MH, Crime, & CJ Midterm

How do people with SMI struggle twice as much?

challenged by:

• stereotypes

• prejudice

• misconceptions

How was mental illness viewed in the Middle Ages?

• seen as God’s punishment

• demonic lens

Mental Illness during the Enlightenment

• Institutions were established for the mentally ill

• stigma peaked during Nazi Germany, 100k+ MI were murdered/sterilized

What specific group with SMI is the most affected?

schizophrenia

What do prejudices allow for?

emotional reactions to stereotypes/stereotyped people

What do prejudice and stereotypes lead to?

discrimination

What are the rates that people with MH experience discrimination?

• 50% with schizophrenia report discrimination in personal relationships

• 2/3 anticipate discrimination when applying for work, looking for a relationship, etc.

What are the rates of those with negative attitudes towards those with SMI and a substance abuse disorder?

• 75% of the population have negative attitudes toward drug dependency

• 2/3 of the population have negative attitudes toward alcohol dependency and schizophrenia

What are the 3 approaches to changing public stigma?

• protest

• education

• contact

Protest Approach to Changing Public Stigma

• inaccurate representation to challenge stigmas

• sends a message to stop reporting inaccurate representations and to stop believing negative views about MI

Education Approach to Changing Public Stigma

• helps the public make an informed decision about MI

• research shows that those with a better understanding of MH are less likely to endorse stigma and discrimination

Contact Approach to Changing Public Stigma

• contact with those with MI can diminish stigma

• research shows inverse relationship between having contact with those with MI and endorse psychiatric stigma

What are 3 major misconceptions of MH in Western culture?

• fear and exclusion

• authoritarianism; SMI are irresponsible and life decisions should be made by other people

• benevolence; SMI are childlike and need to be cared for

What are 4 forms of discrimination from the public stigma?

• withholding help

• avoidance

• coercive treatment

• segregated institutions

Self-Stigma

prejudice where people with MI turn against themselves

Manifestation of Self-Stigma

assumed personality characteristic that is followed by emotional approval

What are the 3 channels for intervention strategies?

• mass media

• opinion leaders

• persons of trust

19th Century and Mental Illness

• the rise of recognition of new illness, “madness”

• anyone considered deviant was put into asylums

How were asylums viewedf?

a tool of social contruct

What did Goffman argue the function of asylums were?

mould their inmates into some socially approved purpose

What lead to the “particular version of childhood” emerging?

“normal” childhood behavior was controlled by health “experts” that defined what behavior is acceptable

What did the emerging of “particular version of childhood” lead to?

those who did not fit that version were labeled with “disorders”

What are the 4 Main points of ‘The Social Construction of MI’ arguement?

• all scientific concepts are inventions of the imagination

• human sciences paradox (what is believed to be true about behavior affects the behavior that it’s purpose is to explain

• trajectory of illness is influenced by the beliefs patients and doctors hold

• physicians are constrained by socially constructed roles

What are some problems of the Human Sciences Paradox for social scientist?

because they are often believed, their theories become part of the “connecting principle” that we seek to discover

What did Waxier’s studies of peasant society culture in Sri Lanka find?

• insanity ascribed to causes external to the individual

• illness regarded as a threat to family and must restore patient to former self

What do the symptoms displayed by the patients at the hospital result from?

the institutional environmen

What are the course and outcomes determined by?

the meaning where the culture ascribes to the disease and the treatment available to the patient

What type of approach has the CJS adopted?

punitive

What is the result of the punitive CJS?

• policies and restrictions to support

• fueled criminalization of MI

• ex; 0 tolerance policing, mandatory minimums

3 Categories of Crimes the MI Typically Fall in

• a product of MI (disorderly conduct, trespass, etc)

• economic crimes

BJS

• prisoners with mental illnesses are twice as likely to have been unhoused before arrest

• 40% unemployed, 50% binge drinkers

Co-Occurring Disorders

• suffer from both MI and substance abuse

• at a higher risk of incarceration

Rates for Co-Occurring Disorders

• proportion of 25-50%

• 60% MI state prisoners have reported drug use a month before arrest

Revolving Door

• btwn jail and ‘street’ propelled by untreated MI and co-occurring substance abuse disorders

• minor crimes

How have emergency rooms, homeless shelters, and jails been affected by the ‘revolving door’?

