Insane: America's Criminal Treatment of Mental Illness (Ep.74)

Guest: Alisa Roth,author :

Alisa Roth is a print and radio journalist who has reported extensively on the criminal justice system. Her first book, Insane: America’s Criminal Treatment of Mental Illness, investigated the mental health crisis in our courts, jails, and prisons. The New Yorker called it an “essential exposé” and The New York Times said it “is rife with sharp, brutal details that pull the reader beyond the realms of abstract policy debates.” She is former mental health correspondent for American Public Media.

1. Describe one example of the worst (e.g. solitary confinement or punishment for self harm) and the best (e.g. PACE, program for accelerated  clinical effectiveness) you saw in your travels. How did we get here?

2. What is it like for the officers who work in prisons? What is in their training or lack of it that stands out? This isn’t what they signed up for…yet they are asked to do it.

3.Is it hard to identify those with mental illness at first?

4. What works , and what could help make it work better?

5. Could family involvement help?  Do prisons request or get histories of patients?

6. We often hear that during deinstitutionalization we took people out of institutions and the mirror image number people are now in jails and prisons. In “Insane,” you contend that the story is far more complicated. Please explain.

7. You note that race, poverty, and mental illness overlap in the criminal justice system, but of all the gross imbalances of our current approach to criminal justice, perhaps no group has been hurt as much as people with mental illness. Why is that your conclusion?

8. Why is society more willing to spend money on jails and prisons (e.g., mental health units) than regular mental health care?

9. You write that about 80 percent of people with mental illness in the criminal justice system have a substance use disorder in addition to the mental illness. Have we made any progress in treating these illnesses in tandem?

10. You write that 30 % of those with serious mental illness receive no treatment at all. What kinds of mental health care do we need more of?

11. You note that in many states, much of the inventory of beds is reserved for forensic patients, at the expense of civilian ones, thus sending more people with mental illness to jail and prison. Do we need more inpatient care and long-term care?

12. What should a better mental health care system look like?

13. You write that since the changes of the 1970s, many cite the barriers to involuntary commitment as one of the reasons for the increased criminalization of mental illness. Do you also subscribe to that theory?

14. Why is enrollment in mental health courts so limited, making them, as you write, unable to make a dent in the number of people with mental illness who end up in the criminal court system.

Links:

AlisaRoth on twitter/X - @alisa_roth

Website: http://alisaroth.com/

Mindy and her book: https://mindygreiling.com/

Randye and her book: https://www.randyekaye.com/

Miriam and her book: https://www.miriam-feldman.com/

Want to know more?
Join our facebook page
Our websites:
Randye Kaye
Mindy Greiling
Miriam (Mimi) Feldman

Transcript

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Randye Kaye: this is episode 74, if you are watching on Youtube. You may notice we have 2 moms and a guest, and that is because Mimi Feldman is in Italy with very shaky Internet. But she's on a retreat, and we're a little bit jealous. But we waited so long to get tonight's guest that we did not wanna postpone. So it's

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Randye Kaye: 2 moms in the trenches and one mom in Italy, and a wonderful guest, Alisa Roth, who we will officially introduce in a minute. But she is the author of a book with the same title as tonight's episode, which is insane.

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Randye Kaye: America's criminal treatment of mental illness. And since we're here presenting a mom's point of view, da da, da, we both have our dueling copies. It's also how it affects families. So it it just so happens, Alisa, that you happen to have the 2 moms who have a little bit of experience from a family point of view, with the

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Randye Kaye: been an all justice system, Mindy, why don't you just briefly explain? I think you said you had a a good thing to tell us. But tell us briefly about your criminal justice experience.

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Mindy Greiling: Jim has been in jail 3 times, and

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Mindy Greiling: they thankfully are pretty far in the rear view mirror at this point.

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Mindy Greiling: Both times he was in jail for you know, 2 to 3 days, and then was released, and we never PAL paid bail. I never knew why he was released so fast. Sometime one time he was released in the middle of the night in the winter, and we got a call from him who thankfully he had his cell phone and we had to go retrieve him from the curve right outside the jail. I don't know what he would have done if we hadn't been home.

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Mindy Greiling: but it's a mixed blessing, and I think I've mentioned the story on this podcast before. Once I tried to call and find out how he was doing. And they said, Ma'am, this is not a hotel, you know, so there's the communication does not exist in jail for families.

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Mindy Greiling: But I just want to share

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Mindy Greiling: a happy note that has nothing to do with Jim ever being in jail that's going on just 2 days ago. He's doing so well. Right now, which is, I attribute to this podcast because, Alisa we had on this

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Mindy Greiling: program, I guess. Dr. Robert Leitman, who's Mimi, son's psychiatrist. He's now Jim's psychiatrist. He's in New York. We both do him by telehealth, and he includes families in the whole thing. But he has just brought Jim back to life, and on clause of pain and treating all the side effects is incredible. So we went to New York last month to go to his picnic. Randy was there. She just drove over from Connecticut.

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Mindy Greiling: We got to hug for the first time in our lives and meet each other for the first time. I still never met Mimi but that little trip that Jim and I took

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Mindy Greiling: meant that he wants to fulfill his lifelong dream of getting overseas. He's the only one in our family that's never left the Continent. So 2 days ago he applied for a passport. We're gonna go over to us an island

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Mindy Greiling: next spring next summer, and he's going to get his dream fulfilled because he's doing so well. So for anybody that's listening, who has somebody in jail, or, worse yet, prison

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Mindy Greiling: things can turn around.

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Mindy Greiling: But Randy's in the thick of it. So, Randy, why don't you tell us?

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Randye Kaye: Yeah, thank you for that. And and for our listeners, I know sometimes you know you. You join us on Episode 74. So I invite you to go back and check out the episode we did with Dr. Layman. He also has a book on Amazon. Just check the show notes because he is not taking any more patients. But there are listings and information, for where you can find similar types of treatment in your state. So I want you to know that that is available.

