I knew Carter. My organization, Street Sense Media, worked very closely with her for the last 19 months of her life. She turned the pain and joys of her life into beautiful poetry and performance art. She published that poetry in the Street Sense newspaper and performed onstage at Busboys and Poets. We had the privilege and opportunity to get to know her as a woman of talent and potential.
Her death reflects a collective failure of our shared responsibility to the most vulnerable members of our community. Our safety net failed to protect Alice Carter.
Instead of pursuing her passions and contributing her talents to our community and economy, Carter navigated a culture of cruel judgment and condemnation. She spent much of her adult life homeless, trying to survive in the dark shadows and dangerous margins of our city. In that netherworld, extreme poverty, housing instability and being transgender made her an “other,” vulnerable prey. Her situation was further complicated and her vulnerability amplified by mental illness and substance abuse. It did not take a medical expert to recognize that her use of alcohol and drugs was a desperate form of self-treatment made all but inevitable in a city with a long history of failure to successfully deliver community mental health care.
Carter’s death was preventable. In 2018, she had multiple run-ins with police, all minor; all nonviolent. Appropriately, her legal cases were diverted into D.C. Superior Court’s Mental Health Community Court (MHCC) for people diagnosed with serious and persistent mental illness, who are charged with certain misdemeanor or low-level felony offenses. The MHCC recognizes that jail is an ineffective and unnecessarily costly intervention for people whose lawbreaking behavior stems from mental illness. These courts, when they succeed, save taxpayers millions of dollars. They offer critical lifelines of opportunity to defendants. They appropriately identify with defendants as patients in need of care and leverage the power of our criminal justice system with the carrot of treatment instead of the stick of incarceration.
But Carter’s case did not stay within the confines of the MHCC. The presiding judge in her cases grew impatient with her inability to maintain sobriety and issued a “last chance” ruling that she engage in treatment for her substance abuse and mental illness or her case would be returned to the standard criminal courts. That ruling set off a chain of events that led to her death.
She did not meet the deadline for enrollment in treatment, prompting an arrest order. In the course of the arrest in March, when a D.C. police officer insulted Carter by using her former name, Carter spit in his face, a poor decision that led to the most serious charge against her — resisting arrest. Carter spent the next two months in jail, precisely the outcome that the MHCC was set up to avoid.
The complexity of mental illness and the relatively primitive and massively underfunded systems of community mental health care in the District and the nation do not afford us the kind of impatience shown to Carter by the D.C. criminal-justice system. In theory, the MHCC is ahead of its time. In practice, at least in this case, it was not allowed to operate as designed.
In jail, Carter was subjected to an array of dehumanizing treatment, including being housed in the male general population. Not surprisingly, on her first night out of the jail, Carter almost died of alcohol poisoning. I was among those who was convinced that she was suicidal and in need of civil commitment for both mental health and substance abuse treatment — the precise route that the MHCC had “prescribed” months earlier.
Carter needed treatment. Her degree of vulnerability and disabling impairments placed a heavy responsibility for care on the private and government agencies that exist to protect people such as her. When they work, mental health diversion courts can lead to dramatic and positive changes in the lives of people with mental illness. The easy out is for us to conclude Carter was beyond help; that she got what she deserved. I refuse to accept that.
We need to examine the effectiveness of our community response to people with mental illness.
D.C. Superior Court should examine whether it did all it could to adjudicate Carter’s nonviolent crimes in the most effective way. The D.C. Department of Behavioral Health needs to recommit itself to finding more effective ways of treating hard-to-serve citizens. And we need to look at our laws for civil, involuntary commitment to protect people who are so impaired by mental illness and substance abuse that they present a danger to themselves.
I am going to miss Alice Carter and the beauty and art she brought into the life of our community. My hope is that we can gather the lessons of how we failed her to perhaps help others like her who still need assistance.