Sophia Karris

         Madness on Cardboard represents an exploration into the roots of my subconscious stigmatization of severe mental illness (SMI), mental health treatment, and the role media plays in creating this stigma. Widespread research initiatives affirm the media’s significant influence on the stigmatization of SMI and mental healthcare (Edney, 2004). Analysis of film and print involving individuals with mental illness identify three salient themes that contribute to stigmatized attitudes towards mental illness: a fear-based perception of people with mental illness as homicidal maniacs, that those with SMI maintain childlike perceptions of the world, or that their mental illness stems from weak personal character (Corrigan and Watson, 2002). I portray my own stigmatized, fear-based perception of SMI artistically to uproot my hidden fears and find a more significant understanding of what creates such stigma.

   

         Using a mixture of acrylic paint, oil pastels, graphite, and marker, I reflect on three highly awarded film and television depictions of individuals diagnosed with SMI and their healthcare providers. At age 13, I viewed the television program American Horror Story: Asylum. Despite its campy nature, the show’s horrific brutality solidified a traumatizing association with mental health care and violence. Years later, the narrative of the film The Dark Knight exposed me to the Joker: an individual with SMI portrayed as a criminal, animalistic, homicidal maniac. My education regarding the deinstitutionalization movement involved examining the 1975 film depiction of One Flew Over the Cuckoo’s Nest. My decision to represent this film artistically examines how biases against SMI and mental health care often persist in society despite widespread public education regarding SMI (Link et al., 1999). Despite educating myself regarding the societal stigma mapped onto SMI, I wanted to examine the persistence of my inner biases despite this education and themes in the prolific film that contributed to societal stigmatization.

         Completed on a white piece of cardboard, primary colors and black comprise the mixed media project’s color scheme. While the piece does not explicitly address childlike mapping stigmatization onto individuals suffering from mental illness, One Who Flew Over the Cuckoo’s Nest utilizes this theme in its plot. For example, the hospital transports its psychiatric patients on a yellow school bus and shapes the patient’s childlike portrayal in the film. The vibrant blue, red, and yellow of the piece inverts the childish nature inherent in the color scheme and binds it with themes of darkness ingrained in the black marker work. The oil pastel portraiture employs the same primary colors, thus tying together all three portraits’ identity in a shared state of insanity. Despite their different roles as criminals and mental health care professionals in their narratives, each character represents collective media narratives that impinge upon reality to demonize mental healthcare and mental illness.

         Outlined in black in the upper corner, the prolific Nurse Ratchet stares emotionless into the distance. To her bottom left, red portraiture depicts criminal Dr. Arthur Adren, of American Horror Story: Asylum. Their positioning near Briarcliff Manor represents their connection with the flawed idea of mental health treatment, based on manipulation, violence, and control. The predominantly white portrait of Nurse Ratched maintains her mechanic, unfeeling exterior. Tinged red highlights subtly represent her manipulative, emotional violence, while the black marker work shrouding her image symbolizes her internal wickedness. Arden’s violence is far more apparent, consuming his identity as the “mad doctor.” Unlike Nurse Ratched, the dark outline around his face defines the portrait just as Arden’s internal evil defines his character. While Adren’s experimental “treatment” involving graphic surgeries of asylum patients lacks basis, in reality, the strong association between violence and mental healthcare creates a fear-based narrative, especially traumatic and distressing for younger, impressionable viewers attracted to the show.

         The themes inherent, particularly in Arden’s character, exist in haunted asylums or straight jackets as Halloween costumes, all of which exploit stigmatized representation of mental illness and mental healthcare treatment with overtones of horror and brutality. Above the heads of Arden and Ratched reads the epitome of the stigmatization of mental health treatment: electric shock therapy. A central theme in any haunted asylum narrative is that the giant block letters command the viewer’s attention and evoke a feeling of discomfort. The red lettering of therapy summons unsettling feelings of violence as it coalesces with the murderous red used in both Ratched and Arden’s portraiture.  