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Randye Kaye: So that's great news. It's always good to have a little hope on classapine, as our listeners know. My son did really really well, and got off social security for a while, but everything went crashing in Covid, and the crash continues. For the first time in my life I am going through. Well, my son is going through, but I'm experiencing the ups and downs and unfairness

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Randye Kaye: of the criminal justice system. Now, the book we're about to talk about goes deep into extremes.

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Randye Kaye: And I

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Randye Kaye: so we're sort of in just jail, being where they are before they're sentenced. Prison being where they're sentenced after the trial. Is that right, Alisa? Pretty much. Yeah, she's good straight, like. So you know. I will just say that.

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Randye Kaye: yeah, my son, had a court date today. Supposedly, this is just a little bit from a family point of view.

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Randye Kaye: Okay, I geared everything up. I set aside this morning to show up at court and

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Randye Kaye: support him. I spoke to the public defender. I did put everything in place that I could picked up. Stuff.

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Randye Kaye: you know, spoke to her at length. Got a copy of the police report, you know all the things to support from afar that I can.

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Randye Kaye: and they changed discord, date without telling anybody clerical error. And he ended up going yesterday, and the judge saw him for 22 s and said, I can't decide about jail diversion right now. Put him back in jail. And well, I need letters of character references, and we'll see you in November thirteenth. So that's kind of where we are.

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Randye Kaye: November thirteenth. Yep. So II have to see if I can get a different kind of lawyer. This is what families who try to support go through.

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Randye Kaye: So that's all I'm gonna say right now, just know that we're in the throes of A. And I called his social worker. I called. I have to. I have to clear his stuff out of the place he was living. And and they said.

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Randye Kaye: This depends on the judge depends on what judge you get. This judge didn't want to hear anything except the victim story, and, by the way, this thing is the victim's word against my son's word. He says he didn't do it, I don't know. But anyway, so that's so. This is how it is, and I'm about to start teaching an Ami family to family class, and I was talking to my co-teacher tonight, and he said.

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Randye Kaye: when his son went to jail that he

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Randye Kaye: was. The police treated it like a raid.

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Randye Kaye: and this was on marijuana possession. 3 years ago they

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Randye Kaye: smashed down their front door

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Randye Kaye: $6,000 worth of damage. They handcuffed everybody in the house like it was the whole thing, and for marijuana possession I'm talking a bag. It was $375,000 or $275,000 bail like it was insane, anyway, but they're past it. They're over it. But so the stories abound.

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Randye Kaye: However, let's bring in an expert. Our guest tonight, Alisa Roth, who Mindy has already met and been on a podcast with, I think, when the book first came out

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Randye Kaye: so excited she is a print and radio journalist. She has reported extensively on criminal justice. Her first book which is again title of tonight's episode, Insane America's Criminal treatment of mental illness.

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Randye Kaye: Oh, my God, what a scary thing to read when you're a mother who's got a son in jail? Hopefully, not facing this. But you never know. She investigated the crisis in our courts and our jails and our prison, and you touch on police, and there's so much that you touch on in this book.

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Randye Kaye: New Yorker called it, and rightly so, an essential expose. And the New York Times said, it's rife with sharp, brutal details that pulls the reader beyond the realms of abstract policy debates, because there are many stories in there.

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so please please welcome Alisa Roth.

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Alisa Roth: Well, thank you for that lovely introduction, and thank you both for for reading it. I always tell parents if they're gonna read this. They can't read it before they go to bed, because

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Alisa Roth: because they're living it. So they don't need to an extra extra dose of it. But thank you. Yeah, absolutely. I mean, there's there's so much that there's so much we want to ask you. We have a list of, I think, 14 questions. But you know this is a conversation.

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Randye Kaye: If I could just ask you, starting to just describe, like one of the worst

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Randye Kaye: stories in your book, like a really worst example of the treatment of people with mental illness in the hospital, and maybe the best like, I know, you talked about pace, a program for accelerated clinical effectiveness. So you went from the worst to the best. Can you give us an example of each, and

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Randye Kaye: kinda how did you give it an extensive history in the book. But briefly, how do you think we got here to where we are?

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Alisa Roth: I hate to compare suffering. I think we could talk about the worst cases all night and not finish. A couple of quick examples. There's a wonderful man that I met in Virginia who developmental illness ended up in jail and actually ended up blinding himself.

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Alisa Roth:  Which gets me every time I say it. He is a wonderful, wonderful person who, I'm happy to report is, is doing quite well, living independently, and

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Alisa Roth: presents often with and tunami, and to police departments is doing well. So it has a happy ish ending but it gets me every time. Another horrible thing that I've witnessed was the solitary confinement cell in a jail in Oklahoma.

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Alisa Roth:  And it was solitary confinement because it was suicide watch, and the person was in a cell by himself, with a with an officer sitting outside the door to make sure he didn't do anything to himself, but I remember I still remember the the sound and the smell of this cell, which was stuck in a back corner of this jail, and it it stink so badly from urine that ammoniac smell that I just remember it burning my nostrils so.

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Alisa Roth: But we could go on. I'm serious that we could go on all night about the awful stories. Unfortunately, I think there are more awful stories than than good ones.

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Alisa Roth: but there are some good ones. I think that the the the center in in San Antonio, Texas, that was developed as a as a sort of a one stop shop for for mental illness, where police are

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Alisa Roth: not just allowed, but expected to bring people with mental illness, or who are intoxicated to the center. There's a special place for them to come in. They come in through a side door, they sit down, they fill out the paperwork and are on their way.

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Alisa Roth: and the people can be evaluated. So I sat in on the, for lack of a better word, a drying out room where people who are intoxicated could be brought in to just sleep it off. And it was a room full of mats like you'd see in a kindergarten class or something, and the guys were just

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Alisa Roth: sleeping it off, and they

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Alisa Roth: There was a substance, use counselor, who, when they woke up, would sit down, give them a very gentle offer of if you'd like some treatment, we have it over here, and if you'd like to be on your way, go ahead, and in the same building. They had a place where you could be brought in if you were in the throes of of a psychotic episode, or whatever it was, you could be brought in, admitted for your 72 h. Taken care of, and then guided

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Alisa Roth: 2 longer term treatment that suited you. And they really had a whole range, and and still have a whole range of services, so so a place that you could be directed to long-term treatment, to inpatient, outpatient all sorts of of things. And so that was reassuring this understanding that that the police may be the way that you arrive there. But it doesn't need to be the the end game of this interaction.

