Change Is Coming

At the intersection of psychiatric disorders and law enforcement

Photo Credit: Lucy Nicholson, Reuters

Today on The Mary Trump Show, I had an extraordinary conversation with fellow Nerd Avengers Norm Ornstein, Jen Rubin, and Jen Taub about the importance of changing the way we think about psychiatric disorders and the way we treat the people who have them, especially when they come into contact with the criminal justice system.

[Below the video, I’ve provided a transcript, edited for clarity and flow, if you prefer reading.]

Mary

I was going to start the show by listing all the news that broke over the last week but simply reading the list would've taken the entire show.

Before we start, I just want to say this: as varied as our problems are, there's one unified solution and that's getting as many Democrats into office as humanly possible; and doing everything we can to mitigate the damage that Republicans do in places from which they can't be entirely removed, like the entire American South.

One of the things we mentioned last week and that I'm realizing more and more forcefully as I think about it, is just how much we forget or how much we are unable to deal with—in terms of current events and in terms of in our own lives—because of the constant onslaught. We constantly seem to be at the mercy of current events as they unfold, which they really have been with a vengeance lately.

And some important issues that, if we focused our attention on them, could improve our lives, our communities, our society in very profound ways, do not get our attention. So, today we're going to take a step back and focus on one of the most important issues facing us as human beings, as Americans, as a society: criminal justice and mental illness reform.

Norm, you are at the cutting edge of this issue. I know it's incredibly important to you, as it should be to all of us. And I'd like for you to start us off by talking about some of the extraordinarily effective initiatives that have been enacted in places like Miami. And just as an aside, everybody should watch the documentary The Definition of Insanity. It's absolutely extraordinary and moving. It demonstrates the possibilities that face us if we do something incredibly simple, which is to inject empathy and kindness and humanity into our justice system.

Norm

As some know and others don't, we lost our son, Matthew, on January 3rd, 2015 after a 10-year struggle with serious mental illness. At age 24, he had a psychotic break. He was a brilliant young man who had been a national champion, high school debater, went to Princeton, was out in Hollywood when this happened.

We don't know what triggered it, but a part of his brain disease was a phenomenon known as anosognosia which means he had no insight into the fact that he was ill. He would not take treatment. He had, as so many others in these situations do, religious ideation. He believed that God had taken his soul but not his body. He didn't know why, and he was on a quest to recapture his soul and taking medication would have moved him further from that path.

He had 10 years of hell, as we did. He died accidentally of carbon monoxide poisoning. He was living in a motel in Newark, Delaware. Like so many with serious mental illness, he smoked heavily. Something in the nicotine hits the right synapses in the brain to ease whatever else is going on there. So, there was the dual stigma—smoking in this society makes you a pariah, understandably so. If you have long hair and a beard as he did—he looked like Jesus—if you walk on the streets, as you'll see so many of them do. That also was an issue.

After he died, we formed a foundation in our family and we began to do our due diligence about the problems here. Matthew was not in a situation where he had been caught up repeatedly in the criminal justice system but the vast majority of people with serious mental illness are, in one way or another. And a part of the problem is, we have no facilities. So, people end up in jail and, in many cases, sometimes they'll end up in jail for minor offenses like sleeping on the streets. We do it with homeless people, they put them in solitary confinement, which is the worst thing you can do and it makes matters worse. And a very large share of those in jails and prisons have serious mental illness. A very large share of those on the streets have serious mental illness and anosognosia.

We ended up through a series of events down in Miami where this remarkable judge, Steve Leifman, transformed the way the criminal justice system deals with people with serious mental illness over a 20-plus-year period. And what he did was to find ways to save lives and save money. And that's a critical part of this. We pour a lot of money into very bad things.

And, by the way, it costs so much more to imprison somebody than it does to get them treatment or to find a bed in an appropriate place. But what Leifman did had many components. I'll just talk about a few of them quickly. We're taking this around the country to try to spread these best practices. Miami Dade is the seventh most populous county in America with perhaps the largest concentration of those with serious mental illness. It's partly people who are there, but it's also people gravitate there. The weather, you're not going to freeze to death sleeping on the streets, the availability of drugs, because so many self-medicate when they aren't able to get other treatment and a lot of them end up in jail with drug offenses and they're really shouldn't be treated that way.

