Pete Earley speaks on the mental health system.

Dr. David Sommers, an NIMH scientific review administrator, said the idea for the discussion started when he read Earley's 2006 book, Crazy: A Father's Search Through America's Mental Health Madness. After talking with colleagues whose visits to prisons confirmed the extent of the problem, and in the wake of the Virginia Tech tragedy, Sommers decided that such a forum could help make the crisis clearer for NIH staff, as well as for the public. "At the end, I hope you'll have an increased appreciation of the problem, its magnitude and severity," he said.

In introductory remarks, NIMH director Dr. Thomas Insel, who toured several states with HHS Secretary Michael Leavitt in the days following the shootings at Virginia Tech, stressed that what he heard in "state after state" was a perception that an epidemic existed of "serious mental illness among children, adolescents and college students," and that both families and providers feel there is "no capacity, no network of mental health services that is really geared up to meet this rising need." He said it is time to take a step back to ask, "What's happened here?" And that maybe by discussing personal experiences and making the public more aware of the problem, we can decide what steps to take "to figure out what we can do as a community to have a greater impact."

Perhaps no personal experience could outline the problem more clearly than that of Earley, who spoke quickly and pointedly. His story began when, on a drive from New York City to Virginia, his college-age son, Mike, turned to him and asked, "Dad, how would you feel if someone you loved killed himself?"

Mike had been diagnosed with bipolar disorder the previous year, but had recently stopped taking the anti-psychotic medication prescribed to him. His behavior - and that question-led Earley to take his son directly to a hospital near their home where a doctor came into the waiting room with his hands up, "as if he was surrendering," and said he couldn't help Mike because he refused medication. "And the doctor turned to me and said, 'Bring him back when he tries to kill himself, or he tries to kill you,'" Earley said.

"Getting arrested should not be the first step in getting mental health care, but that's what's happening across this country."

In the days that followed, Mike sunk into a "mental abyss." When he broke into a stranger's house to take a bath, Mike couldn't be sent to a hospital unless he'd threatened to kill his father, a police officer told Earley. Earley lied so his son could receive treatment. Once Mike was placed in a community treatment center, his insurance company said he'd have to leave, until Earley mentioned that he was a former Post reporter. Then the police charged Mike with two felonies from the break-in incident. "I felt so frustrated," Earley said. When he told his wife how helpless he felt, she suggested he use his journalistic skills to investigate the issue.

After getting his son's permission to share his story, Earley started the work that would lead to his book, Crazy. In preliminary research, he learned that more than 300,000 people with mental illness are in America's jails and prisons. He went to the Miami-Dade County jail, to the floor where most psychotic prisoners are housed, and saw "terrified, angry, deranged men," whose guards had no training to work with them. He then shadowed several inmates back into the community, including Alice, who had schizophrenia and had been shuttled between a hospital and jail for 3 years without being brought to trial, and April, whose parents had her arrested so she could receive treatment.

People like this, Earley said, "are stuck in a revolving door." He provided some historical perspective of the problem, how well-intentioned state hospitals became "giant, abusive warehouses," and how deinstitutionalization-the closing of these hospitals-sent people with mental illness back to the streets with no community services to help them, prompting the number of prisoners with mental illness to skyrocket.

	Former Washington Post reporter Earley discusses his personal experience with the nation's mental health crisis.

Now, he said, "our jails are becoming our new asylums." This is exacerbated by the criteria of "imminent danger" - that people can only be sent to hospitals if they threaten to harm themselves or others. "I feel 'imminent danger' has created an excuse to not help people who are in need," Earley said.

He does, however, see reasons for optimism. Many cities have set up mental health courts, "and I applaud these programs," he said. But we also need to remember the lessons of deinstitutionalization and target our tax dollars at improving and broadening community-based services, he explained, adding that we should have crisis-intervention trained police and correctional officers and decent housing within communities for people with mental illness. "To be blunt, we need to turn mental illness back into a health issue," he said.

The forum also included remarks from Denise Juliano-Bult of NIMH's Division of Services and Interventions, who detailed what the institute is doing to find places where people with mental illness can be diverted from the criminal justice system. Dr. Arlene Rogan, acting director of the Montgomery County Mental Health Core Services Agency, explained community initiatives.

But it was the speaker who followed Earley, Clare Dickens, who brought his message home. Her son, Titus, took his own life last year after struggling with bipolar disorder. Her description of what he and his family went through - jail time, being refused treatment until he threatened someone, the system failing him - all too clearly echoed everything Earley discussed.

As for Mike Earley, his father said he's doing better, but that it's still a struggle. "My son has a mental illness," the writer concluded. "This cruel disease wears his face. And I will be forever grateful to people who can look beyond the madness in his eyes, and see a son, a human being, a brother who needs help and who has relatives that love him and are appreciative of anyone who gives him a hand when he needs it."