>> thank you for being here and also alisa roth your wonderful >> thank you for being here. that's a drive-- dive right in. i've done a little bit of reporting on prisons and i know how difficult it is to get inside them. your book has seen that the la county jail, the chicago jail, women's prison in oklahoma among many others that have seen behind the laws of these this is who she is better in-- notoriously difficult to get cuto. how did you do this? >> some places were welcoming. you mentioned the cook county jail in chicago.

the sheriff there has been very active in bringing awareness of this crisis of people homeless in the criminal justice system and he really feels like it's part of his job to bring people into see what's going on, so he even has an open letter on his website to the other sheriffs and wardens across the country and one thing he mentions as a way that sheriffs and wardens should respond to the crisis is to invite journalist in. i was invited into a jail in virginia where a prisoner had died a really awful death and i felt like they were bringing me in to let you lookin under t the beds in the closets to say we are doing the best we can. we are cleanhe. my favorite story about this is when i was doing reporting in and i wanted to go into a prison in our wrote to the press person and he said i need a letter from your editor and my editor timely wrote a letter saying what i wanted to do and they went back and forth and then set i'm sorry i can't let you come.

icon on the phone and call them and said can we negotiate and finally after several back and forth he said i suggest you investigate another state. [laughter] >> sounds like my experience in the florida. well, you do take us inside. tell us early in your book you talk about what you see as a crisis. what is this crisis and tell us a little bit about what you actually saw. >> we can start with the fact that about 50% of the people in jail and prisons have a mental illness. on the mental health side we can talk about the fact that for a lot of people we deal with mental illness on the crisis management level, so in oklahoma, for example, if you go into a mental health center with symptoms of mental illness of my shoe or actively suicidal or

actively psychotic you will likely not see a psychiatrist or you want to see one for months. >> so, why should we worry about -- just you back, there is the word crisis, signals something that should alarm us and if i'm an unknowing book browser looking at your book i might think, well, mentally ill people who commit crimes should be put in prison. it makes the streets safer. makes the subways safer. why is this a problem? >> i mean, on a very personal level something like 90% of people who go into prison will eventually get out and so if we treat people with mental illness in our jails and prisons we should be treating them properly, but when we talk about

criminal justice reform which we have seen across the political spectrum being embraced as something we need to do, we talk about race, we talk about poverty and we really need to talk with mental illness. >> i mean, just the sheer numbers or the fact that people are entering institutions they shouldn't be? >> both. we have re-created. we shut down in the middle of the last century we effectively shut down the state psychiatric hospital system and while we didn't transfer people from those hospitalsls to the jails d prisons we have effectively re-created all of those conditions that we saw in the hospital, the understaffing, under population, over predication and basically warehousing of the people, we have re-created that in the jails and prisons. >> tell us a bit more about that because your book in a sense

tells us that the conventional understanding of how and why we got to where we are is wrong and that the forces that led us to a situation where half the people in our jails and prisons have mental illnesses, what got us here? >> that story that we shut down the silos and transferred everyone into jails and prisons is a nice oneha. it has a cause. it has an effect. it has a easy solution if the reason people are in 11 jails and prisons is that they're not treated for mental illness, and all we have to do is treat that mental illness and people won't end up there anymore, but when you dig in deeper you see for starters the population of those hospitals with largely elderly white female diagnosed with schizophrenia, there were also a

lot of people there who had either develop mental disabilities or other issues that were not necessarily mental illness per se. when you look at the jail and prison population, obviously it's young, not white, mostly male and the diversity of disease you see is much closer to what we see the outside world , just more concentrated. i think this is really a story about mass incarceration. we have locked up tremendous numbers of people in this country and in doing so we cut huge number of people with mental illness in part to the tactic that grew the kernel justice so-- a system. we talk about the war on drugs. if you look the population of incarcerated people with mental illness something like 80% of them have a substance abuse

