plan was to take people from the regional state hospitals and slowly reintegrate them back into the community with a continuation of care. President Kennedy had a personal connection to this Act. His sister Rosemary had been difficult for her parents to manage as a teenager, and her father had subjected her to a secret lobotomy. She was forever disabled, and spent the rest of her life in an institution.

States began to shut down the regional mental hospitals to cut costs, in anticipation of federal investment in community-based mental health treatment centers. But that never happened. After Kennedy signed the National Health Act, he was assassinated. The Vietnam War escalated, and the National Health Act was never funded.

The mentally ill are displaced from state mental hospitals and back to jails

In 1955, the number of those in state mental hospitals peaked at 558,000 patients or 0.03 percent of the population. If the same percentage of the population were institutionalized today, that would be 750,000 mentally ill people. See The Balance: Deinstitutionalization: How Does It Affect You Today (July 2017). Between 1955 and 1994, roughly 487,000 mentally ill patients were discharged from state hospitals. That lowered the number to only 72,000 patients. States closed most of their hospitals. That permanently reduced the availability of long-term, in-patient care facilities. In 1973, Washington state closed Northern State Hospital near Sedro-Woolley—which once housed 2,700 patients. By 2010, there were 43,000 psychiatric beds available nationwide. This equated to about 14 beds per 100,000 people. This was the same ratio as in 1850.

Right now, there are fewer than 30,000 people in state hospitals around the United States. In 2016, there were approximately 1.5 million people suffering from serious mental illness arrested and incarcerated in this country. In effect, the United States has never deinstitutionalized its mentally ill population. Those suffering mental illness were simply transferred out of the massive state hospitals to local jails, many of which rival the deplorable conditions that led to the closing of so many state mental hospitals.

We’ve gone back to the days of Dorothea Dix—and the problem is worse.

Now those with mental illness have to deal with the double stigma of mental illness and a criminal record. This makes it almost impossible for them to get housing or a job, making it more likely that they will continue to recycle through the system of incarceration for life. Almost 200 years have passed since Dorothea Dix tried to decriminalize mental illness and jails have once again become the primary place to warehouse people with mental illnesses. We waste taxpayer dollars criminalizing the mentally ill in jails, when community-based solutions would cost far less. See the Vera Institute of Justice, Treatment Alternatives to Incarceration for People with Mental Health Needs in the Criminal Justice System: The Cost-Savings Implications (2013). We have failed people with mental illnesses, and the consequences include an increase in: (1) emergency room visits by the mentally ill; (2) homelessness and joblessness; (3) law enforcement shootings of the mentally ill; (4) law enforcement officer injuries and deaths; and (5) an increase in recidivism of those with both mental health disorders and a criminal record.

Jail is not the answer to effective treatment of mental illness

Building a new jail will not solve the mental health crisis in Whatcom County. Eventually, an inmate with mental illness is released back into the community—the same community that lacks effective local mental health treatment. There is no assisted transition for this vulnerable population from the jail to any community mental health services to increase the likelihood of a successful outcome and to reduce the likelihood of recidivism. In fact, many inmates with serious mental illness are held in jail for months pending a mental health evaluation. One inmate was incarcerated nine months pending a mental health evaluation, and then was inexplicably released by jail staff in the cold on a dark winter night with nothing and nobody—and nowhere to go. The stigma of both mental illness and a criminal record leads to hopelessness and isolation—a dangerous place to be.

Connor Leib’s Story

Connor Leib

Connor Leib

Rob and Jamie Leib settled in Whatcom County in 1989, to build a business and raise three boys. They moved from Vancouver, BC, Canada, and considered Whatcom County paradise, and a perfect place to raise three active and adventure-loving sons. Connor was the middle child, and started his young life with exuberance and a love of the outdoors. They lived in the county, where the kids could spend their free time playing outside exploring with each other and friends. Connor was known for his joyful smile and infectious laugh.

Along with his brothers and close childhood friends, Connor excelled at both skateboarding and snowboarding. From a young age, he could fly through the air on his skateboard. On his snowboard, he could run on powder and catch big air on jumps at Mount Baker like a pro. He was never happier than when he was with his friends at the skate park or filming their exploits at Mount Baker as they became pro-boarders.

Connor Leib

Connor Leib

Connor’s parents loved and supported him, but began to recognize the signs of declining mental health in their 17 year-old son. Connor was then self-medicating with marijuana. Rob and Jamie Leib tried desperately for more than a year to get Connor long-term residential mental health treatment. By February 1, 2011, Connor had been hospitalized for treatment of serious mental illness, and was deemed disabled due to mental illness by the Social Security Administration. He was 18. At that time, he had never been arrested, accused or convicted of any felony or other crime. Connor lived independently—as was his wish. He rented a room in Bellingham, and paid his expenses. He was proud to stand on his own, and wanted to live and work like anybody else. Unfortunately, Connor was unable to remain stable.

