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Thank you for taking on this subject. My Viet Nam Vet brother is
an unmedicated mental, drug and alcohol addicted patient in solitary
confinement at a state medium security prison. He has been there
for one month, and they expect to keep him there for five more.
He wouldn't and has never hurt a fly. He is incapable of following
the rules, and smoked in his room. It is so inhumane. I thought
he would at least receive the correct medication there, but they
are indifferent to his mental condition.
This morning before jaunting off to the ER of the local 220 bed
hospital, Pardee Hospital, here 20 miles south of Asheville in the
"Foothills of the Great Smokies" as the locals like to
characterize the region, I heard your very timely and extremely
well-done segment on the mentally ill in the jails of the Minneapolis
area. You could have done this program in ANY area of the country
and I am sure that your findings would have been even more stark
and disheartening in the larger urban areas such as DC, Newark,
Miami, Phoenix, LA, etc.
I am a veteran journeyman child, adult and geriatric triple board-certified
psychiatrist here. I am 52 and am old enough to have now at this
stage of my life, an historical perspective on some matters that
I have observed and/or participated in myself. TWENTY YEARS AGO
I was consulting at a state prison farm, Caledonia State Prison
in mid eastern NC as a weekend psychiatrist driving 80 miles one
way two Saturdays a month to run a psychiatric clinic. That prison
is a very old huge prison farm facility that grows ALL the meat
and veggies for all the public schools of the state of NC, a huge
place with over 6000 acres of land under cultivation, and a gazillion
inmates working the fields. It is also the place where "Carbine
Williams" perfected the lever action Winchester rifle over
100 years ago! The first day I went there they had the remnants
of the remains of an inmate fried up on the electrified main fence
in front...! They took me to the library through several dormitories
where hundreds of huge inmates watched me warily as I walked through
with an unarmed inmate and male nurse. In the library on the terrazzo
floor, there was a large rusty stain where the week before the inmates
had eviscerated and despined Mortal Kombat style a stoolie. I never
have forgotten how scared I was the first clinic I held there---until
I met the inmates who by and large were the MOST appreciative patients
I have ever worked with -- especially the lifers that I did secret
psychotherapy with as the prison officials didn't want me 'giving
them any ideas' through liberating psychotherapy.
Even then 1 in 10 inmates were officially mentally ill. The pathology
I saw was UNbelievable. I recall one inmate who was a transexsual
who had burned all the overlying flesh off his forearms so one could
see all his tendons "working when I move" as the inmate
All that was in the early 1980's. I have never forgotten those
men. And now it is 1 in 4. Even worse. Our mental health system
in our laissez faire capitalism run amok Republican system has neglected
millions. Most of the homeless are indeed chronically mentally ill.
Programs like yours are very much needed but they make me angry:
Us mental health types have known since the 1970's all the issues
your report highlighted and still it gets worse...
Oh, incidentally, I was on call today and when I went to the hospital
to make inpatient rounds on our small inpatient psych unit, I had
to go the ER first to see a prisoner brought in from the local jail,
treat and get him a bed somewhere which was no easy task since private
units dont want patients who are inmates and even if we could take
him on our unit, the jailers would not let him be admitted, since
he "might escape." Oh well..
Frank B. Miller MD
Posted July 31, 2000
There need to be more programs like this to make the public aware
of the difficulties families face in trying to get services and
medical help for someone "suffering" with mental illness.
There has been no increase in funding in Massachusetts in over three
years, and more and more mentally ill are ending up on the streets.
Some are placed on long waiting lists and for many the wait is too
long. They end up sicker, in jail, or dead.
NAMI-Massachusetts (National Alliance for the Mentally Ill of Massachusetts)
is holding a March and Rally on October 3rd (around Boston Common
with speakers in front of the State House - beginning at 10 AM).
We are having high profile speakers (Tipper Gore will be in Boston
that day and she is a spokesperson for NAMI. We are waiting to hear
from her secretary if she will join us that morning).
Thanks, again, for the fine job you did covering this topic which
is heartbreaking for so many individuals and their families.
40 Plain Road
Westford, MA 01886
p.s. I just heard from a woman who told me how her family tried
to get help
for her son who is mentally ill. They tried to get help for him,
but couldn't - mainly because he refused to go to the hospital voluntarily.