disorder, so if you chase down people who have drugs, are dealing drugs, selling drugs, near drugs it stands to reason you'll also get a lot of people with mental illness. >> so, in a sense, it's a story of the fact that we treat-- we have locked up too me people generally and it's one more population that being locked up disproportionately? >> exactly. >> you also talk about a new book about the fact that people are winding up in prison and often getting treatment for the first time, are often coming from communities where alternatives and maybe intervention is a happening. tell us more about that. >> it's very very difficult to access mental health care in this country particularly if you don't have insurance or you have public insurance. i talk about the situation in

oklahoma. at one point i try to figure out what it looks like in new york city for someone who was on medicaid and needed a psychiatrist, so have any psychiatrist in the city except medicaid and how meeks avenue patients and i spent probably two to three days on the phone trying to track down simply list of every psychiatrist who accepted medicaid and i could not do it. i was doing it not worrying about minutes on my cell phone, not worrying about where i was going to sleep that nightng, not worried about where i would refill my prescription. i had all the time in the world and could have figured outhe ani finally went to the medicaid office of a public hospital in a nice lady handed me a sheet of paperic that have the name of fe different plans and she said it depends on which plan you are or she said you need to go online and see the psychiatrist and then call them and see if they are accepting patients.

i don't know who has that kind of a time and energy and wherewithal to figure that out even if you did not have a mental illness in these other extenuating circumstances to worry about. >> in the reporting on this that i have done which took place in florida where you do some of your reporting there was a report and i think in 2008, in which a task force that the staterc put together called the prison system the unfortunate and undeserving safety nets for mentally ill people particularly mentally ill people who were poor and came from disadvantaged communities. how difficult is that story? >> i think it's true in every city in every state in this country. it's very very difficult to get healthcare and then people get caught up, prisoners are the only groups in this country who have a constitutional right to health care including mental health care.

so, it's not that people are going to jail to get treatment, but it's where they end up getting treatment. >> and what is the quality of the treatment they? >> for the most part, terrible. the case i looked at in alabama, with the young man that had been diagnosed as a six or 7-year old and had been getting some treatment in the community through his life he ended up in prison i think it his early 20s with terribly bipolar disorder with other issues and are dashed early second and he needed helpue. repeatedly asked for help and didn't get it. he described you know, therapist who come by every two months and talk to him through a cell door and i have talked through those cell doors and it's hard to hear the other person is sayingng jut to say good morning how are i yu doing what: anything more

complicated or intimate that might be involved in a doctor's appointment.nt he was repeatedly cutting himself. you is on a unit that was supposed to be the unit for the people who were most say in the system. that's was the kind of treatment he was getting. he was effectively in solitary confinement although they did not call it that. he was in a cell by himself and rarely got out, which contributed to his sickness. >> you explore that in a chapter that maybe has the most shocking headlines or titles of any of your chapters. sanctioned torture. most people associate torture with guantánamo or more likely with what foreign regimes did in the past to political dissidents are you suggesting torture is actually rampant in our prison

system? >> i think we have to differentiate between the kinds of torture that you wrote about in florida, which is the unsanctioned kind. this was-- maybe you should tell this part of it seemed that i wrote a story about mental health award at a prison, date correctional institution where pills-- prisoners were pretty routinely the verbally accosted, humiliated, starved and then eventually it came out subjected to a form of horrific torture in a rigged up shower that a group of guards had set up to basically torture, to punish and torment mentally ill prisoners who had got on the wrong side of them and they did this to a

number of inmates at this facility and in june, 2012, they took a prisoner named darren read me who had been arrested on a cocaine possession charge and put them in the shower and he collapsed and died. his body was covered in burdens, 90% of his body was covered in burdens. no one investigated. it was detailed in a heavily redacted report that wasn't initially released t. there was no effort to sort of hold anyone accountable until the story was leaked by an inmate who heard ramie screaming from the shower so and eventually made that "miami herald" and i wrote about in the new yorker took its became as you say a kind of horror story much like the one from rikers that people are right about probably in the "new york times"

where the abuse was delivered its, systemic, intentional. there is another kind of abuse that maybe you are suggesting is even more common. >> i mean, to me being-- to have a severe mental illness and to be locked in jail or prison is in itself a form of torture. to not be getting the treatment you need, to be kept in a title -- tiny cell 22 hours out of the day, to be from your friends and family is a form of torture, but more specifically we talk about things like solitary confinement. it's used as a form of punishment. it's being put as many of you know into a room like a new york city bathroom, space bar bathroom, a man standing in the center of the room can reach both walls with his hands. often, no windows and no contact with anyone else ended this is something we have known for at

