The desperate and the dead

families in fear

Few have paid a higher price for the nation’s mental health crisis than the loved ones of severely mentally ill people. At least 17 parents with signs of mental illness allegedly killed their children from 2005 through 2015, while a similar number of children allegedly killed their parents. But the toll of violence reaches far beyond family. From 2005 through 2015, 10 percent of all homicides in Massachusetts in which a suspect is known were allegedly committed by people with a history of mental illness or clear symptoms. Many of those deaths might have been prevented had the killers received the mental health care they needed.

police confrontations

Police in Massachusetts are increasingly called on to respond to mental health emergencies. It is a role police were never meant to fill, and the mismatch leads to tragedy. Police across the state shot people who were suicidal or mentally ill dozens of times in the last decade. Part of the problem is tactics: When police are confrontational, they increase the risk of a shooting. But it’s also the failure of other institutions such as hospitals to provide mentally ill people with the care they need.

community care

Governors, state legislators, and federal officials together cut hundreds of millions of dollars in mental health spending over the last 50 years. They stood by as community service providers withered and shrank, and as counseling, psychiatric prescribing, and other services grew harder to access. The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe.

courts

Defendants suffering from mental illness have been streaming into Massachusetts courtrooms in growing numbers since the state began closing psychiatric hospitals in the early 1970s. The courts weren’t ready for this onslaught, and they still aren’t today. As a result, defendants with mental illness are much more likely to receive punishment than treatment, putting Massachusetts courts behind much of the country in addressing the mental health crisis.

prisons

If you tried to design an environment where mental illness would thrive, it might look a lot like jail or prison. Yet this is where thousands of people with mental illness end up: locked up in harsh correctional settings steeped in fear and violence, where drugs flow freely, overworked clinicians juggle 50 or more cases, and the favored punishment is segregation. At least 30 percent of the 20,000 jail and prison inmates in Massachusetts suffer from mental illness, and far more struggle with addiction. Yet the state has cut spending on prison mental health care, ensuring most incarcerated men and women get minimal treatment. Many emerge from prison sicker than when they went in -- and more likely to commit additional crimes.

homelessness

Chronically homeless people are often ignored by the public, living on the margins, many of them struggling with severe mental illness and addiction, discarded by a world that has given up on them. But, in some quarters, the chronically homeless loom like giants, challenging and sometimes overwhelming the front line workers charged with sorting out their problems. For police and courts and caseworkers who manage mental health care, for jails and emergency rooms, homeless people are not forgotten; it’s just that their efforts to help so often fail.

solutions

Fifteen years after San Antonio and surrounding Bexar County, Texas, committed to fixing mental health care, they’ve built a treatment and jail diversion system that’s widely considered a national model. Their collaborative, integrated approach has reduced the jail population, cut downtown homelessness, trained thousands of law enforcement officers, and saved taxpayers tens of millions of dollars. Massachusetts could learn a lot from San Antonio.