Introduction to Bottom Line Mental Health Care Needs Reform

Dealing with mental health today. We are in the final chapter of this series: “Bottom Line Mental Health Care Needs Reform” As we can see, the United States and even the world do not provide an excellent job of caring for the mentally ill. 

First, we have to understand that the term “Mentally Ill Person” encompasses a vast array of labels. The WHO World Health Organization provides a few helpful facts:

Key facts
1 in every 8 people in the world lives with a mental disorder

Mental disorders involve significant disturbances in thinking, emotional regulation, or behavior

There are many different types of mental disorders

Effective prevention and treatment options exist

Most people do not have access to adequate care

Here are a few of the types of Mental Illnesses:

Anxiety disorders

Behavioral and emotional disorders in children

Bipolar affective disorder


Dissociation and dissociative disorders

Eating disorders

Obsessive-compulsive disorder


Post-traumatic stress disorder



Looking at the list, we can see some things that you may laugh at and say, “Well, hell, I have that. It’s not a mental illness, “but yes, it is. 

Society sees people with mental illness as different and not a part of society. They are “not like you and me,” so they are shut out from being a part of “normal society.” Let’s look at what happens to someone with a mental crisis. 

An example of a mental crisis 

Police are called to a location because of a young man causing a disturbance. First, the officers arrive on the scene, find the young man, and start to try and figure out what is happening. They received very vague information that a young man was causing a disturbance. That is all they know. 

The young man just wants to leave. He keeps repeating he wants to leave. Bystanders are saying, “he’s crazy. He’s been threatening everyone,” One of the officers tries to stop him from going, and the young man pulls away. 

Now both Police Officers grab the young man. Now the young man starts to resist. The officers call for backup. The young man is now yelling, “No, no, no, I have to go home!” 

The Police are now restraining the young man. Both officers are on top of him. The young man is now trying to push the officers off him, and you can hear backup arriving with lights and sirens blaring at the scene. 

At this point, one of two things will happen the arriving officers will now all jump on the young man. The young man will go into full combat defense mode to escape and fight with the officers until exhausted. The officers will continue to hold him down, waiting for him to exhaust his energy. 

The second thing that could happen is the young man will escape restraint by the officers and run. All the officers will pursue him, and once they seize the young man, he will be in full resistance as he is taken to the ground. 

Ok, several problems; the young man’s mental illness issues include anxiety disorder, bipolar disorder, paranoia, and PTSD. He can’t handle large crowds. They overwhelm him and make him panic. The sights and sounds, flashing lights and sirens, and the officers shouting and even conflicting orders only worsened the situation. The young man feels even more threatened.  

The first problem for any person with a mental illness is that they deal with it daily, but society does not. Society does not know how to deal with these situations. 

The mentally ill person knows that their coping skills are not advanced enough to handle this situation as it unfolds and may or may not be adequately medicated. 

Things are moving too quickly, and their heart is pounding louder than the sounds that they hear. They just need a moment to start to process what is happening around them. 

It is my guess you or I could not manage this situation any better. But because the people around him have already labeled him a threat to normal society, they now want to remove him from society’s view. 

Altercations and Statistics

In one such case reported by UPI News, a man was restrained face down on the ground, and when finally handcuffed and the officers moved, he was unresponsive and later died. However, The coroner’s report states cause of death was a medical crisis. Please read the story and decide for yourself. 

The Los Angeles Times reports a 58-year-old man was declared incompetent to stand trial in March 2001. With a lack of proper treatment by the facility due to overcrowding, he was left in Jail for more than a year. 

In another case, it is reported in CalMatters that in four years, one mentally ill inmate was transferred 39 times until the pandemic hit and his movement stopped. Seven months later, he was dead. 

On the last day of Adam Collier’s life, he had breakfast in his cell in Kern Valley State Prison. He made two letters, one to his mother and the other to a guard that would later find his body. 

On October 17th, 2020, He committed suicide. Despite the many transfers, he had never been placed in a proper treatment facility due to poor documentation of his mental history. 

It is estimated that in April 2020, 1 in 8 California prisoners had a diagnosed mental illness, and in 2022 that number increased to 1 in 3. 

According to Arkansas Times, a mentally ill Ft Smith man charged with domestic terrorism for pointing finger guns at Police was placed into Sabastian County Jail. 

He was in solitary confinement for more than a year because he could not pay a $100 bail bond. He ate his feces, drank his urine, and showed other signs that his mental health was spiraling out of control and needed help, but nothing was done. 

He dropped from 185 pounds to 90 pounds in 12 months. He was found unresponsive on the floor of his cell in a pool of toilet water and urine. 

A statistic that absolutely shocks and appalls me that was issued by The Treatment Advocacy Center reports that people with mental illnesses are 16 times more likely to be killed in an altercation with Police. And you can research for yourself. There are many such cases reported all over the United States. This does not include deaths that are reported after incarceration. 

