User:Sciesearch/Insane: America’s Criminal Treatment of Mental Illness by Alisa Roth

Insane: America's Criminal Treatment of Mental Illness is a nonfictional narrative by the American author Alissa Roth. This book exposes the rising problem of the mental health crisis faced by the criminal justice system. Major criminal institutions such as jails in New York, Chicago, and Los Angeles have taken on the job of housing more people with mental illness than any hospital. Through intimate accounts of individuals with mental illness that have experience the incarceration system, Roth attempts to demonstrate the inadequacy of the criminal system to accommodate the vital needs of prisoners with mental illness. This book is a call for action to eradicate the abuses, and to bring more awareness and compassion to the ways mental illness is approached in society.

About the Author
Alisa Roth is the mental health correspondent for the American Public Media (APM). Some of her previous work is based on economic justice  and the auto industry, which she contributed as a staff reporter in the New York bureau of Marketplace. Some of her awards include being a Soros Justice Fellow and Fulbright scholar. She earned grants from the Pulitzer Center on Crisis Reporting, the International Reporting Project, and the Fund for Investigative Reporting. Outlets such has NPR, The World, The New York Times, and The New York Review of Books have displayed her work.

Plot
The book is divided into three parts

Chapter 1: Jail Is the Only Safe Place
This chapter narrates the story of a former firefighter, Bryan Allan Anderson, who failed by the mental health system, ended up in jail various times and with dire consequences for the rest of his life. Bryan Anderson had a history of suicide attempts and was diagnosed with bipolar disorder. At the time of his first arrest, he had a manic episode and had stripped off of all his clothing, and got into a motel elevator. During his sentence he did not receive proper treatment for his illness, causing his condition to exacerbate. He smeared feces around his cells and threatened offices and other inmates, which cost him solitary confinement. As would be expected for someone that is sick and does not receive treatment, his time in solitary did not help his behavior. Anderson would through his food instead of eating it and would assault officers. The only times he was left out of his cell was to shower and that was in shackles and escorted by several officers. All these events and no one ever noticed he was severely manic; the officers would even taunt him.

After another of his arrests, he was on the jail's medical unit since he was on a manic episode. The officers were supposed to check in on him, but Anderson was unresponsive. He began hearing voices that told him he was a sinner and had to blind himself. To his response, Anderson "took his left finger and shoved it deep into his left eye socket." The result of all this ordeal was plucking of the right eye and scraping of the pupil of the left eye.

Currently, Bryan Anderson is out of jail and lives off with disability payments. He often thinks about how different his life would have been if he had been provided with the right dosage and medication to treat his ailment. He occasionally gives training to the police about how to properly deal with people experiencing mental illness.

Chapter 2: The largest Psych Ward in America
This chapter focuses on the biggest provider of psychiatric care in the country, the mental health unit in the Twin Towers Correctional Facility at the Los Angeles County Jail.

As is the case for most places, people in jail usually leave fast, within a matter of days or hours. However, for people with mental illness, this is not the case, and it is because they are less likely to make bail. According to a study done by New York City, 12% of people with mental illness vs 21% of people without mental illness can make bail, and for that 12%, the process can take 48 days vs 9 days for people without the condition. Special units within the Twin Towers serve very sick people that cannot be housed with the general population; however, it only has 55 beds and those are always full.

The High Observation or "High Obs" unit house people who clinicians and deputies believe cannot safely share a cell with other inmates. Some of these individuals are not even allowed to wear regular jail uniforms, but rather wear suicide gowns, which are quilted clothes that are supposed to be difficult to be torn or tied into a noose.

The Forensic Inpatient Unit (FIP) is a licensed acute psychiatric ward that houses the very sick, and usually commits patients involuntarily. In this unit, there is more demand for inpatient care than there are available beds. There is a substantial amount of people with mental illness that require inpatient hospitalization in the criminal system, and they are not getting it.

