Most people, black or white, young or old, liberal or conservative, have certain things they think they “know” which are actually dead wrong. In my case, I thought that former Gov. John Engler was the reason our mentally ill were now in prisons, not hospitals.
After all, Engler closed Lafayette Clinic and most other state mental hospitals soon after taking office in 1991. But Judge Milton Mack told me that Washington was the real culprit.
Back in the Kennedy Administration, Congress passed the Community Mental Health Act of 1963, which encouraged states to close old, state-funded mental hospitals and provided financial incentives for them to do so. In return, Washington promised to fund a network of community mental health centers to replace the services the old hospitals had provided.
Those centers would provide community-based outpatient treatment. This made a lot of sense. The old, hulking Eloise-style “mental hospitals” were severely outdated, and too often used to warehouse patients. So the old hospitals closed – but Washington didn’t keep its part of the bargain. Congress didn’t provide funding for the community mental health centers that were supposed to be the backbone of the new treatment model.
So they weren’t built; the old hospitals closed, and, as Mack noted, “the lack of adequate funding and the inability (by the authorities) to intervene except in the event of a crisis have led to the dramatic increase in the incarceration of persons with mental illness.”
That’s created the crisis we have now. Last year, an estimated 383,000 people with severe mental illness were being held in America’s jails and prisons.
By contrast, fewer than 40,000 were being treated in state-funded mental hospitals. By the way, the courts and the legislatures have also made it much harder to order someone with mental illness hospitalized against their will.
That’s not entirely a bad thing; there were horrendous abuses in the past. Nor does anyone want to see a return to the old mental hospitals, though Michigan, like most states, does need more beds for those who genuinely need in-patient treatment.
What we really need is policies designed to enable the courts to order what Mack calls AOT – Assisted Outpatient Treatment. That would mean amending current mental health codes or adopting modern ones that would do that.
The courts also need the ability to order such treatment prior to the time the patient gets caught up in the criminal justice system.
Naturally, there would have to be safeguards. We don’t want to make it possible for a lazy caregiver to turn someone into a docile zombie. But every professional I’ve ever talked to agrees that community or outpatient treatment is far better for the mentally ill than prison.
Actually, prison is about the worst place imaginable for the mentally ill. Mack told me once about a mentally ill arsonist who was sent to a Michigan penitentiary.
When he got there, he chewed off the ends of his fingers. Our prison system is filling up with severely mentally ill prisoners, and we are paying hundreds of millions to make a bad situation worse. The Michigan House of Representatives has passed a package of sensible bills — HB 5810, 5818, 19 and 20 – that would amend the mental health codes to accomplish a great deal of the sensible reforms we need.
We just need to hope the state senate passes them, as quickly as possible.
