“Well, let’s face it, Joan . . . ”

The Criminalization of Mental Illness

March is National Criminal Justice Month and the disturbing matrimony between mental illness and our criminal justice system is at the forefront of my mind.

Last Sunday I had another visit with Chase at the Iowa Medical & Classification Center (IMCC) in Coralville where he’s imprisoned in the special needs unit (also sometimes called Oakdale), which houses inmates with serious physical conditions and mental illnesses. During our visits, I frequently see inmates in the visiting room I recognize from major Iowa cases—men who I know from news reports have a history of undertreated serious mental illness and are now serving long sentences in Oakdale for major crimes, a few for murder like Chase. But more often than not, Chase mentions fellow inmates with SMIs who are serving short term sentences for what I call a “pile up” of lesser charges. Disorderly conduct, loitering, trespassing, disturbing the peace, shoplifting, petty theft, unpaid court fees and fines, and violation of parole.

 Mental illness and the criminal justice system have become inextricably linked and I see evidence of this toxic relationship constantly. My visits with Chase, emails and phone calls from family, friends, acquaintances and strangers asking for advice for a loved one with an SMI who is in jail or worse, heading to prison.

My friend and fellow advocate Leslie Carpenter recently mentioned this topic in a Facebook post where she said, in part, “We take calls from folks on a pretty frequent basis . . . most often family members looking for help for their loved ones with SMI. The calls break my heart. It is so very hard to find the resources to help folks. But we try . . . But the worst ones? The ones that involve a loved one with SMI who has already gotten so sick they are involved in the criminal legal system. Why are they the worst? Because then, there is very little we can do to help. Believe me, I have tried.”

I felt her statement in my bones.

She went on to reference an excellent but disturbing article by Jennifer Zarour for the Law Journal for Social Justice that mentions the heartbreaking case of a young man in Arizona with an SMI who churned through the medical and legal system for years, before dying by suicide after only thirty hours in prison where he’d been placed in a standard cell without supervision or psychiatric accommodations.

In the article Zarour states what me, Leslie, and so many others see every single day:

“The legal system has effectively criminalized mental illness due to the lack of resources and psychiatric capacity of hospitals to handle SMI individuals.”

In March 2023, the National Library of Medicine (part of the NIH) published the article “Psychiatric Illness and Criminality,” which says, “A far-sighted national mental health policy with expanded availability and access to treatment, while costly in the short run, could be a cost-effective and sensible approach. By some estimates, a ninety-day treatment in a mental hospital might prevent the 10-year imprisonment of an individual with mental illness. . . .”

But here in Iowa, we’re clearly still operating with the attitude that jails and prisons will fill the gaps in mental healthcare, and that attitude has persisted since former Governor Branstad closed two of our four state mental hospitals in Mt. Pleasant and Clarinda in 2015. His reasoning at the time was the facilities represented an outdated way of institutionalizing people with mental illnesses, and that private agencies could provide the same services more effectively and efficiently. Though, he closed them before ensuring adequate replacement services were available.

Photo of prison inmate on suicide watch. Credit: Jenn Ackerman

After a young man named Mark Becker, in the grips of psychosis from undertreated schizophrenia, shot and killed popular Aplington-Parkersburg coach Ed Thomas in 2009, Becker’s mother Joan became an early voice for mental healthcare reform in our state. She was able to get a thirty-minute audience with the then-governor to tell the story of her family’s devastating struggle to get Mark adequate treatment for his increasingly serious illness. At the end of that meeting, Branstad famously told her, “Well, let’s face it, Joan, it’s so much cheaper to get them the help and supervision they need in prison.”

He closed the two state hospitals just a few years later.

What he said to Joan Becker, in essence, was that it’s cheaper to deal with mentally ill individuals after they’ve committed a crime. After they’ve become so sick they wind up homeless on the streets, after they cause damage to other people’s property, or create public nuisances, or engage in assaults, or, in extreme cases, commit murder.

In a 2016 Des Moines Register interview, journalist (and now fellow IWC member) Daniel Finney interviewed a writer named David Rosheim about his three-volume comprehensive history of Iowa’s four state psychiatric hospitals. Rosheim said at the time, “Before the hospitals [were built starting in 1861], the mentally ill were either put in jail or they were left to wander the streets.” But after the sweeping changes to state mental healthcare systems in the 1960s that still persist today, misguided policies sought “to break up the hospitals in favor of community mental health centers that would treat mental health patients quickly. The planners of this . . . did not take into account that large numbers of the state hospital patients had no place to go when released, that large numbers of the patients were too impaired to understand their illness and the need for medication and that some patients were really too dangerous to release.”

Even in 2016, Rosheim worried that the closing of two of Iowa’s four hospitals would turn back the clock on the public progress that began more than 150 years ago, when the Mt. Pleasant hospital first opened.

Spoiler alert: it has turned back the clock to 1861. Our most serious mentally ill citizens are once again frequently put in jail or left to wander the streets.

Rosheim concluded that interview by saying, “Gov. Branstad has always said that he wants to run Iowa like a business, which is another [example] of an ideology unreflective of reality. The question should be asked, ‘Save money for what?’ Is not one of the reasons for public money to improve the situation of helpless fellow citizens and care for them and heal them?”

After yet another visit last weekend to Oakdale, I can assure my fellow Iowans we’re not “saving” any money with hospital closures and this stubborn insistence on community-based care. We’ve merely shifted expenses to our jails and prisons, as Branstad said, but with an even steeper secondary cost: human lives. ~

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I’m a proud member of the Iowa Writers’ Collaborative. We’re a group of writers from all around the state and contribute commentary and feature stories of interest for those who care about Iowa. Readership and paid support helps keep us going!

A few of my favorite Iowa Writers’ Collaborative Columns:

The Paragraph Stacker by Daniel Finney

In the Dirt by Beth Hoffman

Iowa Politics With Laura Belin