• become de facto service centers

• overloaded

• lack of adequate treatment resources

• increase likelihood of offending and incarceration

How is ‘dangerous’ often defined by the states or laws?

imminently dangerous

Florida MH Act revision of 1971

• strengthen due process and civil rights of persons in MH facilities

• Maxine Baker saw MI deprived of liberty

Before Florida’s Baker Act

• could be placed in hospitals of 3 people signed affidavits and a secured judge’s approval

• no specific time period before a person’s confinement would be reconsidered by a judge

What did the FL Baker Act prohibit?

• indiscrimination admission to state institutions/retention w/o just cause

• mandated court-appointed attorneys

• provide reviews of involuntary placements

• established patients’ bill of rights 

• placement of persons with MI in jails unless they commit a criminal act

Reasons why a person can be held involuntarily for 72 hours in a MH facility under the Baker Act?

• believe a person is MI

• person refused voluntary examination/can’t determine if a examination is necessary

• w/o treatment they are likely to suffer from neglect, self-harm, or harm someone else

Who can initiate a Baker Act

• Judges

• Law Enforcement Officials

• Doctors

• MH Professionals

What happens after 72 hours under the Baker Act?

• person released outright/referred to outpatient treatment

• facility can request consent to continue commitment voluntarily

• a administrator can file a petition through the circuit court for involuntary placement

Critics of the Baker Act

• too many people cycle through with little/no follow-up treatment

• 195k Floridians taken into custody for Baker Act evaluation in 2015-16

• most released with no follow up

Recent Baker Act Rates

• up 105% since 2000

• 100s undergone repeated Bake Act evaluations

Reasons for Arrest With SMI

• most people behind bars with SMI for misdemeanors

• frequently use ‘disorderly conduct’ charge when no other charge is available

• alcohol/drug charges

What typically leads to the arrest of a MI person?

a direct relationship between MI and behavior

Reasons for Arrest for People With Paranoid Schizophrenia

• Often arrested for assault; mistakenly believe someone is following them

  • esp true for women

• Mercy bookings are common for police

Pressure Btwn Businesses and Police

• get rid of ‘undesirables’

• most commonly seen in tourists towns

• ‘clean streets’ by arresting vagrants and homeless people

Arrests of MI Study in 1992

• 29% of jails were holding MI people with no charge

• waiting for psychiatric evaluation, hospital bed availability, or transportation to the hospital

• state laws permitting emergency detentions

• common in rural states

What is the last resort for those who need intensive, inpatient care?

psychiatric hospitals

What decimated public psychiatric beds?

• deinstitiutionalization

• 1955-2016; state hospital beds dropped 97%

• 14 beds per 100k people

• 2005-2010; 13 states closed 25% or more total state hospital beds

What was the result of the absence of treatment after psychiatric hospitals closed?

• admissions to hospital emergency departments, jails, and prisons

• overcrowding; some released w/o treatment 

• police calls for people having a MH crisis grew

• number of people with MI that are unhoused increas

Prisons/Jails in Colonial America

• housed ‘mentally disordered’

• nonviolent 'lunatic’ or ‘mad person’ were kept at home

• jailers paid fee by family or the town

1752 Psych Ward

Pennsylvannia admitted first ‘lunatic’ into psych ward

1773 Psych Hospital

VA Governor authorized first psych hospital for the insane in Williamsburg

1820s Organization of Boston Prison Discipline Society

advocated for improved prison/jail conditions and hospitals for MI prisoners

Mass Legislature of 1826

• investigate conditions of state jails

• approved psych hospitals

• recommended confinement of MI people in jails/prisons be made illegal

What did Dorothea Dix advocate for?

funds to build state psych hospitals

What did Dorothea Dix argue?

inhumane and unjust for MI and fellow inmates

What did Dorothea Dix do?

