Arun Venugopal: I'm Arun Venugopal and this is The Takeaway. Glad you're with us. Several recent events have placed more public scrutiny on how police respond to emergency calls about people with mental illness. Yesterday, we took a look at Daniel Prude's case, a Black man killed by police in March while suffering a psychotic episode in Rochester, New York. Protests broke out in Rochester last week after a body camera footage was released showing police holding a hood over Prude's head to prevent him from spitting. Prude died a week later from asphyxiation. In an update to that story, the entire police command, including the chief, have resigned.

In Salt Lake City last Friday, 13-year-old Linden Cameron, who lives with Asperger syndrome, was suffering a mental breakdown when his mother called 911 for help. Police responded to the call and shot him multiple times in his home. He's now in serious condition. These cases are continuing to spotlight police interactions with people who have mental illness. According to the Treatment Advocacy Center, a person with severe mental illness is 16 times more likely to be killed in an encounter with police. With me is Alisa Roth, a mental health reporter at American Public Media and the author of the book Insane: America's Criminal Treatment of Mental Illness. Alisa, welcome to The Takeaway.

Alisa Roth: Thank you.

Arun: We hear terms like "psychotic" or "mental breakdown" to describe people, including Daniel Prude and Linden Cameron. These terms tend to sound pretty alarming. What does an episode like that typically look like?

Alisa: It can present in a variety of ways. Often, the person will be hearing voices that nobody else can hear. They'll be having hallucinations, so seeing things that weren't actually there. For the person who is experiencing this, it can be a really frightening moment. What we'll often see is the person shouting or lashing out or running away, but they're running from things that they alone are seeing. It's not real threats and that can come across to the police, to other people as this person is acting threatening. This person is presenting a danger to me when, in fact, that person is just frightened and trying to protect him or herself.

Arun: In many of these cases, and this is just an ongoing problem, you have men and women with guns who show up and who, as you just explained, don't necessarily know how to deal with these situations. Why is this the norm in so many American cities?

Alisa: It starts with the problem that we have nobody else to respond to a mental health crisis. If heaven forbid my house is on fire, I know to call the fire department. If my neighbor is having a heart attack, I know to call the ambulance service. If a person is having a mental health crisis, very, very often, it's the police who respond. The police have been called on for-- It's been decades now that the police have been called on to respond to a mental health crisis. For the most part, police have very little training in how to deal with this. Police are instead trained to respond as if this is a public safety emergency and respond accordingly.

Arun: Are there other options for them besides calling the police or what should the options be instead of calling the police in a better world?

Alisa: It's interesting because this is a place where the people who say we should defund the police and the people who say we absolutely should not defund the police really come together and say police officers should not be the ones responding to a mental health crisis. It should not be a police officer who's trying to talk somebody down if they're threatening to hurt themselves. It should not be a police officer who comes when a mother calls because her 13-year-old son is having a mental health crisis and runs off.

There are various approaches that different departments have taken, different cities have taken. In some cases now, we're starting to see police officers being trained. How do you respond? How do you de-escalate the situation? How do you talk somebody down from this moment and convince them to-- whether it's, "Drop the weapon," or go to the hospital? We're seeing police departments that have teamed up with a mental health professional. You call 911 because your loved one is having a crisis and a social worker and a police officer may be dispatched. In a few places, we're actually seeing just the mental health professional being dispatched. In many, many cases, we're just seeing the police respond and they shouldn't be.

Arun: As you mentioned earlier, a person with severe mental illness is 16 times more likely to be killed in an encounter with police. There's no breakdown there in terms of race. Presumably, this is even worse for people who are Black, who also are dealing with mental illness, correct?

Alisa: Absolutely. We know that Black people and Black men in particular are much more likely to be shot by the police. The flip side of that is that police encounter a white person having a mental health crisis, they're much more likely to see that as a mental health crisis and that this person is in need of help rather than this person is a threat. Absolutely, it is much more likely.

We see roughly one in five fatal police shootings involve a person with mental illness. That said, I've seen many, many fatal police shootings of both white people and Black people. I think that the problem is that people with mental illness are being seen as a threat by the police and, again, that police are being called in to respond to a situation that they're not prepared for, that they're not trained to do.

Arun: I've seen figures from the past saying that Cook County correctional facility, Rikers Island, these jails tend to be some of the biggest mental health facilities in America, is that correct?

Alisa: It is true that they are among the largest providers of psychiatric care in this country. People with mental illness are much more likely to end up in the criminal justice system. They're much less likely to make bail. Those who do make bail are much more likely to sit for a longer time in jail while they're waiting to come up with the money. That means that you have many more people who are sitting in the jails with mental illness. On the prison side, they're much more likely to get sentenced. They're much less likely to get a plea bargain. They are much more likely to get a longer sentence and they're much less likely to make parole or a good time or all of the things that could get them out sooner.

Arun: Alisa, we talked about the disproportionate number of people with severe mental illness being shot or injured. Do we see something similar when it comes to incarceration rates for people with mental illness?

Alisa: By some estimates, as many as 50% of the people who are locked up in the jails and prisons in this country have a mental illness. That's a much, much higher proportion of people than in the general public.

Arun: I mean, is it even possible to get decent care if you're behind bars?

Alisa: Well, as you probably know, people in our jails and prisons are the only Americans with a constitutional right to health care and that includes mental health care. They're guaranteed health care that is equivalent to the health care that they would get in the outside world. Unfortunately, the courts have left it up to the jails and the prisons in the states to decide what that looks like. What does it mean to have equivalent care? In many, many cases the treatment that they're getting is minimal. The other part of this is that jails in particular, but prisons as well, are terrible for people. They're terrible for everybody.

Let's make that clear, but they're particularly bad for people with mental illness who need routine and calm and steady, steady care. I've heard psychiatrists refer to jails as psychotogenic, as in inducing psychosis. They're loud. The lights stay on all night. People are concerned about their safety. There may be a sense of paranoia, but it's actually quite legitimate, "Am I going to be attacked?" We have this public perception that people with mental illness are dangerous when, in reality, we know that the people with mental illness are much more likely to be victims of violence rather than perpetrators of violence.

Arun: Within correctional facilities, within jails, within prisons, are they ever separated from other parts of the population?

Alisa: Yes. Particularly, the larger jails and also the state prison systems will have a special mental health unit where somebody with severe mental illness may be sent, both so that they can get care and so that they can be separated and protected from the general population. The problem is that very few people are "lucky enough" to get sent to that mental health unit. I visited the inpatient unit in the LA County jail.

That was like winning the lottery if you could get sent there because it was quieter and you were going to get the care that you needed, but there are so few beds available that really very few people would end up getting sent there. What's much more common is that somebody with mental illness is being disruptive because of their disease and are sent to solitary confinement, which is the absolute worst of the worst for everybody but absolutely for a person with mental illness. We know in fact that solitary confinement can trigger symptoms of mental illness in people who didn't even have them before.

Arun: Alisa Roth is a mental health reporter for American Public Media and the author of Insane: America's Criminal Treatment of Mental Illness. Alisa, thank you for joining me.

Alisa: You're welcome.

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