Our overall societal systems show that mental health care issue stress with suicide at number 10 for the most common cause of death at 1.7 percent of the population in the United States, about 47,173 deaths in 2017, according to CDC.gov. The recent death of George Floyd has raised increased protest over police use of force, with the Washington Post records tracking 1000 people killed by police. This contrasts with the the FBI data on crime, up to 6 million reports, with 60,000+ assaults on officers and 10,800+ resulting in injury, with at least 12.4% of these occurring while handling offenders and 510 criminally killed in the line of duty. 72% of those attacked occurred with the offender having a personal weapon according to https://ucr.fbi.gov for the year 2017.
In writing my family memoir, I wanted to look back and see where my family went wrong with my brother who is mentally ill, a former drug addict with a history of crime. I wanted to remember what occurred with everyone of our social systems that he encountered, including the schools, the police, the court system, the jails, child protective services, rehab hospitals, and decided to do a lot of reading. One problem with working with anecdotal understandings of systems is the fact that a lot changes in our systems over a thirty year period, so some of what he experienced is not necessarily experienced today.
What I found was each social system was investing more money for employees to deal with mental health care. More mental health care usually involved an employee taking a day to a semester class to improve their understanding in the case of police contrasting with school psychologists facing increasing loads. This contrasts highly with the coursework most mental health professionals undertake as part of being qualified. I’ll provide some more data.
Let’s start with the medical doctors. Scott Teitelbaum[1], who says in his popular manual for families on addiction, “All physicians will see alcohol abusers-addicts, drug abusers-addicts, medication mis-users-addicts in their practice, clinic or hospital. Yet virtually none of these are prepared to deal with a patient who clearly has addictive behavior.”
In reading about schools, Natasi etal (link goes to recent version) [2], who outlines the mental health issues and how school psychologists can be more effective, says “Yet, the profession has struggled with redefining the role and functions of the practitioner and convincing school administrators and policymakers of the potential contributions of psychologists to comprehensive mental health service delivery. To function as mental health specialists, school psychologists need to confront current notions of who they are and what they do, and to prepare themselves to assume an expanded role.” This contrasts to the reality of today which apa.org covers in “School Psychologists feel the squeeze”, which discusses growing demands on school psychologists with loads increasing for 1200 students to up to 5,000 along with budget cuts in the schools.
In reading Community Policing [3], the police documented a number of issues related to incidents of violence and prisoners and I’ve provided updates to their statistics. They found:
· Homeless populations are distrustful of police. We have a population of 567,715 people according to endhomelessness.org.
· Non-English speaking populations have difficulty understanding and responding to police requests and many come from countries where the police have poor reputations. We have a population of 67.3 million people who don’t speak English at home according to cis.org
· Mentally ill often have poor ability to understand or respond to police and are often distrustful of everyone. We have a population of 47.6 million currently mentally ill in the US according to samhsa.gov while more than 105.6 million people in the USA have an existing mental illness issue according to NAMI.org.
· There were 3.1 million victims of crime in the US (also requiring mental and physical health care assistance), according to samhsa.gov. In additional, there’s a population of 49,000 victims of trafficking in the US in 2018 according to bjs.gov with 300,000 at risk of trafficking. I don’t know if these are included in the victims of crime statistics.
· The population of offending drug users is about 26.3 million people according to samhsa.gov.
· Immigrants entering the US yearly run about 1 million per year according to migrationpolicy.org, and they typically have a lack of understanding of how to navigate US society in addition to potential language skill problems and distrust of police.
What has worked with changing the dynamics of these situations is the development of Crisis Intervention Units with mental health professionals, language experts, social workers and police providing backup support. Not all police organizations in the United States have Crisis Intervention Units.
In reading about the court system and the revolutionary approach to dealing with crime related to addiction Rebecca Tiger [4] explains “the “drug court team,” usually comprising the judge, prosecution, defense, probation representative, and a clinical director with drug treatment experience, meet prior to the court session to discuss each case and the defendant – client’s progress in treatment.” In other court situations, mental health professionals testify only if the defendant’s lawyer includes them and since many plead guilty, none are consulted.
Finally, in a study of at-risk juveniles, Victor M. Rios[5] reported what they wanted, “I witnessed as school and community centers were unable to provide him the support he believed he needed: help looking for a job, a mentoring program, and somewhere to hang out where he did not have to feel forced to prove himself.” He also discussed how the students felt punished when sent to a counselor at school, since it became a discussion in the school, with all students and faculty knowing the status. Additionally, he talks about what he calls hyper-criminalizing of students, with a blown up escalation of status for students. This is sort of similar to how my brother was first treated, with every offense bringing punishment from a growing group of adults, fined by the courts, extra homework and study after school, loss of job, and grounded at home.
While my study was by no means comprehensive, a longitudinal study would definitely help point out best methods but until we have a federal policy, each school district in each state will have varying policies and overused and underused staff, without consistent access and coverage for families. While mental health care is provided via the Affordable Care Act, bringing it into family hands is not necessarily a straightforward activity.
So what personal mental health care for a family can mean is early detection of problems, early treatment with a variety of services, reduced punishment instead reinforcement of positive behaviors, plus privacy.
On behalf of society, the fact that so many organizations document the need for mental health care and try to provide it, means that we are making ineffective use of our resources. Instead of a consultation with a professional, a standby offers what help they can provide. Problems escalate and lead to overall long term problems including the lack of education, job training, interpersonal communication skills and family dysfunction and even violence.
[1] Teitelbaum, Scott A, Addiction: A Family Affair . The University of Florida Department of Psychiatry. Kindle Edition. 2011
[2] Nastasi, Bonnie Kaul. School-Based Mental Health Services: Creating Comprehensive and Culturally Specific Programs (Applying Psychology to the Schools) . American Psychological Association (APA). Kindle Edition. 2004
[3]Miller, Linda, etal. Community Policing. Delmar Cengage. 2014
[4] Tiger, Rebecca. Judging Addicts: Drug Courts and Coercion in the Justice System (Alternative Criminology) (p. 15). NYU Press. Kindle Edition. 2013
[5] Rios, Victor M.. Punished: Policing the Lives of Black and Latino Boys (New Perspectives in Crime, Deviance, and Law) (p. 57). NYU Press short. Kindle Edition. 2011