A mental health crisis can be a frightening thing to the individual experiencing it as well as to people witnessing it. Those in its throes need help, but all too often get handcuffs.
We have seen that scenario play out from the inside and the outside. It’s time for it to change.
At age 35, I was locked up in a holding cell in a county jail in Georgia. My crime? Experiencing severe symptoms of psychosis. It wasn’t the first time I had been jailed for this, nor would it be the last. But it was one of the worst.
My symptoms had led me to believe that the other 15 people in the cell were conspiring to kill me, and fear had taken over. My behavior became erratic, but no one recognized that it was the symptoms of my psychosis that was causing me to act this way. I was tased and beaten unconscious. When I woke up, I found myself restrained to a chair: my arms and legs were strapped down and my head pulled back and immobilized. Eventually I was sent to “the hole” for solitary confinement.
After weathering the storm — and due process finally returned — I got out of jail alive. Not everyone does: Natasha McKenna, a Black woman with psychosis, died after being tased in a Virginia jail.
Today, I am in recovery, but I consider that a miracle after 40 years in and out of the justice system. I finally got the help I needed, including supportive housing, outpatient treatment, peer support from the National Alliance on Mental Illness (NAMI), and folks to hold me accountable.
As the CEO of NAMI, I hear stories like Bill’s almost every day. What he and others have gone through — what many are still going through — is unconscionable.
Following George Floyd’s killing by police officers in Minneapolis, the outcry from communities of color and white people alike has created an inflection and reflection point for our country. Black Lives Matter and others are forcing a conversation about the role of law enforcement in our communities.
For decades, stigmatization, prejudice, and discrimination against those with mental health conditions, especially Black Americans, have taken a huge toll on countless lives. That didn’t happen by itself: As a society, we’ve allowed it to happen. Our neglected mental health “system” provides too little help too late. Law enforcement officers are often the first responders to mental health emergencies. And we’ve defunded programs like the one that helped Bill. To save lives, and to live up to our values of fairness, inclusion, and compassion, we need change.
A four-point focus for mental health crises
Calls for racial justice, the Covid-19 pandemic, and the ensuing economic crisis have emphasized a painful awareness about what happens to the most vulnerable in our society. To change outcomes, we need to disrupt the system that puts police at the forefront of crisis response. To do this, NAMI believes that policymakers need to focus on four areas of community mental health: crisis care, inpatient care, social support and outpatient care. Bill’s “miracle” outcome could be the hope for everyone with mental illness if we commit to these policy changes.
Crisis care. Our country needs a compassionate and evidence-based response to mental health crises. Establishing 9-8-8 as a nationwide hotline for helping people having mental health crises and preventing suicide, something the Federal Communications Commission is moving forward with, would give people a dedicated, easy-to-remember number to get help. We also need a range of culturally competent crisis services for people in need, including mobile crisis teams and crisis stabilization programs. And anyone who provides care for people with severe mental health symptoms, including law enforcement officials, should be offered training in effective de-escalation and engagement strategies.
Inpatient care. In the U.S. today, individuals with the most severe symptoms of mental illness typically can’t get inpatient care unless they are deemed a danger to themselves or others. That makes no sense. It’s like a hospital telling someone experiencing chest pain, shortness of breath, or other symptoms of a heart attack to come back later when your heart stops. That doesn’t happen: the symptoms are seen as serious signs and treated to prevent them from recurring and becoming worse.
The symptoms of severe mental illness — such as mania, delusions, and paranoia — should be treated just as seriously. Instead, people with severe mental health conditions are routinely turned away from hospitals, or discharged home or to the streets before they have been truly stabilized.
Social support. Ensuring individuals have access to necessities like a safe place to live, food to eat, a source of income, and a supportive community are essential for getting them on paths to recovery. Unfortunately, most communities have not invested in this, contributing to the fact that approximately 20% to 25% of people experiencing homelessness have a mental illness, and are also disproportionately people of color.
Outpatient care. People with mental health conditions should be able to get the best possible care early. Yet 60% of the counties in our country don’t have a single practicing psychiatrist, let alone professionals who represent the diversity of our nation’s people or who have training in the most effective interventions. We cannot accept the status quo. We need a trauma-informed mental health workforce — one that is racial-trauma-informed — that is equipped to serve everyone, especially the most underserved, with mental health care when and where they need it.
Acknowledging the role law enforcement still plays
As we work toward a system that provides a proper mental health response to people experiencing mental health crises, we cannot ignore the role that law enforcement still plays in this area: they are often the first responders. According to the Washington Post, 194 people with a mental illness were shot and killed by police officers in 2019.
To prevent such needless deaths, NAMI has been promoting programs like crisis intervention teams for the last 30 years. This is a police-based model designed to improve the safety of the public and officers and to help people with mental illness get treatment instead ending up in jail. We have also advocated to change agencies’ policies and procedures so they divert people with mental illness away from involvement in the criminal justice system.