In early 2012, Connor was admitted for three weeks to the psychiatric center at St. Joseph’s Hospital. He was diagnosed in the hospital with Bipolar Affective Disorder, Type 1. After his release from St. Joseph’s Hospital, Connor was still manic, with high energy and impulsiveness. He was provided a 90-day treatment plan upon discharge that included continued medication and therapy. It was difficult for him to remain compliant, because he could not tolerate the side effects of his medication. Eventually, Connor was hospitalized a total of three times for treatment of his mental illness. He had been evaluated at the emergency room numerous times before his admissions to inpatient care, and generally presented as manic, fearful, angry and paranoid with persecutory delusions. During his final emergency room evaluation, the mental health therapist expressed surprise that Connor had not yet been involved with law enforcement, which typically happened with those suffering serious mental illness.

Connor intersects with a Whatcom County justice system unable to handle mental illness and the die is cast

If you tried to design an environment where mental illness would thrive, it would be a jail. This is where thousands of people with mental illness end up: locked up in harsh correctional settings steeped in fear and violence, where overworked social workers juggle too many cases and the favored punishment is segregation. As much as 58 percent of jail and prison inmates in Washington state suffer from mental illness, and far more struggle with addiction. See Behavioral Health Needs of Jail Inmates in Washington State – Report to the Washington State Office of Financial Management’s Statistical Analysis Center (2014).

Yet the state has cut spending on prison and community mental health care, ensuring most incarcerated men and women get minimal treatment—inside and outside of jail. Many leave jail or prison sicker than when they went in—and more likely to commit additional crimes. We appear more willing to pay more money to incarcerate the mentally ill than to treat them—and we endanger public safety by doing so.

In 2011, Connor Leib was on Social Security Disability because of mental illness. That should have been relevant to jail administration when he was later arrested and incarcerated in the Whatcom County Jail. He should have been transferred to a mental health facility. Instead, he was provided no medication to control his symptoms in jail, and that was the beginning of the end of Connor’s life and all that he might have become.

After a conflict with his live-in girlfriend, Connor was first arrested on February 17, 2013, and charged with Assault 4 DV (a gross misdemeanor). He was released on bail, and was attempting to move his own possessions out of the apartment he had shared with his girlfriend (who was not present) and he was arrested a second time on February 23, 2013, for violation of a no-contact order (a gross misdemeanor). Because no law enforcement officer was present as required by the no contact order, Connor was also arrested for Residential Burglary (Class B Felony), 3rd degree theft (gross misdemeanor), and Possession of Marijuana by a minor (a misdemeanor). He was immediately bailed out, but was arrested soon after for a Failure to Appear.

He would not be bailed out again until 6 weeks later.

Once jailed, Connor was off all his medication. On March 25, he explained to jail staff that he had bipolar disorder and PTSD and needed his medication. Jail staff told Connor that he was scheduled for a mental health evaluation “later.” Without his medication, Connor began to decompensate. On March 31, three corrections officers put Connor (who was 5 ft. 9 in and weighed 135 pounds) in a restraint chair, and then removed him for a strip search in a mistaken belief that he may have been concealing metal from a wristband. The three corrections officers then returned Connor to the restraint chair.

On April 2, Connor was again placed in the restraint chair—this time by four corrections officers “to prevent self-harm.” A deputy said that Connor attempted to remove his hands from the restraints, and when Connor refused to stop, the deputy put Connor in “a cross-face hold to gain pain compliance with Deputies orders.”

On April 3, three Whatcom County corrections deputies working in the jail, again worked to forcibly strap Connor into restraint, while Connor spiraled out of control. He reportedly yelled threats and “attempted to bite” one of the officers—none of whom are trained in crisis intervention and de-escalation techniques for those with serious mental illness. The three corrections officers lodged three separate complaints to the prosecuting attorney against Connor for felony harassment—even though these officers had complete physical domination and control over Connor. The officers complained that Connor threatened their lives and had “attempted to bite” one of the officers. The prosecuting attorney then stacked three additional felony counts against Connor—while Connor was in jail custody. Connor was thereafter put in segregation and was placed in a “wrap system” from time-to-time, supposedly to prevent self-harm.

During this time, Rob and Jamie Leib repeatedly contacted the jail to say that Connor belonged in a mental health facility, not in jail. The jail refused to transfer him to a mental health facility, and so his parents bailed Connor out. They observed his substantial deterioration, and succeeded in getting him in-patient treatment at St. Joseph’s Hospital for 14 days. He was still unstable after the two-week hospitalization, so his parents petitioned the court to continue his hospitalization. Their request was denied, and Connor was released to his parent’s care under a 90-day less restrictive order.

Connor’s criminal cases were finally resolved after multiple delays and continuances. Eventually, he pled guilty to one felony and multiple misdemeanors, and was ultimately charged $13,000 in fines, fees and other costs (known as Legal Financial Obligations). With a felony conviction, Connor was unable to find housing or a job on his own. The weight of his felony conviction made him feel helpless and hopeless. He could not see a way out.

On July 7, 2016, Connor was alone at his parent’s home at 3 a.m., when he called 911 for help. He said he was sick and needed to go to the hospital. He indicated that he had smoked marijuana and had swallowed some pills (which he said he spit out). The dispatcher told Connor sheriff’s deputies were on the way, and asked if he would be ready to go when they arrived. As Connor began to respond, the 911 call inexplicably went blank.