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Mindy Greiling: So I have. I'm not sure. When you came to Minnesota, you know, you know what the side here. I just realized I'm on this program with 2 professional radio people. So yikes. But I'm the I'm the slug in the group. But Alisa, by radio people many times, but this is a different side. But I'm not sure, Alisa, when you came to Minnesota public radio. If this was before or

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Mindy Greiling: after you got here. But there was a proposal in the Minnesota Legislature shortly after I left, so close to, you know, probably 8 or 8 years ago or so to do something very similar to this and with Senator Goodwin, who proposed it. I don't do recognize this, anyway. It was supposed by by

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Mindy Greiling: Minnesota, because the reason was.

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Mindy Greiling: I believe if I'm correct, it was that they didn't want people coming to a center like this, that the door to the mental health system would be through the police, and they would then be in a place where there wasn't medical care, in case they had also physical needs, too, that there wouldn't be integrated care

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Mindy Greiling: and so it was not past. I would have supported it had I been there. Have you run into this dynamic anywhere else around the country.

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Alisa Roth: I mean, I think there's always going to be somebody who opposes

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Alisa Roth: options right? And I think that there is this question, should we be brought in by the police? And I think, to me, at least, the question is, not, should we be brought in by the police in a in an ideal world. No, it's not the police who are who are bringing people in, but in an ideal world people are not

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Alisa Roth: in a in a psychotic state on a street corner, right? So if the police are who they're picking them up, then it seems to me that the practical response is to have a place for the police to take them. That's that's not

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Alisa Roth: jail. And so I've heard variations on on the the criticism. You know, the police shouldn't be involved, or we need to take them straight to the hospital or you know various other possibilities.

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Alisa Roth: To me the San Antonio model is at least one plausible way of handling it. It was interesting when I met Judge Leichmann down in in Florida that he said. He's sort of come to it

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Alisa Roth: from the opposite end of things. He started on the court, and then has moved towards the the figuring out where people need to go, but he has also moved towards a sort of one stop shop model.

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Alisa Roth: So it's definitely out there and and being talked about and and proposed.

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Mindy Greiling: Judge lifeman is somebody we have talked about. We actually haven't even had him on here, Randy. We have. We have such a long list. We never have gotten to him. So we need to do that to hear about his program, because, as you wrote in your book, he was able to close one of them to Miami jails. And now, there's a lot less people in jail and a lot

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Mindy Greiling: more people that are getting help. So he went to the one stop shopping. Interesting?

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Randye Kaye: Yeah. And and you know it is so helpful to know, even at the beginning of our conversation, that there are some

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Randye Kaye: solutions or or a adaptations of what's happening that that does seem to help. And I think we can agree. There's a lot of pieces to this puzzle, Alisa, right? It's you know. You go into the the history of deinstitutionalization which we've talked about before, and when medication came in.

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Randye Kaye: people were supposed to go to community centers, and that never got funded and has to do with Medicaid and Medicare, and you know all that stuff. But

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Randye Kaye: it's pretty well known that many people with mental illness wind up on the street.

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Mindy Greiling: you know. That's one thing I would like Alisa to talk about, because we have said on this program, and some of our guests have that. It's the same people. It's the same number that were in state hospitals now. They're on the street, or the jails or the prisons, and I have actually never read anywhere except in your book. Insane that that is not really a totally accurate picture. So I think I you should take some time to explain

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Mindy Greiling: why you say that in your book I think it's important.

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Alisa Roth: Well, let's start with the the myth piece of it. I think part of the the confusion is that that it looks when you draw a graph of the population.

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Alisa Roth: It looks like they should have switched places. And I'm gonna it's just gonna look backwards when I show it to you on the screen. But basically, if we look at the deinstitutionalization starting in 1950 or 55. I can't remember what the the height is somewhere in there, and we look at it over the next 50 years. Let's say it goes down like this. And starting in 1970, Ish, you look at the population in jails and prisons, and it goes up like that.

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Alisa Roth: And so it makes this nice X. And you think, oh, well, we've just switched things. And oh, by the way, we have this huge population of people with mental illness in our jails in prison. So clearly, we've just traded places. And the problem is that when you start taking it apart, it doesn't

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Alisa Roth: let me let me say one more thing when you, when you look at it that way, it it looks like it's this really easy problem with an E really easy solution. Right? We let all the people out of the jails in prisons. They couldn't get mental health care. They're out on the streets. They're doing bad things because of their illness, they end up in jail, in prison. Boom! Here's our problem. And so then the obvious solution is, besides not losing your

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Randye Kaye: you're probably talking.

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Alisa Roth: Is that so? The the obvious solution there is that that we we provide the the institutions for for people to get their mental health care. And we're not gonna have this problem anymore. Right?

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Alisa Roth: Okay? So then, now, we've we've set up our problem. And and this myth, let's let's deconstruct it for starters. Even if we look at the the height of institutionalization.

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Alisa Roth: the majority of people with mental illness were not living in institutions. So that's

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Alisa Roth: problem number one. The vast majority of people, even back in 1950 or 55 were living in the community.

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Alisa Roth: so then, then, the next piece of the problem is, when we look at the population. The people who were in those institutions were largely elderly. They had, or at least like middle aged to elderly. They were largely diagnosed with schizophrenia

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Alisa Roth: and there was a mix of men and women the way we have in the community.

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Alisa Roth: If we look at the population of jails and prisons. As we all know, the vast majority are young, they're male, and they're not white. So.

