Insane

February 1, 2018
A searing expose 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?

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Starred review from April 2, 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.

June 1, 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

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