Although not yet ideal conditions, the FPI unit is the best place in the correctional units. The FPI has better treatments, food, and more comfortable cells. This place is only reserved for the sickest patients and is highly demanded. Meetings about who gets placed in the FPI units and who gets to go take place between the clinician and the deputies. Deputies give their non expert advice to the clinicians about who should enter the unit, while the clinicians attending the FPI units decide who will leave. As a result of a rule passed in 19996, the Health Insurance Portability and Accountability Act (HIPAA), deputies –who are directly responsible for their prisoner's safety and treatment—are not giving information about the mental states of the inmates. Thus, medical information that can help deputies understand the prisoner's state is kept confidential while the psychiatric examinations are held in the open, in places where the deputies drink coffee, work in their computers, and look out for people.Prisons and jails are not equipped for people suffering from mental illness. Policemen are not trained to deal with these people, and sometimes doing their job, they exacerbate the afflicted individual.

Chapter 3: The Asylum Fallacy
In this chapter, the author explains how prisons and jails ended up being the providers of psychiatric care for people with mental illness. The author suggests that something close to the "Penrose hypothesis" ( states that throughout history there has been an inverse relationship between the population of asylum and prisons) could be used to explain the current crises. The issue of psychiatric care and that of prisons and jails being populated with mentally ill patients have been shaped by the same forces: "lack of resources, lack of effective political interest, and above all, a lack of understanding of the actual needs of those who are sick." Throughout these chapters, the author tells an account of the history of psychiatric care and the criminal justice system in the 19th, 20th, and 21st centuries. The drive for deinstitutionalization in the middle of the twentieth happened as a result of three factors: the creation of new pharmaceuticals, new funding for community-based care, and the creation of Medicaid.

Chapter 4:  Jail As Hospital
This chapter focuses on two of the largest jails in the United States: Cook County Jail in Chicago and Rikers Island in New York. It is estimated that about 20% to 30% of the nine thousand prisoners in the Cook County Jail are affected with a mental illness. Big jails like the one in Chicago are embracing their new situation and are trying to accommodate as best as possible their mentally ill patients. The Cook County Jail is offering initial screenings to their incoming prisoners to determine if they have a mental illness; this gives a head start to prepare a course of action to help the prisoner. Screening for mental illness before arraignment, however, can be tricky because prisoners might still be intoxicated or high during their arrests. Other programs such as the Program to Accelerate Clinical Effectiveness (PACE) in Ricker's Island are destined to provide the best possible treatment for mentally ill patients. On PACE units, there is more personnel and patients can engage in more activities such as group therapy and art activities. The medical team and the correction officers also work and train together, which reduces tension between the rapidly increasing health care mandate and the primary goal of jails, which is to maintain safety. Among other benefits of the PACE units are consistency in clinicians, the use of reward systems, and having security officers that are specifically trained to work with mentally ill patients. Supreme court cases such as Estelle v. Gamble, Ruiz v. Estelle, and Madrid v Gomez are introduced to discuss how they have shaped the standards of care provided for mentally ill patients in the incarceration system.

Chapter 5: Destined to fail
The problem of mental health in prisons is worsened by factors such as a growing population of prisoners that are increasingly severely mentally ill, extreme overcrowding, lack of qualified staff, and persistent underfunding for incarceration facilities. One of the big challenges that the criminal justice system faces is not just the increasing number of patients with mental illness, but that they are also receiving "the sickest of the sick." The problem of overcrowding makes the conditions a lot worse for mentally ill patients because of the difficulties of basic living such as the noise, competition for bathrooms among other utilities. The author presents an observation of these challenges among incarcerated women at Mabel Basset Correctional Center in Oklahoma. Nationally, 75% of women in state prisons compared to 55% of men suffer from mental illness. Apart from mental illnesses being more common in women than in men, women in the criminal systems have been more likely to experience "trauma, physical abuse, and sexual abuse and/or to have substance use problems," all situations that are connected with mental illness. Overcrowding can make living situations difficult for women with records of abuse since giving order them orders and physical acts by correction officers can be more traumatizing. For women that are mothers, the custody of their children is usually taken away, but if this does not happen, distance, cost, and regulations of the criminal institutions make it hard for women to see their children. Anxieties and depressions caused by not seeing their children can worsen their conditions. Severe overcrowding can also make it difficult for criminal institutions to provide mentally ill prisoners with adequate mental health care, as concluded by the Coleman v. Brown supreme court case. A lack of incarceration staff also makes jails and prisons more dangerous, and worse for mentally ill patients that need to be escorted by correction officers to their therapy appointments.