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Alisa Roth: and I think I may have forgotten to say that in my my characteristics of people who are in the institutions, they were largely white. So so when we look at the jails in prisons, it's a completely different population. So numerically, it all looks beautiful on paper. But when we actually

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Alisa Roth: breakdown, who's there? It just doesn't

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Randye Kaye: add up yeah, that that that's a very good point you mention also a lot that, for instance, I called this morning

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finally found who my son's

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Randye Kaye: counselor is, and you know II am finding that

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Randye Kaye: th, the this is all new to me. But people are very nice. I mean, they're human beings working in in the prison system. So if you're nice to them, they are generally nice to you.

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Randye Kaye: And so I did reach my son's counselor, and I didn't start by complaining. Why haven't I spoken to you before, because that would have gotten me nowhere. But when I mentioned to now, my son's been there 5 weeks waiting the first court date, and now it's 6 more weeks awaiting the second court date.

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Randye Kaye: and I said to the counselor.

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Randye Kaye:  do you know that my son has schizophrenia? Oh, no, I didn't know that now. He has to have an injection once a month, and they have given him the injection. But the counselor has no idea that he has a diagnosis. So I was able to say to him, and I'm in case you're new to us on conservator as well. So I have. I/O, you always have the right to give information, but I have the right to get it as well.

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Randye Kaye: and I said so when it comes time for his injection. I just want you to be aware you might see him fighting a little harder to focus. That's a gentle way to put it so, he said. Thank you for telling me. I would not have known that otherwise. So I'm wondering why you know a a. Why he didn't know

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Randye Kaye: he's not a guard. He's a counsellor, and you make the point in your book that a lot of the people who are guards, or whatever they call them, depending on the system they're in.

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Randye Kaye: They end up having to be counselors, and they're not trained for that. Some of them are very well meaning, too. It's not. It's not the cliche of terrible guards and the poor prisoner. Some of them really wanna help, but they don't know how to help. They're not. They're not trained to identify mental illness. They're not trained to help with mental illness, you know. Can you speak to that? And you know I'm I'm just wondering if

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Randye Kaye: information from families could be of any use or getting the background of a

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Randye Kaye: you know I know it's I know it's jail, and it's not a hospital, but it's the same problem we have. Even.

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Alisa Roth: That's a big league. messy, messy problem. So let's separate into 2 pieces. I think that the counselor piece.

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Alisa Roth: presumably he is a trained mental health.

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Alisa Roth: professional I don't know what level of education, but a trained mental health, professional, and

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Alisa Roth: were I in that person's position, I would want all the information I could get right. I would want to know that there was a diagnosis. I would want the family history. I would want to be able to talk to the mom whether she's the conservator or not.

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Alisa Roth: because I would want all the information, because if you put yourself in the position of that police officer or that corrections officer? Who's

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Alisa Roth: Who's who's bringing the person into the jail or taking care of them in the jail?

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Alisa Roth: You're you're starting from, from, not just 0. You're starting from like negative information. You have a person who's coming in who's behaving, perhaps erratically or strangely. But you have no idea is this how he always acts?

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Alisa Roth: Is he drunk? Is he high? If he's high, what is he high on? Does he have mental illness? Does he have diabetes? And he has low blood sugar, which, by the way, could also present that way? There's any number of scenarios that you could be dealing with.

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Alisa Roth: and you have no idea. So

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Alisa Roth: do would I want all that information absolutely. But for a variety of reasons, there's the legal reasons. There's the the person realizing that you know that that officer, realizing that he needs the information. There's that officer not knowing how to contact

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Alisa Roth: family member there. There's a lot of reasons why they might not have that information. So so it makes the job very, very difficult. And certainly all these things, like hipaa.

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Alisa Roth: make it even more complicated because he can't call you up and ask you I mean, in your case he could, but in in most cases he can't. And I think just a little, by the way, is that I think that the misunderstanding of hipaa makes things so unbelievably complicated, because

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Alisa Roth: because understanding who really isn't allowed to say anything, and who just thinks they shouldn't and doesn't want to get in trouble for saying the wrong thing.

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Alisa Roth: makes things very, very complicated.

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Alisa Roth: So there's there's the counselor piece of it. And then if we switch over just to the straight corrections officer

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Alisa Roth: problem, it gets

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Alisa Roth: a thousand times more complicated. This is a person who is trained as a law enforcement officer. Their primary job is as a law enforcement officer.

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Alisa Roth: The training

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Alisa Roth: in mental health and mental illness is at best minimal. There are people who have gone through CIT. Training. There's all sorts of training that's out there. But even so when you look at the the absolute amount of time that people are spending in training, and what that you know how much of that training is

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Alisa Roth: mental health versus something else.

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Alisa Roth: people are minimally trained and they have a million other jobs to do right. They're worried about their own safety. They're worried about the safety of the other people there.

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Alisa Roth: And then we haven't even talked about the problem of the jail or the prison itself

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Alisa Roth: being what one psychiatrist said to me, is is psychotenic, it is psychosis inducing. I don't know if either of you have ever been inside jails, whether visiting or or touring or anything else. It is legislators. So I've certainly been in jail. So you know what it's. It's it is the most disorienting.

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Alisa Roth: disconcerting space that I have ever been in. There's no windows, or the windows are tiny, so you can't tell what time it is. It's noisy. The lights are on all the time. Sometimes they turn them off at night, sometimes they don't. You have people who are

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Alisa Roth: sometimes acting incredibly, erratically around you, and even when they're not, it's just noisy. There's a lot of yelling

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Alisa Roth: often. The way that the the schedule works which you, as a detainee have absolutely no control over is that you might be woken up at 40'clock in the morning for your for your hill call. You might be given breakfast at 30'clock in the morning, because that's when we serve meals, you know. You may not go outside. Randy has your son gotten to go out at all? Yeah, he. So he's in a minimal security. He's got

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Randye Kaye: where he is right now. 110 people with a big wall in the middle. He says, so there's 55 people. He's in the top bunk. It's near the TV. So that's good. If the football game is on, but it's not good. If it's 30'clock in the morning, and someone's watching TV. So the you know, he's starting to explain some of these things. I have to say that as

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Randye Kaye: coming from where he was, which he had spiraled from really being very, very productive to

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Randye Kaye: to a pot addiction and

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Randye Kaye: a housing situation. That was. he had graduated to an uns, basically unsupervised housing situation.