least 200 years, can trigger mental illness in people who do not have it before and can exacerbate the problem for someone who already has it. this is perfectly legal, but really almost exclusively extrajudicial, so you're not sentenced to time in solitary confinement. it happens after you go to jail and prison and correctional officers decide you have broken a rule and decide to send you to solitary confinement often without telling you when you will get out. you could be sent therefore indefinitely, effectively. then, while you're in solitary you can have more time added on. theirs, i mean, this is widely used.

it's called by a variety of different names. it's hard to know how many people are in solitary, but p something like 80000 people on any given day are in solitary confinement. not all of them obviously have a mental illness, but it's hard to know how many you do because sometimes you put someone in without it and they come out with mental illness or symptoms of mental illness. there are other forms of torture, also. the men i wrote about in alabama , when he would get in trouble they would deny him and visits with family d. he would beg to see-- he would cut himself sometimes and say what he do that and he said i wanted to see my father and haven't been able to see my father or people in solitary are sometimes cut off from having letters even, so there is all sorts of forms of torture that we see that are perfectly legal and just part of the system. >> what about force, excessive

force, how common is it? come to characterize it? >> we don't know how common it is in part because it's so hard to get in, but we know that it happens and it happens a lot. one of the more astonishing forms of it that i have encountered are what are called cell extractions. someone is supposed to their cell and doesn't want to for whatever reason the correction officers suit up in what's really right year. they have shields and masks and helmets, often pepper spray and they were basically break into the cell and someone out. i have watched people suit up for it and i've watched videos of actual extractions and they are terrifying even if you're not the subject of the thtraction. >> so, and by the way just a

footnote to your comments about us not knowing how many people are actually in solitary confinementno, the mental health unit in this florida prison was not called solitary confinement, but every cell in it was solitary confinement cell and the inmatesnf in the or let pro- let out for whatever a day of the locked and they weren't let out for when our a day and it seems from your reporting you found a similar situations where what is called solitary, but essentially it was. it was putting people in isolated cells pretty much all the time. >> teit's not necessarily intend as punishment. in la county on the mental health unit people are kept in single cells because they-- they're jail has determined it's too dangerous for them or their cellmate to have a cellmate, but it ends up being solitary confinement and that officers will bring them out for their

our or two a day. in la county, for most of the people when you come out it's not like you come out and sit and talk to other people. you are chained to a table like a dog, so you can't even really walk around or if you are well behaved, sometimes they will take you to the rec yard, which again to use an animal metaphor it looks like the dog pen you see in a kennel, so someone can run back and forth, but it's from there today are. >> the prison i looked at was the men's prisoni . a lot of the scenes in your book are about facility housing male prisoners. are they the only ones affected? >> women prisoners actually have much higher rates of mental illness that male prisoners. the numbers get a little bit skewed because when we look at the overall population of jails

and prisons there are so many more men women, but among the female prisoners you see much much higher rates of mental illness s and in some cases you are seeing the mental illness being made worse by the in a lot of so cases the women are the sole caretakers of the children and when they get incarcerated they have left these children behind. i've met several people in oklahoma who had either already lost custody of their kids a or were terrified they were going to lose custody of their kids, so regardless of everything else that was going on they had tremendous problems of anxiety and depression because they were worried about their family. >> it's actually higher percentage of women prisoners at this point who are exhibiting or sort of fall into the category than men even though the aggregate--