         Depicted in both One Flew Over the Cuckoo’s Nest and American Horror Story: Asylum, the stigmatization of electric shock therapy, medically referred to as electroconvulsive therapy (ECT), misrepresents its modern use in treating mental illness. The violent image of Randel P. McMurphy or American Horror Story: Asylum characters Lana and Jude receiving ECT criticized its early use from the late 1930s into the mid-70s in asylums such as Briarcliff Manor and the Oregon psychiatric hospital depicted in One Flew Over the Cuckoo’s Nest. After receiving extensive ECT, McMurphy and Jude behave as if in comatose, suggesting that the treatment destroyed their cognitive abilities and true, human nature.  Despite the factual accuracy of the past ECT abuse, the celebration and preservation of these narratives demonize ECT by presenting it as a central theme in horror stories that stigmatize mental health treatment and fail to represent the modern administration of ECT.     

         In reality, many psychiatrists use ECT as a highly effective treatment recognized by the American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health. Present-day ECT involves trained medical professionals briefly stimulating the brain of an anesthetized patient with an electrical current. ECT treats severe mental illnesses, such as severe major depression, bipolar disorder, and schizophrenia. The stigmatization of such treatment impacts patient treatment choice, patient consent, and provision of and referral for ECT (Griffiths and O’Neil-Kerr, 2019) that can potentially influence an individual’s access to ECT-aided recovery.

         Positioned under nurse Ratched’s omnipotent portraiture, representing the power dynamic presented in the novel and film, Chief Bromden lifts the water fountain in his final escape scene from the psychiatric hospital. While Kesey spends time developing complexities and nuances in Bromden’s identity, the film falls short in its portrayal of his character. By failing to explain Bromden’s reasoning behind hiding his cognitive abilities, the film suggests “Chief” (as he is referred to in the film) is “faking” mental illness. This oversimplification of Bromden further contributes to the themes of “faking and pretending ” mental illness, ideas identified as mapping stigma on individuals with mental illness (Crumb et al., 2019). Furthermore, Bromden’s belief that he is weak and damaged further plays into the narrative that mental illness is the result of personal inadequacies instead of actual sickness.

         Bromden represents the only central character of color in the film, yet he is drawn in black and white graphite. His colorless depiction speaks to the film’s failure to address the prevalence and reality of SMI in individuals of color. Native American populations are 2.5 times more likely to experience severe psychological distress (National Center for Health Statistics, 2017) and far less likely to access medical treatment (Gone, 2004). His red outline refers to his final act in which he kills a comatose McMurphy in a gesture of mercy, further shadowing mental illness narratives in themes of violence. In lifting the massive water fountain, Chief Bromden must overcome the weight of his racist film depiction, his oppression in the psychiatric facility, and his mental illness that Kesey describes in the novel.

         Beneath Chief Bromden, the Joker, as portrayed in the film The Dark Knight, throws his head out of the window of a cop car. Regarded as the ultimate villain, actor Heath Ledger described the character as a “psychopathic, mass-murdering schizophrenic clown with zero empathy.” As the Joker, Ledger captures certain behavioral components of mental illness that demonstrate the “mad-dog” theme associated with the villain, an identity depicted above the Joker. The Joker’s tongue movements, a manifestation of tardive dyskinesia, and occasional growling further solidify this characterization. White words used to describe the Joker in the film connect the Joker’s portraiture and his mad-dog identity. These words further clarify the Joker’s stigmatized portrayal that characterizes individuals with SMI as inherently inhumane, unpredictable, dangerous, and criminal.

         The embodiment of narratives disparaging mental health in the three highly acclaimed and popular television and film programs suggest my analysis might reflect stigmatization embodied not only in myself but in the American public. This artistic recording of enhanced self-reflection and following academic analysis represent the importance of unrooting inner stigma against mental illness within the general public, academia, law enforcement, and most importantly, among future and present mental healthcare professionals. Effectively devising and implementing a policy aimed at ending mass incarceration and persecution of those diagnosed with SMI requires individuals of the aforementioned groups to reflect upon their subconscious, foundational biases against those with SMI.

Fact Sheet Karris (4)

 

         In late May of 2020, the murder of the Black American George Floyd by the Minnesota Police Department ignited social justice protest aimed at police reform.  Since May, a cry to “Defund the Police” now leads movements to reevaluate law enforcement’s role in maintaining public safety. Currently, 25% of fatal police shootings involve individuals with mental illness. Furthermore, 20% of jail inmates and 15% of prison inmates have a severe mental illness (Bronzon & Berzofsky, 2017), with Black individuals with serious mental illness facing a significantly higher risk of being jailed (“Black and African,” 2020). Thus, reimagining law enforcement’s responsibilities and duties also involves examining police intervention in mental health crisis calls.