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Randye Kaye:  And he was bored. He couldn't get work.

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Randye Kaye: His appearance looked even. The police report, said he.

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Randye Kaye: The you know he looked homeless so, and and this is someone who spends a lot of money on clothing that he doesn't wear. But anyway,

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Randye Kaye: he doesn't like to be told what to do all the time, but I think there's a part of him that's enjoying the structure there there is. There's one story in your book about someone, the recidivism raid, who just like wanted, got out and wanted to get back in and says, Can I have my old room back?

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Mindy Greiling: I will. I will say that Jim absolutely

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Mindy Greiling: hated jail. He was the quintessential person with schizophrenia who totally deteriorated in jail. He was once in only for overnight, because we had to do that to facilitate some hearings coming up faster. You could get a hearing if you're coming out of jail really fast, but if you were in the community. You had to wait weeks to get one, so he just can. I pause for a minute just to say how utterly

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Alisa Roth: mind-blowing it is that to get somebody a hearing, you have to send them to jail, I mean, I know. Yeah, thank you, for I thought so, too. I've been so

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Randye Kaye: beaten down. I kind of forget to be us. We're we're used to it. The the thing is, families are used to it. We're used to oh, you know, I mean, sometimes the system works for us. I got conservatorship of my son, and I was told in his first hospitalization ever that if I applied

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Randye Kaye: then they couldn't discharge him. So yay, that was good for me. It gave him more time in the hospital, but there's so many ins and outs to the, to the system in general. But yes, there is, you know, my my son.

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Randye Kaye: you know I what he did says he didn't do very, very small.

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Randye Kaye: but it looks big, and the original bail was like a hundred 1,000. For someone who's never had a criminal record never been violent a day in his life had nothing but speeding tickets in the computer. But it's just they look at him.

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Randye Kaye: and they go always dangerous, just because his teeth are now black from his meds.

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and if it gets close to the time when he needs, you know he has that vacant look in his eye, and so the treatment, the appearance, is part of the treatment. But yes, I agree. Oh, we'll get you a hearing faster if they're in trouble. It's like it's the same mentality that's like, Oh, we can't get them in the hospital unless they're a clear danger to themselves or others. And then you have Senator Kredes, who couldn't get again another story from your book

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Randye Kaye: that you know he couldn't get his son into a bed, even though the son wanted a bed, and he ended up getting stabbed, you know, so there's all stories of it has to be terrible, terrible, terrible before any help

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Randye Kaye: can be can be given. So. Yes, I understand from my son's experience, and I know every state is different. He was put in lockdown for a week. He didn't like that, but after a week which Jim never got to, he got to go to. I'm just calling at the Dorm. I don't know what else to call it, you know he's got a top bunk, and you know that where he is right now the they get 20 min to eat instead of 10,

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and and

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Randye Kaye: and he's playing cards. He has more people to talk to. My, I have a fear that he's gonna like it there, I mean. Well, I was gonna say, to contrast. So Jim hated it one night that he was there. He was a coherent, rational person, and the next morning, when he was in the hearing, he didn't even notice I was there, and I picked him up later.

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Mindy Greiling: He was totally decompensated just in one day, to contrast that his girlfriend, who, by the way, is currently in jail. I wrote about her in the book for people who have read it. I called her Colleen, and she's the one that got Jim into lots of trouble. She

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Mindy Greiling: loves it in jail. I almost think that she's there now because she's lonely in her apartment. She's lost her car. She has no structure in her life, and she's a totally different person than Jim. But I think, Randy, when you say somebody might enjoy it there.

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Mindy Greiling: Everything is relative in life, and for her there is a community there. She's a social person. She's not a

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Mindy Greiling: a person who gets worn out by being in jail like like Jim. But I think for people with schizophrenia

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Mindy Greiling: there's

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Randye Kaye: a lot of people who get worn out in jail. And again, this is pre trial holding. It's not like a 2 year prison sentence which could be an entirely different prison. So we've been chatting and almost leaving Alisa out of the situation. But you know, as I said, as a conversation here, we haven't mentioned the statistics which your books been out about 5 years right, and a and a recent addition came out in 20

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Randye Kaye: 2020, I think. So can you.

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Randye Kaye: in case people don't know, can you share some of the statistics like, what percentage of people in the nation's criminal justice system

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Randye Kaye: have a diagnosed mental illness?

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Yeah.

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Alisa Roth: I will tell you numbers. And then you're gonna have to check me because I have not

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Alisa Roth: written my numbers down, and I'm not a brilliant numbers. Person on. We can do ish we can do ish I think in the criminal justice system the numbers are something like 50% of people have a diagnosed or diagnosable mental illness. It's higher. If you're looking at

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Alisa Roth: specific portions of the population. So among women, for example, it's quite a bit higher. I think, where it gets very messy, is. Well, there's a couple of places where it gets messy. I keep using that word because this is a messy problem. One is that

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Alisa Roth: we see a lot of places that aren't looking. I think maybe a little bit like where your son is. So if you if you don't ask the question, then you're not gonna see the problem. So Alabama got in trouble because the the people that they were using

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Alisa Roth: to do the the mental health intake for their prisoners. This was at the state level. I don't know what was happening to the jails there, but state level. They just weren't trained to to realize it. So they're they're really under diagnosing. I think the other question is, is, when you start getting into

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Alisa Roth: how do we define mental illness? So different states and different jurisdictions will use different criteria. So schizophrenia is an obvious.

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Alisa Roth: not a question there. But when we get into things like Ptsd or anxiety, some places will count in some places, won't

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Alisa Roth: so so it's hard to get a precise handle on it. But I think we can safely say that a large number of people in our criminal justice

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Alisa Roth: system have mental illness and a large proportion of people. One thing we saw during Covid was that the numbers of people in jail and prison went down quite a bit. But actually, the percentages of people with mental illness went up.