Her lawyer told her that her best hope was that he commit some minor
crime so that he would end up in jail, where maybe the judge would
order him for treatment. Well, he ended up committing a pretty major
crime and is in prison. She tells me that it is a relief for her
and her family that he is confined, and they hope he will be ordered
for treatment through the judicial system. Most people cannot imagine
that our families get relief when their son or daughter ends up
Did you know that the only ones that can commit a mentally ill
person to a psychiatric hospital - INVOLUNTARILY - are the police
and psychiatrists? Because of Managed Care and lack of beds, Psychiatrists
often don't commit a mentally ill person; the police are frustrated
having inherited a job they didn't want or train for.
Posted July 31, 2000
Great job on why the mentally ill need treatment, not incarceration!
Especially liked the your beginning with the words of Dorothea Dix
that ring so true today.
I have been writing on the problems with New York State's abandonment
of the mentally ill for several years. Governor George Pataki deliberately
withheld funding for community-support and housing. Now we have
the specter of Mayor Rudolf Guiliani fighting a class action judgment
from the court demanding treatment plans for mentally ill prisoners
being released back into the city with a metro card at the Queens
Plaza subway station at midnight. No help with their medications
or anything else. The court ordered the city to take responsibility
and the Mayor is appealing. It's appalling that the politicians
in New York refuse to provide treatment. Thanks for your well documented,
informative and superior treatment of this national problem.
Posted July 31, 2000
I congratulate you on "Jailing the Mentally Ill." It
perfectly blended compassion and information. I am heartened to
see the plight of the tens of thousands of people imprisoned by
mental illness brought to the public's attention in so enlightened
I would, however, like to offer some constructive comments on the
portion of the program which contemplates whether criminalization
can be reduced by getting treatment to people before they end up
in jail or prison. More particularly, I find somewhat skewed and
incomplete the consideration of how to help those in desperate need
of treatment but who have lost the ability to make informed decisions
concerning their medical care.
I will briefly address some statements made in the program:
"Most groups representing the mentally ill don't want a return
to forced treatment or confinement in hospitals. What's needed instead,
they say, is more and better voluntary treatment. That might prevent
more of the mentally ill from doing jail time."
The "instead" in this sentence is out of place. Proposals
for more services and those for treatment law reform are not in
competition with one another. They deal with two different things,
the first with the amount of services we have and the second with
getting those services to those who need them most.
And I will not venture to assess the aggregate opinion of the various
groups composing the entire mental health field, but, for starters,
NAMI, the APA (psychiatry version), and the Treatment Advocacy Center
(my organization) all support the use of assisted treatment (an
umbrella term for the various forms of interventions) to help those
overcome by mental illness.
"It's not clear how society could force mentally ill people
to take medication outside of institutions."
Forty-one states already have laws for assisted outpatient treatment
(a.k.a outpatient commitment), although, admittedly, many of those
make little use of it. This treatment mechanism, whereby a court
orders an individual to maintain treatment in the community, is
receiving much attention in the mental health field, especially
after last year's passage of a law establishing it (Kendra's Law)
in New York. The weight of the studies are firmly behind assisted
outpatient treatment's effectiveness at keeping people out of the
hospital and in the community This includes a recent Duke study,
which is the most comprehensive ever in this area. Conditioning
probation on treatment and compliance stipulations by the emerging
mental health courts are also used towards this end.
"Anyway, civil libertarians would object to forcing treatment
on anyone who isn't proven to be dangerous."
You are absolutely correct, but civil libertarians (whose view
you seem to settle on) are only a fraction of the population. There
anticipated opposition is a pale justification for not undertaking
reforms that could mean needed treatment for thousands upon thousands
who would otherwise be left homeless, in jail, or with their lives
Excuse me if I am overly passionate on this subject. It hits home.
I am bipolar. My life was saved by treatment -- treatment that was
not of my express choice (and actually against my psychosis ruled
desires). I shudder at where I would be, if at all, had that decision
not been made for me.
I encourage you to explore our website (www.psychlaws.org)
for more information on the side of this debate which you did not
present, except through the one comment by Mike's mother.
Please don't let my concerns of this small portion of your show
diminish my previous acclaim of it. It is excellent.