>> yes, in absolute numbers are lower, but percentages are higher and when you look at trauma like the number of people who have experienced trauma in their life up to this point, in women it's almost all of them have experienced serious trauma. >> you spend a lot of the book detailing fairly horrific cases. it's not easy reading. it's important reading, but you also do something that i think is somewhat rare in books that are such direct indictment of the criminal justice system. you don't talkic in a condemning way about the people on the other side of this institution, speaking of corrections officers and also some mental health providers. what does this crisis as you put it mean for them? >> i think it's easy to say the

system tortures the prisoners who are caught in the system, but i think that it really is a form of torture to everyone involved in it. you talk about corrections officers to our in some cases quite that law enforcement and in other cases they are actually law enforcement, so in los angeles sheriff deputies who are responsible for the care of these people, the same deputies that would stop you for a traffic stop. for the most part they are underpaid, overworked. i heard stories in florida of the people who would try to leave at the end of a 12 hour shift and they literally would not put them into gates. they said sorry, you are working a double shift work i heard a couple stories i wasn't able to cooperate of corrections officers actually calling the cops saying they were being held

captive in the prison because they could knock out to the home and i think worst of all is that they are not trained for this. this is not what they signed up for, but also not what they train for so they are effectively workingwi as a psychiatric technician or some low level mental healthw- clinician and they received little or no training and then on top of it and this is true across the board, they are being subjected to the same unpleasant circumstances of working in a jail or a prison, so the noise, the chaos, the pat downs, the locked down so when jail goes on lockdown if something happens hoey will shut the whole jail and there's no movement, so doctors describe how frustrating it is when you are ready to go home and you cannot go pick up your kid from school because the jail is on lockdown or worse, cases where your witness to

something like a horrible beating of a prisoner and you feel like you're for your own safety you can't intervene in any way because you may be subject to some sort of violence >> what about the other group of people who work in these facilities, the mental health counselors and stop, how should we view their role in all this? >> i met some really amazing doctors and psychologists and other clinicians who really felt drawn to do this work and felt like this was their callinghi, this was something they were meant to do. and that they were really making a difference by going in and trying to make the best of a terrible situation, so here at writers we have heard horrible stories about what's happening there, but i think especially

the mental health staff has been doing phenomenal work there could be developed a bunch of behavioral health units designed to mimic the behavioral health units a regular hospital. there are others-- one-- a physician who used it to work in a prison system said no u one graduatesai from medical school and says hey, i want to go work in a prison. they are underpaid, under resourced. it's a very very tough population to work withpu, so in some cases you see the absolute toughest cases because these are people who have lasting mental illness that have never been treated properly in a very un- therapeutic environment and the east clinicians are some of the least qualified people to be doing it. >> let me push back against a

they are discarded the system like everyone else. at the prison in floor-- for they were starving prisoners, torturing them. they killed a man. they actually did kill another sometime later. another prisoner died sometime later and none of the mental health staff with one exception challenged the gardens that this i unacceptable. you cannot do this. it's a violation of basic rights you know, shouldn't the staff that are in these facilities or in effect there to serve patients , shouldn't they be standing, you know, in some ways against, not the obvious reasons, but these are things like solitary confinement? >> solitary confinement is an interesting piece of this because the clinicians talk about this problem of the dual

loyalty, so on the one hand you are-- the phrase people use a guest in their house meeting this is a corrections facility, a correctional facility and you are there to serve that purpose and you are subject to their rules and so that is true in terms off you are supposed to follow their rules. it's also true in terms of you are dependent on them for your own safety. there are certainly plenty of people in jail or prison you would not want to be leftt alone with, so i heard a lot of stories from psychologists and psychiatrists in particular about when a corrections officer is angry with you if you have made the powers that be mad you are not getting get access to your patienceou or you are young woman, social worker let's say who's locked in a cell with a big burly guy with aic psychotic disorder and the officer kind of wanders away, so you are

beholden to them on that side. at the same time as a clinician you are supposed to be healing people and taking care of people so you are left in this place. often, clinicians will be asked to determine so some jails and prisons have started limiting the use of solitary confinement for people with mental illness and so what happens is they will take the prisoner to the clinician and to say is this person fit to be in solitary and it puts the clinician in this very awkward position of-- on multiple levels. you don't want to determine whether your patient is fit or not. you don't want to be subjecting your patient to that end in a larger sense by saying some people are fit and some people are not you are implicitly

