From Locked Wards to Locked Cells

From Locked Wards to Locked Cells
By Carl Blumenthal
New Book on Mental Illness Behind Bars
We all know jails and prisons—not hospitals—are the largest providers of psychiatric care in the U.S. And that folks with mental illness are treated like s__t in these places. The truth is punishment for crime and recovery from mental illness mix as badly as a cocktail of psychotropic medication.
So why should we read Alicia Roth’s new book, Insane: America’s Criminal Treatment of Mental Illness? 
There are so many ways that penal institutions fail our peers, you need a spreadsheet to keep track of them. Roth is the kind of investigative reporter who balances statistics, laws, policies, and history with how these abstractions reflect the messed-up lives of real human beings. 
There is Bryan Anderson, diagnosed with bipolar disorder, who spends his life savings helping people because God tells him to. When the voice says, “You’ve got to blind yourself,” Anderson gouges out his eyes while in jail. Miraculously, he becomes a peer counselor despite his trials and tribulations.
Troubled by mental illness since age six, Jamie Wallace murdered his mother at 16 and killed himself in prison at 24. According to Roth, hospitals, courts, and prisons all failed him. 
Kyle Muhammad was arrested 18 times in 35 years and hospitalized even more. “One gets the impression that every time he finds some stability in his life—a job, an apartment, a community-based treatment program that works—his illness is once again neglected, or he has a run-in with the law, and he ends up in the hospital or jail—or both.” 
Twenty-three years in solitary confinement hugely messed up Brian Nelson’s head. The prison medicated some of his symptoms but never recognized how severe his PTSD was. When he's finally released after a lawsuit over prison conditions, Nelson finds that the only psychiatrist who understand him works with victims of torture. 
At 16 Keith Vidal was so depressed his mother feared he would harm himself. When he picked up a screwdriver, she called the police to prevent that from happening. Two officers arrived and wrestled him to the ground. Unfortunately, this tactic didn't satisfy a third cop who shot Keith to death.
These stark tales are part of a larger, more complicated story of living with mental illness behind bars. Complicated, because Roth is a reporter obligated to understand everyone's point of view.
As a sympathetic interviewer she gains the confidence of prisoners and corrections officials alike. Maybe that's why she doesn't witness any abuse. Neither between guards and prisoners or among prisoners themselves. Nevertheless, she can’t ignore the reality that the chances of mental health recovery and prison reform are as likely as inmates and guards walking into a Hollywood sunset holding hands. 
Ultimately, Roth’s view of what prisons look like is a hive of cells where all the bees are dysfunctional. Given how little control inmates have over their minds and bodies, she’s fascinated by the many forms of protest; especially the ingenious ways they mess up the guards and their cells with their feces.
Roth discovers the ultimate purpose of mental healthcare is to make prisoners well enough to survive their incarceration, and the resources to accomplish even this rarely exist. She is skeptical that improved inpatient units in the Los Angeles, Chicago, and New York jails she visits will ever serve more than a fraction of the sickest inmates. 
Thus, to offer the reader some hope, Roth turns her attention to breaking the link between mental illness and crime before it's too late. She touts crisis centers, where those arrested get help before arraignment; crisis intervention training (CIT) for police to reduce conflict with those they call “emotionally disturbed persons”; mental health and drug courts to divert low-level offenders to treatment; and forensic assertive community treatment (FACT) for keeping people at home rather than in jail.
Alicia Roth is a keen observer, sympathetic interviewer, and dogged researcher. She recognizes the bind corrections officials, mental health care providers, and inmates with mental illness are caught in. Why? Because society prefers to keep all actors in this tragedy far off the stage of “normal” life. But Roth is still an outsider no matter how concerned. 
On Rikers Island, she meets Dr. Elizabeth Ford, once the head of Bellevue Hospital’s prison psychiatric ward, and now mental health director of the jail. In a recent City Voices review of Ford’s book (in the summer 2018 edition) about her time at Bellevue, I described what an adept observer and devoted practitioner she is. Ford notes every detail of what happens on the unit and still manages to do the best for her patients against overwhelming odds.
In her next book about the prison-hospital complex, I hope Alicia Roth will profile more folks doing good inside and out of those forbidding walls.

Pullout: “These stark tales are part of a larger, more complicated story of living with mental illness behind bars…the chances of mental health recovery and prison reform are as likely as inmates and guards walking into a Hollywood sunset holding hands.”