• visit 300 county jails and 18 state prisons

• opened 75 psych hospitals for 50 million

Earty 19th Centery and Asylums

• patients had symptoms appear suddenly

• chronic sufferers cared for in the community

Why did it take longer for the implementation of asylums in the US?

costs deferred to the states

19th Centery Elderly Patients in Asylums

• needed assistance increases as lifespans increased

• county institutions became crowded

Where did doctors place their hopes during the 19th century?

• moral treatment

• rehab through exposure to normal habit

How did the increased lifespan affect doctors roles?

shift from therapy to caretaking at end of lif

Psychiatrists in the late 19th through early 20th century?

• began working on cures and preventive techniques

• growth of eugenics, forced sterilization

1896 Connecticut

• first state to prohibit marriage for “imbeciles and feeble-minded”

• mandated sterilization

Buck v Bell

• argues sterilizations didn’t violate people’s rights

• concluded “3 generations of imbeciles is enough”

What was the most famous treatment for MI?

• ECT

• induces seizures through shocks

1927, Insulin Shock Therapy

• introduced as a cure for schizophrenia

• injected larger doses

• often induced comas

Henry Cotton

• believed illness is product of untreated body infections

• removed teeth, tonsils, spleens, ovaries (30-45% mortality rate)

Great Depression and Institutions

• hospitals became overcrowded

• quality of care deteriorate

Shame of the States Book

• cataloged abuses witnessed in state hospitals

• overcrowding, beatings, near absence of rehab therap

The Snake Pit movie

showed the hospital where patients deemed beyond recovery abandoned ina padded cell

National Mental Health Act (NMHA)

created National Institute of MH (NIHM) signaled federal government would play larger role in MH

NIHM in mid-1950s

• studies calling for community care 

• arrival of psych medications and treatment

What was the first antipsychotic in the US?

Thorazine

What was the first state to provide funding to outpatient clinics for therapy ormedications?

New York

Where did President Kennedy want the MI to stay?

in the community

Where did President Kennedy put 150 million dollars?

• states to construct community MH centers (CMHCs)

• offer inpatient/outpatient services, 24-hour emergency, education

• goal of 2k CMHCs built by 1980

• assassinated soon after this act

What was the result of the CMHCs Initiative?

• underfunded, only 754 built

• patients who needed significant care often sent to hospitals

Reagen Leader in Deinstitutionalization

• taxpayer dollars saved from limiting involuntary commitments

• diverted money into state general fun

What was the result of psych hospitals budgets getting slashed?

• quality of care decreased

• accelerated calls for closure

• O’Connor v Donaldson

O’Connor v Donaldson

people not deemed a threat to themselves couldn’t be hospitalized against their will

What was the result of the deinstitutionalization fo asylums?

• number of halfway homes exploded

• promise of meds to “cure” MI faltered

Reagen, Omnibus Budget Reconciliation Act

• repealed federal funding for CMHCs

• allowed states to use remaining funding with little oversigh

When are individuals with SMI at higher risk of offending?

when they have a substance abuse disorder and/or in a state of psychosis

What increases the risk of violence with individuals with SMI?

antisocial disorder

Where do individuals with SMI typically live?

• socially disorganized areas

• high levels of crime and victimization

• or homeless

What should intervention efforts include?

• providing housing services

• implementing community-based intervention

• treatinf MI and substance use problems

• addressing family and employment problems

What does the ACE Framework suggest?

certain experiences are a major risk factors for causes of illness, death, and poor quality of life

What group is overrepresented by ACE and sufferes the most from it?

unhoused

Who has become the “gatekeepers” of the MH system?

police

1st Paradigm fot Change - Edu and Training

• lack of knowledge and skills of officers

• edu is now the norm

2nd Paradigm for Change - Police Interventions

focus specific police resources on the issues

What are some potential solutions for policing MH?

• crisis intervention training

• MH officer