suggesting that solitary confinement is okay in some way. >> by the way, i have heard that issue, the difficult situation of people on the front lines is that there are people like ken appelbaum who was the director of the mental health system in the massachusetts department of corrections and he has tried very hard to push pressure professional organizations, apa, to stay something about this as an organization, to take a stronger stance work they have put out various policy statements, but they tend to do that thing you mentioned in a sense not into society, the department of corrections, the criminal justice system that this really isn't our business, this is for you to kind of set the terms for and he and a few others had taken the position that it's not good enough. if we think anyone in a severe--

who has a severe mental illness or even just a mental illness will likely deteriorateik in solitary confinement as an organization they have to have a stronger policy than that and i wonder if that makes sense to you that in a sense we need more light shed on this and stronger positions taken from the outsidh rather than just leaving it to the people that are inside. >> i think part of the problem is that because people don't know what's going on, so people on the outside really don't know what's happening there, so it becomes hard to say this is not acceptable, so when you talk about solitary confinement i don't think most people realize how common it is or we think it's what-- the hannibal lecter of the worlds and of course they should be in solitary confinement. so, it's very difficult to get people to have that kind of an

outcry because i think there is this sense whether spoken or not that the people are there deserve to be there. i think t there has also been legally a reluctance to step into that jail and prison world and in the case of jail for instance or on a county level young award in a sitting there with his little system and a lot of what goes on there is no one's business. no one knows. >> that's a very dark-- appropriately to call it an indictment, i mean, it's true a lot of people don't know, but it's also true a lot of people don't want to know. in other words we do actually have awareness that solitary confinement is used, certainly professional organizations are aware, but we don't necessarily

dwell on it. it's like an inconvenient thoughtut and this gets to in a sense the third part of your book, which is more hopeful and must kind of in the indictment and much more kind of plea for alternative approaches. tell us a bit about that third section of the book, what's in it and why he put it there, why you think maybe there is some room for hope. >> there is some room for hope. i was very heartened that just about every single person i spoke to for the book, whether it was the prisoners and their familiese or a prosecutor or the defense attorneys or the judges, you name it, there was absolutea agreement that what we are doing is wrong and it's not serving anyone.

it's not serving the people locked up. it's not serving those people that i talked about, so that is hopeful that we at least acknowledge it should be happening and we have to somehow change it. part of it is that the system is really a whole series of little tiny systems and so the change will have to come in those little tiny pieces. we are starting to see that, so there's a move to train police officers and this is been going on for a while nine-- now, train police officers who are first responders in many cases to a mental health crisis had a better respond. , two else going the situation, but rather coming in the escalate, see how they can be helpful, how they can find a way to get the person helping need .

the second piece of that is training the police officers how to respond, but if there is no place to take them the police end up taking those people to jail anyway because it's a fast, it is a doable solution. if you have been to the er you know you can be sitting there for two days before you see someonekn. no cop supervisor once his or her officer sitting there for hours, so we saw that in san antonio. they have created a center where a police officer can bring people in crisis and be treated for, days and then connected to services in the community. it's been very successful and it's happening all of the country. then we see diversion programs, so ways to get people out of the criminal justice system when it's obvious they don't belong there and convincing them to seek treatment and helping them

find that treatment rather than locking them up. >> you say-- can you say a little bit about the program in miami right about along those lines. >> this is one of those diversion programs. there's a judge who's really been at the forefront of changing things once you are in the judicial system side of thingsal and basically in miamif you are picked up on a nonviolent mostly misdemeanor but a few felonies at this point you will be almost automatically diverted out of the system, connected to treatment. you had to come back and check in with him or one of his fellow judges periodically to make sure you are on track, but they have been so successful they actually managed to shut down an entire wing of the jail there that's being copied all over the country.

>> i want to give the audience a chance to ask questions, but one more question for you. how unique is america and all of this? this is not an easy population to treat humanely generally speaking. how much worse are things heree than say norway or france and i'm not. >> everything is better in norway. >> how unique are we? >> we can start with the criminal justice system. we incarcerate>> by orders of magnitude more people than any other country, so when you look at the next-- our closest tinder, which i think is russia we are here in russia is here, so there is that part of it where we are off the scale. then, there's the healthcare side of it, so you talk about

