The U.S. spends more than $150 billion annually on programs that do little to help those with serious mental illness and leave many untreated. Individuals with the most severe diagnoses, like schizophrenia and bipolar disorder, are thrown into an endless cycle of jail stays, homelessness, and repeat hospitalizations.
Jaffe and Eide argue that policymakers should focus resources on those who need them most, expand the use of assisted outpatient treatment (AOT) to help people with severe mental illnesses, and stop looking to the criminal-justice system to solve the problem.
John Stossel discusses this often-neglected national issue in an op-ed for Town Hall.
This video is part of a special collaboration with John Stossel and City Journal contributors.
Man #1: Stand your punk a-- up!
John Stossel: How would you like to be on the subway with this man?
Man #2: Sit down dude.
Man #1: You stood up. That's a threat.
John Stossel: Or this person? Or how would you have liked to have been in Denver the day this man terrorized people swinging this pipe at them, hitting some. Later he said, I didn't mean to hurt anyone. He only did this in self-defense, he said because he felt threatened. He was paranoid and he thought these people had been attacking him. DJ Jaffe gave up a successful advertising career to try to improve the way America deals with people like this man. In jail, later the man apologized. He said, Most of the disoriented and threatening people we see on the street are schizophrenics or people with bipolar disease who stopped taking their medication. They cycle in and out of hospital emergency rooms. And some are a danger to others.
DJ Jaffe: Russell Weston shot two guards at the Capitol because he knew there was a ruby red time reversal system in the basement and if he could get to that, he could save the world.
John Stossel: Weston wasn't taking his medication because he didn't believe he was sick.
DJ Jaffe: Almost all these cases are individuals who are known to be seriously mentally ill and not treated. Russell Weston was one of them, so was John Hinckley who shot President Reagan. John Hinckley shot Reagan because he knew, not thought, knew that was the best way to get a date with Jodie Foster.
John Stossel: Years ago, more mentally ill people were locked up in mental hospitals, asylums that protected us from people like these. But the asylums were horrible places.
Stephen Eide: They were overcrowded, very shabby conditions, so we decided we would largely replace that system with a system in which people would receive mental health care in the community.
John Stossel: Made sense. They'd be closer to their family perhaps, who could visit, be cheaper in the neighborhood, but that didn't happen.
Stephen Eide: Nope. The largest jail or prison is going to have a larger population of mentally ill people than the largest mental hospital.
John Stossel: Today, thousands of mentally ill people are locked up in Los Angeles County Jail, Cook County Jail, and Rikers Island in New York City.
Stephen Eide: You will find a much larger population of seriously mentally ill people in those facilities than you will find in any mental hospital.
John Stossel: The guards are not trained in handling mentally ill people.
Stephen Eide: A jail or a prison is no place for somebody with schizophrenia, however that's where they're going to remain.
DJ Jaffe: As hospitals went down, incarceration went up. And in fact, in the 1960's and you compare it today, there's virtually the same number of people institutionalized.
John Stossel: Just in jail instead of asylums?
DJ Jaffe: Absolutely.
John Stossel: And in jails, they barely get treatment and the mentally ill people in jails stay much longer.
DJ Jaffe: And they get abused, and they get victimized, and they get thrown in solitary, and they can't visit their families. It's a horrific place to be.
John Stossel: There could be better alternatives. America has some high-quality mental hospitals. Bellevue in New York City is world-famous, but Bellevue doesn't have enough money to give the extended treatment that most seriously ill people need.
DJ Jaffe: It has become harder to get into Bellevue than Harvard. If you're well enough to walk into a hospital and ask for care, they're gonna say you're not sick enough to need it.
John Stossel: If you are sick enough, as this man may be, hospitals often practice what Jaffe calls "treating and streeting."
DJ Jaffe: They discharge you sicker and quicker. It's basically treated and streeted is the new policy.
John Stossel: The police call it catch and release. Of course there'd be more money for treatment of the repeat offenders if government didn't promise something for everyone.
NYC First Lady Chirlane McCray: There's something for everyone.
John Stossel: In New York, Mayor Bill de Blasio appointed his wife head of a program meant to address mental illness.
John Stossel: Her program, Thrive, says 1 in 5 New Yorkers has a mental health condition.
NYC First Lady Chirlane McCray: Thrive includes 54 initiatives backed up by almost a billion dollars.
John Stossel: But most of that money goes to people who are not very sick, writes Jaffe and City Journal.
DJ Jaffe: They wrap anything that makes you sad, bad grades, poverty, coming from a single-family household, in a mental health narrative.
NYC First Lady Chirlane McCray: 1 in 5 New Yorkers have a diagnosable mental health condition in any given year.
Stephen Eide: Blurring the lines between various mild mental disorders such as anxiety or mild depression and schizophrenia is not a bug, it's a feature of the program. The program is supposed to do that because it believes that the only way that New Yorkers will support improvements to mental illness policy is if they are convinced that everybody has a mental illness.
DJ Jaffe: They're totally oblivious to the bigger problems.
John Stossel: “20% fight mental health woe.”
DJ Jaffe: If you have anxiety, you're in that 20%. If we're gonna spend all our money on people who are anxious or can't sleep, what's left for the seriously ill?
John Stossel: Not much. Thrive spends 80% of its money on problems like anxiety and loneliness. Money that Jaffe says would provide housing and basic treatment to more than half the seriously, mentally ill and homeless. Mental health professionals want to help people.
DJ Jaffe: No, they're focused on all the wrong things. If you ask any cop what we need he's going to say, we need more hospitals, we need easier civil commitments, so that when they bring somebody, they're admitted. We need to keep them on their medication so they don't deteriorate. Now I go to a mental health conference and they go, well we have to educate the public, and we have to fight stigma. The ability to get care has become inversely related to need.
John Stossel: Why?
DJ Jaffe: It's a much easier population to serve. They don't cost as much to help. Serving the seriously mentally ill is a really difficult task.
John Stossel: But let’s say America did focus care on the sickest people. What happens if they then stop taking their meds? You can't force them to take the medication forever.
DJ Jaffe: There are people who lack the maturity of their faculties, and as a kind and compassionate society we should be helping them get treatment, not helping them go further into psychosis.
John Stossel: 46 states now allow officials to order dangerous people into assisted outpatient treatment, which forces them to accept treatment, including medication. I would fear my government having the right to forcibly drug me. What if some psychiatrist doesn't like my politics? Maybe I'll get locked up.
DJ Jaffe: Nobody can lock anybody up without extensive court review. But being psychotic is not a right to be protected. It's an illness to be treated. Making someone accept treatment can free them from the bastille of their psychosis. It's a reasonable use of the police powers of the state to help people who can't help themselves.
John Stossel: Helping people who don’t help themselves before they hurt themselves, or others, and helping them without just locking them away, that would certainly be more compassionate than what we do now.
Stephen Eide: We tend to think of ourselves as a very tolerant society, certainly a very compassionate society. But a century from now, when people look at the situation with the seriously mentally ill people, they're going to look back on us and wonder how compassionate we really were.