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Pete Earley: The TT Interview

The author of Crazy: A Father's Search Through America's Mental Health Madness on the criminalization of mental illness, the need for community-wide solutions and how Texas wastes the money it spends on the problem.

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Pete Earley thought he knew a thing or two about mental health and criminal justice after working for a couple of decades as a journalist. But when his mentally ill son was arrested for breaking and entering, Earley discovered he still had much to learn.

After struggling to find treatment for his son's bipolar disorder, Earley immersed himself in the criminal justice system to try to find out how and why jails have become top housing institutions for the mentally ill. His book — Crazy: A Father's Search Through America's Mental Health Madness — grew out of that investigation. Today, he is in Austin to talk with policymakers and advocates about his findings and about how and why states like Texas need to stop criminalizing the mentally ill. There are nearly eight times as many people with serious mental illness in Texas jails as there are in psychiatric hospitals, according to a study released earlier this year. The Harris County Jail is one of the state's largest housing facilities for the mentally ill.

Earley talked to the Tribune last week about the criminalization of mental illness, misconceptions about the affliction, the need for community-wide solutions and how the state is wasting the little money it spends to combat the problem. An edited transcript and audio selections follow.

TT: Talk a little bit about how you got started with the book and your exploration of the mentally ill and the criminal justice system.

Earley: When my son got sick,  I got plunged into this world of catch-22s and protection of civil liberties and hospitals and insurance, and it was just an ongoing nightmare. What happened was that he became sick while he was in college, and I tried to get him help, and I couldn’t get him help. He ended up breaking into a house to take a bubble bath — luckily, the people weren’t home. He got arrested. And I was so frustrated. I wanted to help him, and I didn’t know how.

I discovered what happened to my son was not a freak occurrence. Right now, as we’re talking, you’ve got 365,000 people with bipolar disorder, schizophrenia, major depression in jails and prison. You’ve got a half-million on probation, you’ve got a million going through the criminal justice system every year, and the largest public mental facility is not a hospital; it’s the Los Angeles County Jail. So I decided I’d write about my son’s struggles and combine that with a larger story. I tried to find a jail to go into where I could follow people who had mental illness and then follow them out through the system onto the streets to see what happened. I ended up in Miami, where I followed a series of persons who had schizophrenia through the criminal justice system out onto the streets to see why our system is failing so many people, and how we could save money and actually help people rather than doing what we’re doing now, which is wasting money and not helping people.

TT: What were some of the things you found out about why people are in jail instead of getting the treatment they need?

Earley: These weren’t Hannibal Lecter serial killers. They were people who are sick — they used to be in hospitals — who really need good community services, and unfortunately, because we’re in a recession, everybody is cutting back on services. It’s really a case of being penny-wise and pound-foolish in many cases. Let me give you an example. Right now studies show that about 16 percent of all persons in jails and prisons have a mental illness that is the reason why they’re in jail or prison. That’s different from somebody who has a mental illness and is a bank robber. Many of them are homeless, chronically ill — things like my son breaking into a house to take a bubble bath — and they end up in jail and prison.

There are 1,200 of them right now in the Miami jail. It costs $100,000 a day. That’s $36 million a year, and they’re not getting any better. For half that, you could put them in affordable housing. You could get them an act team — a team that actually would work with them — and you could actually help them get better. And that’s an example of where we’re wasting money every day that we shouldn’t be wasting where we could actually help people. Jails and hospital emergency rooms are the most costly, least effective way of dealing with somebody who has a mental illness and runs afoul of the law.

Everybody's under pressure to cut, cut, cut. But you have to do those cuts wisely and look for ways to save money and get maximum benefit.


TT: What are some of the ways that Texas might need to think about increasing its expenditures to help people who are dealing with mental illness? Recent studies show that we're 49th in the country in terms of per-capita spending on the issue.

Earley: What you have to understand are two things. One, that schizophrenia, bipolar disorder, major depression are illnesses. They’re not necessarily the fault of the person who got them. The heart can get sick; so can the mind. The second thing is, you are paying money right now. You’re spending money right now — you’re wasting money right now — and you just don’t realize it.

A study found that with a population of 2 million in Miami, 1,200 people were homeless. Most of those people move through the system, except for 507, and they were chronically homeless. All of them had mental illness. All of them had been arrested. You’re going to find the same thing in Austin: the guy who has a co-occurring problem. He has a drug or alcohol problem, and he’s constantly in jail for two weeks and then out on the street. Those people cost $40,000 to $60,000 per year. They are high users of all kinds of services, and that’s a drain on your tax dollar. Just by ignoring them, you’re going to continue to pay that.

The Washington Post did a study. They wanted to find out who was making 9-1-1 calls. They found out that the number one guy making 9-1-1 calls, who made over 200 calls in one year, had schizophrenia. And because we do things so well in Washington, every single one of those calls cost about $900. That’s an example of waste because of untreated mental illness that you don’t even know is related to mental illness. So we are spending money, and jails and emergency room are some of the costliest, least effective ways to deal.