Treatment Advocacy Center
3300 North Fairfax Drive, Suite 220
Arlington, VA 22201
Posted July 31, 2000
I'm a retired (1999) Ohio prison psychology supervisor. Jails are
only the gloss on the mental illness population. The Ohio lawyers
told us that 11% of the population was mentally ill. Hogwash. If
you followed our actual caseloads, the real figure was at least
25%. At Chillicothe Correctional Institution, we had over 1,100
of 2,500 inmates on our caseloads. With a CCI staff of 33 (including
secretaries and administrators), we couldn't begin to keep up with
the workload. After 10 years in the business I fell into a depression
and anxiety tailspin and applied for and got a psychiatric retirement
myself. It's a thankless business.
Jails may well be be the revolving door, but prisons are the terminal
holding bins for the mentally ill -- judges have nowhere else to
park these souls. It's the sad truth that once a person is locked
up, off the streets, and out of sight nobody cares about them again.
From what my Ohio colleagues tell me, the situation has only gotten
Frederick V. Malmstrom, Ph.D.
Psychologist (Ohio #4360)
Posted July 31, 2000
From an anonymous mother in Idaho:
I would like to send you a copy of a letter which our family wrote
this spring. Our adult son, "Jason" (not his real name),
has schizophrenia. He has been diagnosed with paranoid schizophrenia
for about 3 1/2 years, although we knew that something was terribly
wrong before the actual diagnosis was made.
As a result of his illness he has also had several medical problems,
the most serious of which is a spinal cord injury which he sustained
in a fall from a balcony. He has had drug and alcohol problems,
been in the state (Idaho) mental hospital twice, been in jail, and
been in the local mental hospital about 10 times. He had a (nearly
fatal) stomach bleed caused by mixing alcohol and huge amounts of
aspirin together for several weeks. He was just diagnosed with Hepatitis
C and we are all being tested (our family) as we have been exposed
to his blood and body wastes. Jason is twenty six years old. The
letter is the story of every family which is dealing with an adult
child with a serious mental illness.
To The Persons Involved With the Mental Health Care of Jason:
We are writing this letter in the hope that our concerns about
our son and brother, his illness and the treatment of his illness
have been or can be communicated clearly. We, as a family have had,
for the most part, two kinds of contact with the people who are
involved with Jason and his illness. Either we (1) have had up to
twenty strangers in our home in a crisis situation, or we (2) have
had the chance to talk on the phone to people who are very busy
and are complete strangers to us. This is what has almost always
1. By the time we have called Mobile Crisis, or the police, or 911,
we have been so stressed, tired or frightened that we, ourselves,
can hardly function. This often has happened on a week night, after
we have been at work or at school all day. We never know who is
going to show up when we call for help. Often we need to start out
by explaining what schizophrenia is to young police officers who
have little or no experience with this illness. We have called 911
twice when Jason has had grand mal seizures. We did not know either
of those times that the seizures were caused by Jason's self-medication.
(On both of these occasions, the doctor recommended that Jason make
an appointment to have an EEG. As of this date he has not made an
appointment to have an EEG.)
We have called Mobile Crisis when Jason was drunk, running around
the house naked. We have called Mobile Crisis when Jason was screaming
and yelling and threatening to beat one of us up. We have called
for help and the police, the fire department (usually two engines),
the paramedics and Mobile Crisis have all showed up. Almost every
time we end up being told that Jason is not demonstrating that he
is a danger to self or others, everyone shakes his or her head and
leaves. The same sequence has happened over and over and over....
We have decided that there is no point in calling anyone. If we
stop calling for help, we won¹t get any LESS help and we will
save everyone (including ourselves) money, time and energy. Our
neighbors will stop complaining about all the uproar. We will stop
having strangers milling around in our house for hours. We will
stop taking Jason to the emergency room and spending half the night
sitting there only to be told to take Jason home; that he really
does not have any problem they can treat. Our daughter won't have
to study for tests as the firefighters helplessly wander through
the house or as she waits with us in the family waiting room of
The one time someone has visited our house to evaluate Jason and
has had a clearer picture of how he usually functions was when a
doctor came and talked to Jason last May. Even though the physician
identified himself as a designated examiner, Jason did not realize
that he had to do his "normal" act. The doctor actually
got to see what IS normal for Jason (it was better than his usual
"normal" and much better than what would have prompted
us, in the past, to call for help). The examiner went to the judge
and had Jason put in the hospital. As I write this, Jason is in
the hospital. He has been in the (local) hospital for about two
days. We have been called one time by a social worker. The social
worker has returned a message that we would like to speak with her
one time. This situation is an example of number two (below).
