PROVIDENCE – These were seasoned people, with years of “in the system” experience. There was structure to this public forum, convened by the Mental Health Association of Rhode Island on Dec 8, entitled: “The Criminalization of Mental Illness.”

Three guest presenters sat to the far left on the raised stage at the Ray Conference Center on the spacious grounds of Butler Hospital. On the extreme right was a podium. Spanning the center was a white screen, to receive the projections from the little table in the center of the aisle at floor level.

This was a free event, with online registration. It was noted that the event would reach capacity quickly. Several e-mails came, querying: “Are you still coming?” It promised to be a standing-room-only event.

I had registered early. I have had a lifelong concern about the mentally ill, and a new-found interest in the criminal justice system’s challenges, with incarcerating the mentally ill being just one.

Attention spans
As I drove up Blackstone Boulevard to the Butler campus, I thought about the uproar happening over an estate being put up for sale, and how the plan to chop up the property into smaller parcels had garnered so much ink in the press, with many minutes on the airwaves, and how, by comparison, there is so little uproar over the state of the mentally ill.

No talk show banter, not a lot of ink – unless there is an award-winning newspaper series underway, or, heaven forbid, an act of violence occurs that snaps to attention our ever-decreasing attention span for a few distracted minutes.

I thought about all the times my phone has rung with some official on the other line – from an institution – the police, the hospital, the mental health clinic –asking me: could I come, it’s my aunt. She’s tossing her clothes out the window. She’s been picked up and taken to the ED and is now in restraints, wild and combative. She’s opening and slamming her apartment door, over and over again. Could I come?

I remember the days when I would be afraid. I remember the time she slammed her door shut, with me inside and her firmly in front of the door, and queried aloud whether anyone would know what happened to me if I just disappeared that day.

I had learned, even as a young girl, how to sense when an episode might tip that balance. And, to always have a plan.

Through the campus
I drove onto the grounds of Butler Hospital’s campus on this cold winter day with the sun already setting. I found parking in the way-back lot, and made my way through a biting, brisk wind, following little paper signs on trees to an auditorium that was not easily found.

The room was set for half its capacity, with folding chairs in two tidy sides and a walkway in the middle. In the front row sat important people, like agency department heads. In the last two rows sat a smattering of R.I. State Police. There were more than 200 people in attendance.

The forum began with awards to the families of Edward LeDoux and Scotti DiDonato, both advocates for the rights of the mentally ill, who had recently passed away.

It was to be a brief forum. Each speaker – one from Georgia, one from Connecticut and one from Maine, was given 20 minutes.

Funding and prevention
The most engaging speaker was John Head, of the Bazelon Center for Mental Health Law. He spoke extemporaneously, with a few note cards to remind him of salient points.

Head is the author of a definitive book on depression in black men and stigma and mental illness and incarceration. He talked about practical issues – funding and prevention – and how you can’t just do crisis intervention. The resources have to be there, too.

Head stressed the power of housing as a major support service. And, that there has been a documented 50 percent reduction is prison episodes of the mentally ill if there were stable housing available – with someone having his/her own home, and mainstream scatter housing. “Mainstream” stood out to me.

Crisis intervention
The next presenter was Madelon Baranoski of Yale University, who gave a detailed presentation about the Connecticut experience with CITs – Crisis Intervention Teams.

She talked about the need for greater access, funding, setting standards, community buy-in, clinical slots, beds, teams, and training.

“This can’t be therapy as usual,” Barmamoski said. Community mental health centers, she continued, should be seen as community places – in Connecticut, the centers host farmer’s markets on the weekend, and concerts. The centers should not be seen as scary places, she added.

Out of the box
The third presenter, Jo Freedman, of the Portland Police Department in Maine, said she was the only paid member of the Crisis Intervention Team, working hand-in-hand with the local police department. For staffing, she said she creatively uses hand-picked, “free” masters degree students.

Freedman detailed some steps that were out of the box, such as baking chocolate chip cookies to build camaraderie where there was none between departments; or getting individuals to sign releases that allowed group meetings with all people involved in a person’s care and crisis to come together to plan.

“We’re way more similar than different,” she said, referring to the mentally ill – and everyone else.

Prison as a last resort
At the end of the presentations, the microphone was passed to A.T. Wall, head of the R.I. Department of Corrections, for his comments. Wall spoke about the goals and mission of a prison and how it quite often runs contrary to the ways to reach someone suffering from mental illness. And, how prison should be someone’s last resort. He ended by saying, realistically: “I don’t foresee resources coming in financially. So, what do we do now?”

Reducing stigma
Craig Stenning, the director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, took the microphone next. Stenning talked about budgets and funding levels being a challenge in Rhode Island. The current system of care is now bits and pieces, he said.

“The stigma of mental illness is at an all-time high, with each tragedy – such as an Adam Lanza [the shooter in Newtown, Conn.]– making that even more so. People don’t feel they can recover,” Stenning said.

“Our state needs to embrace recovery and get resources, such as jobs,” Stenning continued. “Five or six years ago, we all didn’t talk; today we are talking. This is not a public vs. private system. This is a community-based, all-age, all-population model and approach.”

The role that race plays
A member of the audience posed a question about the role that race plays. Head responded by saying that the issue was about race and poverty: “There is no voice for people who live in poverty, and poverty overlaps with race.”

Baranoski asked the audience: “You know the show, ‘Orange is the New Black?’” Many in the audience nodded. Baranoski continued: “Well, the star is a rich white woman; we would not be seeing it otherwise.”

Head, in response to concerns raised about difficult state finances, said: “We’ve seen states where things get so bad they’re forced to find the funding.”

Thoughts upon leaving
I left thinking the forum was very short, and it could have been an all-day conference, with lots of chairs, a more accessible location, break-out sessions, and real dialogue. Who were all the people who had gathered here today? Were there any legislators or newly elected officials? Will there be a follow up, to gain momentum, to strategize, to listen, as well as to speak.

It isn’t often that you hear of bad incidents involving the R.I. State Police. It was nice to see them there. But where were the Providence police? Or, the police from Pawtucket, Central Falls, Woonsocket, and the East Bay? What is the plan to engage them?

Should we bake some cookies to bring people together?

The real world intrudes
As I was writing this, on deadline, I had to leave to pick up my aunt, who insisted that I had said 11 a.m. and not 2 p.m., and she was standing in the cold on the sidewalk, waiting for me, several towns away. She was getting a little loud and I was fearful she would cause a commotion. I dashed out the door.

Old age has calmed some of the wrath of her mental illness. She is slight and quiet now, in her 80s. She has had her time in the “system” – the restraints, the straight jacket, the Haldol, the counseling.

I try to keep her out of the system. She is safe in her own apartment, her fierce sense of individual freedom intact. We went to the grocery store, where, in the midst of shopping, she took out a big white garbage bag and wanted to bag her groceries, right there in the center aisle. She said she didn’t want their dirty bags.

I diverted here by showing her some chocolate chip cookies on the shelves – and success! The garbage bag was put away, she quieted her tone, and we were off to the checkout.