Insane: America's Criminal Treatment of Mental Illness

by Alisa Roth

Overview

An urgent exposé of the mental health crisis in our courts, jails, and prisons

America has made mental illness a crime. Jails in New York, Los Angeles, and Chicago each house more people with mental illnesses than any hospital. As many as half of all people in America's jails and prisons have a psychiatric disorder. One in four fatal police shootings involves a person with such disorders.

In this revelatory book, journalist Alisa Roth goes deep inside the criminal justice system to show how and why it has become a warehouse where inmates are denied proper treatment, abused, and punished in ways that make them sicker.

Through intimate stories of people in the system and those trying to fix it, Roth reveals the hidden forces behind this crisis and suggests how a fairer and more humane approach might look. Insane is a galvanizing wake-up call for criminal justice reformers and anyone concerned about the plight of our most vulnerable.

Product Details

ISBN-13:	9780465094196
Publisher:	Basic Books
Publication date:	04/03/2018
Pages:	320
Product dimensions:	6.20(w) x 9.30(h) x 1.40(d)

About the Author

Alisa Roth is the mental health correspondent for Minnesota Public Radio and frequent contributor to various NPR programs. A Soros Justice Fellow, her work has also appeared in the New York Review of Books and New York Times. She lives in St. Paul, Minnesota.

Table of Contents

Introduction 1

Author's Note 13

Part I Ensnared: How We Got Here

1 Jail Is the Only Safe Place 21

2 The Largest Psych Ward in America 39

3 The Asylum Fallacy 73

Part II Locked Up: What Happens Inside

4 Jail as Hospital 97

5 Destined to Fail 111

6 Sanctioned Torture 131

7 Better Off Dead 151

8 Guilty by Reason of Insanity 175

Part III Breaking Free: Toward a Better Way

9 Inside Out 195

10 The Cycle 209

11 Shooting the Victim 229

12 The Good-Cop Solution 241

13 Disorder in the Court 259

Conclusion 269

Epilogue 283

Acknowledgments 287

Notes 291

Index 313

Editorial Reviews

…Alisa Roth has written a chilling book that argues that American jails and prisons have become de facto warehouses for the mentally ill…America has never quite known what to do with the mentally ill, and Roth argues that the latest solution—lock them up!—is the worst option of all: morally wrong, medically wrong and economically wrong…It's hard to read Insane without concluding that the way the criminal justice system has dealt with mental illness is profoundly broken, and that its flaws have led to tremendous anguish…[Roth] convincingly diagnoses the glaring inadequacies of mental health treatment in prison…but she is not out for scapegoats. In fact, she writes sympathetically about prison officials being asked to do difficult, specialized work for which they're woefully unequipped…Insane is rife with sharp, brutal details that pull the reader beyond the realms of abstract policy debates.

The New York Times Book Review - Sam Dolnick

★ 04/02/2018
Marketplace reporter Roth’s cri de coeur uses moving anecdotes of how the American criminal justice system treats the mentally ill to make the problem palpable. Roth provides a deeply disturbing synthesis of her research, both academic and in the field, including conversations with professionals, and the mentally ill, to show how despite the increased understanding of mental illness over the last two centuries, and apart from the development of more effective medications, “we continue to treat people with mental illness almost exactly as we did before electricity was invented.” In one of the more unsettling examples, a businessman and former firefighter with bipolar disorder was arrested for indecent exposure after he stripped naked in the hallway of a hotel when he was unable to open the door to his room. Later, when he turned violent, correction officers with no access to his medical records or understanding of the care he needed put him in solitary confinement. Roth proposes sound alternatives, such as San Antonio’s investment in a 24/7 crisis center devoted to keeping people with mental illness “out of the criminal justice system and into effective treatment.” Roth strikes a powerful balance between big picture analysis and individual stories to make this searing account of America’s misguided treatment of the mentally ill hard to ignore. (Apr.)

