 So, again, I want to thank you all for joining us today. This should be a terrific day. I know I felt a lot of excitement just chatting with people before, and it was lovely to see a bunch of old friends and getting to meet some new people as well. And I hope that we'll have time during the day where you can actually connect with each other. So without getting us any more delayed in the program, I wanted to go ahead and introduce our morning keynote speaker, Pete Early. Actually, I was out of the office all of last week. And when I came in to do my little Saturday morning check-in in the office, someone had neatly snuck Pete's book into my office and left it on my desk. So I was glad I checked in because I was able to read a bunch of it on the plane last night. Super compelling story that he put forward in his book Crazy, A Father's Search Through America's Mental Health Madness. I am unsurprised, having read that much of it, that it was one of the two finalists for the 2007 Pulitzer Prize. Pete is a New York Times bestselling author, former Washington Post reporter. And I think what's compelling about him telling the story of his son struggling to deal with his psychotic break and his brushes with the criminal system and other efforts to try to get help. And the stories that he followed of the people who were incarcerated and stuck in the de facto dysfunctional mental health system that we have in the American prison system is that the problems are truly challenging. And a reflection is we are putting huge resources into something in a way that actually makes no sense. I was mentioning to him as we were sitting down earlier. In public policy, there's often tension between the concepts of anecdote and data. And in many respects, anecdote is disrespected while data is put on a pedestal. And yet the ability to tell a story through actual people's actual experiences really does spark interest in driving toward understanding problems and then driving towards solutions from there. So I greatly appreciate the work that Pete has done. He has tremendous, in the time he's focused on this, just tremendous background. He was recently named the parent member of the Interdepartmental Serious Mental Illness Coordinating Committee, one of 14 non-Federal Commission members appointed by the Secretary of HHS to advise on federal mental health programs and has testified five times before Congress about the need for mental health reforms and has lectured in, I'm going to ask, which is the one state you've missed so far, but 49 states. Missing Hawaii? I think we can help with that. And five foreign countries. So Pete, thank you so much for joining us today. We're honored to have you here. And look forward to what you have to say. Thank you very much. OK. Thank you. Good morning, everyone. I'm thrilled to be here. Thank you so much for inviting me. I've been given three tasks this morning. One is to tell my family story, which I'm happy to do, put a face on mental health. Second is to talk a little about what I discovered when I did my research for my book at the Miami-Dade Correctional Center. And the third is to talk about ISMIC, which I love how federal agencies always put their letters together and come up with these acronyms, which I am the parent member on that. So my family story starts like so many family stories start with a phone call. My son, Kevin, was a student at the Pratt Institute in New York. And we talked every Sunday. And I got a call from him. And he said, Dad, I've stopped eating. Food doesn't taste good. And I went, OK. I don't want to talk about it. He called back an hour later. And he said, Dad, I think I took four or five homeless people to breakfast this morning. Really? I don't want to talk about it. And they called back. And he said, Dad, I don't know if I really, really took those people to breakfast or I'm imagining it. I'm having a hard time telling what's real and what's not. Well, of course, I jumped in my car and I raced in New York. And my wife, Patty, was fortunate enough to find a doctor who actually would like to be available to see him. Now there's an important point I want to make here. My son was an anti-treatment. He wanted to know what was going on. He was confused. He was scared. So we went to the doctor. Now let me tell you what happened when we went to that doctor. He examined my son. He came out. He says, well, Mr. Early, if you're lucky, your son's using drugs. And if he's not, he has a mental illness, bipolar disorder. And then he called both of us in his office. And he said, now I'm not going to do you any favors by sugarcoating any of this. I'm going to tell you exactly what's ahead for your son. Bipolar disorder cannot be cured. It lasts forever. Your son's always going to be sick. He'll have to take powerful medications to control his symptoms. That medication will make him gain weight, probably be pre-diabetic. He'll be susceptible to that. He told me Kevin probably wouldn't be able to work because of his mental illness. He wouldn't have much of a promising career if he did find a job. Marriage, unlikely, family, don't want to chance that. And if your mental illness gets worse, there's a good chance you'll get arrested. There's a good chance you'll end up homeless. And oh yeah, people with mental illness, they die 25 years before