Executive Director, Ohio Advocates for Mental Health.
I have been asked to write about who I am. I also wonder what I am, sometimes where I am, and always why I am. To paraphrase one of the great philosophers of our time, Popeye, "I am what I am." Many years ago, I was diagnosed manic depressive psychotic and ever since then I have tried to live up to it. I was a rebel without a cause before spending three years in psychiatric institutions. During those three years I found a cause.
- Howard Geld (Howie the Harp)
The subject of mental illness and criminal justice is seemingly very complex. Solutions would appear to be costly at best and unaffordable at worst. Our expectations of the public mental health system would appear so great that those providers in mental health and criminal justice, no matter how concerned and caring, may be unable to meet the growing need.
As a person with a mental illness and as an advocate for others with a psychiatric diagnosis, however, my perspective may be somewhat different. I've been accused of seeing simple solutions to complex problems. Consider, however, that the public mental health system is a $1.5 billion industry in Ohio. Criminal justice is even larger, and there are many who are quite interested in protecting a system that provides their employment and security. Many may jump to say that my approach is too simplistic. Maybe they will be right. I would argue, however, that what we are doing doesn't seem to be working and that maybe a fresh look at an old problem is in order.
I am a bit awed by being asked to write an article for a prestigious law journal, as well as by the experience, education, and expertise of the experts contributing to this work. Frankly, my introduction to mental health is from the opposite end of the spectrum. I had a career, a home, and a future that ended up trashed because of my failure to get treatment when needed. I spent years using long work hours to avoid looking at myself, and I used alcohol to self-medicate.
The title of this Article is Solutions. Those experts in mental health will, I am sure, tell you that the keys to the problem of increasing numbers of people with mental illnesses filling our jails are the following:
* Treatment must be available;
* Medications must be available;
* People must have safe, affordable housing;
* People must have safe, affordable transportation; and
* People must have an opportunity to contribute to society.
Let me focus on several issues of importance to me-issues that I feel may be a key to many of the problems facing the system and people with psychiatric disabilities. They are quite interrelated.
Those of us with mental illnesses are often viewed as psychotic stalkers, comic figures, neurotics who do everything to excess, or sometimes as sympathetic characters. Seldom are we depicted as competent.
How do we break that stereotype? We can complain to the media, to Hollywood producers, or to publishers. But the heart of the problem, I believe, is segregation. People with mental illness are placed in separate hospitals or in separate, locked wards in general hospitals. We have separate treatment facilities. We frequently live in segregated housing. And we get services in a system that mandates that you be impoverished to get long-term treatment, and remain impoverished to stay in treatment. To the general public, we remain separate, unknown, and feared.
One could argue that people with mental illnesses can't get jobs and housing in the community because of stigma. One could just as easily argue that until people with mental illness are part of the community working and living side-by-side with the "chronically normal," we can't hope to break those false beliefs any more than we could break the prejudice that women and minorities couldn't be lawyers, judges, or mental health professionals until they were given the chance to prove the prejudice wrong.
The first step in breaking that cycle is to emphasize services that move people from dependence to independence, from tax users to tax payers. We need to promote services that permit people to achieve economic independence. Without hope for a normal life, a stable income, a family, and our own home in the community of our choosing, what incentive is there to want to recover? Without hope for the future, alcohol, drugs, and crime may seem a logical solution in an illogical world.
A second problem I see is that the public mental health system continues to grow. Since Ohio passed the Mental Health Act of 1988, state hospital populations have dropped from 4,000 average daily populations to about 1,100 people. The public mental health system, however, has grown Page 927 from 225,000 people to more than 300,000 clients. The number labeled as severely disabled has doubled from 38,000 to 76,000.
A major reason for this growth is that laws enable insurance companies to have a lower annual and lifetime benefit for...