Crazy: A Father’s Search Through America’s Mental Health Madness

Earley returns to Miami and learns that Judge Leifman has arranged for him to go on a ride-along with a member of Miami’s CIT named Officer Mario Garcia. While on patrol in the rain, Earley learns how the police are required to handle interactions with unhoused individuals. Police harassment of such people was the subject of a 1988 American Civil Liberties Union of Florida class-action lawsuit, the results of which put officers under more scrutiny. Officer Garcia must now adhere to strict rules when dealing with unhoused people.

They respond to a call about a woman who has slashed her wrist after going off her antipsychotic medication and bring her to the hospital emergency room. From there, they respond to incidents with residents at two state-subsidized assisted living facilities (ALFs).

The next day, Officer Garcia and Earley respond to a call from the mother of a man with schizophrenia who went off his antipsychotic medication and is now threatening her with a knife. Officers on the scene attempt to talk to the man to calm him down, but eventually they must use two Tasers to subdue him. Officer Garcia assures Earley that if not for CIT training and Tasers, the man would most likely have been shot and killed by police.

Another visit to the ninth floor of the jail brings potentially exciting news: Dr. Poitier was able to call an involuntary commitment hearing for Freddie Gilbert. The hope was to forcibly commit him to a six-month treatment program at an outside hospital. Dr. Poitier explains to Earley that those with serious criminal charges are the most likely to qualify for intensive outside treatment, while incarcerated individuals like Freddie who have been charged with misdemeanors do not have access to this kind of help.

Dr. Poitier insists that the Baker Act (a 1971 Florida law stating that an individual can only be involuntarily held for 72 hours in a psychiatric unit) is outdated and out of touch considering today’s better understanding of mental illness. During a brief interview with a commitment hearing public defender, Earley learns that while the public defender doesn’t enjoy watching a person with mental illness avoid hospitalization, someone must look out for their basic civil rights. Dr. Poitier testifies on Freddie Gilbert’s behalf, and the judge agrees to hospitalize Freddie for six months.

To better understand the Baker Act commitment process, Earley speaks to Dr. Morton Birnbaum, who campaigned for civil rights for people with mental illnesses. When Earley tells Dr. Birnbaum about Mike’s story and their frustration as a family, Morton insists that he did not intend for his civil rights campaign to produce the results it has today.

While studying mental illness and public policy at Harvard University in 1959, Dr. Birnbaum wrote a revolutionary “right to treatment” theory that stated that all patients with mental illnesses have the right to medical treatment. Otherwise, institutionalizing them would be a form of penal “life sentence.” Many patients in state-run institutions hadn’t committed crimes, or if they had, they had never had the chance to stand trial. This theory would become the legal backing for legislation that forced states to treat all patients with mental illnesses in their care in state-run facilities. Over the years, it would also open the doors to both civil rights cases and campaigns for better treatment for people with mental illnesses, while also putting financial pressure on state budgets, eventually leading to deinstitutionalization. It also sparked later debate about the rights of people with mental illnesses to refuse treatment.

Dr. Birnbaum maintains that he never intended his theory to lead to deinstitutionalization or to make it more difficult for parents today to get help for their children. Wishing to hear from the other side, Earley speaks to Robert Bernstein at the Judge David L. Bazelon Center for Mental Health Law to better understand the right to refuse psychiatric treatment. Bernstein insists that national mental health systems are what need the overhaul and that nothing can be done to help a person with mental illness who does not wish to be helped without violating their civil rights. Given his experience with Mike, Earley is doubtful that any parent in his position could fully side with Bernstein’s argument.

Earley once again returns to the jail, but this time he shadows a psychiatric nurse on the ninth floor named Evelyn Johnson. Johnson has a difficult relationship with the correctional officers because she has reported their bad behavior in the past, this dynamic is indicative of a tension Earley notes: “The nurses, social workers, and Dr. Poitier saw the inmates as patients. The officers saw them as prisoners” (163). After sharing horror stories concerning some incarcerated individuals, Johnson says that she can get past this because “These inmates aren’t themselves when they’re sick” (164).

Dr. Poitier invites Earley to a luncheon sponsored by a pharmaceutical company. The jail’s “fail first” policy meant that Dr. Poitier had to prescribe the antipsychotic Risperdal to patients before any other drug, even if the patient’s past prescription was for a different antipsychotic. Risperdal costs one-third the price of other antipsychotic medications on the market, and prescribing it was considered financially advantageous for the jail.

Earley explains that Dr. Poitier grew up in a family of doctors in two different Black neighborhoods. His later work with forensic psychiatry made him committed to working with incarcerated individuals and patients with mental illnesses. After a chaotic day, Dr. Poitier admits that despite his passion for the work, the jail atmosphere wears on him.