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

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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.

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