         Police typically respond to various mental health calls, often related to homelessness, public indecency, drug use, or calls made by concerned family members of individuals experiencing a mental health episode. While the widespread implementation of Crisis Intervention Training (CIT) has reportedly reduced the number of negative interactions between police officers and individuals with mental illness (Borum et al., 2000), social justice groups continue to demand law enforcement reform. Even police officers voice the opinion that CIT training alone cannot fully improve police responses to mental health calls (Sweeney & Gorner, 2020).

         In early December, the Chicago Department of Public Health released a $1.4 million proposal to dedicate three-person teams composed of police officers, mental health clinicians, and paramedics to respond to mental health calls in two Chicago police districts in 2021. Chicago based its mental health crisis response program on a pre-existing initiative in Eugene, Oregon named CAHOOTS. In 1989, the White Bird Clinic launched the Crisis Assistance Helping Out On The Streets (CAHOOTS) program, which serves as an alternative law enforcement response to non-violent crises. The program features two-person teams of medics and mental health crisis workers that provide various community services, including conflict resolution skills, welfare checks, substance abuse intervention, stabilizing suicide threats, and non-emergent medical services. Both team members remain unarmed and respond to non-violent 911 calls involving behavioral health. In 2019, only 150 out of 24,000 calls directed to CAHOOTS teams required police backup. Furthermore, by responding to 17% of the Eugene Police Department’s overall call volume, the CAHOOTS team saved the city an estimated $8.5 million in annual public safety spending and $14 million in ambulance and emergency room costs (“CAHOOTS & The Police,” 2020).

         Redistributing law enforcement funding to community mental health facilities represents another component of the movement to defund the police. By strengthening programs that offer substance abuse treatment, temporary housing, or psychosis stabilization, individuals experiencing mental health disorders may receive proper mental healthcare and are less likely to re-offend and interact with the police later (Armita et al., 2020). By investing in community mental healthcare, communities preemptively reduce the necessity of law enforcement or mental healthcare teams that handle destabilized individuals experiencing mental health disorders.  In cases that necessitate outside intervention, mental healthcare teams represent a safe and effective way to de-escalate situations without excessive policing or force.

         As social justice movements place increasing pressure on law enforcement to retrain officers and restructure funding, police response to individuals experiencing mental health disorders (specifically individuals of color) must also face reform. Improvement of current mental health crisis intervention must not only include mandated CIT police training and the establishment of programs that position teams with mental healthcare professionals to respond to mental health crises as opposed to police teams. These mental healthcare teams must work with community mental healthcare facilities to connect individuals who have severe mental illness with treatment and support groups. Particular emphases on these law enforcement rectification and community mental healthcare programs in communities of color will ensure that this reform reaches communities most directly impacted by police brutality and the persecution of individuals who have mental illnesses.

In early September, National Public Radio’s The Daily podcast’s episode: “What Happened to Daniel Prude?” investigated the distressing relationship between the criminal justice system and individuals living with serious mental illness (SMI). In late March, police apprehended Prude naked in the snow,  amid a psychotic episode. His brother, Joe Prude, had called the Rochester Police Department earlier, concerned for his brother’s well-being. Upon encountering Daniel, police used a restraint technique that limited Daniel’s ability to breathe, causing him to asphyxiate. Hours later, Joe Prude rushed to the hospital to find his brother completely brain dead. One week later, Joe removed Daniel from life support.

Daniel Prude’s death exemplifies the lethal dangers the criminal justice system and law enforcement pose for individuals experiencing unstable mental conditions, particularly individuals of color such as Prude. Under current policy, individuals experiencing mental illness are 16 times more likely to die in encounters with law enforcement and 13 times more likely to find a bed in jail than a state civil hospital (Gabriel & Sadoff, 2020). In 2015, research from the Treatment Advocacy Center stated at least 1 in 4 of all fatal police shootings involved individuals with SMI. While Black Americans, such as Prude, experience mental illness at similar rates to non-Black groups, they are less likely to receive guideline consistent mental health care (APA, 2017). Work by individuals experienced in public policy, concerned by the frequent persecution of individuals living with SMI, attempts to address these issues by restructuring the criminal justice and law enforcement system.

