Common Sense, Huge Impact

One of the lessons  that I’ve learned visiting mental health programs in 46 states during the past four years is how often a small, common sense change in policy can have a huge impact on helping persons who are ill. 

I saw an example of this when I toured the Los Angeles City Jail, which many of you know has become the largest de facto public mental heath facility in our nation with an average population of 1,400 prisoners with mental disorders.

For years, prisoners who were homeless and had drug, alcohol, or mental health issues were simply released to the streets with no money, no shelter, no medication, and no one to help them navigate the massive red tape that comes when applying for city, county, state and national social services.  Not surprisingly, more than 70 percent of these homeless prisoners were arrested again within a year.

These men and women were not Hannibal Lector serial killers. Most of them were in jail because they had a mental illness.  A typical charge was possession of a grocery cart, a common crime in L.A.’s Skid Row because the wheeled carts make excellent storage bins for transients.  Many of the homeless prisoners were called “frequent flyers” by jail officials because they were caught on a treadmill that had them wandering homeless on the streets for a few weeks and then being arrested and put in jail only to be released a few weeks later back to the streets.

L.A. Sheriff Leroy Baca, who had mental illness in his own family, took steps in 2000 to break this cycle. He created a “Community Transition Unit.” Now, when inmates are booked into the jail, they are asked if they are homeless, have a mental disorder, or have an addiction problem. If the answer is yes, one of the Sheriff’s 18 specially trained assistants makes certain that prisoner is put in touch with public and private community service groups BEFORE he is released.  These groups help the prisoner find housing, obtain meals, and enroll in treatment programs. The goal is to make the jail an entry door into services that can help persons begin getting meaningful help.

By simply identifying prisoners with mental problems and plugging them into services, the L.A. jail has managed to reduce recidivism among “frequent flyers” to 35% — an astounding drop given how long many of L.A.’s Ski Row regulars have lived on the streets.

Sheriff Baca’s transitional unit has not only helped homeless prisoners but also has changed attitudes inside the jail. Department Chief Alexander Yim, who currently runs the unit, became emotional when he described how he used to be as “tough” as anyone when it came to handling the Skid Row derelicts who paraded daily through the cells.  He considered them bums and freeloaders.  But once he started working with them, he realized that nearly all of them were ill and “needed our help.” 

I’ve seen this change in attitude in other law enforcement officers who have undergone CIT training. (Crisis Intervention Training.)

Of all the jails that I have visited, the ones in Allegheny County in Pittsburgh have the best transition services for prisoners. Officials there developed what is called the Sequential  Intercept Model that identifies points in the criminal justice system when a prisoner who has mental illness can be identified and helped.

In New York, the Corporation for Supportive Housing helped launch FUSE (Frequent Users Service Enhancement) that moves homeless inmates and repeat offenders directly from jail into individual apartments and enrolls them into treatment services. A study by John Jay College found that FUSE not only helped break the “frequent flyer” cycle, but also had the potential to begin saving tax dollars after three years by reducing stays in jails ($129 per day average cost) and reliance on homeless shelters ($68 per day.)

Because of the unplanned closing of state hospitals, an ongoing lack of community treatment programs, and restrictive involuntary commitment laws that only allow loved ones to intervene when a person becomes an “imminent danger,” our jails and prisons have become our new mental hospitals.

So you would think that starting the re-entry process in jail – as Sheriff Baca has done in L.A. – would simply be common sense. 

But sadly, that is not the case.

Ohio generally ranks among the best states when it comes to providing services for persons with mental illnesses, but recently the Ohio Justice and Policy Center filed a class action suit against Ohio for dumping prisoners with mental disorders onto the streets. One plaintiff, identified only as Anthony G. was abandoned at a homeless shelter by deputies even though he had spent most of his 41-years in state mental hospitals and correctional facilities, including nine stints in jail since 1987, for nonviolent offenses related to his psychosis. Three weeks after he was dumped on the streets, he announced at a crowded food bank that he had a gun (he didn’t) and was arrested for “inducing panic.”

He was returned to jail only to be released a few weeks later back to the streets.

If you want to help reform our system, check with your local officials to see if your jail has a re-entry system. Get involved. Make your voice heard and if you enjoyed this post, send it to a friend. Spread the word that we need to reform our mental health system. Remember, you can make a difference!