One of the greatest public policy failures of modern times is the dismantling of our nation’s state mental health systems and the failure to replace them with any meaningful treatment options. The elimination of the mental health hospital system was as disastrous as it was well intentioned.
In the 1970’s, when I was a young police officer, the stated plan was to replace the state hospitals with neighborhood mental health clinics. Officers could take people they encountered in difficult but not criminal situations to these clinics for an assessment and treatment if required. For those persons who didn’t qualify to be held for 72 hours, they did get counseling, medication or just a place to sit quietly. It was an incredible resource for police officers. Sadly, funding for the program was eliminated. Worse, nothing came along to replace it.
What is left is a system that all too often consigns people to the street and eventually the correctional system, usually the county jail. Our jail and prison facilities have unfortunately replaced the mental health care system.
Additionally, there is another population, equally significant but far less visible. I refer to them as the housed mentally ill. They are the people who are receiving care and shelter from an aging parent or sibling. For those patients, there can be significant issues, too. Because they are mentally ill, they can be unstable, unruly and at times, dangerous. Authorities are often called in some of these instances, where once again cops become social workers and are forced to intervene. In others, no call is made, which means people are living in fear of the people they are caring for.
In either situation, the patient often ends up dealing with law enforcement. Police officers and deputy sheriffs have become a de facto modern day mental health “provider.” Obviously, that’s not their role. Police officers receive training in dealing with mentally ill people, but let’s not confuse them with doctors and practitioners of mental health. We have created a situation where we expect them to become mental health caregivers, but the only tools we have given them is a loud voice and a gun.
Look at all of the use of force incidents that are making news today. All too many of them involve police interactions with persons who are mentally ill. Within the custodial facilities, it is estimated that the number of inmates with a history of mental illness range from 15-to-30 percent, although I believe that figure is even higher.
The closure of the state mental hospitals was one of those rare times when conservatives and liberals found themselves in alignment on an issue; specifically, the need to close the state hospitals. Conservatives felt the hospitals were too expensive and liberals thought that sick people were simply being warehoused. There was legitimacy to both of those beliefs. However, the closure of the hospitals without a corresponding commitment to long-term funding for alternative programs was ill-conceived. Without anywhere to go, the mentally ill person often finds themselves in dangerous situations with very limited options. All too often, the result is jail or death.
In both cases, we have failed them. We have sacrificed a critical safety net in the name of civil liberties and cost-effectiveness. The state of Florida has recently begun using a program like the one we had in California so many years ago, the idea being to provide alternative facilities for mentally ill to keep them out of jails and prisons. In all but the most serious cases, these are people that need to be taken out of the prison system.
Additionally, we need to look at the rules and protocols involving when we can enter the home of a person we suspect of being mentally ill, run checks for firearms and review social media accounts. We have not yet answered the question: how and when should government (i.e. law enforcement) intervene in the lives of the strange and different? We are conducting a balance test between safety, both for society and the patient, and liberty. We need to answer the questions.
Honestly, I don’t know what it would all look like. It would take a collection of good minds because everyone has ideas on the issue. It’s not like these are new issues. Back in 2000, I served on the National Policing Commission of Mental Health. We came up with a lot of good ideas and possible reforms. I’d be curious to know which, if any, of those have been implemented since then.
The sooner, the better. This is a crisis that is not going away.
Bernard Melekian was appointed the Undersheriff for Santa Barbara County in January 2015. He has 36 years of local law enforcement experience, including serving as the police chief for the city of Pasadena for 13 years. He also served with the Santa Monica Police Department for 23. He was selected as the Director of the Office of Community Oriented Policing Services (COPS), serving from 2009-2013.