Real reform overdue at your public library

Urban public libraries across America are experiencing the inevitable consequences of a mental health system that is broken. There are more than 200,000 people in our nation today who are homeless and have a severe mental illness such as schizophrenia or bipolar disorder. On cold days, many of these people will seek shelter at the local public library.

At Ekstrom library on the University of Louisville campus, students compete with the homeless to get on computers. As one student observes, “If the homeless are using property reserved for paying U of L students, then something needs to be done about it.” However, according to library staff, unless the homeless person is causing a disturbance, they are usually left alone.

Chip Ward described the disturbing conditions at the Salt Lake City public library in his poignant op-ed last year.

“People mumbling to themselves, shouting obscenities, and poking nails into celebrity pictures are just some of the problems encountered. Ward observed, “Like every urban library in the nation, the City Library, as it is called, is a de facto daytime shelter for the city's "homeless."

“Homeless” is indeed a misleading term because it clearly focuses on the wrong problem. Most people who remain on our streets over a long period of time do so not because they lack the means to find housing. Rather, up to 70 percent of the homeless are struggling with a serious mental illness, and for them providing housing without treatment is pointless. Remember Nathaniel in California?

Sadly, the general contempt for those who are homeless will only grow as our system continues to ignore the underlying problem. The real solution to this problem will not be found in new library policies. It will be found when our mental health system assumes responsibility to care for people who have mental illnesses so severe they don’t understand they are sick.

Keeping children safe

As a community tries to understand the shocking deaths of three children at the hands of their own mother, today’s Deseret Morning News reports on the link between severe mental illness and filicide:

In the medical community, the practice of parents killing their children is known as filicide. A study printed in a 2005 Journal of the American Academy of Psychiatry and the Law article found about 2 percent of homicides are filicides.

Another study found about 40 percent of filicidal parents previously had been treated for psychosis, but about 75 percent likely were suffering from symptoms of mental illness.

While people who are being treated for their severe mental illness are no more violent than the general population, those who are not properly treated for their symptoms do pose a greater risk to themselves, others and, sadly, even their own children.

Librarians as mental health care providers?

Nationwide, more than 200,000 people living on the streets have severe mental illnesses. And, at any given time, there are more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals. Since these people aren’t receiving treatment, the burden of care falls on groups other than the mental health community. As Chip Ward explains in an op-ed in the LA Times, librarians are one of those de facto care groups.

So where are we to turn for help? Social workers are too few, under funded, overworked and overwhelmed. If a homeless guy is inside the library, then the view is, "Hey, mission accomplished."

Local hospitals also are uncertain allies. They have little room for the indigent mentally ill and often can't get reimbursed for treating them. So they deal with the crisis at hand, fork over some pills and send them on their away.

The cost of this mad system is staggering. Cities that have tracked chronically homeless people estimate that a typical transient can cost taxpayers $20,000 to $150,000 a year. You could not design a more expensive, wasteful or ineffective way of providing healthcare to individuals who live on the street than by having librarians dispense it through paramedics and emergency rooms.

"I'm the face of a thousand people behind me just crying for help"

One mother in Utah has tried to help three of her adult children get the treatment they need. But what does it take to get them that treatment?

For these three siblings, the answer was murder, a suicide attempt, and an arrest. Two of the three are now receiving treatment in prison.

In 2005, nearly 1,300 people deemed "seriously and persistently mentally ill" were booked into Salt Lake County Metro jail. To incarcerate, assess and treat this population would cost the county more than $7.3 million.

That's just one jail system, and doesn't account for the human costs, said [Sherri] Wittwer [of NAMI Utah].

"What a difference it would make, for the individual, the family and the community, if we intervened earlier."

Waiting for competency - for 23 years?

Almost 10 months after he allegedly killed his brother, Eryk Drej has been declared competent to stand trial in Utah.

It took almost 10 years for Joseph Guendulain, accused of killing his roommate, to be found competent to stand trial in Washington state.

Carolyn McDonald spent 23 years in an Indiana psychiatric facility waiting to be found competent to stand trial for the murder of her sister – she pled guilty and was finally sentenced this week.

Which is the greater burden on civil liberties and society?

#1. Society does nothing until someone who is psychotic commits a crime, then we lock them in a hospital - or a jail cell - until they are deemed competent to stand trial. Sometimes that takes years, sometimes decades. It is all on the taxpayers’ dime, and all contingent on the person first deteriorating enough to commit a crime to trigger the whole process.

#2. Society court-orders someone with a severe mental illness who meets very specific criteria to receive treatment in the community, before a crime is committed. They stay out of an institution. They get the treatment they need. They can be restored to the point of again making informed treatment decisions. They get their life back.

Tools to help?

The Mentally Ill and the Criminal Justice System: A Review of Programs (Paul W. Spaite and Mark S. Davis, June 2005) offers an overview of tools that have emerged to deal with mentally ill people in the community – like Crisis Intervention Training (CIT) and mental health courts.

The authors note that one of their goals is to “persuade communities that have not yet adopted programs to deal with their difficult-to-treat population, to do so.” [In fact, author Paul W. Spaite would like to hear from anyone who knows of similar activities.]

Many are trying ...

• Creating a mental health court (La Crosse County, Wisconsin)
• Training cops for the mentally ill (New Utah, Utah)

Because something must be done ...

• Too soon to judge, not too soon to learn (Albuquerque, New Mexico)
• Air marshal shooting sad, but not surprising (Miami, Florida, incident)