everybody else. Well, we went walking out of that office. And obviously, we were both kind of stunned. And my son turned to me and he said, you know, Dad, that guy's crazy. My son wasn't going to be one of those homeless, psychotic people who roam the streets, ranting and raving. Now, recently my wife was diagnosed with kidney cancer. And we looked at the odds. And we came out there and we said, we're going to beat this. We're going to do everything we can. Well, my son was the same way. He went back to school. He took medication for 30 days. It worked. He felt better. He stopped taking medication because he wasn't one of those folks. He wasn't going to be classified that way. Where everything went fine for about eight months. And then I got another frantic phone call. And this time it was from his older brother. And he said, you've got to come to New York. Kevin has gone crazy. And I raced to New York again. And I found him. He'd been wandering around the city for five days. He'd barely slept. He'd hardly eaten. He was convinced God had him on some secret message. And during that four hour car ride from New York to Fairfax County, Virginia, where I live, he would laugh one minute and begin sobbing the next. And I pleaded with him to take some of that medication. He said, leave me alone. Pills are poison. And then he said, Dad, how would you feel if someone you love killed himself? Well, we got to the emergency room at Fairfax Inn of El Hospital. And the nurse rolled her eyes while Kevin was talking gibberish about God and this. And then we were taken into a room all alone, be away from everyone else. And we sat there for four hours. And finally my son said, there's nothing wrong with me. They don't want to see me. I'm going to leave. I said, hang on, hang on. And I went out and I literally grabbed a doctor. And I will never forget how that doctor came in the room. He came in with his hands up as if he was surrendering. And he said, I'm sorry, Mr. Early. I really can't help your son. I said, you haven't even examined him. And he said he didn't matter. At that time, Virginia law was very clear unless a person posed an imminent immediate danger to themselves or others. There was nothing they could do. They couldn't force him to take medication. My son had said, pills were poisoned. But he looked at me and said, you seem like a very concerned dad. I'll tell you what, you bring him back after he tries to kill you or kill someone else. Well, I took my son home. During the next 48 hours, I watched him sink deeper and deeper into a mental abyss. At one point, he had tin foil wrapped around his head because he thought the CIA was reading his thoughts through the television. He slipped out of the house. He slipped out early one morning. He broke into a stranger's house. Luckily, no one was there. He broke in to take a bubble bath. It took five police officers and an attack dog to get him out. And when they got him out, they rushed him over to the mental health center. Then it would burn. And they called me. And I went driving over frantically. And a policeman was standing outside. And he said, hold on, Mr. Early. Let me give you some father-to-father advice, even though we picked your son up in a stranger's house, even though he's taking a bubble bath, even though he's clearly psychotic, even though he told us he has bipolar disorder in his office meds. Unless you go tell the psychiatrist in there that your son has threatened to kill you, he will not be taken into any kind of treatment. He will not be taken to a hospital. He'll be taken to jail. And you don't want that. And I looked at him and I said, but my son hasn't threatened to kill me. And he shrugged and walked away. So I tell you this, and I deal with no pride because it really hurt my relationship with my son. I lied. I went in. I said, my son's threatened to kill me. And that was good enough to get him held over to Mount Vernon Hospital where he voluntarily admitted himself to the next day. But our problems were far from over. I got another telephone call this time from the Fairfax County Police. My son was charged with two felonies, breaking and entering and destruction of property. He became one of the 2.2 million people with mental illness who are booked into our jails every year. He joined the 367,000 persons with mental illness who are in our jails and prisons. According to the National Alliance on Mental Illness, 40% of persons with mental illness will have a serious encounter with law enforcement during their time. 49% of police shootings involve persons with a mental illness. They stay in prison four to eight times longer than others charged with the same crime. They cost seven times as much to incarcerate. They have a recidivism rate that's 15% higher than average, 85%. A person who are arrested with serious mental illness will return to jails and prisons. But Pete, your son broke the law. He needed to go to jail. He should have been in jails and prison. All right, let's talk about Miami-Dade County. Let's talk about the kind of people I met when I went down there for 10 months and spent time in jail. Let's talk about Alice Ann Coyer, classic case of schizophrenia, the kind of person who used to be locked up in one of these hawful institutions, but now she's back. And where was she? She was living on the