It’s all about the base – and coming full circle

WESTBOROUGH, MA April 7, 2018 The myths of mental illness come up over and over when criminal justice reform is discussed. Here in Massachusetts a significant update of the Criminal Justice laws has just been passed and await Massachusetts Governor Charlie Baker’s signature.
In truth most criminals are not mentally ill. The question is how do so many people who are mentally ill wind up in prison populations?  Jail diversion projects are being introduced from coast to coast and will directly impact the number of people with mental illness who are in the state prison and county jail systems.  It has worked elsewhere including San Antonio, TX.   We are led to believe that as much as
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Aerial photograph of once resplendent state hospital campus in Massachusetts – now crumbling and unsafe to enter. (Google image)
40 percent of the inmate prison population has some form of mental illness although I do not dispute this. The stigma associated with being “mentally ill” calls for added resources for treating them.  Just as resources are provided for those with diabetes, atrial fibrillation and COPD.  These patients are not stigmatized for the maladaptive choices they make that may confound the medical complexity they experience and its cost to society.  Some of the worst cases of COPD I have worked with continue to use tobacco products.  Similarly, those with uncontrolled diabetes may require diseased-related  surgical amputation of toes, foot, legs, yet remain non-compliant with checking their blood glucose. Why?  They are not stigmatized – unless they are obese.
Each time we see something horrific we automatically assume the person to whom the acts are attributed “must be sick”.  These notions have been discussed over and over in these pages. In truth, mental illness has less to do with aggression toward people than crimes such as petty theft and other nuisance offenses like disorderly conduct and panhandling. My sense is that whenever an arrest is made the differential diagnosis is all about the base – and underlying addiction and substance abuse must be considered and treated.
In the 1970’s the Massachusetts state hospital system had been deconstructed and was taken out of the continuum of care. The chronically ill fell off the treatment radar and went rogue.  Importantly in Massachusetts, this triggered the swing away from hospital-based care to the community health centers that became the front line for those in crisis.  At this point the myth of mental illness began its insidious transformation and jail became the containment center in the absence of the venerable state hospitals.  These insights are not new.  The problem is that there are not enough treatment options including inpatient mental health care to make a viable change in the current trends.
“The short version is that while people with serious mental illness are slightly more likely to commit acts of violence than people without mental illness, the risk that it creates is pretty small compared to other known risk factors.”  According to Joel Dvoskin “alcohol accounts for a great deal more violence than mental illness does.” APA, 2018
“So, when somebody feels depressed, enraged, insignificant, they have access to a firearm, maybe they’re drinking too much that night, maybe they just got fired and so on – it’s like this perfect storm of despair. ” according to Dr. Dvoskin.  There are several states who are taking a close look at the removal of guns from people known to be violent or threatening – even prior to formal adjudication.  Until now, there was little that could be done to remove weapons from a dangerous person until he committed a crime.
Here in Massachusetts the substance abuse problem and the mental illness problem are commonly lumped together.  They are not mutually exclusive and I have posted previously that mental problems are often inflamed by substance use. We have come full circle in understanding the need for intensive resources that may have been lost by closing the hospitals and letting them crumble.

Dvoskin, J. (2018) Speaking of Psychology: Dispelling the myth of violence and mental illness Episode 27 American Psychological Association

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