In Miami-Dade County, Florida; Cindy A. Schwarz works as the Project Director of the Eleventh Judicial Circuit of Florida’s Criminal Mental Health Project (CMHP). This program focuses on retraining law enforcement to interact prudently with the mentally ill and connects criminal offenders living with SMI with existing services to aid their treatment and community reintegration. Shwarz’s contributions to CMHP combats the cyclical nature of the relationship between those living with SMI and the criminal justice system. First, police arrest individuals suffering SMI for small misdemeanors such as trespassing, panhandling, and public urination. Before the establishment of CMHP, the courts immediately lost jurisdiction over offenders incompetent to stand trial. These individuals then languish in jail before their release onto the streets. Offenders with SMI finally reenter society without a diagnosis, treatment plan, housing, or a support system and eventually re-offend and cycle back through the criminal justice system a month later.

In early 2000, Judge Steve Leifman established The Criminal Mental Health Project in an attempt to aid the 175,000 adults living with SMI in Miami-Dade County caught in the criminal justice system. The CMHP encompasses stakeholders in healthcare, the criminal justice community, jails, and law enforcement to ensure that criminal offenders with SMI receive treatment and rehabilitation instead of punishment and abandonment.  Hired in 2003, Schwarz acts as the Substance Abuse Mental Health Administrator, connecting criminal offenders suffering from SMI with community mental health programs. At first, she admits, “We didn’t understand criminal justice. We didn’t understand the language … how the system worked.” The general difficulty navigating the criminal justice system is compounded for individuals that not only suffer from SMI, but often cannot maintain an exact mental state to understand the court proceedings.

Luckily, upon arriving at CMPH, Schwarz hit the ground running. “Seventeen years later we have made fantastic efforts and really moved the needle on what our project does and how we integrate into the community,” she tells me. Since the program started, participants are 55 percent less likely to re-offend. With a substantial decrease in inmates since the implementation of CMHP, Miami-Dade County even closed one jail facility, estimated to have saved taxpayers $12 million per year.

The care comprising CMHP’s pre-booking and post-booking components unquestionably contributes to its impressive success. The pre-booking jail diversion program consists of Crisis Intervention Team training, a nationally recognized program used to educate law enforcement officers to interact with the mentally ill. CIT training encompasses 40 hours of specialized training covering areas such as psychiatric diagnosis, suicide prevention, behavioral de-escalation techniques, mental health and substance abuse laws, and treatment programs available in the community. Since its implementation in Miami-Dade, the program has trained 7,600 police officers, educating more mental health care officers than anywhere else in the nation. Since the program’s implementation, the influx of CIT trained police officers corresponds with a decrease in arrests from 118,000 to 56,000. Since the implementation of CIT, police shootings have decreased from two per month to six in the last eight years.

Despite CIT’s unquestionable importance, most of CMHP exists within its post-booking programs. Defendants undergo mental illness screening and those who show distinct signs of mental illness move to the community-based crisis stabilization unit which provides medication and psychosis stabilization. CMHP participants then work with the court system to create a collaborative treatment rehabilitation plan. Specific to each individual, treatment plans include medicine, housing, a plan to find work or education, and mentorship. In court, a public defender, state attorney, and judge work together to modify or dismiss CMHP participants’ criminal charges as the individual progresses through the program. 

In addition to connecting mentally- ill offenders to pre-existing community treatment programs, Schwarz played a crucial role in introducing the SOAR Entitlement Unit Program in 2007. SOAR connects individuals experiencing SMI with public entitlement benefits such as Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and Medicaid which provide resources to access housing, treatment, and support services to the community. Upon integrating SOAR into CMPH, Schwarz realized, “This is going to be the best thing that ever happened to us! Bring me someone, bring me anyone, and I’ll do the first application.” 

CMPH workers brought Schwarz a young man named Justin Volpe.

At the time, Volpe had spent 46 days in Miami-Dade County’s Pre-Trial Detention Center Psychiatric Unit until being identified as a contender to participate in the CMPH program. After agreeing to cooperate in the post-booking diversion program, Volpe settled into an assisted living facility paid for by the social security money secured through the SOAR program. Soon after his release from jail, Volpe relapsed using crystal meth until he finally decided he had had enough. Relapse isn’t uncommon, Schwarz informs me. In Miami-Dade county, 20 to 25 percent of program participants are rearrested and need treatment and services.