2. Most of the input we, as a family, have had has been confined
to what one or the other of us has been able to communicate by telephone.
More often than not the people we call do not return the messages
we leave. Usually one or the other of us has tried to talk to the
person who has called us at the same time we were trying to do our
work. Jason's step-father is called and tries to explain our concerns
while his clients are waiting to be helped (he is a psychotherapist).
Jason's mother is called and tries to explain our concerns while
she tries to teach learning-challenged first grade children who
are present as she talks on the phone. Nobody listens to Jason's
sister at all, no matter where she is or what she is doing. Nobody
even asks her what she sees or what she thinks. We are supposed
to be giving Jason his medications but, until recently, nobody called
to tell us what medications he was supposed to have or when the
medications were changed. Sometimes we have been called a few hours
before Jason is released from the hospital. Those calls are made
to inform us that we need to come to the hospital to give him a
We have had calls from people who have advised us not to be so
codependent; that we should let Jason lead his own life. We have
had calls from all the people to whom Jason owes money. We have
had calls from people who tell us that we should evict Jason (and
then we have been told that, if he is homeless and without medication,
nobody can do anything because being homeless is not a sign of being
a danger to self or others). Jason calls us ten or twenty times
a day if he is in the hospital, at his own place or even at home
where we live. He pages us on our pagers to call him. We pay his
bills because people call us and tell us that he will go to jail
if his bills are not paid. When we said that we would stay out of
the picture and let Jason live his own life as an adult, we got
calls from the police, the landlord, the property management companies,
Blockbuster Video and the places where he had appointments and had
not kept them. Every month we get calls from some collection agency
telling us that Jason owes money from five years ago. One of us
always has to call some pharmacy to make sure that Jason's medications
are delivered to us so that we can make sure that he takes them
(if anyone has taken the time to tell us what the medications are
and when we should give them to him).
God help us if we did not have telephones. God help us because
There are really very few things we want.
1. We want to have personal and face-to-face input on and information
about Jason's treatment. The way things have turned out, WE are
the treatment providers. Our home is Jason's care facility. We do
not think that most patients would be admitted to a care facility
without the facility being informed or consulted about the care
of the patient.
2. When we call for help, we want people to understand that we
are doing that calling as a last resort. If we call for help, we
need help. We are a very tolerant family and we would NEVER call
anyone to help us unless we were pushed beyond the ability of any
normal family to cope.
3. We do not want to keep telling the same history over and over
again. If it is possible to call up traffic records and find out
if someone has had a ticket from years ago, it should be possible
for someone to get the records of our interactions with community
agencies so that we do not have to keep filling out the same forms
and reeducating the same community agencies again and again.
4. If Jason does not follow through and make or keep appointments,
somebody else should be in charge if making sure that he does. At
the very least, we should be informed of when his various appointments
are and notified if he does not keep them.
5. We should be consulted and informed about changes in Jason's
6. Jason needs structure to his days and that structure must be
enforced in some way. Jason needs to be held accountable for attendance
at daily activities of some kind. It is possible that he could have
a productive life if he was required to attend some kind of assisted
work or work training program. Someone outside of this family needs
to enforce consequences if Jason does not attend his daily activities.
It may be necessary for someone outside of his family to escort
him to these activities whether he says he "feels" like
attending or not.
7. We really need a break sometimes. It is much less expensive
to the state to have Jason cared for at home than in a group home
or in a hospital. We, unlike the workers in a care facility, NEVER
get a day or a night off.
8. We love Jason and we want him to have a full and happy life.
If Jason wishes to live with us and can do so with reasonable adjustments,
we want him to do so. If he wants to live in a group home instead
of living with us, we have no problem with that. Jason has shown,
however, that he has little or no ability to live alone or in an
unsupervised living situation. Since he is not able to even manage
his own medications, cleaning, or his own money, it seems unlikely
that yet another try at putting Jason in an unsupervised living
situation would be at all successful.
As you make provisions for Jason's care or decisions about his
future, please keep the above things in mind. The mental health
and the successful functioning of at least four people are affected
by the choices you make. A little time and money spent carefully
now can save a lot of time and money later. It is impossible for
the state mental health department to serve everyone but, in this
case, the state can get a lot of help from us. This situation could
end up with four more or four less functioning people in this society.
Please do not let our lives get wasted.
p.s. Since this letter was written, Medicaid funding in Idaho has
decreased for group home care and many of the group homes have closed.