One of the things that Judge Leifman did with more than 30 separate jurisdictions in this county, he trained over 8,000 police officers in a week-long program that originated in Memphis called Crisis Intervention Team policing. It teaches people to see when individuals are in crisis and how to deescalate, and it's done in a lot of places. But it was particularly effective in Miami because what their Crisis Intervention trainer, who's terrific, discovered was once they started doing this, they're getting between 150 and 250 calls a month from cops with their own mental illness issues. Huge numbers have PTSD. More police die of suicide every year than in the line of fire. There are, of course, huge problems with drug abuse, alcohol abuse, domestic abuse, and getting them treated, which they do outside the department so they're not viewed as pariahs or taken off the street. This has changed the culture of the police.

In the process of doing this, they cut the number of arrests in this county from 118,000 a year to 53,000. They were able to close one of their three main jails at a savings of $12 million a year. That's now 10 years. They've saved 120 million dollars. They used to have an average of two shootings a month. Now they're down to one or two in the last five or six years. They improved the bond rating in the city of Miami because the wrongful death suits that were costing taxpayers hundreds of millions of dollars have almost disappeared. But along with that, they have a pretrial diversion program and now a pre-arrest program.

For the pretrial diversion, if you come into their system and there's any history or signs of mental illness and you have a misdemeanor or a non-violent felony, like a lot of drug offenses, you can have the choice of going to trial or going into a program where they find you housing and give you wraparound services. You come back to the court once a month, usually for a year, it's a personalized program, and if you comply with the program, they expunge the charges, which is huge.

And they've taken large numbers of people and actually given them back their lives in this way. It was stunning to me when I first saw this and my wife and I were blown away by the program. Right around the time that I met Judge Leifman, I had done my first public statement about what had happened to our son. It was several months after he died, the 21st Century's Cures Act, hat ultimately got enacted, the first mental health reform Congress did, was foundering because of problems with a lot of members, but especially with the man who was trying to push it through. And I got called by several members of Congress saying, "Can you help?"

So, I did a piece in the New York Times about what happened with my son. It really went viral. And one of the calls that I got was from the Director of Corrections in South Carolina who said, "I'm the repository of the largest number of people with mental illness in the state and we don't want it and we don't know what to do." And I mentioned Miami and he'd never heard of the program down there. And I thought, “We've got to do something.” So, we did this documentary, which aired on PBS, but you can't just do a documentary that airs and then it's over with. We wanted to use it as a catalyst to take around the country. So, we've now done that with discussions with key players in many cities and states with judges nationally. And we just got back, as Mary knows from Portland, Oregon where Earl Blumenauer, the congressman from Portland, saw our documentary and pulled together an incredible program.

Portland has a lot of problems and they do not have the facilities to deal with this and, like so many other communities, they're foundering. We pulled together a group that included the governor, the mayor of Portland, the executive of the largest county, Multnomah, the sheriff, several members of Congress, and others, as well as some in the mental health world. And I think they're going to start to act in ways that will change things. We've done the same thing in my home state of Minnesota and Keith Ellison, the Attorney General there, is eager to try to transform the system. We're trying to work with the new governor of Maryland, Wes Moore.

Maryland actually is ranked 50th out of 50 states in access to treatment by the Treatment Advocacy Center. And, frankly, it's because the most liberal states, Connecticut is also at the bottom of the barrel, they take civil liberties, which are important and necessary, but move them to the extreme as if people have agency. As if individuals are saying, "I really want to freeze to death under a bridge." If you are delusional, if you don't believe you're ill, if you refuse treatment and over time you deteriorate, bad things are going to happen, tragedies are going to happen. And we have to find ways to balance the civil liberties with the need to get people treatment who otherwise will refuse it.

We're trying to take this everywhere and there are other places doing good things. This is not the only model, but it's a model that works. And we're at a time when the need for criminal justice reform is palpable, the need for police reform. But you're not going to do police reform unless you can find a way to get some buy-in from police. And we have an utterly broken mental health system. And I will just end this lengthy monologue by saying, we know it's going to get so much worse after COVID, and we know it's going to get so much worse after the inhuman Dobbs decision and what we're seeing with other radical fanatic judges.