Upon Volpe’s return to the program, Schwarz realized what Volpe’s treatment plan was missing: meaningful work. “When we had a position available, I said to the staff ‘Let’s have Justin do it.’” This marked the beginning of Volpe’s work as a Peer Specialist, a mentor diagnosed with mental illness who works with program participants to facilitate engagement in CMPH and community reintegration. Judge Leifman admits,“The secret sauce of our success is our peer support system.” Now a consultant for mental health facilities and substance abuse programs, Volpe has played a role in helping over 1,000 people avoid jail on top of training over 3,000 local police officers to approach the mentally ill. Twelve years after enrolling in CMHP, he lives with his wife and eight-year-old son in Miami and continues to spend time working for CMPH as a Peer Health Specialist.

Schwarz’s work in the Mental Health Court presents faith and forgiveness in a world that so often averts its gaze from the suffering of the marginalized. The Criminal Mental Health Project provides someone with the tools to succeed, watches them fail, and still say, “Let’s try again. I believe in you.” While grief cannot resurrect Daniel Prude and the countless others killed on account of their mental illness, current efforts to reform the criminal justice system offer some hope for the future.  In an op-ed piece published in the Washington Post, Volpe remarks, “working with the 11th Judicial Circuit Criminal Mental Health Project in Miami-Dade … saved my life.” To mend what is broken to save human lives, faith and forgiveness must triumph over punishment.
[Read more…] about Faith and Forgiveness Demonstrated in Miami Dade Mental Health Courts

         Television shows such as Criminal Minds, Law & Order, and Bones commonly create a fear-based rendition of the “criminally insane”. Unfortunately, these programs often overlook the harmful effects of these narratives in the context of the mass persecution and incarceration of the mentally ill. Research estimates one in two Americans living with severe mental illness face arrest over the course of their lives. A study conducted by the Washington Post in 2017 cited 25% of fatal police shootings involved a person with mental illness. Insane: America’s Criminal Treatment of Mental Illness examines how a flawed criminal justice system emphasizes punishing the mentally ill over treatment and rehabilitation. Roth mobilizes the history of mental healthcare, the personal perspective of mental healthcare workers in the prison system, and narratives of individuals living with mental illness. Framing her argument in logic, Roth suggests that, despite their good intentions, laws and prison standards fail to understand the nuance and complexity necessary to rehabilitate and treat offenders with serious mental illness.

         Roth first contextualizes her mental healthcare critique within a broader historical debate: should mental healthcare exist within regular healthcare systems or specialized facilities? Roth marks the growth of pharmacology, the movement towards community-based mental healthcare, and the development of Medicare and Medicaid as noteworthy in her historical narrative. These events later set the stage for the present degradation of the mental healthcare system and its eventual replacement by prisons and jails. The 1954 FDA approval of chlorpromazine and the drug’s ability to control psychosis provided new insights into medicating mental illness. The eventual overuse of these drugs by mental healthcare workers to treat mental illness depicted mental illness as incurable and stagnant. Within the same period, political policy began to direct resources towards financing community-based care in specialized mental healthcare facilities which sought to replace state hospitals that functioned within the regular healthcare system. However, the failure to materialize these new community-based care options left many mentally ill patients without care options. In 1965, the creation of Medicare and Medicaid incentivized states to move patients from psychiatric hospitals to nursing homes or outpatient care. The overuse of new pharmacology to treat mental illness, the failure to instate community-based care options, and the development of Medicare and Medicaid coalesced into the deinstitutionalization movement, essentially abandoning those in need of mental healthcare.

         The emphasis on public safety spending on health care units in jails and prisons as opposed to funding public mental health care punctuates Roth’s historical analysis of mental health care. Contextualized by the deinstitutionalization movement, personal accounts of those working in the prison system highlight this inequity’s impact. Within these narratives, Roth expertly portrays the inherent flaws of the mental healthcare provided in prisons. In prisons, deputy duties include feeding prisoners, enforcing suicide prevention methods, escorting prisoners to therapy sessions, extracting prisoners from their cells, and making sure prisoners consistently take their medications. Despite this crucial interaction between deputies and inmates, deputies remain uninformed of inmate’s diagnoses due to HIPAA restrictions. “ We as deputies, we know how to arrest people,” one deputy explained to Roth. “We don’t know how to take care of people with mental illness” (101). Often, deputies aid in admitting prisoners into inpatient psychiatric units. Little room exists in these psychiatric units, like in LA County Prison where only 55 beds accommodate roughly 15,000 prisoners. With such limited space, prisoners experiencing psychosis rarely access these facilities and the treatment they provide. Instead, mentally unstable prisoners usually endure time in the prison’s general population. They face solitary confinement, “outdoor time” in dog kennel-like cages, and abuse from other inmates.