Finding a bad group home is almost impossible; finding a good group
home IS impossible.
Posted July 31, 2000
It has been over six years since my husband's bout of mental illness, and the accompanying troubles in our family's life, and we have moved on and tried to recover. But the part of your radio essay that I heard rang too true for us both, and brought back terrifying memories of the atrocities of our judicial system in the United States.
While much of the population thinks that defendants "get off" with an insanity defense, they do not know or understand the double punishment that most mentally ill defendants in the judicial system receive. In our case, after paying for legal defense for 6 months, and getting within a day of a jury trial, we opted to enter a "no contest" plea for my husband. He had suffered from Brief Reactive Psychosis, and had embezzled money as a bank employee, in his paranoia. It broke all of us, including our lawyer, to enter that plea, after our hard fight, but if we had lost in a jury trial, the judge made it very clear that he would have given my husband the maximum sentence allowable, simply as punishment for pushing the trial through. And even if we had WON the trial, and he had been found not-guilty by reason of insanity, my husband would STILL not have been released. He would automatically have been sent back to a federal mental hospital, 10 hours from home, and been kept there until he was found to be no threat to society, and allowed to be released. That would have taken a minimum of months.
He had been kept already for six months in various jails and prisons, being shipped from one facility to another for diagnoses and holding until trial. When in jails, he was unmedicated and untreated, often paranoid and suicidal, without help. We were afraid that, after having been found not guilty by reason of insanity, the government would no longer feel a need to medicate him, to make him competent to stand trial. Without medication, and with increasing depression away from his family, we felt he would be detained longer.
We opted to sacrifice my husband's honor, and enter a plea with which we were not in agreement, simply to save his life. We believed that if he remained for more months in government facilities, he would find a way to end his own life. With the plea agreement, we were able to take him home THAT DAY from the court room. The prosecutors and the judge knew that this was an option that we would not be able to resist. After coming home, his mental health improved fairly quickly, and he has had no significant relapses of his unusual condition.
I falsely always believed that the judicial system of our country was a pure, blind, unbiased goddess who would be there to find justice for any citizen when in need. I now know that it is a system full of judges and prosecutors who view each conviction as a notch on their legal belts. Those men knew that keeping my husband in jail, in spite of his non-violent offence, and his full restitution of the funds taken, was the best manipulation of his family and his mental state, for their own ends. They won. But we saved his life.
My heart continues to ache for those families whose mentally ill loved ones inevitably fall into the grip of the legal system. They are victims. I think some do hope that they will receive treatment and medication, and even control, for their loved ones, when they are incarcerated. That is a false hope. The county jails and even larger institutions of our country are not equipped to handle these patients with care, and with promptness. Often they are put in solitary confinement, stripped of clothing, left in a bare metal room. This humiliation is their solution for those who are so depressed in their state that they wish to end their lives. Wouldn't you?
Thank you for your program. Perhaps eventually the people of America will listen, and the plight of the mentally ill will be understood as the illness that it is. The joint stigma of mental illness and a felony conviction is a lifetime of punishment for my husband and our family.
My brother is serving 50 yrs and that it is in Wisconsin there is little to no hope for him to ever get early release. He was 19 when he committed his crime of burglary without a weapon and will be 50 before parole is considered. But the bad thing is he is third of five generations in our family with mental health issues. While he has extremely high IQ he suffers ADHA with Bipolar disorder and depression as well as many others. He is now 38 and is pursuing education as much as he can. The problem lies with his sentence and treatment. One he is not getting treatment at Wisconsin RCI for his Mental Health, where he was transferred to from Winnebago County Mental Health Prison. He was doing well at the WCMP because he was getting treatment. Since the move he gets none. One requirement for early release is he has to go through a AODA assessment which is a level 6 program and is only available at certain prisons, none of which have mental health treatment. They tell him it will be 6 years at least before he is eligible for this program so they will keep him at WRCI until then. My son is 19 and is another in the prison system with mental health where drugs intervention makes his symptoms worse. Where and when will they both get the correct treatment in a prison? No our great state will set them free without the help just so they end up back there within months. I have 2 grandsons who are the same as my brother and son, what will happen to them?
We find it hard to get proper help from anyone when it comes to mental health, especially in jails and prisons in Wisconsin, probation officers laugh at you when you even mention a client needs help, prisons are worse they just ignore. Who can help those that need it most before it's too late?
Thanks for listening