It's going to create a problem for women, for young girls who are raped and forced to carry their rapist’s, which may include their relatives, babies to term; it's going to get a lot worse with people who don't know where to go. And we know with kids who were not able to go to school for a couple of years, we're already seeing an increase in suicide and suicidal ideation. And we know that serious mental illness, because stress can trigger it, especially if you're in that period from 17 or 18 to 25 or 26 when the prefrontal cortex is just developing, we're going to have more schizophrenia and other kinds of serious diseases. We just have to do something in this society among the many other problems that we have.

Mary

Norm, you could talk all day and I would listen to you. Jen Rubin.

Jen R

I actually have a question for Norm. Obviously, the police component of this is so important, but, I forget what the year was when we changed our whole approach to mental illness from a mass incarceration process to "we'll let people out, but they'll have medication, they'll come back." But as you said, that's not very effective when people do not believe that they are ill or if the medication, in many instances, has side effects that they don't like. What do we need to correct course here? Is it an easier system for evaluating people? Is it more education in schools and parents? What do we need? We're not going to go back to the days of mass incarceration [in psychiatric hospitals], or should we? But what do we need to correct the system before you get to the police stage?

Norm

One of the things that we know is early detection makes an enormous difference. And we also know that the vast majority of people who have a serious mental illness have had trauma in their lives. And often that trauma occurs early in childhood. We now have ways to measure. If you look at women in prison, the vast majority have faced sexual assault or other kinds of domestic assault. Young men have trauma in their families, things that they've seen. By the way, what we know with police is that if they've had a traumatic event during the day, not one where they were necessarily involved, maybe it's going to a brutal murder or a scene of domestic violence, they're more likely to be involved in a violent accident or event that same day. Taking people off the streets can matter.

What we know is if you can check early on and find kids that you know have a greater propensity later on for mental illness, you can begin to track, maybe find some ways to get some early treatment for them that can make a difference. But what we also know, Jen, is that when we had this move to decarcerate, when we had the move to deal with these horrific, insane asylums, often people were put away because their families didn't want them anymore or they wanted to get access to their money. There were a lot of bad reasons and it was easier to do; we needed to recalibrate with civil liberties. But the whole idea was that we were going to set up community health centers with places for people to go, and they never appeared. A part of the reason was Ronald Reagan basically took away all the federal funding and the states simply never responded.

We need more beds. There are lots of places where you're actually getting good police or professionals who find somebody who's willing to get treatment but they have no place to take them. Sometimes they go to the emergency room but if you're a cop and you go to the emergency room you're going to have to wait there with this person for hours and you're off the beat. And the easiest place to put them is jail.

We also need more training for people, and it's not just police and teaching how to deescalate when you have somebody in a crisis. Look at all the footage that we've seen from cell phone cameras of a kid acting up in school and a peace officer in the school slams him against the wall, or cops come in with a six, seven, or eight-year-old, and handcuff them behind their backs and put them in a cruiser. What are the odds that that person, which may include somebody who doesn't have any history of serious problems but got into a tussle, usually a person of color, and gets put in a police car? That's a trauma that's going to stick with you for the rest of your life.

We're working with a psychologist named Xavier Amador in New York, who wrote a wonderful book called I'm Not Sick; I Don't Need Help! about anosognosia and how to communicate with people where logic isn't going to work if that's in your head. He trains people in how to build partnerships and deescalate, and we need to take that to principals, to school health officials, we need to take it to prison guards and prison wardens. If you're a prison guard, you're probably getting 10 or 12 bucks an hour, you are working in brutal conditions, and you're not trained to deal with any kind of uprising except by escalating. And of course, we see all these tragedies in jails as well. We need a top to bottom approach.

