Naomi Ishisaka: Locking up people with mental health issues won't help; here's what will.

Jun. 22--It took 30 years of searching, but Rick Hoffman finally found the healing he was looking for.

Since childhood, Hoffman (Santee Dakota Sioux) struggled with generational and familial trauma, abuse, addiction and ultimately, about 12 years of incarceration.

But two years ago, in the last week of a 90-day stint at Seattle Indian Health Board'sThunderbird Treatment Center in Rainier Beach, he said he finally found his path. "We were singing our traditional Native American songs and it hit home. It was like my ancestors, my relatives, they covered me with a blanket and said, 'You know, you're going to be all right. You just keep doing what you're doing. You follow our ways.'" He has been sober since.

Hoffman, 56, now lives at Eagle Village, Chief Seattle Club's pilot modular housing project to serve the needs of Native adults, who face twice the incarceration rate of white people. He has stayed on track with the help of inipi ceremonies (sweat lodge), Native support groups and culturally specific addiction resources.

Hoffman is just one of millions in the U.S. who faced incarceration due to a mental health or substance use disorder. As the growing movement for racial justice asks what defunding policing and the criminal legal system could look like, we must also talk about who is currently being incarcerated, for what reasons and what kind of interventions actually work.

In the 1960s, as the horrors of psychiatric care in hospital settings came to light, a move began to "deinstitutionalize" mental health care and instead move treatment into community-based settings. While it was a welcome change, the community-based care never appeared and instead, jails and prisons have become de facto mental health treatment facilities, a process called "trans-institutionalization." But jails and prisons were not designed to serve this role. The National Alliance on Mental Illness reports that 83% of incarcerated people with mental illness did not have access to treatment.

Amid the federal decertification of Washington's largest psychiatric facility, Western State Hospital, there have been numerous plans to reform Washington's mental health system and at long last fulfill the promise of community-based treatment, most notably a massive overhaul from the governor and lawmakers last year. But with an $8.8 billion budget shortfall due to the coronavirus pandemic, it's unclear how those initiatives will fare. Already, the University of Washington announced it would close a psychiatric facility, Seven North, due to the COVID-19 budget gaps. After the 2008 recession, for example, states cut $4.35 billion in public mental-health spending.

Ethan Frenchman, an attorney for Disability Rights Washington's Amplifying Voices of Inmates with Disabilities program, said Washington is reflective of the national trend.

"In Washington, [mental health is] criminalized and individuals are incarcerated and arrested over and over and over again when they are engaging in oftentimes disability-related behaviors," he said. "Jails are often just used as a way to momentarily get people off the street."

Worse, people with mental illness make up nearly a quarter of people killed by police, according to The Washington Post. The Post also reported incarcerated people with mental illness are held four to eight times longer than people without mental illness charged with the same crime, are less likely to make bail and cost seven times more to detain.

"We know that it is bad, it is expensive and ineffective to try to treat a health condition through the justice system," said Leo Flor, the director of King County's Community and Human Services Department. He emphasized that an upstream approach -- ensuring people have the supportive housing they need to receive and benefit from treatment, for example -- must be part of the solution for sustainable change.

Another part of the solution, Flor said, is looking at opportunities for diversion at every step. How could we get people the behavioral health care they need before they become one of the 40% of people with mental illnesses who come in contact with the criminal justice system?

As part of the Trueblood settlement between the state's Department of Social and Health Services and Disability Rights Washington on behalf of people with mental illness who had been warehoused in jails, more diversion programs, mobile crisis response units and other measures are coming to some Washington regions. King County is slated for phase two of the plan in mid-2021, but implementation depends on funding from the legislature.

While the state figures out how to move forward, people like Jeremy Garretson will be there to help. Garretson (Northern Arapaho), is the reentry case manager for Chief Seattle Club and has firsthand experience with the lack of resources for incarcerated people. He first was incarcerated as a juvenile and then spent a number of years in prison as an adult.

For people with mental health needs in prison, "it's laughable to downright cryable," the services available, he said. And if mental health services aren't there, he said, "the release is just the countdown to the next incarceration, if you haven't addressed the issue."

He said in his experience, people with mental health needs in prison fall through the cracks nine times out of 10. But he is hoping his work can help fill the gap in some small way.

"I'm trying to be ... the one that everyone can come to. If you don't have community or family support, you still got some support out here. Cause I got you."

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