The top providers of mental health services in Maine are not hospitals or community-based clinics but our prisons and jails.
This is not news. It’s been observed so many times that it sounds normal, but it shouldn’t.
Police and the courts are doing a better job of recognizing when a crime is caused by underlying mental illness, but they can’t do it all. The state has to do a better job of delivering mental health services.
Ten years after Congress gave mental health and substance abuse treatment parity with general health, people with mental illness are still regarded with fear, and law enforcement is seen as the first line of defense. Police have become more sophisticated about defusing what could be volatile circumstances and recognizing that some criminal behavior is caused by mental illness, not bad intention.
It’s a sign of progress that all police officers in Maine get some instruction in mental health intervention, and a number of police agencies, like the Cumberland County Sheriff’s Office, have invested in more extensive training. But it’s also a sign that the rest of our mental health care system is not doing its job.
People with mental illness need care, not punishment. Imagine if jails became the de facto treatment centers for people with diabetes or cancer. Would we consider the treatment to be good enough, or would we demand facilities that are focused on their illnesses? We don’t just need better jails – we need appropriate alternatives for people who don’t belong behind bars.
It’s important to get the rest of the system functioning because we are in the middle of an epidemic of mental illness.
Suicide rates are up 24 percent since 1999, and the average age at which mental illnesses present themselves is going down steadily, according to the National Alliance on Mental Illness Maine. Many of the people swept up in the opioid epidemic are people who turn to drugs as a result of the pain of untreated mental illness.
The Cumberland County Sheriff’s Office reports that calls for service classified as mental health emergencies have risen from 383 in 2013 to 486 last year. That’s probably an under-count because it doesn’t include interventions that were initially reported as domestic disputes, shoplifting or some other offense. And the number of Mainers who were found not competent to stand trial has climbed from seven in 2008 to 136 last year.
There are a number of problems with an overreliance on law enforcement. Most people with mental illness suffer privately and might never come into contact with law enforcement. And jails are not treatment centers. People are released when they finish their sentence or pay their bail – whether they are ready to return to society or not.
Dallas County, Texas, has introduced a creative approach that identifies people who have mental illness as soon as they come into contact with law enforcement and places them in an appropriate setting instead of jail. It has improved mental health outcomes in the county and has reduced recidivism as well. And the county jail there is no longer the biggest provider of mental health services for the region.
Maine would do well to study this approach, and dedicate the resources necessary to do the job. Police and the courts deserve credit for trying to do a better job facing this challenge, but they can’t do it alone.
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