What they're also doing in Miami, let me say, what Judge Leifman is doing, and this is going to happen within the next few months, he has gotten a building that was formerly the place where they did competency restoration. It was terrific, and he's creating a one-stop shop, which has 180,000 square feet. People can come in on the ground floor who are in crisis. There's a courtroom there. Sometimes you need to have people who are actually behind locked doors till they can be stabilized, but then they have beds for people who can stay for up to a year. They have a podiatry clinic, an eye clinic and a dental clinic. Homeless people, often, one of the worst problems that they face is from their feet, which can create an infection that can kill you as well. It's humane. They have a culinary facility, a 5,000-square-foot kitchen where they're going to take people when they're stabilized and give them training and they're going to have deals with caterers and restaurants in Miami so that people can go out and get jobs.

When we were in Portland, there is a hotel with 300 beds and two kitchens that the owner wants to sell at a bargain price. It's not far from the place where people in crisis go. If they can buy that and turn it into a facility where you actually have places for people who can stay for a period, maybe even live there, you're going to get a lot of homeless off the street. In Miami, they had over 8,000 homeless people, they're down to 1100. And, of course, these are the toughest cases. They are the ones who mostly male, mostly with serious mental illness, it's going to be hard to deal with them, but they're finding that they're actually able now.

One of the great things is we have these long-term injectable medications. If you can get people where you know the medications will work and give them something that can last for three to six months, what they're finding with some of the worst cases is they're getting a little insight. Once they get a little insight, they're saying, "I don't really want to live on the street and maybe be beaten up or have horrible things happen, have no place to go to the bathroom.” You can make a difference.

To use the cliche, it's not rocket science. We're still way behind in terms of understanding the brain. These medications, most of them are primitive in a lot of ways, we don't know exactly how they work, but we're getting better on that front. But we also know things that can be done that would make a difference in a huge number of lives.

And then finally, one of the things that we've seen in Minneapolis, they don't have enough people in the places where people can go to work there because they pay them a pittance. We need some money up front and we need to train people to be able to work with those with mental illness or dual diagnosis and those with drug issues. And they're out there. And I think we can get an awful lot of young people. A lot of these jobs, you don't need a college education. We can get good jobs with people who can make a real difference in the lives of those who suffer.

Jen Taub

Norm, thank you so much for this. I'm wondering how could we bring the documentary Definition of Insanity to our own communities? My law school is located in Springfield, Massachusetts. I'm sure either the Hamden County Sheriff or the Hampshire County north of us would benefit from this, or maybe the law school could sponsor an event. All of us have different kinds of networks, I wonder if there's a way to use the law school world network to get this into as many communities as possible.

Norm

That's great. I think we've worked with a couple of law schools. The documentary, first of all, is available for anybody to see or to use in whatever fashion they want. You can get it online at doifilm.com. That's Definition of Insanity, DOI.

Norm

Or you can go to our foundation website, which is mornstein.org, and there's a link there as well. There are two versions. We premiered it at the Miami Film Festival, and there's an 80 or so minute version and then there's the version that we used, the broadcast one, which is 55 minutes, which is also very, very good. And I'm happy to talk to you about having some people come.

I will say one of the most heartening things is the chief justices in all the states rarely make a policy statement. They have now made a policy statement about this. One of the problems we have, I would say, is in most states, the definition of what it takes to get somebody treatment is you have to be an imminent danger to yourself or others. And in most places, the way that's defined is you have to have almost literally a gun to somebody's head or a knife to your own throat. And then if you get into a place to get treatment, they'll keep you for 72 hours and once they determine that you are no longer an imminent threat, you're back out on the street and nothing positive has changed. We need to change that definition for people who are delusional, and that's happening.

We've been working with the Association of State Courts, which is all-in on doing something about this, so we're getting enormous cooperation from judges. And Judge Leifman obviously has been a major part of this. And that's been, I think, the bright spot here. But we have not yet worked enough with sheriffs, with those running jails. I mean, we have this terrible abortion of private prisons where their incentive is to keep people—they love recidivism. But if you run a public jail or prison, you don't want people there and you especially don't want those who have some kind of mental illness.