Chapter 6: Sanctioned Torture
This chapter gives accounts of various prisoners who spent time in solitary confinement and exposes its consequences, at times fatal. Jason Echevarria was a prisoner at Rikers diagnosed with bipolar disorder. After a year in solitary confinement, and an extensive history of suicide attempts, he was able to go through the process after a correction officer gave him a soap ball to clean his cell due to a sewage backup that had flooded his cell. He ate the soap ball and called for help after to an officer who spoke to Terrence Pendergrass, the supervising captain of duty, about what was happening. Pendergrass responded with "don't call me if you have lived, breathing bodies… only call me if you have an extraction or if you have a dead body."

Another prisoner includes Jerome Murdough, a homeless former marine diagnosed with schizoaffective disorder, who was arrested in a stairwell of a housing project in Harlem after trying to protect himself from the cold. Murdough died a week after arriving at a mental health observation unit at Rikers when a malfunction in the heating system caused temperatures to reach above 100 degrees and officers forgot to check on him.

Jamycheal Mitchell was arrested after stealing five dollars' worth of junk food at 7-11. Mitchell was diagnosed with schizophrenia and bipolar disorder and was supposed to be transferred to "the state hospital for competency restoration." He was never transferred and died of starvation in 4 fours in the Hampton Roads Regional Jail.

Darren Rainey was diagnosed with schizophrenia and arrested for cocaine possession in a Florida prison died after officers took him to a special shower at a temperature of 160 degrees (the legal limit being 120 degrees) and left him there for two hours.

Brian Nelson was convicted of accessory to murder and was placed in solitary confinement for 23 years, which triggered a major depression that put him on suicide watch. He lives but is emotionally scarred from the experience.

Chapter 7: Better off dead
This chapter presents the story of Jamie Wallace diagnosed with ADHD, bipolar disorder, and schizophrenia, and post-traumatic stress disorder. Wallace entered the criminal system at age 16 after killing his mother in cold blood as his 8-year-old brother watched. He also attempted to kill his step-grandfather and stole a tractor-trailer to escape. Wallace was placed in solitary confinement from the start, in a filthy cell infested with rats. The hourly of the prison where he was placed was not just cruel but also counterproductive. Breakfast was served at 3 or 4 am, and pill calls happened at any hour of the day or night. Wallace had a long history of harming himself. He committed suicide by hanging himself a week before talking to a psychiatrist who did not recognize his symptoms and put him as "not suicidal".

Chapter 8: Guilty by Reason of Insanity
In a justice court, there are two instances where the defendant's sanity matters. One instance is at the time of the trial, in which case the case cannot proceed until the defendant is deemed competent, and second at the time when the crime was allegedly committed, in which case one could plead not guilty by reason of insanity (NGRI). The plea for NGRI is not very common, an estimate suggests that attorneys ask for this plea between 0.1-0.5% of felony cases, and only 10-60% of those times, the plea is successful.[1] Furthermore, a person who is found NGRI could end up spending more time in the hospital than in prison, one reason attorneys are usually hesitant to apply for the plea, especially if the defendant was committed for minor charges. The chapter also provides an account of how the history of NGRI originates dating back to the 1500s, but with the modern interpretation arising from the case of Daniel M'Naghten in 1843.

Chapter 9: Inside Out
Mental health care has changed dramatically since the 1950s. Previously, mental health care was provided in institutions where people used to stay for long-term hospitalization, now mental health care has expanded to community-based care, and inpatient has become very rare. The number of providers specialized in mental health care has also changed, with the job of clinicians, social workers, therapists, counselors, psychologists, and psychiatrists. Apart from all those changes, it is still very difficult to have access to mental health care. One big problem is the shortage of inpatient hospital beds. The majority of those beds in hospitals are assigned for forensic patients, that is, patients in the criminal justice system. For example, Texas has 2300 state beds for mentally ill patients, but only 1100 of those beds are reserved for patients that come through civil channels. Meanwhile, people outside of the incarceration system that also needs that in-patient care are not receiving it and as a result, become extremely sick and most end up in prisons or jails. In other words, the shortage of community care caused by the criminal justice system having more mentally ill patients is increasingly responsible for sending more mentally ill patients to jails and prisons.

