Mental Health Cuts Would Strain Local Texas Jails
Sterling Shepherd sat at a metal picnic table dressed in an orange Harris County Jail-issued jumpsuit and described what got him into this situation — again.
“I’m extremely mentally ill and extremely intelligent,” said Shepherd, a 43-year-old with intense brown eyes and a big grin. During a recent 12-minute interview, Shepherd veered in and out of reality, talking at times lucidly about taking medication for his severe bipolar disorder and at other times describing how Vice President Joe Biden spoke to him through the television and explaining that Pope Benedict the XVI is his grandfather.
It was Shepherd’s eighth ...
Comments (8)
Christian Miner
Dear Ms. Grissom,
Your article on mental health patients in Texas prisons neglects several, um, key background facts:
(1) the cost of keeping a person in prison is many times greater than the cost of outpatient mental health care that would allow a person to remain safely in the community;
(2) I'm not sure about Texas in particular, but in many states the cost of keeping a person in prison is far greater even than the cost of keeping them in a state psychiatric hospital (long-term hospitalization is very rarely necessary for those with mental illness, if ever);
(3) What percentage of the Texas prison system is "privatized" and "for profit"? Follow the money!
(4) One of the hallmarks of Western Civilization since the time of the Enlightenment, has been the now- obvious insight that mentally ill people are ILL and deserve treatment, not prison. This is an idea that goes back over 200 years to the time of John Locke in England, Duke Pietro Leopoldo in Florence and, famously, Dr. Phillipe Pinel in Paris. One of the fathers of American medicine, Dr. Benjamin Rush, likewise embraced and fostered this fundamental principle. Again, we're talking about a value embraced by civilized countries since the 1700's.
(5) The Republican phobia against people paying their fair share of taxes also flies in the face of a really fundamental (maybe the MOST fundamental), Western frontier value that our forefathers in the West held from the days of Sam Houston (and before): we've all got to take care of our neighbors in times of need.
It has for years been obvious to much of the rest of the country that The Lone Star State is headed in a seriously wrong direction. Incarcerating people who are mentally ill is simply barbaric. Tell me, how is Governor Perry's plan to succeed from America going? Is there anything the rest of the country can do to help speed this effort along?
Christian Miner
P.S. Consider that as an independent country, a Lone Star Republic would probably contribute substantially to, and benefit substantially from, the economies of Mexico and the rest of Central America. Y'all could probably even join the OAS!
Of course, even most of your neighbors to the South would look down on a rich Northern neighbor that puts mentally ill people in prison. Eff them! Just smile and move on!
Once Texans have eliminated the rest of the ideals of the Enlightenment, well, the future is as bright as the past! Dark Ages, here we come! Whee-you! I betcha in a few years, y'all could have gladiators and lions eating the infidels! Doesn't that sound sweet? Can you imagine the tailgait parties?
Christian Miner
P.P.S Gosh, it just came to me! This would be a "Modest Proposal" if only it weren't such a no-brainer, such an obviously great idea! Lookee here! The only real down side to Texas seceding from America is that you folks probably wouldn't get the Super Bowl much any more, right? OK, I get that that's a serious problem.
But wait! Here's an even better idea! Once, Texas secedes from the Union, what y'all can do (this may take a few years to set up, mind you, nothing is easy) is to have Gladiatorial Spectacles where you feed the mentally ill to the lions! Yes! Imagine the tax savings! Y'all can put all the lunatics and criminals in big stadiums and charge admission to folks (who'll come in droves! Droves, mind you!) who want to watch the crazies being disemboweled and devoured by your locally available wild beasts! Coyotes! Mountain lions! Gila Monsters! Armadillos! I'm pretty sure we could arrange for some serious national network figures to provide color commentary to a televised contest between, say, a couple of thousand Armadillos and a few "Persons with Mental Disabilities," as we call them. Right? Wackos eaten by armadillos! What a fabulous idea! Yours for free.
For any limp-wristed pansies who might be concerned that lions-eating-lunatics might be inhumane, never fear! I can assure you that a quick and summary death is much, much preferable to the slow. terrifying tedium of wasting away in a jail rife with all sorts of abuse. Yessir, "Lions Eating Lunatics!) That's a real winner of an idea and y'all can have it for free! Not only that, I'll also give you Lions Eating Lifers! For free! Cut down on the prison population as well.
Jane Fleming via Texas Tribune on Facebook
Duh.
Mary Lynn VanZandt Neill via Texas Tribune on Facebook
This trend began many/ several years ago and is not only unfortunate but is extra hours and work for other departments in State. Terrible misuse of funds as well as personnel.