How do you get around that? You want to talk money? Let’s talk money. Right now, one big opportunity that states are missing is this: Because of the wars that our soldiers are fighting, the federal government authorized a lot of money for veterans. And yet when somebody goes into a mental health center, they’re rarely asked if they’re a veteran. If they’re a veteran, they have access to a great pool of money to help them with psychological problems. That frees up money for somebody who’s not a veteran in the mental health system. That’s just a very small thing — having people ask about that.

If you can’t cut money, if you can't find more ways to use it, then you look at taxes. Of course, no politician’s going to say, "Raise taxes." But let me cite you an example. Right now, a study shows that 44 percent of all cigarettes in the United States are bought by people with a mental health diagnoses. They are huge consumers of cigarettes. Why? Because nicotine alters their brain chemistry and they feel better. That means maybe you should think about tacking on a tax on cigarettes that would go specifically for mental health issues. Virginia has one of the lowest taxes, and if we just raised it 10 cents, we would raise $100 million that could be earmarked for mental health. In Illinois, they put a homeless fee on all kinds of real estate transactions; they raised $25 million just through that, so you can do targeted taxing. It’s never popular, but there are some taxes that make sense. You either have to raise taxes or you’ve got to do cost avoidance, like they’re doing in San Antonio, and start jail diversion programs.

TT: How is your son doing today?

Earley: He’s doing fantastic, actually. My book ends after his first arrest, and like many parents, I thought, "Wow, it’s all over. Everything’s cool. No big deal." Well, he went off his medication, which is a common problem with persons with bipolar disorder. And he ended up getting in trouble again, and this time he got Tasered by the police. I had written a book. I have Washington Post connections. I live in one of the wealthiest counties in the United States. You’d think that services would be great there. And yet I couldn’t get my son help, and he ended up getting Tasered. So what chance does somebody sitting in Austin who has no connections, no money, no knowledge of the system have of getting through that?

After that he had another breakdown, but this time he actually got plugged in. He had a crisis intervention team officer pick him up. My son was walking naked because he thought he was invisible — he was psychotic — and they took him to a treatment center, where he had a case manger. She helped him get to the psychiatrist, got him on the proper medications, got him into a group home, got him into a job. And now my son, who is 33 — we’ve been dealing with this for 10 years — is what’s called peer-to-peer, which is a person with mental illness trained to help other people with mental illness.

This is not a case of us not knowing what to do. We know that medications are highly effective in a large percentage of persons with mental illness. We know that if you provide someone with housing, if you give somebody a safe place to live, if you give them counseling, if you give them opportunity to work, if you give them wraparound services where you actually help them move forward with their lives, they will recover. Some small part will not. Some people are so sick that we have to take care of them, and that’s just part of living in a civilized society. But most can recover. We have to provide those tools. When you don’t provide the tools, it’s not going to happen. What we’ve always done, historically, is tried to do it on the cheap. And that has been why we haven’t made much progress.

TT: Do you think that, in addition to money, some of the stereotypes and misconceptions about mental illness also play a role in the lack of resources that available for treatment?

Earley: The big problem is stigma. We’re scared of people, especially people who have a mental illness and are ranting and raving. We see reports like Virginia Tech, and so it’s a very frightening thing. But you have to look at why we treat mental illness differently. I don’t think there’s any shame in having a mental illness. I think the shame is not helping people with mental illnesses.

One of the problems is this: We see somebody who’s psychotic, and we want to say, "Oh, well, the devil’s in him," or we want to say, "Oh, he deserves it, because he's on drugs," or, "Oh, he probably did something — maybe he used cocaine all his life or he's a bad person." Why do we want to say that? Why do we want to not admit that this could be an illness, that it could happen to anyone? It happened to my son just out of the blue; there were no warning signs. Because if we admit that, if we honestly say to ourselves, "This person has a biological problem in their brain," then we realize it could happen to us. We realize it could happen to our children. We realize it could happen to somebody we love. And we don’t want to admit that.

TT: What do you think are some of the priority recommendations that would help improve treatment for those with mental illness in Texas?

Earley: There’s a simple formula. First, you’ve got to realize that you’re spending money anyway. What we’ve done here that’s so tragic is we closed down all state institutions. The reason we closed those institutions was not mercy. It was not compassion. It was money. The federal government said, "We’ll start paying for persons with mental disorders," so that’s why they started closing down those hospitals. Well, the feds have never given the states enough money, never created a good community network.

So now we’re in a situation where a large percentage of people are ending up in jails and prisons. We’ve turned it into a criminal justice problem instead of a mental heath problem. It’s costly, it’s wasteful and it’s morally wrong, and we’re depending on jails and prisons, mental health courts, jail diversion programs. We’re depending on law enforcement to solve this problem. They’re part of the solution, but the real solution is everybody working together. Stop thinking in terms of silos and start realizing that mental health is a transportation issue, a veterans issue, an education issue, a criminal justice issue. It's all these things, and you’ve got to start working together.

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