I prefer to call it brain disease because one of the great pathologies here, which we saw with our son, our friends—highly educated, well-intentioned—used to say to me all the time about my son, "Why don't you just kick him in the ass?" The term mental illness basically leaves people thinking that this is voluntary. It's a disease like any other organ. And we used to refer to our son's illness as stage four brain disease. But jails are not places for them and they don't want them. Andwhat Leifman did was to get this incredible cooperation from natural adversaries—the prosecutors, the public defenders, the jailers, the police, and the judges who all understood that this was going to benefit everybody and save lives. So, if we could pull them together in Springfield, that would be great. We started to get a little traction in Rochester, New York after Daniel Prude was killed by these cops when they put the hood on him.

Every day there's somebody in distress and there's a tragedy. Police who are not trained, sometimes police who are trained, shoot, and we've got to change that. And of course, if you're a person of color with a brain disease, the odds of something really bad happening to you go up astronomically. That's the reality in our society.

Mary

I just want to follow up on a lot of what you've been saying, just some statistics that I think are important for people to keep in mind. There are 400,000 people incarcerated who have brain disorders, psychiatric disorders, every day in this country at a cost of, in excess of something like $18 million a year. It costs $31,000 a year to incarcerate somebody. It costs $10,000 a year to treat them comprehensively in community mental health services centers.

With this program in Miami, the recidivism rate, including among non-violent felons, fell from 80% to less than 25%. And one of the things that I found most striking about the results in the documentary was, as I mentioned at the outset, the level of kindness, empathy, and humanity among not just public defenders, but prosecutors and judges. One judge actually said, "We have to believe in rehabilitation and redemption in order to be part of this program." Which made me realize, wow, not all judges believe in either one of those things, which is a serious problem.

We saw police officers participating in a training program that was required in order for them to participate in this program, and one of them said, "I learned more in eight hours than I have in nine years.” And it also, as Norm was alluding to, shows us just how much responsibility we put on police officers. One, they need to be trained differently, but two they need assistance in the form of social workers and other mental health professionals, because dealing with somebody who is having a psychotic break is very different from dealing with somebody who is purposely being violent and criminal. It's making these distinctions.

The other thing, Norm, that I found so important was the emphasis on continuity of care. There was one young man who got through the program. He'd messed up and everybody was pulling for him, and they gave him another chance. He finished the program, he got a round of applause, he got a hug from the judge, he got a certificate, he got cupcakes, and the prosecutor congratulated him and said, "Okay, I'll see you next week." And the young man was like, "What do you mean?" He never thought he'd see this man again. He's like, "Oh, no, I'm not letting you go. We'll stay in touch." That's why Judge Leifman's plan for creating these centers is so important, because it's very different from a state mental hospital.

That's what happened when we had all of these advances in psychotropic meds. These people with brain disorders, psychiatric disorders went from being placed in dangerous, horrific state mental hospitals and went to being released because as you said, Norm, the Reagan administration did nothing to fund the proper treatment centers, and psych patients ended up being incarcerated in dangerous, horrific prisons. So, there's so much potential here.

I don't know, it just seems like all we would need is for everybody, every elected official, every municipal law enforcement agency to watch this documentary and talk to you and you would think that they would jump at the chance. Because I worked in a state psych hospital in the admissions ward. It's very difficult work if you're trained for it. And if you're working in the prison system, you're not trained for it.

Also, just one more thing. I was an intern. I didn't even have my PhD yet. I got paid more than everybody in that hospital except for the full-time psychologists and the administrators, and I was paid very, very, little, especially considering it was New York City. I made $26,000 that year, and I was paid more than 95% of the people in the hospital. In the Admissions Ward people came in at their worst, at their most ill. But the other employees, they're cleaning, they're working with patients in more difficult situations, they're working with patients when they violent, they were doing much harder work than I was. And in some cases, much more dangerous work than I was and I was getting paid more. It's just a broken system in that regard as well.

Jen R

I think there's a misnomer in part because we get such a skewed view of crime in America that people with brain disease are criminals and in fact, they are so much more likely to be crime victims because they are not aware of their surroundings, they live on the street, they don't pick up on social cues and danger. And so, I think the attitude of so many Americans is either they are time bombs waiting to go off or they're a nuisance, they're bothering me as opposed to understanding why that person is where they are. And I think it's rather indicative of a more generic problem in society, which I've talked about some, and that is an empathy deficit. You talk about empathy as being the core factor that has to bind all these people together, care for your fellow human being.

