(5-10-16) How many more horror stories need to be told?
It’s time for us to stop the inappropriate jailing and imprisonment of persons with mental illnesses.
On April 17, CBS 60 Minutes broadcast a segment that showed how prisoners with mental illnesses were being neglected and abused at Rikers Island in New York.
On May 2, The New Yorker published MADNESS by Eyal Press, which tells how mentally ill prisoners in Florida have been tortured, driven to suicide and killed by correctional officers.
The nurses said that Rainey had been locked in a stall whose water supply was delivered through a hose controlled by the guards. The water was a hundred and eighty degrees, hot enough to brew a cup of tea—or, as it soon occurred to Krzykowski, to cook a bowl of ramen noodles. (Someone had apparently tampered with the T.C.U.’s water heater.) It was later revealed that Rainey had burns on more than ninety per cent of his body, and that his skin fell off at the touch.
There is a promising national effort underway. Stepping UP: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails was launched last year by the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation. It is a great effort.
But I believe we need to set an achievable goal. In February, I asked Washington area management consultant Steven Kussmann to suggest ways the mental health community could be more effective. His number one recommendation was defining an actionable goal.
Define an Actionable Goal: Movements with an actionable goal succeed. Movements focused on a ‘virtuous’ goal do not. Universal CIT training for police, prison personnel and hospital emergency room staff is an actionable goal. Mental health screening and treatment for all detained prisoners is an actionable goal. Destigmatizing the public’s view of mental health is a virtuous goal. The LGBT community’s strategy was not to change attitudes but tochange state law. Their actionable goal was practical. It changed attitudes and outcomes. The mental health community’s lack an actionable goal frustrates its ability to effectively change the system that controls how mental health services are provided. Changing how our penal systems manages inmates with mental illness will change public attitudes about the mentally ill in prison. We need to retarget our movement to achieve an actionable goal.
What we have now is a virtuous goal. What we need is actionable goal.
Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors, has suggested a 25% reduction in the number of individuals with mental illness in our jails and prisons by 2020. In a recent blog, he wrote:
Just a few months ago, I suggested that our outrage at this obvious injustice can drive a decarceration movement. I also suggested at that time that we must have a simple national action plan, and that we must have a practical goal.
I want to reiterate that goal here: We must decarcerate at least 25% of those with mental or substance use conditions from our county and city jails by 2020.
Implementation of this goal through a simple, national action plan can be a decisive positive force for much needed change. The goal specifies “what” and “when.” The national action plan will define “how.” We also need to define “who” and “why.”
I am joining Manderscheid in suggesting we make that goal a priority.
It is a worthwhile challenge. An estimated 16.9% of jail detainees have a serious mental illness. The same is true of inmates in state prisons. That’s between 365,000 and 500,000 men and women in our jails and prisons on any given day.
Reducing that population by 25% would be a major shift and with that shift must come a transfer of public tax dollars. Florida alone devotes some $718 million a year to mental health programs, but it pours nearly $1 BILLION a year into jails and prison for housing and medicating inmates with mental illnesses.
Which brings us to the second item on Kussman’s list.
Focus on State-by-State Action: The same sex marriage victory demonstrated that a state-by-state strategy can be highly successful. Political gridlock at the federal level is the norm, and the federal approach to social change is not working. Today’s successful social movements, such as the legalization of marijuana and racial prejudice, focus their efforts at the state and local level. They get a handful of pioneer states or communities out in front, and then as their movement reaches a tipping point or is catalyzed by a key event or court case, other states get engaged and federal legislation and policy follows suit. The mental health community needs to refocus its resources on actions to change state law and policies rather than federal legislations.
Stepping Up is working in Ohio because retired Justice of the Ohio Supreme Court Evelyn Stratton is driving from one community to another persuading local officials to sign on. It is working in Miami Dade County because of Judge Steven Leifman’s hand-shake by hand-shake approach. If this national effort is to have any impact, it must be implemented and supported on the grassroots level.
Kussman’s third and fifth points also should be remembered.
Reinvent our Network: Successful social movements embrace, expand and leverage their networks to bring about significant, scalable and sustained social impact for their strategic goals. The network embodies the movement. It is the collective force for social change. It is not a program or the root structure of a single organization. Strategic in scope, it is rifle-focused on a single issue or objective. Solving that problem catalyzes its influence, expands awareness, drives action, learning and participation and changes public attitudes as it targets policy and practice. Its leadership and membership are unified around a shared goal and a common understanding of how to apply its resources and influence. The network has its own identity and greater scale than any single organization engaged with it. It is the heart and soul of the movement.
Rethink Relationships: Successful movements are decentralized, geographically diverse and are comfortable operating with multi-level leadership. Most organizations struggle with this approach as it implies a loss of control over objectives and resources. Action-based networks are unified around an objective not an organization. Members of the network will come from inside and outside the mental health community, but all its members are unified around that common objective. Achieving real change in mental health policy and practice will require a community of action that transcends traditional mental health community relationships. Shared leadership, responsibility and resources will be tied to the goal set and the partnerships defined by the strategy. As the LBTG community learned over time, change requires relationships with groups and individuals united around a common goal and equally committed to its success.
Kussman has given us a blueprint. Manderscheid has give us an achievable goal. And Stepping Up has given us a platform.
25% reduction in 2020.
It’s time for all of us, despite our differences, to rally around that goal.
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