BACK IN 1955 THERE WAS ONE PSYCHIATRIC BED FOR EVERY THREE HUNDRED Americans. But by 2010 most of those beds had disappeared, and the ratio was one for every three thousand.1 Some of this immense decline in residential treatment can be attributed to advances in psychiatric care, particularly the formulation of a whole new galaxy of medications. But wholesale deinstitutionalization of mental patients had little to do with good medical practice. The patients weren’t cured. We just stopped looking after them. The most acute cases remained in institutions, but the rest, if they had no families to care for them, were left out on the curb like abandoned furniture. Many spent the rest of their lives bouncing from homelessness on the street to homelessness in jail. At least two generations of mentally ill people have lived this way.
Two groups with different perspectives converged to make this happen. Human-rights reformers believed it was unethical to keep noncriminals confined against their will. Most of these patients, they said, could be cared for in their communities as outpatients. Meanwhile, conservatives looking to cut government spending decided they didn’t want to pay for any more patient care than they had to. These two perspectives met in the Community Mental Health Act of 1963.2 Among its many provisions, the act mandated that state hospitals liberalize release criteria. Released patients were supposed to be placed in single-room occupancy (SRO) hotels and enrolled in community mental health centers for treatment and follow-up. But, for the most part, new local clinics never came into being, and those that did exist didn’t receive nearly enough funding. Patients, many of them schizophrenic, wandered off onto the streets without medication.
Meanwhile, available SRO spaces dwindled as property owners found more profitable uses for their real estate. The relatively limited population of homeless people at the time was suddenly joined by hundreds of thousands of mental patients, substance abusers, and unemployed people who’d run out of options. They all competed for sidewalk space and soup-kitchen meals. Skid row populations seemed to double every year or so. Entire families were now out on the street. More and more people lived in vehicles. Aging motels took in those who couldn’t pass credit checks or scare up enough cash for a security deposit for an apartment. These beaten-down rooms were often a last stop before the sidewalk. The National Coalition for the Homeless estimates that 20–25 percent of the single adult homeless population suffers from some form of severe and persistent mental illness.3
“Too often, a person with a severe mental illness is not treated until an encounter with law enforcement or the criminal justice system,” says the Treatment Advocacy Center, a national nonprofit that promotes effective treatment for severe mental illness. Police officers can grow weary of dealing with the mentally ill. In July 2011, for example, six officers at a bus station in Fullerton, California, beat and tased Kelly Thomas, a homeless schizophrenic, into a coma as witnesses looked on in horror. Moments before the assault, Officer Manuel Ramos had sat Thomas on a curb and ordered him to stick his legs straight out and place his hands on his knees. Thomas, confused, had trouble complying. Ramos put on latex gloves and told Thomas, “Now see my fists? They are getting ready to fuck you up.” The beating went on for ten minutes, a blue orgy of violence against a victim who, witnesses said, didn’t fight back.4
Why did five other officers follow Ramos’s lead? Because cops on the street have an unwritten rule: once it starts, you join in. An officer who hangs back invites suspicion and acrimony from his coworkers. One day when that officer needs help, he might not get it. Former LAPD detective Mike Rothmiller described how joining in the fight became a kind of Pavlovian response. And the decision to attack or not to attack was always in the hands of the most vicious cop on the scene.5
A photo taken of Thomas at the hospital shows his face grotesquely swollen and covered with bruises and cuts. He couldn’t breathe without a machine; his brain flatlined. Five days after the incident, his parents consented to take him off life support, and he died.
In a video taken by a bystander, Thomas, thirty-seven, can be heard screaming for his father to help him over the clicking sounds of the Taser. But his father wasn’t there, and witnesses were frightened by the raging cops. “The world,” said Albert Einstein, “is a dangerous place, not because of those who do evil, but because of those who look on and do nothing.”
Ramos was charged with second-degree murder and involuntary manslaughter. Another officer was charged with involuntary manslaughter and the use of excessive force. They both posted bail and proceeded to craft a defense with their respective attorneys. History shows it’s an uphill climb to get assault convictions against police officers on the job. The case was still moving through the courts as we went to press.