streets of South Beach where she was psychotic and had been picked up 10 times in the last year. And this time she was arrested because she was walking down the street and she saw a person waiting at a bus stop and she said, stop stealing my thoughts. And she raced over and she shoved the older woman, not hard enough to knock over, but she shoved her. And then she went running away. And well, meaning witnesses came up and said, get that woman arrested, get her off the street, you get her arrested, she'll get help. Well, help is not what happened to Alice Ann Coyer. Florida takes crimes against the elderly very seriously. In fact, anyone, and I always hate saying elderly since I'm older than 65, anyone over 65 can be charged with a felony if you do anything to them. And in this case, they charged her with a felony. In fact, it was her third felony. And because it was her third felony, she fell under the three strikes rule, which meant she faced a mandatory, non-negotiable five years in prison. But when she was brought before that judge, he looked down and he said, I can't put this woman on trial because she's not competent. She doesn't know what's going on. We need to restore her competency. Send her to the hospital at Chattahoochee, not to be treated, but to be made competent. And there is a difference. Treatment means you get help. That's not what she got every day. Every day she was brought in a room and she was shown three chairs and one chair was written judge, another one prosecutor and third chair defense attorney. And when Alice Ann Coyer could tell her keepers who sat in each chair, she was deemed competent enough to be put on trial and she was brought back to that judge. And the judge looked down and of course she'd decompensated by then and he said, what is going on? I sent you to be made competent. You go back to Chattahoochee, you get made competent. So back she went. When I met Alice Ann Coyer in the Miami day jail, she'd been traveling between the jail and Chattahoochee 1,159 days, more than three years. And she'd never been brought to trial. Now I'm an obnoxious reporter. I took my little pen and paper. Now we're running over the prosecutor's office. Look what I found. Look what I found. And they told me with absolutely no embarrassment that they knew exactly what they were gonna do with Alice Ann Coyer. In fact, they were gonna keep her five years, which was a statutory maximum. They could keep her before they released her without putting her on trial. Why? Because she was dangerous. Medications didn't seem to help her become stable. And there was no safe place. No safe place in the entire state of Florida. No long-term treatment facilities, no short-term that keep her safe. And so they had her on that bus riding back and forth between the jail. Let's talk about April Hernandez, same age as my son. She was in jail for car theft. And when I got to know the jailers, they came to me and they said, you know, you should investigate that case. She was framed. Who framed April Hernandez? Her own parents framed her. They're conspired with relatives to get her arrested. Why would you want your own kid arrested? Because she was psychotic. She was homeless. She was living on the streets of South Beach where she'd been gang raped twice and attacked three times by people who thought it was hilarious to beat up homeless people. And there was nothing anyone could do because she was not a danger to herself or others. Now, April's case is interesting because as a teenager, she started using drugs. And everybody went, oh, that's why she's acting this way. And it was only after they realized that she had co-occurring both a drug co-occurring problem and a mental health problem that she finally got the kind of help she knows. And we know that people with bipolar disorder 40% have co-occurring. And we know that 70% on average of people in jails and prisons have co-occurring disorders. The last person I want to talk to you about is Freddie Gilbert. All you have to do to meet a Freddie Gilbert is walk out here and walk a block or two and you will meet a Freddie Gilbert. A Miami study found that at any given time, there were 1,700 people who were homeless. They were living on the streets, sleeping on sidewalks. But that study found, and that was in a population of 2 million, that the majority of those folks were able to move through our social network and get some kind of housing, except 507 individuals. They are the chronic homeless. They are always homeless. And of those 507 individuals, every one of them had a severe mental illness. And of those 507 individuals, every one of them had a co-occurring problem. And of those 507 individuals, every one of them have been arrested more than three times. And when I met Gilbert in jail, he was so sick he could not talk. He stood in his cell naked, and controlled him by offering him sandwiches as if he were a dog performing for treats. And when I checked his record, I discovered that Freddie Gilbert had been in and of that jail more than a dozen times that year alone. But no one had ever done anything to help him because there were no programs available, and he was charged with misdemeanors like trespassing, and there was no incentive to get him into a program. As a result, he was stuck in this revolving door. After my book was