By Maureen McNulty, PhD Candidate
What happens to people with mental illnesses who end up on the street?
“Here’s a typical case: The police picked up a guy who seemed to have schizophrenia and was also intoxicated. So, we took him to the hospital. The hospital, recognizing the man from prior visits, said ‘We don’t want this guy. He’s not really mentally ill, he’s just an alcoholic.’ So we got back in the squad car and took him to detox. The man had been to detox many times—he went straight to a bed, laid down, and took off his shoes. But the folks who ran detox said, ‘We don’t want this guy. He’s not just an alcoholic, he has schizophrenia. We can’t keep him.’ And so the poor man was arrested—not because he had done anything wrong—but because there was no other place for him except jail.”
The above is a real life account by Dr. Linda Teplin, Professor of Psychiatry and Behavioral Sciences at Northwestern and Director of the Health Disparities and Public Policy Program. She is a public health researcher with a history of studying stigmatized populations, and is currently leading The Northwestern Juvenile Project, which continuously tracks and interviews nearly 2000 youths who were previously arrested and detained.
Dr. Teplin was recently interviewed for the NPHR by Dietta Chihade, a graduate student in Neurobiology at Northwestern. They talked about Dr. Teplin’s past and current research interests (“I specialize in studying people who fall through the cracks of the mental health and criminal justice systems”), career options for women in the 60’s and 70’s (“The medical school back then was a challenging environment. The washrooms at Weiboldt were labelled ‘faculty’ and ‘ladies.’ I never could figure out which one was the most appropriate for me”), and the intersection between mental health and incarcerated populations. These populations are particularly important to focus on, because, as Dr. Teplin points out, very few public health researchers work with them:
“[W]e have this gap: criminologists study correctional populations, but do not study health. And public health researchers avoid correctional populations. So my group has focused on studying people who fall between the cracks of the disciplines.”
Dr. Teplin first became interested in this area of research because she observed that very few psychiatric patients were being brought to Chicago emergency rooms by police. She wondered what was happening to the remaining people struggling with mental health issues who were undoubtedly on the street, interacting with police.
“My serendipitous observation led me to develop an unusual study. We rode with police during all hours of the day and night to see how they managed people with severe psychiatric disorders on the street. We wondered whether because of deinstitutionalization—and the overall paucity of mental health services— people with severe psychiatric disorders were ending up in jail.”
This resulted in the first large-scale study to look at what happened when police interacted with people with mental disorders. Their results showed that people with mental disorders were more likely to be arrested than those without, even when committing the same types of offenses.
“[This study] established that people with severe mental disorders were disproportionately arrested as a consequence of deinstitutionalization. And, they were arrested not because they were particularly violent, but because the proper infrastructure [like] proper housing, social services, [and] outpatient treatment was never established.”
So now that Dr. Teplin and her team knew that the mentally ill were more likely to be arrested, they figured that looking at what happened to people who were in jail was “the next logical step.”
“Since then, we’ve studied men in jail, women in jail, and kids in detention. Our studies are unusual. Many public health researchers study patients. Or they collect data using household-based samples. Or they sample from school populations. But very few people study incarcerated populations.”
More research in this area is essential, since – as NPHR has previously discussed – huge numbers of people in prison are mentally ill, yet very few jails are equipped to meet prisoners’ mental health needs.
Dr. Teplin’s ongoing research, in which her team continues to track youths once they’ve left jail, has uncovered many new things about stigmatized populations. For example, one study smashed the stereotype that African-American youth were more likely to use hard drugs than were white youth: Caucasians who had previously been detained were 30 times more likely to use cocaine. Dr. Teplin has also found that most psychiatric disorders don’t predict the likelihood of someone having violent behavior in the future, and that youths who had been in detention centers were more likely to die violent deaths. Now, she is working with study participants to examine how incarceration is linked to drug use and HIV/AIDS risk behaviors.
So why is public health research with incarcerated populations so uncommon? Dr. Teplin says:
“I think it’s because many public health researchers are intimidated by the idea. They don’t know how to obtain access to study jails and prisons. They don’t know how to collaborate with correctional staff.”
So then what is the secret to doing public health research with people in prison? According to Dr. Teplin:
“Researchers need to think of ways to give back to the institution that they are studying. When we attempt to gain access I will meet with the people involved—it might be the presiding judge of the juvenile court or the director of the Cook County jail— and I will explain, in very straightforward terms, what our research is about, and why it’s important. We present the larger public health context…. Also, we try to provide a product for them that helps their work. So, we often say to people who run the institution, ‘We are going to be doing this research paid for by the Feds. What can we build in that would be useful for you?’ “
Finally, Dr. Teplin offers some advice for those wanting to do public health research as a career:
“My advice to people is to be well trained methodologically. Then you can pick up any content area. I’ve not been trained in the dependent variables we study, but I understand qualitative and quantitative methods. Also, it helps to be savvy. To be pleasant. To be bold. To choose a methodological approach that best fits the question, rather than the one that you are most comfortable with. To pick brilliant colleagues like mine (Professors Karen Abram and Leah Welty). And finally, to have the perseverance of a Jack Russell terrier.”