norway. i visited a prison in norway which was nicer than some of the public schools i have been in here. most are jails you walk in and you are hit to it this disgusting mix of like dirty laundry and bodies and i don't know, year-end, awful smells. smells-- in europe is both a coffee and cinnamon buns, but because they have universal healthcare and they have health records that are assessable it's extremely rare-- we talked earlier about people getting treated for the first time and it's common that someone gets booked in jail and that's the first time they've been treated for it and the psychiatrist in norway told me that rarely happens, the only time she has seen it in-- is when someone has been a substance abuse user for so long that it's really off the grid, but otherwise not only can they go in and see someone's

been treated, but they can go in and say this guy had a break when he was 18 and we treated with him and it worked. yet another break at 22, that didn't work, so they start very much ahead of the game whereas herehe often even coming from jl to prison, which is technically not the same system, but it's the same path, someone arrives in prison and they are starting this detective work all over again to figure out what's wrong with someone. >> it's a very striking point you make in the book that because of the supreme court decision where an inmate challenged the system the supreme court ruled there is a constitutional right to healthcare for prisoners. >> for prisoners. >> not for ordinary regular american citizens, which would be socialism and we don't want that. anyway, should we turn it over? >> yeah.

>> let's have questions from the audience. >> do you have a microphone. talk normal. >> do you see this primarily a healthcare problem? >> i see it is that parallel tracks problem, so we have a healthcare problem. we can access mental health care. it's hard to access and is hard to stay in the treatment went to get it. you might get sure one visit with the psychiatrist and that's it, but it's also a criminal justice problem like we need to keep-- stop mucking up so many people-- stop locking up so we people. >> i'm speaking from having worked at a prison in ohio.

in the prison there were a lot of programs run by inmates that were mental health programs liky thinking positive was one of them in these different programs , art therapy and other things that were the most seemingly effective, talking to inmates about them and i wonder if that is something you saw in your research or not really icon professionals or inmates themselves running the mental health programs? >> we are starting to see more , so pennsylvania recently embraced a peer-- i forgot what they called it, something like a peer support program so they train prisoners with mental illness to then help and provide guidancece for their fellow prisoners, which is something we see in the community, peer support network. and then there are outside groups that command and la

county i saw someone doing i think it was either alcohol awareness or aa meetings or something like that, a volunteer from outside. i think in part because the budgets are so low for any kind of treatment, the prisons really depend on volunteers from the outside to fill in some of those's-- gaps. >> when people come in, what are they charged with like when they drop them off at the jail? >> it's really easy to find something to charge people with. this is not mental health, but i was on a ride along with state police officers who are trying to catch people that were texting and driving and the officer said i can stop any car you want to because there's always a pretext, the tail light

is out, you did not signal when you changed lanes and we know officers often use that to arrest disproportionately, arrest people of color, but in the case of someone with mental illness they could be sleeping on the sidewalk. it could be disorderly conduct, it could be menacing passersby, i mean, you name it, they can find a way to charge them. >> building off that, we didn't really talk much about race and class and how much this is actually a story not about health care at large or mental illness at large, but actually about concentrated disadvantage in certain places that then become catastrophic when you add mental and listen to the picture, so for communities of color, poor communities,in is tt

really where public concern should line where this problem it's doesn't transcend those barriers? >> it's both, i mean, you do see wealthy people and white people picked up, people with mental illness picked up. the story of brian sanderson, a firefighter in virginia developed bipolar disorder and was arrested the first time because he was writing an elevator in a hotel naked and they call the cops on him. he was charged with condition exposure for which you can spend three years in prison in south carolina. it's a misdemeanor. yes. he ended up spending six months in jail before a judge told him to get out of town and not come back, but it was six months he was largely in solitary confinement because he was convinced the corrections

officers were going to kill him so he attacked one of them and a date through him in solitary, but it's largely about race because you can't talk about criminal justice in this country without talking about race and poverty and they all overlap and intersected it's hard to pull out, is someone not getting mental health treatment because they live in a neighborhood where the clinic seven shutdown and so it all goes together, but if you happen to fit in to her three of the categories of likelihood you will get and then the outcomes of like how well you do to get out is the same problems that we see in communities of color, generally. i was at rikers visiting one day i was in line to go in. yet to go through security and there was a woman ahead of me who was from long island. she was white, clearly affluent