published, the University of Florida did a mental health institute followed 97 of these frequent utilizers like Freddie Gilbert. Now listen to this, over a five-year period, every one of them had schizophrenia. Every one of them was homeless. Of those 97, they were arrested 2,200 times. They spent 27,000 days in jail, 13,000 days in crisis stabilization units, state hospitals, and emergency rooms. They cost $13 million, and not one of them, not one of them, got any better. Oh, but Pete, your book came out in 2007. I mean, that was a decade ago. Surely things have improved, have they? Let's look at Hampton Roads, Virginia. Last year, Jay Chamele Mitchell, a young 23-year-old man with schizophrenia. He gets arrested. He gets put in the jail there. His paperwork is sent off to the state hospital so he can be made competent. And nobody realizes he's still there until 101 days later when he dies and is found in his feces-covered cell. And what did we discover? We discovered they died from a heart attack brought on by starvation. The correctional officers didn't give him food because he wouldn't follow their instructions. He'd lost more than 50 pounds in 101 days, and even the nurse checking on him hadn't bothered to report it. And what was his crime? He took $5.05 worth of snacks from a 7-Eleven. Thankfully, there has been progress, but it only comes after a tragedy. After years of struggling, Judge Steve Leifman has closed down the dreaded ninth floor that I visited in Miami. All you have to do is go to San Antonio, see what Leon Evans has done there in Bear County. The Stepping Up campaign by the Council of State Governments, everybody's jumping onto that. It's a wonderful program, and it always does the same thing. It starts with law enforcement. It says everybody needs crisis intervention, training, we need our CIT officers to learn that we don't want Rambo coming through the door, and then they go, oh, wait a minute, we really need a diversion program. We need to divert people from even getting into jail. We need mental health dockets, now called therapeutic courts to make them a little more acceptable, especially in Virginia, where we actually try to get people out of the system. We have the sequential intercept model, which designs key points when you can identify someone in the criminal justice system and figure out how to get them treatment. We have release programs, they're fabulous. All these things can save money by cost shifting and they're important because they can save lives and they can keep people like my son for Kevin from getting a criminal record just because he got sick. But I'm here to tell you today that during the last decade I have been advocating the numbers have not gone down. We still have 16% overall of our people in jails and prisons. Why? There are many reasons. The most obvious is that these wonderful programs are aimed at helping someone after they get into trouble. They're aimed at helping someone after they reach stage four of their illness. And this must change. Come on, let's leave you some common sense. If I broke my arm, I wouldn't call up the police department and ask them to fix it. If I needed heart surgery, I wouldn't call up the sheriff and say, hey, can you do a heart transplant? And if I had nasty hemorrhoids, I wouldn't call up the judge and say, hey, judge, come on over, take a look, tell me what you think. So why are we counting on the police and the sheriff and the judges to do what should be a community mental health program? We need to start thinking about what is called zero intercept. Not getting the police involved at all, but rather helping people who are sick just like we'd help anyone else. Now this is so cliche, but it's also true. What other illness do you call the police? You don't, you call an ambulance. So how do we change our system? Well, this brings me to ISMIC. I love it, ISMIC. All right, ISMIC. And I'm the parent member. It's gonna create a pathway. It's gonna help us figure out how to take eight federal agencies that run 112 programs and make them in duplication, see who works, come up with the metrics. We're gonna do all this great thing. And that is fabulous. I'm glad I'm on it. Mary Gilaberti's on it. We're trying to make real progress. But you know what? All right, here comes the pain in the ass reporter. The Trump administration dinged around to appointing Dr. McCann's cats into August. We had our first meeting. And you know what that did? Then all the federal agencies said, oh, we don't have time to go through the rigorous practice of having everybody check everything. So we're not really gonna contribute to any of the solutions. So what did that mean? That meant nobody from the Department of Education was there to say, hey, we should be writing about how to do early intervention. It meant, hey, no one from the federal Bureau of Prisons was there to answer why they're locking up people in isolation for two years and then turning them loose on the streets, making their illness worse. So instead, you have your 14 members, including me, coming up with a wish list of everything we wanna do. And that's fabulous. And it's a good roadmap. But in the past three decades, every president has come up with a roadmap and nothing has gotten done. And we don't know yet if this administration is gonna do anything