Approximately 15 percent of men and nearly a third of women in U.S. jails have a serious mental illness, according to the Vera Institute of Justice, and rates of serious mental illness in state prisons are two to four times higher than among the general population. The justice system is not a good substitute for mental health care, but it has become the provider of last resort, the report said.
In a new book, “While the City Slept,” journalist Eli Sanders puts a human face on the issue of public mental health at a time when it is being debated in conjunction with both mass shootings and police violence, illustrating how a neglected system has failed some of the people most in need of help.
Sanders traces the personal and family lives of three people: Isaiah Kalebu, a troubled young man with severe, untreated mental illness, and Jennifer Hopper and Teresa Butz, whom Kalebu assaulted in Seattle in the summer of 2009, killing Butz and injuring Hopper.
Sanders, now associate editor of The Stranger, said he hopes his book will help readers understand and feel ownership of the country’s broken public mental health system and motivate them to call for reform.
Sanders’ coverage of the Kalebu trial for The Stranger, a Seattle weekly, won a Pulitzer Prize for reporting in 2012. He spoke to the Deseret News about the trial, the history of the public mental health system in the U.S., and the healing Hopper has found in the years since the tragedy.
This interview has been edited for length and clarity.
Deseret News: You write that prisons are the new mental institutions. Walk us through the history of how that happened.
Eli Sanders: It's painfully ironic. Much earlier in this country, we just incarcerated the mentally ill. Then when the shameful conditions of the prisons where they were housed were exposed, the movement for publicly funded mental hospitals began.
But then in the 1950s, it became clear that people were being sent to these mental hospitals for no good reason. They also weren't being well treated there.
So under the John Kennedy administration, the community treatment movement began. The idea was that people could live with mental illness and be integrated into their communities and receive community treatment that was funded at public expense.
The problem is that in the decades since, funding commensurate to the need never appeared. For decades we have neglected our community treatment system, and when people have fallen through those cracks, they have often ended up in the prison system for committing crimes that are really at the root connected to the person's psychological disturbance.
It's important to say that the vast majority of people who live with mental illness are nonviolent — in fact, they are more likely to be victims of violence than perpetrators. The most common outcome is chronic homelessness, or people lapsing into drug addiction who are self medicating in an attempt to deal with their disturbance, or just grinding pain for family members who don't have money for great mental health treatment and are trying to help a loved one but can't.
DN: Teachers, caseworkers and family members all knew Isaiah Kalebu was at risk, but he never got the help he needed, in part because his family lacked resources. Does the lack of diagnosis and treatment occur disproportionately among the poor, and does that affect how we address it?
ES: We now have 10 times more people in our state prisons and jails who are mentally ill than we do in our publicly funded mental health hospitals in this country. That is a staggering figure.
We also know that we have disproportionate incarceration rates. You can take those two data points and pretty well assume that yes, the needs of lower-income Americans — many of whom are racial minorities — are not being met when it comes to the need for mental health treatment.
This is not a new problem. Many presidents have known about this for decades. The Obama administration recently declared that our public mental health system in this country is in a state of crisis. The president is arguing for $500 million for the public mental health system in the context of combatting gun violence.
DN: You note that funding for the public mental health system has been slashed. Why is it hard to make a case for funding prevention?
ES: Nationally, in the wake of the great recession, more than $4.3 billion have been cut from state mental health budgets. In Washington state, which is a microcosm of this problem, in the years that Isaiah was on his descent toward these crimes there was a $23 million cut to the state's mental health budget.
In this book I tallied up the cost — the cost to Teresa's family, the cost to Jennifer, the costs to Isaiah Kalebu's family. Those costs are incalculable. But if we want to talk in taxpayer dollars and cents, which is how we frequently talk about things in our current politics, then let's do that for a moment.
The cost of incarcerating Isaiah Kalebu while he was awaiting trial; trying him at public expense and paying for his prosecution with public money; paying for his defense with public money because he was too poor to afford a lawyer; paying for his appeals; and now incarcerating him for life — that's all going to cost Washington taxpayers more than $3 million. It would not have cost more than $3 million to have tried to intervene or arrest his slide early.
But it's sometimes hard to make the case for prevention. A politician can't do a ribbon cutting on prevention, because by definition, if you have invested correctly and prevented bad outcomes, you don't have a bad outcome to point to. You can't, like you would with a bridge opening, point to a bridge and say, “Your tax dollars built that.”
DN: When did you know you wanted to write this book?
ES: In 2011, after the trial at which Jennifer Hopper, the survivor of this crime, testified bravely and beautifully in terms of recounting what was lost.
I began to look around and see that in every direction, there were people whose paths had important lessons to teach. Jennifer and Teresa's grace in following their paths; Jennifer's path forward which has taken her on a road toward increased forgiveness for Isaiah and curiosity about his path — which is just amazing and inspiring; and then the path of Isaiah Kalebu, which very starkly shows serious failings in our criminal justice and mental health systems that need to be addressed.
DN: Talk about Jennifer’s path forward and the forgiveness she's found.
ES: It's remarkable and inspiring. In her discussion of her forgiveness, she says it grows over time. She also says it is a particular kind of forgiveness. It doesn't excuse what he did. It's in large part about her finding a good equilibrium and lessening the weight of what she's carrying.
Another inspiring aspect of Jennifer's path is her involvement with the Angel Band Project, something Teresa’s friends and family, who are very musically inclined, and Jennifer, who is a conservatory-trained singer, created in the aftermath of these attacks. Their intent was to make something purposeful and useful out of such a terrible tragedy, and they have.
They have created and sold albums, they have put on beautiful fundraising concerts in Seattle and St. Louis, where Teresa was originally from, and they have raised money through those concerts to help survivors of sexual violence through musical therapy. It's really wonderful, purposeful work that they're doing.