Oliver: Slow revolving door of mental illness, addiction, incarceration
By Malcolm Oliver, Alexis Villegas and Crawford Coats
The Centers for Disease Control and Prevention report that alcohol, drugs and suicide claimed more than 150,000 lives in 2018.
To put this number into perspective, that’s more than twice the number of American soldiers killed in Vietnam.
The Central Coast is not immune to the revolving door of mental illness, addiction and incarceration. Despair, it seems, is trending, even here.
Consider our most vulnerable populations. In 2018, there were 1,299 people counted as homeless in Ventura County, with 213 identifying as substance users, 228 identified as mentally ill and 230 identifying as recently released from prison or jail.
This population — those suffering from serious mental illness, addiction or recent incarceration — poses a challenge to our social service resources and represents the face of a broader malaise as evidenced by the numbers above.
How do we get a handle on it?
Reports to the police regarding the mentally ill and substance abusers are often so-called disturbance calls for things such as urinating in public, playing loud music or sleeping on sidewalks. They make up a large portion of calls for service.
Once on scene, officers assess the situation and refer individuals to services, issue citations or transport the individuals to jail or the hospital as needed. The immediate goal, naturally, is to make the disturbance go away.
This is the public safety response to a public health challenge.
Framing this issue as a public health challenge allows us to take a longer view of the consequences of untreated mental health.
The city of Ventura has a progressive police department that has trained approximately 40 percent of officers and 25 percent of dispatchers on crisis intervention. These efforts, coupled with those of Ventura County health, fire and emergency medical services, park ambassadors and the nonprofit community, make a tremendous impact on thousands of lives annually.
But just beneath the surface, a crisis is evident. For example, the cost of incarceration in California has risen 58 percent in the last decade, to approximately $81,000 per prisoner per year, according to the Legislative Analyst’s Office.
Those prisoners taking psychotropic medications for mental illness — often the most expensive to house — have increased by 25 percent, according to a brief by California Health Police Strategies.
Jails and prisons, it seems, have become our de facto mental health care providers for the most at-risk in our population.
This is a grand departure from the humane and reform-minded approach Alexis de Tocqueville noted on his journey to America in the early 1830s.
We must acknowledge that the revolving door is not just about public safety, but also about public health.
Mental illness and substance abuse are stigmatized and too often preclude honest discussion and treatment. According to the California Department of Health Care Services, 101,087 people in Ventura County (13 percent of the population) require general mental health care services, while 37,192 (5 percent) suffer serious mental illness.
A person in acute mental crisis will at times act criminally. But that person has very often exhibited signs of mental illness prior to the catalyst event.
We should learn from cities like Houston, where police have had a dedicated mental health division since 1992 that builds relationships throughout the community.
Further, assisted outpatient care costs a fraction of incarceration, and it’s generally better for the community.
Finally, too often a criminal record is a disqualifier for employment.
The assumption has been that an offender is a criminal liability to the business. On the other hand, it might be a treatable, and treated, mental health issue. Gainful employment builds esteem and social connections.
The Central Coast is a beautiful place to live. But nowhere is immune to the costs of untreated mental illness and substance abuse disorders.
This is a dark time for many in our communities, and all of us, especially those in the civic community, have a role to play in getting through it.
• Malcolm Oliver, director of the Master of Public Policy and Administration Program at California Lutheran University, was assisted by two MPPA students — Alexis Villegas, research analyst at Ventura County Behavioral Health, and Crawford Coats, author of “Mindful Responder: The First Responder’s Field Guide to Improved Resilience, Presence, & Fulfillment — On & Off the Job.”