Joe Rutland via Texas Tribune on Facebook
I like the article ... not the fact that mental health will be put on the backburner by our political heroes.
Sheri Alexander via Texas Tribune on Facebook
cut mental health, raise tuition, cut scholarships/grants, no job creation, attack women's health and services for poor-and then allow guns on campus?? and make teachers enforce immigration. wtf? wtf is immature but so is tex leg. grow up create jobs do what youre supposed to and said you would
pragmaticus
This is a national problem. Refer to this Council of State Governments website:
http://consensusproject.org/
Though I agree that funding is an issue, I also worry that policies and laws are contributory. The fervor to deinstitutionalize superimposed the naïve wishes of well-doers upon the realities of serious mental illnesses. The “law of unintended consequences” was evoked as great freedom was granted to those who suffer from serious mental illnesses - more freedom than the illnesses can accommodate.
For example, one of the most vexing obstacles to management of serious mental illness is a neurological deficit seen in many - anosognosia. A brain can be afflicted in such a way that it does not know that it is ill. This is clearly seen with delirium, strokes, dementia … and “dementia praecox,” the old term for schizophrenia. Simply, the afflicted person’s brain doesn’t know the brain is ill.
I cannot say how many times I’ve talked with persons with serious mental illnesses about why they’ve been hospitalized dozens of times and labeled with a psychotic disorder. They cannot make sense of it. They know they’re not ill.
A person who is unable to see his own illness does not show up for appointments and stops taking medication. Psychiatric literature indicates that untreated psychosis grows worse, and less responsive to treatment.
Anosognosia and community integration make for a very difficult mix. While medication helps many greatly - with resulting stability prompting efforts at community placement, anosognosia corrodes medication adherence until the illness again assumes full control.
Severe mental illness doesn’t care about our well-wishing hope for community integration and “freedom.” The real loss of freedom is not behind the walls of an institution. It’s the loss of freedom imposed by the illness itself. I’ve seen many persons with serious mental illnesses be freer from their illness within an institution than they could be under a bridge. Perhaps some think institutionalization is automatically an egregious loss of freedom. I don’t. I've seen too many badly decompensated mentally ill persons in jails ... and too many subsequently stabilized to dignity after months/years in a forensic hospital.
Mental illness does not have binary severity - i.e., catastrophic severity or none at all. Therefore, institutionalization is not appropriate for many with serious mental illnesses.
However, until miraculous cures are found, institutional beds are simply not optional. Mental illness will forcefully, if needed, find the institutional beds it requires. Our decision as a society is whether those institutional beds will be civil or criminal.
250 civil beds closed in Florida in 2002. Within a few years, a backlog of mentally ill persons developed in Florida jails, people who were found incompetent to stand trial on charges incurred while in a decompensated condition. Solution? Florida opened a similar number of state *forensic* hospital beds - beds for mentally ill people with pending criminal charges.
Criminal court judges hold the keys to such forensic hospitalizations. Some of these mentally ill persons are too sick to ever regain competency to proceed to trial. But, at least they’re housed in safer and more dignified conditions than the shadow of a bridge.
Social systems have been reluctant to use involuntary interventions such as commitment, involuntary treatment and guardianships, even when blatantly needed. For example, throughout my years of psychiatric practice, I have rarely found a chronically, severely mentally ill person with a guardian. Efforts to pursue guardianship are hamstrung from the beginning by a lack of resources to achieve and maintain it. And outpatient commitment, now on the books in many states, remains uncommonly used.
As a whole, the civil sector has failed to recognize, humanely, the limits of capacity that severe mental illness can force upon sufferers. As a result, the sickest refuse treatment until the criminal justice system intervenes to provide the services the civil sector cannot. This problem has become large enough to contribute to the passage of the “Mentally Ill Offender Treatment And Crime Reduction Act” by the U.S. Congress in 2004.
I have watched the failure of this service structure progressively turn civil inpatient state hospital beds into forensic beds in two states in which I’ve worked. I’ve seen criminal court judges use probation and conditional release to enforce treatment for those with severe mental illness, giving rise now to new criminal justice programs called “Mental Health Courts.” Sadly, effective civil sector clinical services should have prevented arrest in the first place. It seems those with severe mental illnesses must now commit crimes to receive sustained, effective services.
(Google: "criminalization of mental illness")
Additional, suggested reading to further understand problems with the United States mental health services delivery system: "Out Of The Shadows – Confronting America's Mental Illness Crisis," by E. Fuller Torrey, M.D.