Eli Sanders is associate editor at the Seattle alt-weekly The Stranger and author of the new book “While the City Slept,” on the murder of Teresa Butz.
America’s public mental-health system is in a dangerous state of disrepair.
President Obama sees this, as do candidates for president from both parties. Bernie Sanders wants “radical changes.” Donald Trump complains that “too many politicians have ignored this problem for too long.” Hillary Clinton sees a connection between the lack of funding for preventive interventions and our overstuffed prisons, noting that “over half of prison and jail inmates suffer from a mental-health problem.” Jeb Bush says this is an area in which there’s “a clear role” for government spending “so that people don’t fall through the cracks” toward tragic outcomes.
I couldn’t agree more. Having spent six years exploring one young man’s fall through the cracks of Washington state’s public mental-health system, and the terrible events connected to this fall, I strongly believe we need to devote far greater resources and attention to this challenge. In failing to do so, we contribute to a wide array of social harm: homelessness, suicide, the heroin epidemic, poverty and, occasionally, horrific violence.
To be clear: Violence is far from the normal outcome of mental illness. At the same time, when it occurs, we need to see the bigger picture. As the Obama administration put it recently, “While individuals with mental illness are more likely to be victims of violence than perpetrators, incidents of violence continue to highlight a crisis in America’s mental health system.”
The case of Isaiah Kalebu does this quite starkly. He was raised in a fragmented and distressed family environment by parents of modest means, and as he grew into adulthood he showed clear signs of serious mental illness that, for him, was connected to violence. He’d long impressed people with his intelligence, but by the summer of 2009 he was 23 years old, unemployed, intermittently homeless and firmly in the grip of his disturbance. Kalebu needed a robust and attentive mental-health system to help him and protect those around him, but 2009, like many years before and since, was a bad year to be in this sort of need.
Between 2009 and 2012, more than $4.3 billion was cut from state mental-health budgets around the country in the wake of the Great Recession. In Washington state, where Kalebu was born — and where he will die in prison — the 2009 budgeting cycle alone saw more than $23 million cut from mental-health programs. In the years before that cut, the state held a D grade for its mental-health services from the National Alliance on Mental Illness. So did the United States as a whole.
During this period Kalebu’s family members, realizing they didn’t have the resources or tools to halt his slide, sought help from the state. Unfortunately, as Maria Lymberis, a psychoanalyst who later examined Kalebu’s trajectory, told me: “When the family turned to the system, the system had the same dynamic as the family.”
When Kalebu’s mother prevailed upon police to take him to an overburdened, publicly funded hospital for an emergency psychiatric evaluation — rather than to jail for his alarming behavior — he was too quickly released. His mother said that the next day, her son told her to enjoy her “last day on earth,” and on the following day smashed her van’s windows with a rock and struck her head with the metal end of his dog’s leash.
When Kalebu was arrested for this, a judge sent him to an underfunded state mental hospital. He stayed four months, was released on the condition he continue treatment and soon stopped showing up for appointments. No alarms went off.
When his aunt called a crisis hotline out of concern for his continued deterioration, Kalebu was evaluated but not detained. The next day, he got into an altercation with police and wound up being Tasered and shot with non-lethal bean bag rounds. He was arrested again and released again — this time, in part, because the second judge’s computer, in the state that birthed Microsoft, couldn’t communicate well enough with the first judge’s computer.
Soon Kalebu’s aunt was filing for a restraining order, expressing fear for her safety. The next day, she was killed in a fire caused by arson. Kalebu was briefly questioned in connection with her death and released. (The arson case has never been solved.)
After that, as his defense attorneys later wrote, Kalebu “wandered homeless for days, accompanied by only his dog and his delusions, until he encountered Teresa Butz and Jennifer Hopper.” The two women were engaged. On the night of July 19, 2009, Kalebu attacked them inside their home in south Seattle. He raped and stabbed both women, killing Butz.
Compare this long, unchecked descent into violence — observed by many but stopped by no one — with the vision put forward more than 12 years ago by President George W. Bush’s New Freedom Commission on Mental Health. It declared America’s public mental-health system to be a “patchwork relic” and imagined a “fundamental transformation” after which, “at the first sign of difficulties, preventative interventions will be started to keep problems from escalating.”
All over the country, the transformation has failed to materialize. And while the cost of this is incalculable when it comes to lives forever altered, the public bill is worth examining. Bush’s panel put the annual indirect cost of mental illness to the U.S. economy at $79 billion. A recent study by the Government Accountability Office found the federal government spending a comparatively low $5.7 billion in one fiscal year on the challenge of serious mental illness. In Washington state, taxpayers will spend more than $3 million to pay for Kalebu’s trial and life-without-parole sentence — far more than it might have cost to intervene earlier.
If we want to address the crisis in U.S. mental-health care, we will have to spend far more than the $500 million in new mental-health funding President Obama recently proposed. We will also have to admit that at many levels, across many systems, we’ve had things exactly backward for too long. We spend good money after bad outcomes when we should be changing lives, saving lives and saving money by spending now to prevent tomorrow’s tragedy.