The Revolving Door: Mental Illness and the Criminal Justice System

On August 14, 2014, Phoenix Police arrived at Michelle Cusseaux’s home to fulfill a court-ordered transport to a mental health facility. Fifty-year-old Cusseaux, who suffered from schizophrenia and bipolar disorder, allegedly met the police at the door wielding a hammer and threatening officers. Despite knowing they were going to be dealing with a mentally unstable individual, the arguably unprepared Phoenix policemen shot and killed Cusseaux. Four days later, on August 18, Sacramento police shot and killed Jeffery Towe after responding to a behavioral complaint from neighbors. Towe charged at the police with a knife, prompting an officer to fatally shoot him. He too suffered from schizophrenia, as well as bipolar disorder. The next day, on August 19, St. Louis police shot and killed Kajieme Powell after he had stolen two energy drinks and a pastry from a convenience store and was acting erratically in the parking lot outside. Common consensus now has it that Powell was in the midst of a mental health emergency.

These are just three recent examples of a dangerous and growing trend in the United States, where people with mental illnesses are increasingly caught in deadly encounters with the police. An estimated half of all police shootings are of someone with a mental illness. Shootings, as well as other uses of force such as tasering, are a sad fact of life for the mentally disabled community in the United States. Police officers are often unprepared to handle situations involving people with mental illness, and the traditional commands officers are taught to use in dangerous situations are usually ignored or misunderstood in the midst of a crisis. But at a time when American police forces around the nation are, rightfully, under increasing scrutiny for recent shootings, we must acknowledge that they are not solely to blame for the recent tragic fatal incidents involving the mentally ill. Inadequate funding and a lack of long-term care for people with mental disabilities have resulted in a mental health system that is lacking substantive infrastructure. Consequently the burden of dealing with mental health care has been placed on law enforcement, with dangerous consequences.

Police departments first began developing mental health protocols after the end of state-run mental institutions, between the 1960s and 1990s, increased their contact with the mentally ill. Crisis Intervention Team training was created to help officers understand and respond more effectively to mental illness after the 1987 shooting of 27-year-old schizophrenic Joseph Robinson by Memphis police officers. CIT training — which is increasingly used today — changes the officer’s approach to handling dangerous mental-health crises, teaching him or her to speak less aggressively, be more patient and use slower movements to de-escalate the situation.

Small units of CIT-trained officers are deployed on mental-health related calls. Since the program’s creation, almost 3,000 of the roughly 18,000 police departments in the United States have implemented CIT programs. These programs have been shown to work: A study by the American Psychiatric Association found that officers with CIT training were more likely to refer mentally ill people to mental health services than arrest them. Confronted with the increasing frequency of fatal incidents involving mentally ill individuals and the police, more departments are adopting CIT training. While CIT programs are an important factor in preparing the police, they are not foolproof.  CIT units are only deployed to known mental health crises, but often officers will be sent into mental health situations unknowingly and thus unequipped to handle them. And even if one or more officers present are CIT-certified, police encounters with the mentally ill can still be fatal. An officer present at Michelle Cusseaux’s death had undergone CIT training, and so had an officer at Kaijieme Powell’s death, yet this did not prevent the use of lethal force. Even if CIT training were 100 percent effective, it still only treats one of the many symptoms of a much larger problem: a long history of governmental neglect of mental health issues.

Starting in the late 1950s, the American public soured at the idea of state-run facilities for the mentally ill. It did so with good reason. These asylums provided horrible living conditions for patients. Popular books like One Flew Over the Cuckoo’s Nest dramatized the inhumane conditions in state-run facilities and brought the mistreatment of individuals with mental illness into the public conversation. The Kennedy administration led the charge for “deinstitutionalization” with the Community Mental Health Act of 1963, a movement away from state-run psychiatric hospitals and towards community-based mental health initiatives. If they have funding, community-based mental health services tend to be more humane and helpful and allow many people with mental illness to lead more independent and fuller lives. They were seen as the future of American mental health policy. The Reagan administration, however, drastically changed the legacy of deinstitutionalization by decreasing federal mental health funding by 30 percent in 1981, leaving Kennedy’s vision for community-based mental health services underfunded.

