In recent years, mental health issues have become more central to the criminal justice reform debate.
New York’s jails are estimated to host around 900 seriously mentally ill inmates. That number will have to be reduced for the plan to close Rikers Island to proceed. Each new in-custody suicide brings a federal takeover of the city’s Department of Correction one step closer to reality. (There were six last year and there have been two so far this year.)
george soros suggested last week that the large number of incarcerated mentally ill Americans holds potential for broad-based reduction in jail and prison populations.
In principle, Soros is onto something. The criminal justice system should not be in the business of addressing untreated serious mental illness.
However, separating the merely sick from true criminals on a mass scale, and providing effective treatment to the former, is easier said than done. It would require a public mental health-care system far more competent than one we have.
We can and should press forward with plans to reform that system. But we must also think constructively about how best to help the mentally ill right now via programs run by courts, jails and even police departments.
Central to the disability rights agenda is a commitment to ensuring that mentally ill Americans, as much as possible, live ordinary lives. If that’s so, they must face the same consequences ordinary Americans face for criminal behavior.
Progressives promote “person-centered” terms like “a person with schizophrenia” (instead of “schizophrenic”) out of a belief that no one should be defined by their having a psychiatric disorder. To imply that schizophrenia should function as a get-out-of-jail-free pass is to view it as completely defining for whoever has it. Thus, for progressives especially, the idea that no one with serious mental illness should ever be in jail is an untenable position.
So, too, is the contention that police have no business meddling in affairs relating to psychiatric disorders.
Crime control has a public health justification when it comes to the mentally ill. We fought COVID through medical interventions (vaccines, drug therapies) and non-medical interventions (masks, social distancing). The mentally ill need effective community-based mental health programs, but they also need healthier communities. Law enforcement happens to be one of our most important tools for dealing with entrenched problems in many communities.
Much of the Rikers debate has focused on inadequate medical care. Some coverage of recent suicides has implied that mentally ill inmates are broadly desperate for access to treatment, staff neglect denies it to them, and tragedy too often results.
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Correction Commissioner Louis Molina has pushed back on the neglect narrative, telling WNYC in July that “people in custody refusing to go” is the main reason why so many medical appointments are missed. According to June 2022 date, “Production Refusal” accounted for 5,617 of that month’s 8,997 missed medical appointments. Missed appointments “when no [staff] escort [was] available” fell into a different, much smaller category.
Some advocates dispute the city’s characterization of why so many appointments are missed. But anyone familiar with the normal course of mental healthcare will suspect that, at least to a degree, “service resistance” must play a role in inmates’ psychiatric disorders going untreated.
For some people, jail conditions might increase motivation to participate in mental health treatment because they’re determined to get better and/or have nothing else to do. But for others, jail-based mental health programming offered on a voluntary basis might be less effective because informal social mechanisms aren’t as available. In the community, there’s intense interest in what to do about people who would benefit from treatment but are taking a pass. Social pressure is brought to bear, through families or service providers, to get people to engage. Even that often fails.
Investment in mental health services, inside or outside jails, can never operate on the premise that “if you build it, they will come.” The criminal justice system has unique powers of coercion that can be used as leverage to reduce the rate of untreated mental illness.
Programs such as drug and mental health courts, to be sure, won’t save everyone. But they can be life-changing for some. They will be undermined by viewing the criminal justice system as like an electric fence, with which all contact is fatal, for the mentally ill and assuming that everyone with a mental illness will pursue treatment if left to their own devices.
If we learned anything from Mayor de Blasio’s Thrive NYC debacle, it’s that mental health reform won’t work unless it targets the hardest cases. Police and correction officials deal with those hardest cases, those the mental health system has generally already failed. Those officials’ insights therefore should not be dismissed as somehow inexpert. On the contrary, they should be guaranteed a seat at the table in mental health reform discussions.
Eide is a senior fellow at the Manhattan Institute and author of the book “Homelessness in America.”