Reports indicate that two deputies responded to the call and knocked on the front door with no response. They were not accompanied by paramedics or an ambulance. They walked around the house, and then left. The Sheriff’s Department then attempted to call Connor’s parents, who were in Canada. It was the middle of the night, and they didn’t get the message until morning. At that time, they called their youngest son to check on Connor. When he entered the house through the open back door, he found Connor dead in the house from a self-inflicted shotgun wound.

Connor Leib’s Legacy: It is time to decriminalize mental illness in Whatcom County

Connor Leib

Connor Leib at Mount Baker

In honor of Connor Leib, we must do better. Whatcom County should follow other jurisdictions that have developed both pre-arrest and post-arrest diversion programs for those identified with a mental illness. Whatcom County is small, with only 217,000 citizens. That should make us more agile and able to implement rapid reforms. However, our too complex and bloated justice system has become an obstacle to change, and the path of least resistance appears to be the status quo—or at least change at a glacial pace.

Best practices would have our police officers and sheriff’s deputies trained in the Crisis Intervention Team (CIT) model. Successful use of CIT and pre-and post-arrest diversion in other jurisdictions (like Memphis, TN) has led to a sharp drop in the incarceration of those with mental illness. In Memphis, the census of mentally ill individuals in jail custody has dropped from 15 percent in 1988 to 3 percent today. (The national average of mentally ill individuals currently incarcerated ranges from 15 to 30 percent). Arrests were reduced 90 percent, from 20 arrests per 100 calls prior to CIT inception down to 2 arrests per 100 calls since the implementation of CIT.

Where treatment of the mentally ill instead of incarceration is used, public safety has increased.

Post-arrest intervention means a speedy mental health evaluation in jail, and often a transfer of the inmate to a crisis triage center or hospital where their stay can be extended to allow for a sustainable reduction in acute symptoms. If successful in treatment, their charges could be dropped, and they could have assistance from social workers to find housing and jobs in the community. While in treatment, the staff should work to obtain as much medical assistance as possible before release, so that there is a higher likelihood that they will continue in treatment. In jurisdictions that follow this approach, the recidivism rate in this population has dropped by 50 percent. The program has been expanded in some jurisdictions from misdemeanants to felons, with a recidivism rate of only 6 percent. See the 11th Judicial Circuit Criminal Mental Health Project in Miami-Dade Florida.

The best—and likely only—hope for the decriminalization of mental illness is to provide adequate community-based medical and other supportive services for those with mental illness. Mental health deserves the same level of funding that physical illnesses receive. Each person suffering from mental illness deserves a psychiatrist that can spend more than five minutes on diagnosis and treatment; a social worker to help with housing, transportation and employment; and a chance at a successful life—outside the criminal justice system.

There are federal funds available for programs being implemented in Whatcom County and elsewhere including CIT for first responders, mental health courts for both low level and felony offenders, jail diversion and reentry programs. So far, Whatcom County has adopted a mental health court only for low level offenders, and it is not certified. We need to push the county to secure any federal, state or philanthropic funding for alternatives to jail asylums, and expand the eligibility for mental health court.

We need more law enforcement officers who volunteer for Crisis Intervention Training. Properly trained officers learn to engage with those who are acutely mentally ill, and manage to find a way to communicate even with those who are acutely psychotic. De-escalation is essential, and often results in reducing the fear and paranoia common in those with mental illness who have been previously incarcerated, restrained and abused in the criminal justice system. However, even with the best CIT, mental health courts, jail intercept programs, crisis triage centers (with a maximum of 16 beds for those with serious mental illness), and re-entry programs—they will all fail without sufficient community-based services and available beds for both short- and long-term treatment. We cannot divert someone from jail, if there is nowhere to divert them.

The proposed Crisis Triage Center—now deemed a regional center which will reduce beds for local residents—is a short-term facility and will not offer enough capacity to divert those with mental illness from the jail. The county (possibly with private partnership) should consider building a new type of facility—a one-stop shop for potential utilizers of the jail known to suffer from mental illness. It might include a central receiving unit, a crisis unit, short and long-term residential treatment, a day activity unit, a primary health unit to treat the person as a whole rather than focusing solely on mental health treatment, trauma services and a culinary or other supported employment with an in-house kitchen or school/shop for development of technical and construction skills. It would be essential to include transition services to assist with reintegration into the community with housing and job support—the ingredients of hope and opportunity.

Connor Leib did not make it. It’s too late for him, but not for others suffering serious mental illness in our community and in the jail. Unfortunately, neither those in law enforcement nor in our local healthcare system could look beyond his acute suffering to see the person of worth and dignity that he was beneath his mental illness. He was not his mental illness. He was dearly loved by a family whose misfortune was learning firsthand that the criminalization of mental illness is crazy, and that our government and the private healthcare system have failed many of those suffering from serious mental illness.

For further information:

The Pew Charitable Trusts, Getting the Mentally Ill Out of Jail, by Michael Ollive (April 7, 2017)

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