Officers trained in crisis intervention can be lifesavers, but it’s important to keep in mind that they are a reaction to a fundamental flaw in how we respond to mental health crises. They are not the answer to safely resolving them. Investment in a comprehensive mental health care system that demonstrates cultural competence and equitable treatment is the answer.
Our country needs to do a lot of learning and painful growing that includes a real conversation — and a real intentional change process — around policing and mental health, including the disproportionate effects on communities of color. People affected by mental health conditions know all too well what it means to experience stigma, but not all of us know the doubling role race can play. Our communities have a lot of work to do to engage in the real dialogue needed to collaborate on real solutions. Only then can we work together to make lasting change.
Bill Carruthers is the project developer for the Rockdale County Stepping Up Initiative, the CEO of Recovery on Fire, and a former board member of NAMI Georgia. Dan Gillison is the CEO of the National Alliance on Mental Illness.
In broad terms I agree with this, especially the need for more social support and outpatient care. The article, however, would be much more useful if it grappled with unpleasant truths.
When the 911 call comes in, it’s not accompanied by an infallible magic labeling system that differentiates between those who are a danger to others, and those who are not. There is no time or a way for a cop, to conduct a sophisticated psychological assessment. Even for well-trained and very disciplined police officers, protecting those who definitely need protection may very well require a lot of force, even sometimes lethal force.
Second, the mental health professions don’t actually have a very great record of achieving major real life results. We wish they did, but efficacious social programs can not be based on wishful thinking.
Everyone is an expert with a quick fix. I prefer waiting until there are proven, well tested, efficacious programs. These issues are not some newly discovered phenomena. The fact that there are few proven programs suggests these are extremely complicated matters, not truly amenable to quick op-ed
Although I have a mental illness and psychosis, my story of suffering breakdowns has been caused by real situations of being ganged up on in the workplace and at the apt buildings where I have lived. Not only that but the system in the county where I live in new Jersey who was supposed to be advocating for me, also was ruthlessly ganging up on me and completely incompetent. The police in two towns where I lived, one after the next, treated me as the perpetrator, even though I was the victim, and were protecting the bullies who were harrassing me and abusing me, etc. The system deliberately ganged up on me too in the worst way, by scolding me, screaming at me, balling me, and working to ruin my credit and reputation. Many of the people who work in the system are very evil cruel people and very sick themselves. In addition I was choked and gagged and handcuffed and thrown in the mental ward on one occasion, and then hospitalized by police and pesp approx 5-6 more times in a row and held prisoner as punishment through their lies and illegal excuses about me. The truth is that in many situations the patients who do learn to handle their symptoms and are mature, experienced individuals fall victim to these evil, cruel authorities who are, for some unknown reason, well protected and permitted to act against us. They are all one big gang and they all protect each other. The few that seem to be good and really do want to help are outnumbered by the bad and I get the impression they have to put up with it too. I am now with a private psychiatrist who is a nice man but no therapist.
Although I have a mental illness and psychosis, my story of suffering breakdowns has been caused by real situations of being ganged up on in the workplace and at the apt buildings where I have lived. Not only that but the system in the county where I live in new Jersey who was supposed to be advocating for me, also was ruthlessly ganging up on me and completely incompetent. The police in two towns where I lived, one after the next, treated me as the perpetrator, even though I was the victim, and were protecting the bullies who were harrassing me and abusing me, etc. The system deliberately ganged up on me too in the worst way, by scolding me, screaming at me, balling me, and working to ruin my credit and reputation. Many of the people who work in the system are very evil cruel people and very sick themselves. In addition I was choked and gagged and handcuffed and thrown in the mental ward on one occasion, and then hospitalized by police and pesp approx 5-6 more times in a row and held prisoner as punishment through their lies and illegal excuses about me. The truth is that in many situations the patients who do learn to handle their symptoms and are mature, experienced individuals fall victim to these evil, cruel authorities who are, for some unknown reason, well protected and permitted to act against us.
I would think too little too late here. Community and Hospital Psychiatry was dealing with some of the issues way back in 1984.
I for one would like to know your ties to the pharmaceutical industries and what are your ties to the psychiatric survivor movement.
My son has been dealing with mental illness for 6 years now. Jailed with no meds, although I was told he would be medicated. In and out of hospitals, now I took him, with his approval, to a farm in Medellin, Colombia. They are more sensitive to the patient, who are not called patients and have a free living environment. Continuously reconsidering meds to not over medicate them. I don’t know what I’m going to do once he is released, don’t know how he will live here in the states(Louisiana). I’m afraid we cannot live together since he is bipolar and reacts aggressively towards me…
We need to better educate our officials, police and hospital staff. They are judgmental and most not compassionate towards the mentally ill patient.
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