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Alisa Roth: So

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Mindy Greiling: it it's interesting. One thing I would. That's kind of related to that that I would like to ask you about. You know, you know, in Minnesota we have the 48 h rule. So if you're deemed incompetent to stand trial, you in 2 days, you're supposed to be out to a therapeutic setting, and that isn't working so well, because there's not room for the next place to go, and then, because the jail people and the prison people propose prison. You know, people that are there waiting to stand trial.

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Mindy Greiling: They're taking up all the space so that causes a stack up in the hospitals.

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Mindy Greiling: I was interested in your book that it's not just Minnesota that there's other states that are doing this as well, and I'm wondering the ones that end up coming from jail to get to the

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Mindy Greiling: therapeutic sessions. Do you think they are as sick as the ones waiting in the hospital to get there? And then a corollary in Minnesota? Because it's not working. Only felons can get from the jail if they're deemed incompetent. But the others are still have to stay in jail like Randy Son, with lesser charges.

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Mindy Greiling: I think those could be the people with the more serious mental illnesses. They're not as put together to be committing felonies as much as they are to be doing lower level crimes. So could you comment on that whole

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Mindy Greiling: thing?

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Alisa Roth: I mean this.

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Alisa Roth: I think that maybe if we take a step back, the the one of the key points here that I don't think we talk about. Enough is that that we separate the criminal justice system in our mental health care system. And we forget that there really

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Alisa Roth: intertwines particularly when we start looking at a population that doesn't have private health insurance. So they're dependent on the state

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Alisa Roth: systems. We're really looking at the same people, and it depends what day it is or what month it is, or what year it is. Which side are they in as civilians? Are they in as as prisoners? But to try to separate it out gets

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Alisa Roth: gets tricky. I do know that this is a tremendous problem. Nationally, I was at a conference this summer of and talking to to people who work in the state systems, and it is literally everywhere that the that the

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Alisa Roth: the criminal justice population, is sort of taking over all of the beds in the state systems, and everybody's trying desperately to figure out what to do about it, and families are starting to pray. Please let the police pick my son up so he can go to jail so he can get some help.

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Alisa Roth: which is again, mind blowing to me that that's how we deal with it, and I think it speaks to this much, much larger

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Alisa Roth: question is, is, what should our mental healthcare system look like? So that we're we're preventing people from getting to to the forensic patient level before it becomes an issue. And I and I realize that that's the you know, it's not the 1 million dollar problem. It's the like multibillion dollar problem.

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Alisa Roth: But but I think we spend all this time trying to figure out, how do we get one more bed, one more bed. And really we need to be thinking about, how do we

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Alisa Roth: blow up this whole system and and create something that actually, that actually works at a systemic level?

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Randye Kaye: That would that would be the dream. So I also want to leave some space at the end to talk about the response to your book, and also the new book that you're working on. But

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Randye Kaye: so we've talked a lot about the problem. Not enough. There's so much to share. What do you think

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Mindy Greiling: other than blowing up the system.

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Randye Kaye: What do you think are some steps

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Randye Kaye: that you've seen work that we could take? That could make a difference. And you know again, you you initially wrote the book over 5 years ago. And

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Randye Kaye: yeah, and new addition came out. And you had some response, what? What does the solution look like, or what do parts of the solution look like.

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Mindy Greiling: And while you're answering that, could you comment on our mental health courts, part of the solution or not, so many states have don't have them or they have them. But very few people get in.

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Alisa Roth: I really do think that in some ways, in a nonviolent sort of way, that blowing up the system and and starting over is the way like where we need to be going to like a mental health system, abolitionist movement or something.

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Alisa Roth: it just feels like we're we have this

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Alisa Roth: to use 2 sort of lousy metaphors we've got like this patchwork band aid solution right? And it's very, very responsive and trying to fix the solution, you know, fix a problem after it's already happened rather than than preempt the problem. And I think that's very much. How we deal with with mental illness in this country is again. You have to be sick enough to get the treatment. We we don't have the space to see you. So we're not gonna see you until you're very sick. But

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Alisa Roth: you know it's the the mental health equivalent of telling the guy who's

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Alisa Roth: 500 pounds and eating cheeseburgers 3 times a day, and smoking 2 packs of cigarettes, and never exercising

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Alisa Roth: to come back when he's had his heart attack right like. Let's

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Alisa Roth: let's talk about how we might avoid the heart attack rather than than dealing with it when it happens. Green analogy

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Alisa Roth: that said.

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Alisa Roth: I think that along the way there are certainly things that we can do, starting with acknowledging that that we need to separate the mental illness from the criminal justice that the criminal justice response is not the answer to the the mental health

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Alisa Roth: problem. So what does that mean? That means having a place like in San Antonio, where a police can bring somebody and doesn't need to arrest them, because there's no place else to take them.

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Alisa Roth: I think it's something like what we have in Florida, where we say we're not gonna put you through the whole criminal justice system. We have an alternative system that if you do the things that you need to do. We can move you along. We can get you where you need to go and and put you on your way. I think that mental health courts can be

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Alisa Roth: a piece of that.

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Alisa Roth: with some caveats starting with what you talk about, which is that there are very few of them, and they're very hard to get into. They are extremely time intensive. They're extremely labor intensive. And the way that the vast majority, at least that I've seen are set up. They're very limited in who they're willing to take so it's fine for the very low, level

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Alisa Roth: person that we could say are not even criminals. We could have a whole other conversation about what you know. How do we define criminal? But but you know somebody who's

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Alisa Roth: doing something with substances stealing or having or using, or somebody who's stealing things or sleeping in places they shouldn't be sleeping.

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Alisa Roth: but they're they're less interested in people who commit

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Alisa Roth: violent crimes. And again, I think we can have, you know, an air quote conversation about how do we define? A violent crime, I think one of the things that's complicated is that as the criminal justice system has expanded, we've expanded the number of charges that exist, and how those can be set up. And so what is a violent

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Alisa Roth: crime? And having that as as something that keeps you out of those mental health courts?