Chapter 10: The Cycle
Hot-spotters or superutilizers –people who go in and out of jail frequently, often right after being released –are a common aspect for people with mental illness, a substance use disorder, or both. Many times, those arrests are misdemeanors such as petit larceny, residues or small quantity of drug possessions, criminal trespass in the second degree, and turnstile jumping. In states like New York, if a person that is charged with a misdemeanor is incompetent to stand trial, the trial gets automatically dismissed and the person gets out of jail, only to return soon for similar charges. The author presents the case of Edgar Coleman who had a history of mental illness and was arrested two hundred times between 1996-2012.

Chapter 11: Shooting the Victim
The Washington Post reported an estimate of five hundred people with mental illness being fatally shot by police in the two years of 2015 and 2016. The authors give an account of Keith Vidal, diagnosed with schizophrenia, who was tased and fatally shot by the police after his parents called the police to get him hospitalized. Keith Vidal had a small screwdriver in his hand, he had been tased and was on the floor with various people surrounding him, including two officers and his stepfather. Seconds later, Bryon Vassey, an officer from the Southport Police Department, shot the young boy in the chest. Other victims of fatal shootings by police include Deborah Danner, Andre Messina, Dontre Hamilton, Audrey Latham, and Charleena Lyles. Reasons for these fatal shootings can be attributed to the police having to respond to mental health crises rather than the EMTs, and the disconnect that exists between police training and the job they are asked to do with the mentally ill.

Chapter 12: The Good Cop Solution
The Crisis Intervention Team (CIT) is a program that is designed to train officers how to deal with patients that have mental illnesses. The aim of the program is a more humanitarian approach that provides officers with skills to diffuse a situation, whether it is about a person that is thinking of harming themselves, threatening a family member, or just need hospitalization. The first CIT was developed after an incident in September 1987 that resulted in the assassination of Joseph Dewayne Robinson; he was shot 10 times. Dewayne was an African American with paranoia schizophrenia and that at the time the police came he was contemplating suicide. His sister, who had called 911, said "He was trying to kill himself and they [the police] came and did it for him."

Chapter 13: Disorder in the Court
The court systems for big cities such as New York are very slow. Janet DiFiore, New York's chief judge, has mentioned how unfortunate are court delays for everyone involved, " crime victims and their families, as they wait for justice to be done; prosecutors and their cases, as key witnesses move away, memories fade and evidence grows stale; and defendants, presumed innocent under the law, who must return to court over and over again or, too often, sit in jail waiting for their cases to be resolved." Court delays are specifically more detrimental for people with mental illness. An analysis conducted in 2012 by the Council of State Governments found that in New York City, people with mental illnesses were more likely to stay incarcerated longer versus people that did not have any mental illnesses (112 days vs 69 days). One of the problems is bail since only 12% of defendants with mental illness made bail compared to 21% of people without it. Even for those 12% that were able to make bail, the process took longer.

= Reception = Since the book was published, Insane: America's Criminal Treatment of Mental Illness has been lauded. The book has been described as an "essential exposé" by the New Yorker.

The New York Review of Books described the piece as "superb" as the account traced back the need for community mental health services since it was promised during the Kennedy years.

The Marshall Project applauds the commitment of Roth to gain rare access to criminal institutions such as the Los Angeles County jail and the women's prison in Oklahoma. It mentions that Roth reports "with grace" the intimate stories of individuals who as a result of their untreated mental illness ended in the criminal justice system, most times with fatal results.

The Democracy Journal considers the work "powerful", since it addresses "simplistic solutions" to a big issue that the United States is facing.

Los Angeles Review of Books highlights the purpose of the book which is "not toward shaming but toward progress," to provide solutions as to how mentally ill patients can be better treated in society.

Thomas J. Dart, the sheriff of Cook County, Illinois mentions that the book "should be required reading for any person involved with the criminal justice system or legislatures."