Ironically, our society’s solutions for mental illness may be as irrational as the patients. Anyone who frequents a big-city public library knows that librarians are often the de facto day-care attendants for discarded schizophrenics and other mentally ill homeless people. But jailers are their principal attendants. The International Association for Forensic and Correctional Psychology found that New York’s Riker’s Island, Chicago’s Cook County Jail, and the Los Angeles County Jails are the largest mental health institutions in the United States. Estimates vary, but probably about 10 percent of the inmates in these facilities are mentally ill.6 Human Rights Watch estimates that across the United States, approximately 300,000 mentally ill prisoners are in jails and penitentiaries on any given day.7
“Asking prisons to treat people with serious mental illness is pushing round pegs into square holes,” said Jamie Fellner, senior adviser of Human Rights Watch’s U.S. program and co-author of a 2003 report on mental illness and prisons. “People who suffer from mental illness need mental health interventions, not punishment for behavior that may be motivated by delusions and hallucinations.”8
Even when arresting police act with patience, the situation can turn ugly later. “I saw different people picking on this one guy,” a former inmate at Los Angeles County’s Twin Towers Correctional Facility told me. “You could see there was something wrong with him. He just didn’t respond to things. You see enough of these people and you recognize it. There was no way he could handle himself in there. He was like this big target to any asshole who liked pushing people around.” The former inmate knew this man would fare better in the less dangerous “ding” section for the mentally ill, but transferring prisoners into this section isn’t easy. “I took him aside and told him to tell the deputies he was going to kill himself,” he said. If deputies don’t react to a suicide threat, they’re in clear violation of jail rules. The inmate followed the advice and was transferred. “But not everybody like this guy gets somebody to tell him what to do,” said the good Samaritan. “The guards, they should have taken care of it as soon as he showed up. Anybody could see what he was, but they just don’t care.”9
Mississippi’s Atiba Parker, who in his adolescence began hearing voices and seeing faces that no one else could hear or see, was diagnosed at age twenty-four with schizoaffective disorder, an illness characterized by hallucinations, extreme paranoia, mania, and depression. After he began self-medicating with street drugs, he was arrested and fined twice for marijuana possession. When he left his mother’s home and went out on his own, Parker began selling small amounts of crack cocaine. On two occasions, he sold small amounts to a woman working as a police informant. The informant was trying to avoid prison time for several felonies. Around this time, Parker was charged with possessing 2.41 grams of crack and 1.5 grams of marijuana. Police had found the drugs in his mother’s car, which they confiscated thanks to a statute that allowed them to keep vehicles used to transport drugs. After this incident, Parker’s mother helped him get into rehab, he began taking prescribed medications, and he landed a full-time job, which he worked for nine months.10
Although Parker’s therapeutic outcome was positive, prosecutors charged him with two counts of selling cocaine for selling those small amounts to the informant. Parker was offered a plea deal of sixteen years, but he opted for trial. In 2006, at age twenty-nine, he was sentenced as a habitual offender to forty-two years. His projected release date was November 6, 2048. Said his mother, Ann Parker, “I have always taught my children that if they do something wrong there are consequences…. Nevertheless, the amount of drugs my son was prosecuted for did not justify his life being taken away.”11
In Neolithic times, medicine men, in an effort to release the evil spirits thought to cause derangement, chipped a hole in the skull to provide an exit. It’s not clear how many survived the procedure, but at least it was performed in hopes of helping the afflicted. The same can’t be said about the methods used to deal with Parker.
If authorities didn’t have more than 7 million prisoners, parolees, and probationers to keep track of, they might have paid more attention to the danger posed by John Albert Gardner III, an ex-convict who served five years for molesting his thirteen-year-old neighbor. California authorities released Gardner from parole in 2008, even though he’d violated its terms on several occasions. He then, on separate occasions, murdered two teenage girls near his mother’s home in the San Diego suburbs. In both cases, he killed his victim while attempting to rape her. In 2010 he was finally put away for good, sentenced to two life terms without possibility of parole.12 It’s reasonable to suspect that Gardner’s parole agent let his case slip between the cracks because the agent was buried in other cases, including those involving mentally ill offenders who should have been shifted out of the criminal justice system into a therapeutic setting,
From February to September 2010, while a student at Pima Community College, high school dropout Jared Lee Loughner had five encounters with college police for classroom and library disruptions. A teacher and a classmate both said at the time that they thought he might commit a school shooting. The college made no attempt to provide the student with assistance or treatment and ultimately suspended him. On January 8, 2011, at the age of twenty-two, he showed up at a political event sponsored by U.S. Representative Gabrielle Giffords and shot six people to death, including Chief U.S. District Court Judge John Roll. The shooting left fourteen others injured, including Giffords, who sustained a critical head wound. Facing years of physical and cognitive intense therapy, she resigned her office a year later. In May a judge ruled that Loughner was incompetent to stand trial. Yet in preparing for the attack, this severely disturbed young man easily purchased a Glock 19, the Rolls Royce of handguns, for about five hundred dollars at a Sportsman’s Warehouse. He also purchased a jumbo clip that held thirty-one nine-millimeter rounds. One Walmart store actually refused to sell him ammunition because he exhibited “strange behavior,” but he was able to pick up what he wanted at another Walmart store.
Although schizophrenia rarely leads to violent behavior, Loughner showed a host of schizophrenia-like symptoms before the shooting that should have prompted professional intervention. In fact, “a growing body of evidence [suggests] that there are some special things we can do for people in the early stage” of schizophrenic illness, said Max Marshall, professor of community psychiatry at the University of Manchester in the UK.13
Oliver Freudenreich, director of the First Episode and Early Psychosis Program at Massachusetts General Hospital, said, “If we could get people at an earlier stage, they would be less ill, and the disease would not yet have wreaked the damage to social, vocational and family life that often accumulates…. The illness strikes in the developmental years.”14 Loughner was a classic case of a severely mentally ill person who had no substantive contact with institutional therapy until he ended up as a ward of the criminal justice system.
Loughner went on his shooting spree while states were drastically downsizing their mental health programs in response to the Great Recession. The National Association of State Mental Health Program Directors estimated that in 2008–11 states cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities. “These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.15
Said Linda Rosenberg, president of the National Council for Community Behavioral Healthcare, “It’s been horrible. Those that need it the most—the unemployed, those with tremendous family stress—have no insurance.”16 More than 70 percent of emergency department administrators said they have kept patients waiting for twenty-four hours, according to a 2010 survey of six hundred hospital emergency department administrators by the Schumacher Group, which manages emergency departments across the country.17 Ten percent said they had “boarded” patients for a week or more because the only alternative was to put them on the street. Social workers who deal with these unfortunates know that in many cases they’ll end up running afoul of the criminal justice system. That’s when they’re finally given a bed.