and sort of perplexed by this very complicated system where you have to have quarters for lockers and take off your shoes and all these thingss, so i was talking her through some of it and asked her and she was visiting her son who was picked up on a heroin charge of some sort and i said that is terrible what are the prospects were his case or do you have any idea what's going on and she said our attorney will come see him this afternoon or tomorrow and then we will know more and in that one sentence she differentiated herself from everyone in the line and her son from everyone who was locked up because he had an attorney who would visit him and he had anng attorney that hs mother was paying for, so i'm sure his outcome would be different. >> that definitely resonates again with the reporting i've done. question, yes? >> i am interested to hear you talk about chicago and seen

journalists should be welcomed into prison because then i think of torture in america and i definitely think of the chicago pd and i was kind of curious. you've spoken a bit about the relationship of police and mental illness in the prison system. i'm curious about more like if one side of that like if you are in a city with the police department that's rather progressive does that affect the way mental illness is in the prison system or if the prison systemss is really trying tooe attack-- that sounds negative, but deal with mental illness, does that affect with the police officers are doing? >> it depends on where you're talking about, but often very little relationship. there were places where i would talk to the sheriff and he would say i can deal with a peer to me people with mental illness in my jail and i said would you ever go to the cops and say take them to the hospital and he said i

can't do that. that's their business. they make the call. a striking example because the prisons are terrible and they have done a terrible job of dealing with people and mental illness. they have been subject to whole bunch of law-- lawsuits about how they'd treat people with mental illness. when the people i write about who is imprisoned in illinois, he told them he was depressed and i think he said suicidal and they threw him in a cell by himself with no clothes and he was freezing and miserable. who wouldn't be? the jail has really taken it, i mean, the jail-- the sheriff has really made it his mission to try to improve things, so in chicago based screen very very early before you are even booked into the system your body and in the pens they call it they are basically cages where they throw

everyone until they can be booked and they do a mental health screen of every single person who comes in their to try to figure out if they had been treated or diagnosed and what medication they are on. try to get the medication. this is a problem where people come in and i have been on this medication and i need this medication and this is true not just for mental health care, but someone with that-- that is diabetic that needs insulin it maybe three days before they get that, so la-- that is something ellie county is really working on is to speed that up, but it really depends which little piece of the system we are talking about. >> did you come to this story through the lens of mental illness or through the lens mass incarceration? like this was a particularly egregious example and that spoke

to you or you sort of the over into question of mental illness and it became a bigger story? >> i was looking at criminal justice and i kept hearing these stories about race and poverty, but i kept that-- the mental illness kept pocky-- popping up so you talk about solitary confinementt and you realize its really about mental illness in a lot of ways. it felt like no one was really talking about it. you see a story here and there about the largest psychiatric institution being the jail or a case like the daring raining case, but it didn't feel like it was understood in a systemic way and when i started traveling around the country and go into these different jails in different courts i realized quickly that this was really a national crisis, but because the way the criminal justice system st it was playing out in local ways.

>> let me ask you about the definition of mental illness and the diagnosis of mental illness in these prisons, which must be pretty variable. i imagine there's grounds for abuse and a relationship to that do you have any data on the racial composition of those who are diagnosed with mental illness? is there more blacks were latinos especially latino heavy populations? i paid diagnosed with mental illness more than caucasians? >> the definition or diagnosis question the jail and prison is really tricky and interesting because you are accountable he people you're dealing with with mental illness varies dramatically by how you define it, so we sought in new york when the state said you can't

put people with mental illness-- severe mental illness i think was that designation into solitary confinement. all of a sudden the numbers of people with severe mental illness dropped dramatically and i don't dig it was because they were suddenly being cured. the same thing at rikers when they did it, some of the attorneys in new york were saying to me that is fine, but who is deciding whether my client has a mental illness and how are we defining that. at rikers they actually consider ptsd among the mental illness, bipolar, major depression and ptsd, but a lot of places don't account it that way. it makes it hard to figure out even the extent of the problem because everyone has their own way of accounting and in alabama where they were subject to a whole series of lawsuits and one of the pieces that came out in