And I feel that whether you want to blame social media, whether you want to blame politics, whether you want to blame churches that no longer care about people's souls but care about electing their president. That we have become so much less empathetic. And in fact, it was very famous study done that between 1970s and the 1990s, we became 25% less empathetic. They could actually measure it. And I don't know what we do about that. And maybe we just start by doing. There's very Jewish outlook, which is, “you may not believe it, just start doing it and pretty soon you'll believe it.”

And it just seems that whether it's this, whether it's racism, whether it's a myriad of other concerns, empathy is what we need a big dose of and we need public figures to model it, not to model bullying and disrespect and anger and all those qualities that have gotten us into the places we are.

Mary

Yeah. And Norm when you put people in situations in which they feel endangered, in which they feel stressed out, in which they feel in some regard they're the enemy, they are, like police officers often must, going to react accordingly. And we did see that shift. And I think part of it is training, not just training to help police deal with people suffering from serious psychiatric disorders, but also changing the way they interact with the people that they're there to serve and protect. Policing has become us versus them.

And police departments have become so weaponized that I think they always have this sense that “I am in danger and everybody in my community is potentially out to get me” where in the olden days it used to be police officers were part of the community. Right. So that is definitely part of it. But Norm, the other mystifying thing is, if you leave aside empathy, which we never should, but just for the sake of argument, this is financially so much better a system than the one it's replacing. That seems inarguable no matter where you are on the empathy spectrum.

Norm

That's so, so true. There are a couple of areas that are worth reflecting on from what you were both saying. One is on police themselves. We're not going to transform the police until we can change the arbitration system. That basically means that bad cops that police chiefs want to get rid of, they can't because the arbitrators inevitably are going to overrule them. Because you are not going to be an arbitrator unless the police union and the police chief accept you. And if you do anything that the union doesn't like, you're out of a job. So, we're not going to change that. We're not going to get rid of all bad cops. But what we can do is, besides trying to change the culture through this de-escalation, is to change the training of new recruits. One, they're all trained now to shoot, to kill if you're in a threatening situation. We know in a couple of places where they've tried to change it to shoot them in the legs or use something that's less lethal, it makes an enormous difference.

The other thing is you look at all the wrongful death suits that happen that are basically hidden from taxpayers. They don't see that, but all the money is going out of their pockets effectively because of this broken system. And you can make a huge difference and save tons of money. And there ought to be ways to work with police to make that kind of a difference. And I have.

You're so right—most police, I saw just the other day, two cops killed from a traffic stop. If you're making a traffic stop, you walk up to that car and you don't know what you're facing. So, we have to have some empathy for them as well. And we're not going to get anywhere in changing things without that. On the prisons, Stuart Butler, when he was at The Heritage Foundation some years ago, had an idea that I thought was terrific, which is we will reward prisons that have reduced recidivism rates and we will take money away from prisons that have high recidivism rates because, unlike most other countries, we treat prison only in a punitive fashion.

You've done something wrong; you're going to go into this facility and you're going to suffer for it; and then we're going to dump you on the street with ten bucks and you're not going to be able to find a job; you're going to be a pariah; and most likely you're going to end up back here.

If we treat it as a rehabilitation process, if we train people for jobs. . .  There's another wonderful documentary about how Bard College in New York City has begun to use school for young violent offenders in state prisons. And they created a debate team. And this debate team of felons beat Harvard and they beat all of these other top college debate because they really saw it as something redemptive for them. And these kids who've gotten out, many of whom made horrific mistakes when they were 16 or 17, are on their feet and their incredibly productive citizens of the society.

There are things that can be done. And of course, the prison system resisted this, a lot of legislators resisted it. We're going to give a free education to these people in prisons when my kids have to pay tuition? But in fact, it's a huge benefit for society. We have to change our mindset.

And on the empathy issue, when I see what Greg Abbott is doing in Texas now, when you see the reaction of people who call themselves pro-life, shrugging their shoulders when women bleed to death because they don't have access to an abortion, but it's because they're having a miscarriage and doctors won't treat them now because of the vagueness of the laws or the nature of the laws. We’ve got to start somewhere to bring back some sense of humanity in people. And we're a long way away from it.

