Recently I have been digesting comments about the Psychiatric Safety Review Board, a public function somewhat unique to Oregon but not unique in the function of placement of criminal offenders back into the community. These offenders are specific to the criminal justice system in that they are guilty of crimes but judged to have committed those crimes while suffering from insanity. They have gone through the mental health treatment system and are under consideration for reintegration into the community at large. The United States Department of Justice has something to say about this practice because of the Civil Rights of Institutionalized Persons Act (CRIPA) which was originally enacted by congress in 1980.
The State of Oregon has had some difficulties with local activities that have strongly protested the location of facilities in communities. So much has been made of the location of some of these facilities that one county sheriff actually went door to door warning of the potential placement of such a facility in the community. In another instance, the city purchased some real estate that had been designated as a reintegration facility so the property would be unavailable for that use.
Protesters are adamant about not wanting to place sexual offenders in the proximity of schools, or felons in neighborhoods. The situation has created a firestorm of thought as well as discussion about the appropriateness of housing and treatment of mental health offenders. On one hand, no reasonable person would want to place a child at increased risk for any kind of predatory action. On the other hand, there is a reasonable assessment of risk and effectiveness of treatment as well as the responsibility of parents and families to protect their children. There are predators among us with no restrictions. What are we doing about these risks? It seems as though the public thinks the risk from society is zero and the only risk is from those who are treated and supervised. Nothing could be further from the truth.
What strikes me as peculiar is the notion that a person like Peter K. (story to be posted) can attempt to kill himself and others with a 4000 pound car, yet we can deem him to be a reasonable risk to society when treated, but another person, who in a bipolar manic phase can physically attack a person and rape them is not considered a reasonable risk while under treatment. Is it the nature of the result of their crimes that makes them seem palatable as people within society? Clearly, Ashleigh B. (story to be posted) tried to kill the person who was the gas station attendant by trying to sideswipe them from her car. Because of the nature of her crime, do we deem her less threatening than a person who succeeded? Is redemption and treatment only for those who were unsuccessful in the commission of their crimes?
I am not advocating for the placement of sexual predators next to small children, but realization of the difficulty of segregating those among us who are treatable versus the concept of permanently impaired or “undesirable” leaves me with another question. What are we to do as a society with those who are deemed to be too high a risk to reintegrate into society? Are we simply going to fill extraordinarily expensive hospitals with patients at a cost of $153,000 per patient per year forever? Is there no other alternative?
NAMI, the National Alliance on Mental Illness, considered it a legislative achievement to get $150,000 to do a one-time study of the allocation of mental health budget dollars in Oregon. At the same time, a single patient reintegrated into the community could create that much potential savings or that many more assets effectively deployed in more effective treatments. Recently I read an article about the reallocation of treatment dollars in the public budgets heavily favoring medications and depleting funding for programs like supported employment and assertive community treatment (ACT). Follow the Money As citizens we should be very troubled by these developments.
At the same time, we need to examine our own views and question our commitment to redemption and recovery. If we truly believe in recovery and reintegration, some soul-searching about our views of those who suffer diseases and what we should do with those who have committed crimes should be in order. If we deem it improper to locate reintegration facilities because they are too close to schools, where are they to be located? Schools are ubiquitous. Everyone is near one. At the same time, everyone is near a sexual offender or potentially dangerous criminal. Citizens who just choose not to believe that fact do so out of a sense of false security. Does the proximity to public places create unreasonable risk? Is that risk more reasonable than the risk that is unknown because it has not made itself apparent yet? Is it even possible to understand what the risk is to society? Answers to personal safety dilemmas lie not in trying to keep out what we can see and control, but to deal with the risks that are presented to us every day but are unknown.
Are we as parents and advocates unwilling to see in ourselves, our own prejudice against those who have committed crimes except by reason of insanity? Perhaps it is the melting pot of offenders thrown into the state hospital and our own inability to define what constitutes mental illness and the blurred borders between psychosis and criminal behavior that creates this ethical dilemma. These issues are crucial when looking at how we should position ourselves as members of a society that must deal with the realities of human behavior in both its good and bad aspects.
The simple truth is that the frequency of criminal behavior is not able to be controlled by institutionalizing everyone who would pose a risk to other citizens. Since that is a given, what then are we to do to make the risk tolerable to those who may be affected? The answer lies not in denying the creation of treatment facilities, but finding a solution that minimizes the risk and provides the greatest benefit to society. Simply refusing to allow placement at all cures nothing and perpetuates institutionalization at extreme costs.
In the meantime, offenders are denied placement into proper treatment and the system suffers overcrowing and more people are denied basic treatment. It is troubling to watch.
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