the lawsuits wasas that the gatekeeper on deciding whether you sought a psychiatrist to get a diagnosis was someone who had very very little cold-- very little medical training, so the judge in this case talked about i go to my position and it's some kind of a not even a position assistant like someone who takes my blood pressure, but that mostly untrained person is not deciding whether i get to see the doctor or not, but what was happening in the prison system was that it was this very low-level clinician who was making a judgment call and as a result when you look at alabama numbers they had way too few people with mental illness for a system of their size. >> sort of going-- leading with

that question, the ptsd, what you said about the female prisoner population interest me-- interested me because it sounds like a lot of what you're talking about and a great portion is trauma and the experience of trauma before been incarcerated and then the experience of trauma during incarceration. t is there any sort of differentiation you saw katie speak to that issue? >> leaving aside things like grape by officers, which we now happens or just even lower-level sexual harassment, sexual assault , if you look at this population many many of whom have experienced partner violence, partner related trauma , there is a traumatization of coming in and being yelled at and told to take off your close or told that you

have to get patted down and all of these things contribute to the whole mess. >> just wondering because i have not read the book, but talk about substance abuse and obviously the surgeon general came out with a report about it being a disease. can you talk about it why, why not? >> i talk about it in the context of it can be very difficult to get treatment for substance abuse disorders in the jail and prison. a lot of the pharmaceuticals used from the outside to treat substance abuse disorders are not allowed in jail and prison because they are considered currency and they are traded.

alcohol use is actually a big problem and it's one of the things jails in particular worry about that people come in and they are detoxing and if you don't identify it it can be very dangerous, but like there's not enough mental health treatment, there's also not enough substance abuse treatment in the jails and prisons. >> : tosca question which we can talk about, but about money. a lot of the public may hear about this and say, well, it's terrible, it's unfortunate, but you know-- you read today's front page of the paper, shooting, another person that shows signs of mental illness and they should have been imprisoned for this impulse to say this is how society should deal with this, what would you

say to that person and can you bring this sort of question of resources, how much this is costing into that? >> incarceration is really really expensive. incarceration of people with mental illness is more expensive because in a lot of cases they require more cards. the prisons think they require more t cards. you single cell people and set up double cell. we are very quick to agree to spend money on public safety, so building more jails and prisons in the interest of protecting all of us is often a popular thing to do or to promise to do, but to spend that money on the front end to prevent mental illness is unsexy. no one wants to do that. >> do you think that could change? >> like think--

>> it really captures the nutshell about 2008 state task force report in florida was, you know, we are wasting money. we are-- we spend all this money on the backend putting people in prison, causing the court system , putting people in hospitals so they stabilize and then go to court and then get sentenced and then go to prison. >> sometimes multiple times c mccaughan in the cases highlighted in the report often for disorderly conduct or sleeping on a bench or showing up at a fast food joint confused and bothering someone and getting arrested and attacking the officer and then you have a assaulting an officer chargee. all of these resources poll-- poured into that. florida is second last in the country and spending on community mental healthor and te report was basically saying from a practical point of view, this

is so shortsighted. as i say that report in 2008, i'm not sure how much progress has been made in the decade since, but it seems like the progress that's been made on the mass incarceration question has been when it's framed as a waste of resources. the argument raised is the argument appalling and unjust didn't get very far until people were told, well, wait a minute as a state you spend more in your prisons than higher education. can a similar argument be made about this? >> we don't like to spend money on healthcare even when it's physical health care even when there ish no real stigma around it, even when it is something that people have in their store chain-- shame to having it. i think we have seen in some cases-- we now provide health

care for pregnant women, let's say or four kids and we had knowledge we need to treat that population in part because the cost of not treating them as too expensive down the line, but i think it's going to take a really long time to get people to come to that solution on mental health care. >> other questions? [inaudible] >> that's the hardest question of the night. i uncovered a lot of things and looking at this and i feel like there's a lot of whores in the criminal justice system and the mental health care system that needs reporting, so stay tuned.

>> all rights. thank you very much. [applause]. >> every weekend book tv offers programming focused on nonfiction authors and books. watch for more here at c-span2 and watch any of our past programs online at the book tv.org. >>