Mary

We are. Jen Taub, I wanted to give you a chance to address any of the things that Norm just said. And as he's talking, it reminds me that, yes, it's not just the people who are incarcerated who shouldn't be because of their psychiatric disorders. It's people who may have broken the law, but even when they serve their time, they pay for it for the rest of their lives. They are at a deficit for the rest of their lives. And for those watching, in order to understand that in a deep way, please read Michelle Alexander's The New Jim Crow.

Jen T:

What I'm thinking about is how policy change works on multiple levels in the society. Right. Things like what Norm's doing—you get the data, you spread the word, people who at the local levels can make changes. To get the change in the funding from the top down, though, requires really good political messaging. In other words, because it's very easy for politicians to say law and order only means the more people you lock up, the better job you're doing. Whereas catching people with fentanyl coming in the border means you're doing a bad job. There a are lot of confusing messages. And I think the only way at the messaging level is, “Our streets are safer and we save money if we do it this way. If we're wasting resources, locking people up who need treatment, if we don't rehabilitate, then it costs more and we're not safe.”

And the job of law enforcement is not just to enforce the law, but to make us safe. Right. I just think there's got to be some way because otherwise Democrats never are going to win on these points. The documentary has to go out there, there has to be training for people. Maybe even a motion picture that shows these stories. I would love to see Norm be the hero of a movie. Your son's story is so compelling. If the public cares about this, you still need to talk about keeping us safe and couching it differently. I'm not a messaging person but I just feel like this is the old racist Willie Horton stuff that always comes back to win. And it's racism; and lack of empathy sells, unfortunately.

Mary

And in terms of destigmatizing, I just want to point out something that Norm said. It's fascinating to me that the term mental illness, and I agree with you Norm, we can't use it, not because there's anything inherently wrong with the term mental illness. It's because in Western democracy, mental illness and physical illness have been bifurcated. They're the same thing and yet we've come to see mental illness as something separate and apart that deserves to be stigmatized. And that's where language really does matter. So, I say psychiatric disorders, but because that makes sense to me in a particular way because of my training. But brain disease. Exactly. Because nobody's ever told me that I should just get more willpower so I don't have to take my asthma meds anymore.

I have a complex post-traumatic stress disorder and I'm sure there are people out there when I've been experiencing symptoms, who have at times said, “You just need to go to the gym. Just come on.” Sure, of course, of course. Let me pull myself up front by the bootstraps I don't have. Thank you very much. So, Jen, I think a part of it is just a serious reframing and changing the place from where we are coming at these issues which are just issues, as you say, of humanity, empathy and just recognizing that we are all struggling and somebody's struggling in a way that's different from us. Instead of rejecting it or maligning them or belittling them, we need to try to understand them.

Jen R

Yes. Three quick things. First of all, what Norm is doing is so important because for many Americans, until someone who you know, who looks like you, has the same background, has the same education, experiences something, it's not real. “It's just those other people. It's probably because their mothers were on cocaine when they were pregnant.” It's all of these excuses and way of demeaning and marginalizing. And to understand that there are many wealthy kids who have a psychotic break as poor kids who have a psychotic break, although poverty does affect one's brain in many ways. That is so important.

The second thing is our entire approach to juvenile crime is horrendous. We all know now that the brain is not fully developed until 25. And there was this movement when crime rates were very high to treat 16 year olds like adults. You remember that? 15 year olds, 14 year olds, and pretty soon we're down to 12. And it takes a lot of public education to explain that a child who does something, even something horrendous at 16, need not be a criminal their entire lives, need not be saddled with that for their entire lives. So, the way we respond to criminal justice and frankly acting out in school, which is a whole other issue about how people are treated.

And the last thing that I would say is I think we finally have a president who has a deep reservoir of empathy. And I think this is an issue he can do so much more on, that it's not politically dangerous. To the contrary, you can get a lot of bipartisan support if you want to be just crass about it.