The intention behind cutting state facilities was that states would use the money saved to invest in community-based programs for the mentally disabled. But the implementation of the second step is where many states faltered. Federal support for such programs was never fully funded, and in times of economic crisis, mental health treatment has been one of the first things to be cut. While the horrible system we had before has largely been shut down, states were never able to invest in a new system, displacing thousands of people with mental illness onto the streets where deadly police encounters become much more likely.

The 2008 recession brought even more cuts to state funding for mental health. Between 2009 and 2012, states reduced funding for mental health by $4.35 billion. This resulted in 4,500 fewer state psychiatric hospital beds — a 10 percent reduction. The cut in state funding and reduction in state-funded hospital beds has put more mentally ill individuals on the streets and led to an increase in encounters between them and the police. In San Diego, for instance, the number of mental illness related calls to police nearly doubled between 2009 and 2011. Mental health transports by police in Oklahoma have risen 40 percent since 2011. Many other police departments across the country are reporting similar increases.  Police departments often spend huge amounts of resources simply transferring patients to the few available beds, often hundreds of miles away. In 2013, Oklahoma police traveled almost a million miles to find mental health centers with room for more patients. This inefficient system costs departments hundreds of thousands of dollars and countless hours of labor each year.

People with severe mental illness currently make up roughly 25 percent of the homeless population. Homelessness exacerbates existing mental illness, creating more frequent, often violent, crises. In a system where thousands of people with mental illness can’t get the preventative long-term treatment they need, the only contact they receive is after a serious incident, at which point they are often arrested and put in jail. Of state prisoners, 56 percent suffer from mental illness; as do 64 percent of local jail inmates and 45 percent of those incarcerated in federal prison. Prisons now function as the primary means of mental health service available — there are 10 times more people with mental illness in jail cells than in state hospitals.

Furthermore, mentally ill inmates are often victims of cruel treatment by correctional officers. At Riker’s Island, where 40 percent of inmates have some sort of mental illness, attacks by correctional officers on mentally ill prisoners are common. In 2013, 129 of the prison’s inmates suffered injuries from confrontations with officers. Of those seriously injured 77 percent had been diagnosed with mental illness. The use by officers of solitary confinement puts severe psychological strain on many inmates with existing mental health problems and demonstrates correctional officers’ lack of understanding towards the mentally ill.

The current approach to mental health in the United States is one in which a mentally ill person is too often unable to get proper treatment, unable to find a home and is routinely mistreated by law enforcement. People caught in this revolving door — one that takes them from homelessness to prison to a halfway house and then back to the street — are so common in the United States that many police departments have given them a name: “frequent fliers.”

The CIT model may help in preventing deadly incidents between police and the mentally ill, but as Cusseaux, Towe and Powell’s cases confirm, it doesn’t work well enough. While it should be an important part in every police department’s handling of people with mental illness, it can’t be the only reform. When a mentally ill individual makes it out unharmed and without arrest from a police encounter, he or she is still left in a broken mental health system unequipped to handle the influx of mentally ill people spared from the penal system.

Reforming the current system is made harder by the fact that the federal government does not collect reliable data on police shootings, further complicating the quantification of specific effects policies have on the mentally ill. Police shootings that are found to be justified, and nearly all of them are, are counted among the normal homicide rate. This makes it hard for the government — or anyone — to address the problem on a large scale using concrete data.

Unwitting police departments have become the de facto institutions tasked with interacting with the mentally ill — and they’re simply not trained for the job. As long as the criminal justice system is the United States’ mental health policy, the number of fatal encounters between police and individuals like Michelle Cusseaux, Jeffrey Towe and Kajieme Powell will only rise.