This article first appeared in the St. Louis Beacon, Jan. 7, 2013 - We already have a safety net mental health care system in the United States.
It’s called incarceration.
“I am Adam Lanza’s Mother”: A Mom’s Perspective on the Mental Illness Conversation in Americahas gone viral. In her short article, Liza Long recounts her son’s social worker’s advice that to “get something done,” her son needed to be charged with a crime. Jail was the only option.
For the past 12 years, I have worked with the St. Louis County Department of Health as the medical director for corrections medicine. My patients are incarcerated teens and adults. While many of them are there by no fault of their own, many have done terrible things. Some continue on to prison after convictions in court; but most soon return to their communities.
When I see my kids at Detention, I find that many of them are like the apples that haven’t fallen far from the tree. They learned to drink and drug from their parents and guardians. Many have been pimped out by parents. Some see guns, knives, bullying and beatings as unremarkable, or even expected. Other kids in Detention have no clear cause for their illegal behavior. They come from apparently stable families, with successful parents and siblings — people often stunned by the behavior and the situation.
Many kids are mentally ill; however, many are not. Learned behavior is not the same as mental illness. Making poor choices that violate the rights and lives of others may be contrary to human flourishing, but it is not necessarily mental illness. One may reinforce the other, but we as professionals and we as a nation, shouldn’t attempt to over-simplify a complicated situation. And my patients are complicated — and lethal.
One teen, along with his mother, opened fire on an unarmed group of classmates who bullied him in his front yard. A 12-year-old assaulted and left for dead a 6-year-old girl. Countless have brought guns to schools with documented intentions of using them on classmates. All have seen health-care providers before they came into my care. Most have had access to mental health professionals. And many have been on psychotropic medications.
If I had Adam Lanza to examine, I would not know what went wrong in him to bring him to the Detention Center. It may have been a bad chromosomal mix or perhaps some kind of fetal insult during development. Maybe his behavior was a result of external influences of his home or neighborhood. Or his chemistry was off. It could have been all of the above.
What I would know if Adam Lanza had come to me, however, is that, as a child, he did not aspire to be incarcerated. No one does. He was someone’s baby, someone’s student, and someone’s patient. But something went terribly wrong in him. And now he’s my patient.
My kids, ironically, are often in the best place they can possibly be when they are in Detention. The Eighth Amendment to the Constitution guarantees the incarcerated a right to health care; I am part of those safety net services. They have their basic needs met, they have structure and support of staff invested in their well-being, and they have access to mental health professionals and, when appropriate, to regularly administered medications. They can access care and have people on their side who can help them tease apart the situations and conditions that surrounded their admissions. For some, I know that being in our facility is the closest they will ever be to flourishing.
Ironically, all things considered, my patients are the lucky ones — they have been incarcerated. And in Missouri, their chances are improving. As the Annie E. Casey Foundation report “The Missouri Model: Reinventing the Practice of Rehabilitating Youthful Offenders” states: “Missouri’s excellent results, described in detail in this guide, speak for themselves. They produce far lower recidivism than other states, an impressive safety record, and positive youth outcomes — all at a modest budget far smaller than that of many states with less-enviable outcomes.”
Jails and prisons should not be our safety nets. As a nation, we need to address the ironies of this medical, legal, and moral situation. Clearly, our current system provides too little, too late. Mothers such as Liza Long should not have to consider incarceration as a therapeutic intervention for her child. We have resources, we have models, and we have public outrage.
I could have been Adam Lanza’s doctor. Maybe if I had been, the tragedy at Sandy Hook Elementary would not have happened. And, on so many levels, that is another tragedy.
Fred Rottnek is also an associate professor in the Department of Family and Community Medicine at Saint Louis University.