And every once in a while, he does talk about it. Every once in a while, he does say something. But to talk in the terms that we're talking, to hold a national summit on mental illness and the justice system would be such a contribution to that discussion. That is something that I'm certainly going to put my shoulder to the wheel in terms of pushing for and advocating because I think ultimately there's no one who has more influence and more money than the federal government.

Mary

And Norm, I think Jen points to a couple of really important issues. One is we criminalize everything in this country. We are the most punitive country possibly on the planet. It's stunning to me. And a lot of juvenile crime, a lot of that is, as Jen said, it's just kids acting out for various reasons and people in authority not wanting to take the time or not having the patience to understand what's going on. The other thing, of course, is resources. And I mean, I say this with all humility. I don't know where I would be in my life with what I deal with if I weren't in a place of extraordinary privilege. There was a time when I had EMDR therapy, I had a trauma therapist, I had a regular therapist and I was getting ketamine. Ketamine alone is $450 for one treatment.

And there was a time when I was in a privatesfacility, which is insanely expensive, but those kinds of treatment centers should be available to everybody. And then of course, Jen's final point is putting a spotlight, a bright shining light on this issue by people who have the power, the platform, and the bullhorn.

Norm

All true. And one of the things that's so frustrating is that I would be hard-pressed to find a family in America that hasn't been touched by this in one way or another.

Mary

Exactly.

Norm

Every single family has had people with some form of brain trauma but we've never been able to mobilize because of the stigma. And people don't want to talk about it.

I suspect, Mary, that you've had the same phenomenon that I have when I began to talk publicly about this, which is regularly communications from people saying, "I've never told anybody this, but." And sometimes it's about a family suicide, sometimes it's about a child now who is in deep trauma and danger and they don't have any idea what to do, but they're ashamed to talk about it. And if we can get past that, we can, I think mobilize a bit more.

I would also say one of the heartening things. Early on, I talked to top people at the Justice Department about this, and it was right after Merrick Garland had taken over the Phoenix Police Department because of all of its pathologies. And Vanita Gupta, who's the number three at the Justice Department, who's a star and is just terrific. And the guy who's the head of the Bureau of Justice Assistance went down to Miami and immersed themselves in Judge Leifman’s program. They've come away just true believers that we can make a difference. And there is federal money for a lot of this to get it started.

One of the other things to say is there are lots of places that say, "Yeah, we do this. We have a mental health court." If you just have a mental health court, and most of the judges at mental health courts are not trained, you can have somebody who is floridly psychotic, who comes up in front of a judge and somehow is perfectly all right at that moment because it's self-preservation and the judge, instead of seeing the whole record, says, "Well, you seem fine to me," and they're out of there. Or they have no place to put them in any event. And we've got to deal with those who are not in the criminal justice system who have these issues who are not deeply involved.

But if we can get that initial funding done and begin to do the wraparound services, the comprehensive treatment, find the beds for people, get them places to live, give them the empathy that they deserve this. They're just people who want to have their lives and they're afflicted with a disease that they did not cause and this is not a set of willful acts. We will have a better society, but we'll also have a lot more money to spend on other things that are necessities that we have to deal with.

Mary

Which gets lost always, because apparently some people just prefer the cruelty and being punitive and somehow that makes them feel better about themselves. It is a mystery that needs to be solved.

Norm

Bless you for this.

Mary

I've been wanting to do this for a long time, but we keep getting overtaken by events, as they say. And you know what, that's a choice. It may not feel like it in the moment, but it is. So, we have the power to put on the brakes or at least press pause and focus on something that, as Norm said, affects almost everybody and it doesn't get the attention it deserves.

It is crucially important just in terms of people's individual humanity but in terms of where we want to go, who we want to be. And that has been an issue for the last seven years, who exactly are we? Who do we want to be going forward and what are we going to elevate?

Norm, especially in the wake of what happened to Matthew, I cannot tell you how much your work means. I can't tell you how deeply I admire you and love you, and I am just so grateful that I met you and that you're a part of this weird Nerd Avenger thing we have going on here. And we are not going to stop here. We're going to continue to find ways to promote these vitally important initiatives.

Thank you so much Norm for everything you do, but also for taking time today. We had a whole hour to talk about this with you. I feel incredibly privileged.