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Criminalizing Mental Illness

Alisa Roth

LA County: Are You Listening?

With the unexpected election of Alex Villanueva as sheriff of the nation's most populous county—and thus also as jailer-in-chief for what is by far the nation's largest local jail system—the challenging issue of mental health and law enforcement comes once again to the foreground in Los Angeles.

In this context Alisa Roth's important new book—Insane: America's Criminal Treatment of Mental Illness—should be regarded as required reading for the new sheriff as well as for the county supervisors who still seem determined to build a massive new mental health jail in downtown Los Angeles.

Roth doesn't preach, and she doesn't claim to have all the answers to the dangerous interface between law enforcement and a rising population of mentally ill people who act out in public.

Roth doesn't preach, and she doesn't claim to have all the answers to the dangerous interface between law enforcement and a rising population of mentally ill people who act out in public. But she does know what does not work, and her book is filled with warnings about the incompatible missions of law enforcement and proper care for the mentally ill—the inherent tension between the security mission of jails and the kind of environment needed for stabilization and treatment.

How can institutions that are built around discipline and punishment, that rely on officially sanctioned forms of psychological pressure and duress, provide, under any circumstances, the kind of setting necessary for effective treatment? And even if they an, what does it mean for doctors and other medical staff who work within them and must adhere to the strictures of life inside them?

"Strictures." That's a fancy word, but what Roth means to say—and what she illustrates with abundant examples—are the multiple protocols that are followed inside all jails whereby inmates must be escorted to and from treatment, escorted to and from medication pickups, and (of course) compelled at all times to submit and to conform their behaviors to whatever the guards are demanding of them in a given moment. Medical staff within jails are of course likewise bound by these strictures.

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Roth, who spent a lot of time at LA’s Twin Towers along with other major jail facilities around the U.S. in preparation for writing the book, notes that relatively short jail stays—cycling in and out—are especially disruptive to any possibility of treatment on the inside. But longer jail stays—and mentally-ill people often experience longer stays on account of the much greater difficulty they have in making bail—are hardly conducive to treatment, either.

This is partly because a big part of jail culture is the assumption, on law enforcement's part, that inmates will fake mental illness or otherwise try to manipulate the system. And it's also because (stating the obvious again) law enforcement officers are trained to command and intimidate everyone around them: their self-understanding is primarily about taking and keeping control. This typical command-and-control behavior by uniformed armed guards in turn almost always aggravates and even triggers still more "refractory" behaviors on the part of the mentally ill. This perverse effect is likewise even a problem with the deployment of so-called Crisis Intervention Teams—a deployment that is often touted as the "answer" to the problem of law enforcement interaction with mentally ill people.

Roth remains acutely sensitive to the problem of the lack of accessible adequate mental health services outside of the criminal justice system, noting that it's so much easier to slam someone into a cage than it is to get that individual referred to community-based or hospital-based treatment. But she also points out that one big reason services on the outside are squeezed is that law enforcement sucks up all the available public money. And it's not just money, it's also space. Law enforcement also uses up a lot of outside mental health treatment capacity for its forensic purposes—for determining whether a given person is competent to stand trial. In short, it's the worst kind of vicious cycle.

All of the supervisors who voted to build the $2.5 billion so-called "Consolidated Care Facility" should not only read Alisa Roth's book but should also have the decency to tell us (if they still go forward with it) how they intend to answer the questions and challenges she raises.

If they could convince us that medical professionals will actually be running the new facility, with assistance from law enforcement, that might be a conversation worth having. But that's not what our ostensibly progressive supervisors have in mind. Their plan is to build the damned thing, hand it over to the sheriff and his deputies, and then vacuum the troublesome mentally ill into it. It's a surefire formula for disaster and for yet another human rights catastrophe right here in our own back yard.

peter laarman 2018

Peter Laarman