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Alisa Roth:  you know, narrows your your field. And I think one of the things that that people say about the mental health courts is, are these people who might be okay, anyway. Right? Do they have the support system that they need? Anyway, I look at the 2 of you, and I know that your kids, however, they're doing right this minute. Have these very powerful support systems and support systems with

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Alisa Roth: resources, whether financial or emotional, or even just a couch to sleep on.

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Mindy Greiling: Maybe they don't have to be put into the mental health court. Or maybe they do. But we need to expand it to include the people who don't have those resources. I'm gonna push back on that. I am a very, very, very privileged white middle class woman, and my son was in mental health court, and he needed it. Here's why.

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Mindy Greiling: because if he wasn't in court

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Mindy Greiling: he wasn't going to follow recommendations, and I'm not a conservator or a guardian, so I privilege, as I am supporting as we are resources, that we have. The mental health system doesn't allow us to help if he has an Signosia and won't accept help. And then I want to get in one more question, because I see the time is fleeting that's related to this. You stayed in your book that

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Mindy Greiling: since the changes of the 1970 s. Many cite the barriers to involuntary commitment as one of the reasons for the increased criminalization of mental illness, and that plays into no matter how privileged you are.

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Mindy Greiling: These laws bar us from helping. So what can you say about that?

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Alisa Roth: I mean, I think, that the involuntary commitment, along with the involuntary medication is, you know, a landmine question. As it is, I think, and I say this, I should should say this as somebody who has

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Alisa Roth: never been involuntarily medicated or committed, and never had to involuntarily commit or medicate somebody. So I have talked to a lot of people who've been in those positions. But I've talked to the people who make the decisions. But I don't have personal experience with it. I think

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Alisa Roth: that

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Alisa Roth: mental illness I don't have to tell you, and your listeners is is tricky and complicated, and if by nature it is tricky to diagnose right, we can't do a blood test, and maybe we can do a brain scan. But it's not a quick done in the er scan to say, Oh, yes, you do have this. And this is why you're not responding properly.

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Alisa Roth:  and it by definition

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Alisa Roth: messes with your head right? It makes you think differently. Let's say

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Alisa Roth: so. I would like to think that were I in that position, I would like somebody who I trusted to make a decision for me in the same way that if I

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Alisa Roth: killed over on the street, and my husband had to decide whether I should be rushed to the hospital or not, I would like somebody to make that decision, and I would like somebody to have the ability to make that decision. But we also have a long, complicated history of people being voluntarily medicated or involuntarily committed, literally against their will, and for all sorts of wrong reasons. And so how do we negotiate those

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Alisa Roth: laws, and maybe renegotiate those laws? To say, you know who gets to make that

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Alisa Roth: decision? I do think it plays into it because I've talked to so many people who say, If only I could have forced my child into treatment before it reached this point we could have avoided this.

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Alisa Roth:  and I think the question is, how do we rewrite those laws to adjust a little bit to say, well, we can't do it because we don't like that guy that you're dating, but we can do it because you're clearly not

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Alisa Roth: making making sense and not thinking

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Alisa Roth: right. And I think you know the power of attorney that I think you briefly mentioned. At 1 point, Randy, or the signing the Conservatorship, or about not necessarily a medical power of attorney, but a release of information.

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Alisa Roth: or even I've heard from a lot of parents. Now, when we're talking about college age kids, and they're going off to college, and they're encouraging parents and and the kids to sign. If I need the information, or if I need to make a decision. So it's not a full conservatorship. It's sort of an acknowledgement that a 19 year old is not full grown, ready to make a decision, or maybe, if they need a, you know, help. So I think that there are ways to navigate it. But I do think that it's it's coming back to your, to your original question. Maybe I do think it has

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Alisa Roth: complicated things because because the hands are tied and the hands are tied

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Alisa Roth: all the way through. And yet here's a person who, by definition, is not really able to make a rational decision about what's happening. There are many elephants in this room. One of them is what we mentioned before, that people with illnesses like our son. Schizophrenia often don't know they have it. And so they're not going. Oh, yes, I have cancer. Please give me the chemo like, and not that people with cancer

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are that joyous about it. But you know what I'm saying. They're not saying yes, please please help me. They're saying, no, you're crazy. I don't have this. I you know there's nothing to do with anything.

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Randye Kaye: and regarding privilege.

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Randye Kaye: We are very supportive.

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Randye Kaye: but I'm not going to allow my son on my couch right now.

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Randye Kaye: He. I don't trust him.

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Randye Kaye: I love him, but I don't trust him. I have grandchildren.

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Randye Kaye: I don't want him around them unless I would like to say, hey? 90 meetings and 90 days. Then we'll talk so, you know, no matter how much I love him and support him. I have boundaries because I have other people that I love and are including myself, that I am protecting right now.

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Randye Kaye: There's a part. Yes, there, there are boundaries to support

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Randye Kaye: financial.

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Randye Kaye: There's emotional support he'll always have, but financial and practical support. There are boundaries, because.

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Randye Kaye: as there should be. it will be more powerful for my son and any mother of someone who's having a substance abuse problem. Any relative, any of any one will say

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Randye Kaye: I can't talk them into it. They have to want it. So

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Randye Kaye: I asked the Counsellor if he would please let my son know that they're starting any meetings in prison, and that it will look good so that he can get jail diversion to a mental health, you know, if he goes. And even, you know, my son said to me on the phone today, you know I'm leaning 60, 40 towards sobriety like I get it. I wrecked my life.

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Randye Kaye: but I like to smoke

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Mindy Greiling: so so II have one question for you, Randy. I was wondering at the beginning, but I didn't answer it at that time or ask it. But do you think your son has told? Do you think the counselor in the jail asked him

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Randye Kaye: if he has a mental illness, and he said he didn't, or do you think he just didn't ask him. I think he didn't ask him. This is the first time I've spoken to the counselor, he said. Oh, I wasn't aware. So you know. So you know it does. It does get complicated, and you know our sons are in their forties. My son's 41. So it it's a point where I can't convince me of schizophrenia. I can't convince him to get sober.

