Christine Montrose, America, Community Mental Health Centres discussed on Fresh Air

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In today for Terry Gross. My guest psychiatrist Khristine. Montrose has spent years treating people with serious mental illnesses. And she's noticed that many of her former patients end up in jails were prisons where their conditions inevitably deteriorate. In her new book, Montross notes that in America today there are 10 times as many people with serious mental illness behind bars as there are in our state psychiatric hospitals. Incarceration, she says, usually makes mentally ill people worse and renders stable people psychiatrically on well, making the prison system literally maddening. Dr Montrose. His book explores the reasons people with mental illnesses get arrested and incarcerated. She takes readers too many prisons for a firsthand look at the harm the experience does. Can she explores and alternative model for confinement and rehabilitation in effect in Norway. Christine Mantra, says the 2015 Guggenheim fellow in General nonfiction, an associate professor of psychiatry and human behavior at the Brown University Medical School and the author of two previous books. We spoke about her latest. It's called waiting for an echo the madness of American incarceration. Christine Montrose. Welcome to fresh air. Thanks so much, Dave. I'm delighted to be here. You're a practicing psychiatrists. You freed a lot of patients with serious mental illnesses. What's taking you two so many jails and presence? So I work in an inpatient psychiatric hospital, and I work on floors that are called the intensive care units, which is like the psychiatric version of an icy you. I've been struck over the years that my patients routinely come into contact with police. And sometimes those outcomes are helpful ones. Police bring them to the hospital. And sometimes those outcomes. They're really punitive. One's police take them to jail in prisons, And as I talked to my patients, they would often explained that the circumstances that led them to the police encounter were essentially the same reasons that brought them into the hospital. So undertreated symptoms you know, shouting in the Starbucks are causing a disturbance in the community that really were more about their symptoms of mental illness than about any kind of criminal behavior or intent. So I started to think about how my patients must do in these moments of the police encounter, and then how it must be for them to be in jails and prisons. So I decided I wanted to look for myself and see what those environments were like for the mentally ill people who are held in them. So you visited a lot of correctional facilities doing research. You also do work in court cases, right evaluating psychiatric patients, right. So so I visited a lot of prisons, and I also began working and jails doing competency to stand trial. ERROL evaluation. So when the court asks whether someone is able to understand their court case, the proceedings the charges that they're facing whether they're mentally well enough to work with their attorney, they often ask for the expert opinion of psychiatrists. So I began performing these evaluations as well. TTO learn more about what goes on when mentally ill people are charged with crimes. Right? And I wonder if you could just contrast the experience of Talking to a patient in a treatment in a clinical setting and going to a prison where you're asking questions for a different purpose in a very different atmosphere. So they're there to really remarkable differences in those circumstances. One is the environment and one is what I'm being asked to do, and I had to learn a great deal about the difference in those two things. So so the 1st 1 in terms of what I'm being asked to do when I am seeing patients in a psychiatric hospital. I'm really charged with their care. And it is my job to diagnosis them to treat them to comfort them in the midst of their suffering to work with them and their families and the nurses that are providing their care and really try Tio, help them manage and cope with the symptoms of their illness and help improve that as much as I can when I'm working, doing evaluations in the jails and prisons I'm really asked to be an objective analyst and to ask questions that try to determine almost a snapshot of the person's mental state in that moment, but it's not a clinical or treatment. Encounter on. So that was That was an important thing for me to learn that my job in that role was not to treat but was really to provide an objective analysis of what I was seeing in the moment. The other piece of the question is really A critical one as well. And we're talking about the difference between a punitive environment and a therapeutic one. And one of the things that was so striking to me when I started working in the jails and prisons were that the people that I was seeing in these two places For indistinguishable. So so the patients that I was seeing in my hospital were indistinguishable many times from the men and women that I was evaluating in jail. But the environments were so markedly different one charged with again trying Tio help in hell and the other really designed to control and punish. I want to talk about what you've seen in correctional institutions. But I want to talk a little more about this phenomenon of people with mental illnesses being arrested and incarcerated. Why is it that so often people with mental illnesses who are clearly acting out their symptoms, not intending to necessarily steel or disturb the peace or You know, or make people feel uncomfortable end up in jail. You write that there's a a phenomenon known as a compassionate arrest, which seems like an ironic term. Right, so to really understand the origins of why there are so many mentally ill people in jails and prisons in America. You really have to go back to the sixties and seventies and eighties, when large numbers of people were moved out of our state run hospital's psychiatric hospitals with the goal of shifting mental healthcare from institutions to the communities, And as you said in the opening that was an enormous shift that closed down state psychiatric hospitals. Largely due to the 1963 community Mental Health Centres Act that passed to enact this change of shifting people from hospitalized, institutionalized the lives into the community to receive their care. A great problem with that was that funding for community care was never adequately allocated so people who had required very significant levels of care and support in hospitals and institutions. Or suddenly without.

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