Mental Health Care and incarceration 

As the examples above show, it is easy to be placed in Jail, but it doesn’t have to be someone combative. It could be a happy, confused person. When I was with the agency, we often had calls where we would meet a very nice person who was just unable to remember things and very confused. 

They may have been talking with other people that we couldn’t see. We would ask basic questions like “where do you live?” “What is your name?” but they had no answers for us. 

So we could not leave them alone because someone had already complained or reported them to the Police, so we would have to take him in for “evaluation.” 

The second problem mentally ill people face is that the Police deal with them. Often, these people with mental illnesses are not taking their medications correctly or at all, which seriously compounds the issues. 

But what I believe is the most severe issue that mentally ill person faces is that Police are not adequately trained to deal with them. They are not given the tools they need to communicate, de-escalate or sufficiently deal with the mentally ill person that requires extra time and patience to process a police encounter to a peaceful, non-violent outcome. 

It may sometimes inevitably end in some type of confrontation. Still, if the officer doesn’t have the knowledge and know-how to communicate with the mentally ill person, the encounter will almost always end up in a confrontation, as mentioned above, 16 times more likely to end in death. 

The Atlantic says that most departments don’t provide enough training because they report they can’t fit it in the budget or can only train a few specialized officers in intervention. 

This is just one source, but there are many sources that the department has many excuses for lack of training for an issue that is more of a daily occurrence than once in a great while situation. 


From the previous scenario, the mentally ill person has now had altercations with the Police, is in custody, and will not be transported to Jail.  

This now leads to problem three. Once in Jail, they are processed, which is not a very enjoyable procedure. They are placed in a cell with 1 to 10 prisoners, depending on the Jail. 

One by one, they are pulled out and put into an intake office for around 30 minutes of questioning and then removed and stripped of all clothing; all personal items are processed and placed into property bags. The inmate is then cavity searched and made to shower in an open public shower with a de-lice soap. 

They are given a small towel to dry off and issued prison shirts, pants, and rubber sandals. They have been given a sheet, pillow, and blanket as long as they are not deemed harmful to themselves, which is a whole different story altogether. Once that humiliation is done, they are set to see a nurse who will evaluate them and then recommends and document any medical or psychological issues. 

If the inmate is deemed unfit for the general population by the nurse or any officer during the intake process, the Jail will have to house him in a specialized cell block or in solitary if it is for some psychological issues, a doctor will have to evaluate him and clear him to be put into the general population. 

If, during the intake process, the inmate is combative or uncooperative. It is noted and reported to the Judge at their first appearance.

What is the first appearance? 

All inmates must see a judge within 24 hours of being taken to Jail. 

This is the process of setting bail or determining if the inmate can be released on his own recognizance. 

All inmates taken in on any day will go to their first appearance the next morning. The Judge will examine the inmate’s case and the officer’s reports. 

Then he will look at the Jail reports, including the nurse’s determination, and if the inmate comments on the information about possible mental illness issues. 

The Judge will then say that he needs to be evaluated to determine if his mental illness will allow the inmate to defend themselves or assist in the process of defending themselves. 

Mental Health Care and the prison system 

For example, the Oregon County Register reported that a young man died in Jail after several months in Jail waiting to be evaluated. 

Cal Matters reported on a young man in Jail for nine years waiting for evaluation for a murder case that never even happened. These are not isolated incidents. 

These are only two examples of the hundreds or thousands of examples available for you to research. Jails are overcrowded. We hear this every day on the news but what we don’t hear about are the mentally ill that is irresponsibly placed in these facilities that have not been afforded their rights of a speedy trial because they are put on hold for inhuman amounts of time to determine if they can stand trial because the system says they don’t have the room for them to place in proper treatment facilities. 

These poor individuals who are improperly labeled, mistreated, abused, and sometimes even tortured become forgotten and forced into having to wait their day in court for months or even years before they can answer the charges against them.  


We do not treat the mentally ill well at all in everyday life or the prison system. It is the society that says it is not my problem, so we don’t care. Often, society assigns the role of Judge, Jury, and Executioner to these people and has labeled them for the time they make that phone call to the Police. 

I remember when families used to “hide” their members from the society that was “different” from them. ” We didn’t talk about them. Were we ashamed or afraid of people knowing we had someone “like that” in the family?” 

While yes some things have improved in time, some things remain the same or have even worsened. However, I say it’s one topic that needs much attention. 

Defeat Suicide Foundation states that 1 in 5 adults currently deal with some mental illness. That number is too high for us to ignore. 

We need to continue working on improved treatments, safer and more secure facilities, and more robust and continued support for our neighbors, friends, and family who deal with these issues daily. 


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