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Randye Kaye: I hope that he will come to that decision, but I think if he hangs around the kind of people like if he could get a sponsor like this is what I hang on to that. There are other. There are other hooks to hang your hat on, so you know there are. There are limits even to support. So we haven't quite solved it. But II would like to know

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Randye Kaye: the effect that your book has had on people. What has the response been? Is there a little more hope now? Are people working on things? And what's your next book.

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Alisa Roth: I think my big hope is that

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Alisa Roth: if I dare say this, the silver lining of the pandemic has been that I think that mental health is something that people are paying attention to, and I think that we still don't spend enough time focusing on serious mental illness. But I do think that if we can open up that conversation about mental health and mental illness

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Alisa Roth: at all, we're moving in the right direction, and I think that

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Alisa Roth: I open the paper every day and see a story about the mental health crisis. And even if it's not a crisis

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Alisa Roth: at this level, if it's a crisis at this level. That's an acknowledgement

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Alisa Roth: that that we have a problem, so that I am hopeful. I am hopeful

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Alisa Roth: that I think that the criminal justice I mean. I'm hopeful, even even from back when I was reporting the book, that it is a place where I feel like all the sides agree that this is a problem. So you can talk to the police officer, who has no patience for the the person with mental illness who's standing on the corner screaming at the stop sign.

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Alisa Roth: But he understands that it's a problem, and it's an unacceptable problem, and that corrections officer who doesn't want anything to do with it or doesn't want to know, also thinks it's an unacceptable problem as does the judge and the lawyers and the family members. Of course. So I am hopeful that that if we all agree, there's nobody out there saying, Yeah, this is. This is exactly where they belong. Lock them up right? Nobody's saying that. So I'm hopeful that that it may take us another 50 or 100 years to get there. But at least we're all sort of moving in

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Alisa Roth: in the the right direction.

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Randye Kaye: Okay, II would just add that I, if this is totally from my perspective. But I wish

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Randye Kaye: that if someone is currently on medication and appears okay. that there was some more background. If the judge yesterday had said, What's the background of this kid?

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Randye Kaye: Oh, he's been living in a group home, and oh, wait! Let me cut him some slack here like it was just 22 s. No, no, no, you look weird. I'm not. Gonna listen to you. There's stigma.

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Randye Kaye: There's stigma in the courtrooms, and there's stigma in the prisons, and it depends on who you know again in your book from incredibly kind prison workers to people who have no clue, what it's like to hear voices. So education, I think, could help in the meantime as well.

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Alisa Roth: and I like to call it. I like to call it discrimination. Because I think there's

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Mindy Greiling: if a person has a lower level mental illness, maybe there's more working with them to get something to happen. But when they look really weird, or they're in the psych ward, and they're obnoxious, or, you know, doing really bizarre things there is research to show they don't get as much time or attention. So I think we have a long ways to go

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Alisa Roth: for people with serious mental illnesses. But having said that, I will just add this one, can I pause for 1 Si have to say, to come back to what I said earlier about the privileges, even just the way that they look. I I'm assuming, Randy, that your son is a white 40 year old, and that he walks in there and and looks disheveled, and is already treated

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Alisa Roth: poorly, and you imagine that if he were not white the outcome might have been very, very different. And again, it might have been worse, absolutely absolutely. No, that's what I mean. And on the the support piece, even if you say we're not in a place for you to be sleeping on my couch. The fact that you were ready to be there, and to be calling that counselor, and are able to take the time and the space to do that

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Alisa Roth: is a huge amount of privilege. And so the number of people that I've talked to both who have the support of parents. I've said all along at the the unsung heroes and heroines of this story are the parents, and particularly the mothers. For sure

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Alisa Roth: there are many, many people who don't have any of that support, and so are left to show up in their their jail scrubs. And and you know, if you had been able to be there. Here is this nicely dressed.

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Alisa Roth: well-spoken, supportive person who is showing up there that that puts points on on his side right?

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Mindy Greiling: Huge privilege with that regard. That little tidbit I was gonna say, is I have experience, and I've had many, many families. Tell me that piggybacking out, Randy said earlier that they get often we get treated better by the people in the courts, the people in the jails, and people in prison than in the mental health system. Ii think that's a

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Mindy Greiling: condemning statement. But there's, you know I've had people in the criminal justice side. Pant me on the back, you know. Give you encouraging words. I don't get that. Generally speaking, in the mental health system.

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Randye Kaye: Interesting? Well, you've certainly

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Randye Kaye: done so much to shine a light on this problem. I would like to ask you if there's anything you are hoping we would ask you that we didn't ask you that. You really wanna say I want you to say it and then tell us about your next book.

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Alisa Roth: I think you've asked all the right questions, so I appreciate the chance to answer them. And the next book is looking at the incarceration of women. They women are the fastest growing group of incarcerated people.

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Alisa Roth: And so I'm looking to understand why that is, and and what that means for those women and for their for their families and for us as a society.

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Mindy Greiling: I can't wait for it to come out, and I think your book. because of the statistics that you already cited, that are in your first book

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Mindy Greiling: will shine a light on serious mental illnesses, because so many more women who end up in prison, you said, have a mental illness than than the men, and so I think they have to be quite sick before they end up in prison. So your topic will have to definitely have you back and hear more about that? Okay, thank you. And where can people get in touch with you or find out more about the book

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Randye Kaye: books? Give a website.

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Alisa Roth: I sort of stepped back from Twitter. But I am still there. Haven't we? All? But okay.

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Randye Kaye: Well, obviously, the books are in bookstores, and they're on Amazon. Do you have a website yourself or

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Randye Kaye: I do? It is not kept up, but I can be reached through there. It's Alisa Rothcom, or if you Google me, you'll you'll find me Google her. You'll find it alright, Alisa, thank you so so much for for joining us today and for all the work that you do.

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Alisa Roth: Thank you both for having me. I really appreciate it. It was really fun.