The Charge: Being Mentally Ill In Public


Joan is a 62-year-old woman who was transferred from jail to the hospital for an assessment as to her competency to stand trial. She was arrested in a subway station and charged with disorderly conduct, trespassing and resisting arrest, because she would not leave the pay phone when asked to do so by other patrons. When approached by the police, she began yelling at them and refused to leave the premises.

On arrival to the hospital, she was noted to be hearing voices and to express the belief that she was “the president”. She initially refused medication, but after a few days, she developed a relationship with one of the nurses, who was able to persuade her to begin taking the medication that was offered. She said that this nurse “reminds me of my daughter.”

I was the forensic evaluator who had to evaluate her as to her trial readiness. In so doing, I called the arresting officer, and I asked him why he did not take her to the emergency room, which would have been a quicker way to engage her in treatment. He said, “she wasn't doing anything dangerous – they would not have admitted her.”

What is wrong with our system that a person can be perceived by a police officer as being dangerous enough to require arrest and detention in jail, but not dangerous enough to be admitted to a hospital for treatment?

I am a psychiatrist who has worked over the past 15 years with individuals with mental illness who find themselves involved in the criminal justice system. I have treated them in jail and prison. I have worked with people released to probation, parole or other forms of conditional release. I have supervised staff in large prisons and jails, and I have consulted with police departments, courts, jails and prison systems across the country. The common denominator is this: nobody seems to know what to do with individuals who are charged with crimes because they are suffering with mental illness.

In this blog, I hope to address the multiple issues related to the criminalization of people with mental illness. This is a very old story. In 1857, Dr. Jarvis wrote in the American Journal of Insanity (the precursor to the American Journal of Psychiatry):

But the insane criminal has nowhere any home: no age or nation has provided a place for him. He is everywhere unwelcome and objectionable. The prisons thrust him out; the hospitals are unwilling to receive him; the law will not let him stay at his house; and the public will not permit him to go abroad. And yet humanity and justice, the sense of common danger, and a tender regard for a deeply degraded brother-man, all agree that something should be done for him – that some plan must be devised different from, and better than any that has yet been tried, by which he may be properly cared for, by which his malady may be healed and his criminal propensity overcome.

Things have not changed much in the last 150 years.

Did you know that research data indicates that 15-20% of incarcerated individuals suffer with mental illness? How can we address this?

Erik Roskes is a forensic psychiatrist and currently the Director of Forensic Services at the Springfield Hospital Center in Maryland. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes' employers or consultees, including the Maryland Department of Health and Mental Hygiene. He can be found a

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