         Insane demonstrates how prison regulations and conditions destabilize the mentally disabled, failing to not only rehabilitate the incarcerated but in many cases worsening the mental conditions of those already lost in psychosocial instability. As lieutenant Mike Burse tells Roth, “If you are mentally ill, this [jail] is a horrible place” (92). For example, many mentally unstable prisoners exhibit Scatolia, the act of playing with feces, a behavior seldomly exhibited in the outside world but commonly observed in prisons and jails. Narratives about prisoners released from solitary confinement experiencing heightened panic, stimulus hypersensitivity, and social anxiety solidify the correctional facilities’ pathogenic nature.

         Recounting the experiences of a variety of individuals with mental illness, Roth portrays a plethora of unique individuals from different backgrounds. In a state of psychosis, one schizophrenic man from Texas permanently blinded himself when police officers failed to watch him in jail. Another schizophrenic and bipolar man, incarcerated for stealing five dollars’ worth of food in Virginia, died of starvation in prison after enduring months of abuse from correctional officers. In Florida, correctional officers forced a man who spread feces in his cell into a boiling shower where he subsequently died. Despite the differences between each narrative and each individual, similar themes of arrest, incarceration, and death reveal the tragic danger of living with mental instability in the United States. The book encapsulates its most heart wrenching, memorable points within these narratives, allowing Roth to humanize a misunderstood, demonized population.

         In her exploration of these depressing narratives, Roth occasionally fails to include a more in-depth, holistic analysis of the solutions to the problems she identifies. Her analysis of the Crisis Intervention Team training accurately depicts current programs aimed at training law enforcement to safely interact with the mentally ill. However, her examination fails to address and analyze other intersectional components (race, the criminalization of drugs, etc.) impactful in the interactions between the mentally ill and law enforcement that CIT training fails to encompass. Furthermore, Roth expertly portrays the flawed and underfunded nature of the healthcare provided in prisons. Still, a description of how to most effectively use these funds and fix these programs might provide a complete analysis of the mass incarceration of the mentally ill. For example, while her analysis of The Restoration Center and the Criminal Mental Health Project exemplifies successful programs implemented in jails these programs do not apply to prisons. This may also point to the need for future research dedicated to this area of study. If anything, Roth’s analysis skillfully blueprints current problems for future sociologists, journalists, mental healthcare workers, and policymakers. Individuals working to end the abuse of the mentally ill and providing them effective rehabilitation will find a helpful critique of the current criminal justice system in Roth’s work.

As we enter the twelfth month of a pandemic that necessitates social isolation, maintaining mental health gains saliency. Scrolling through different social media platforms, I consistently view messages that encourage users to check in on their friends, practice self-care, and share links to suicide hotlines all in the name of mental health. Despite their importance and well-intentioned sentiments, these social media efforts often overlook the intersectionality of police brutality, mass incarceration, and systemic racism on individuals with serious mental illness. In order to truly support individuals living with mental health disorders, widespread education and action must address reform regarding how the American criminal justice system interacts with individuals with mental health disorders. 

I begin this E-zene by illustrating the process of uncovering society’s stigmatized ideas regarding individuals with mental illness and my own personal biases regarding mental health and mental health treatment. Exploring this E-zene, I hope that readers can recall the societal biases I identify and recognize their impact on individuals with mental illness. I firmly believe that recognition of personal bias (reflected by large scale societal bias) represents the first step in truly understanding and acting as an advocate for individuals suffering from mental health disorders. In 2020, a new wave of social justice activism specifically focused on criminal justice reform, accompanied the COVID-19 pandemic. This movement cannot understate the necessity to highlight the stigmatization of individuals living with mental illness and demand reform of the current criminal justice system in 2021.