Publishers Weekly

"Chilling...Roth writes movingly of the human toll of incarceration...She convincingly diagnoses the glaring inadequacies of mental health treatment in prison but she is not out for scapegoats...Insane is rife with sharp, brutal details that pull the reader beyond the realms of abstract policy debates."—New York Times Book Review

"This essential exposé, which includes tragic case histories, tells of legions of prisoners put in solitary confinement or subdued with medication...At the heart of the problem, Roth notes, is the changing landscape of mental-health care."—New Yorker

"Superb...Roth stresses America's failure to provide the vital community mental health services first promised in the Kennedy years...Some of the most revealing sections of Insane deal with the officers who patrol these wards...Burnout is inevitable."—New York Review of Books

"Roth got rare access, including at mental health units inside the Los Angeles County Jail and a women's prison in Oklahoma, and dove deep into the stories of a handful of individuals whose florid mental illness led them to prison, was badly managed and resulted in awful outcomes...[She] navigates it with grace."—Marshall Project

"Alisa Roth's powerful new book...calls into question such simplistic solutions to the current crisis in our mental health-care system...Based on in-depth interviews and observations, the book provides revealing snapshots of conditions at New York City's Rikers Island, the Los Angeles County jail, and Chicago's Cook County jail, the nation's de facto three largest mental health-care providers."—Democracy Journal

"50 percent of the mentally ill go untreated-half of them because they can't afford it...The place where the poor are likely to get treated, if anywhere, is prison...With an eye not toward shaming but toward progress, [Roth] gestures at solutions."—San Antonio Express-News

"Powerful, heart-wrenching...A summons to action to correct a system that inflicts needless suffering on people in custody."—Time Free Press

"Deep, broad and well documented. Roth has provided an eye-opening book about mental health care in the U.S."—Missourian

"A searing exposé about the criminalization of mental illness...Though the subject matter dictates that much of the book is relentlessly depressing, the author is such a talented information gatherer and fluid stylist that the narrative becomes compulsive reading. An eye-opening book that cries out for change."—Kirkus (starred review)

"Roth strikes a powerful balance between big picture analysis and individual stories to make this searing account of America's misguided treatment of the mentally ill hard to ignore."—Publishers Weekly (starred review)

From the Publisher

★ 2018-01-22
A searing exposé about the criminalization of mental illness that features a simple underlying theme that a society attempting the same disastrous policies over and over but expecting a different outcome is where the actual craziness resides.Former Marketplace reporter Roth goes broad and deep, first explaining why the United States has never devoted adequate resources to dealing with its millions of mentally ill inhabitants, then using case studies to demonstrate why incarcerating the mentally ill in jails or prisons often makes no sense and does more harm than good. Because compassionate, well-trained, readily accessible professionals are unavailable to most severely mentally ill individuals—those with schizophrenia and/or bipolar disorder especially—when those individuals appear as threats to themselves or others, the first responders are usually police officers or others unequipped to deal with such situations. Too often, Roth explains, encounters between the mentally ill and armed police result in serious injury or death. As for the mentally ill who survive such encounters, their incarceration without medical treatment is quite likely to result in the worsening of the disease, until no amelioration seems possible or suicide results. Although Roth expresses pessimism about the future of mental illness treatment—especially when poverty and race and lack of education enter the equation—she shares rare positive examples of community-based care that is adequately funded as well as the laudable work of a few law enforcement agencies mounting sincere efforts to treat inmates humanely and effectively. In the instances where an incarcerated mentally ill individual enters an actual courtroom, Roth explores how judges can aid in solutions rather than compounding an already fraught situation. Though the subject matter dictates that much of the book is relentlessly depressing, the author is such a talented information gatherer and fluid stylist that the narrative becomes compulsive reading.An eye-opening book that cries out for change—but can policymakers show the resolve to make that change?

Kirkus Reviews

06/01/2018
As reported here by veteran journalist Roth, mental illness affects more than half of the inmates in U.S. prisons, and mass incarceration has aggravated the problem. As a result, correctional facilities have become mental health providers by default, exhibiting many of the poor conditions and abusive aspects of mental asylums of the past. Roth mines an impressive array of interviews, case studies, official records, research, and statistics to support this view. The book is organized around the process of criminalization. Initial chapters discuss how and why the mentally ill are easily drawn into the criminal justice system, including a history of U.S. mental health care. The following section evaluates how correctional facilities provide such care, concluding that failure is inevitable in a security-based, low-resource environment. Finally, the author details reasons for the revolving door that tends to pull mentally ill offenders back into the system. The work concludes with specific ideas for reform. As a broad national survey, it complements similar but more locally focused volumes such as Elizabeth Ford's Sometimes Amazing Things Happen. VERDICT Gritty and fact-filled, this passionate book will enlighten general readers about a vulnerable population in a dysfunctional justice system.—Antoinette Brinkman, formerly with Southwest Indiana Mental Health Ctr. Lib., Evansville

Library Journal