except take that report and file it away somewhere. Recommendations in reconfiguring our federal system must be done. If we just plot along like we're doing now, we'll be giving up on the Alison Colliers, April Hernandez, the Frederick Gilbert's, the Jason Mill Mitchell's and the Kevin Earley's in our world. All right, so ISMIC is doing a roadmap. You're gonna hear more about that today from people who are well aware of that. I'm gonna simplify it for you. We will never create a zero intercept unless we front load our system with evidence-based services that work at getting people quality care and keep them from encounters with the police instead of cobbling together a fractured system that only acts as a band-aid and only intervenes when somebody hits rock bottom and becomes dangerous. I'm talking about the earliest possible intervention about a system where individuals can go not to an emergency room, not to jails, but easily accessible restoration or drop-off centers where people will not be turned away but will be welcomed, can be properly assessed, treated, respected with compassion, best practices, have peer support and also given hope, not some horrific description such as my son and I were told. I look back on my son's story and I see at least six different areas where we could have been engaged and I'm sad that we didn't have engagement as one of the things that people wrote down because that is the key, engagement. And what's the other key? The other key is money. And we need to talk about that because that is always the key. If we want a better system, we have to figure out a way to incentivize psychiatrists, hospitals and insurance companies to make them to wanna provide services because it will be adequate financing and compensation and not compassion, I'm sorry to say, that's gonna change our system. In Miami, the seriously mentally ill eat up, that's four to seven percent of the population, use 40% of our mental health dollars. And that's not spent to help them, that's spent to make them competent so they can be put on trial and sent to jail. For this group of frequent utilizers, we need to begin expanding the box of what is healthcare. It's more than putting a pill in someone's mouth. The importance of supportive housing and helping these folks stay out of hospitals, assertive community treatment, human connectivity, job opportunities, stability, recovery, affordable access to medication. Thankfully, many healthcare providers are beginning to understand that if you wanna stop the seriously mentally ill from going through the streets to the jail treadmill, you also have to stop the hospital to the streets to emergency room and ultimately that makes good sense and good financial sense. All right, let me get back to my son. After his fourth hospitalization, he stopped taking his pills, he wasn't engaged. I could see he was slipping. I called up the Mobile Crisis Response Center. They said, is he dangerous? I said, no, he's not dangerous. Let me tell you what happened. No, you can't judge him on what happened. You call him when he's violent or dangerous. I said, what? Call us when he's dangerous. We only have one mobile crisis for a million and a half people. We can't just come over because he's off his meds. So the night, I didn't have to lie. The night he became violent, I called that same dispatcher. He said, please come, my son is violent. And he says, well, wait a minute. Is he dangerous or is he violent? And I said, he's violent. Oh, we don't come. Call the police. If they're violent, we don't come. The police came, they shot my son twice with a taser, hog-tied him and took him away. Now, I'm telling you that story for a reason. If I couldn't get my kid to calp after writing a book about it, my Washington Post connections, living in fancy, dancey, fair facts, what chance does someone who has no connections know nothing about this system? That's why we have to change it. Next time comes around, my son goes off his meds one more time. This time it's Thanksgiving. He jumps in the car, takes off. I start calling him frantically. He finally answers the phone, where are you going? I'm going to heaven. Not the most reassuring thing a parent wants to hear. He gets as far as North Carolina. I always love that because when I talk in North Carolina, they go, oh, we made it. Anyway, he runs out of gas, okay? He's out of gas. He calls me. He says, I'm out of gas, dad. I said, I'll come, don't come. I'll range for, well, go to the gas station. I'll call ahead. No, dad, you don't understand, you don't understand. If I step out of this car, I'm going to die. How do you know you're in this room? How do you know you're listening to me? Your mind is telling you, and I'm telling you, his mind was saying if he stepped out of that car, he would die. He believed that. So I did what no father should do. I range for him to get gasoline. He drove completely psychotic up high 95, went off the road twice. Luckily it was never stopped. He came home. I said, look, I'm tired of fighting with you. Tell me what you want to do. I want to go to a safe house. I just want to think about this. I don't like medication. Okay, I'll take you to a safe house. Got him to a safe house. Checked him in. That night he got up, middle night he took off all his clothes because taking off your clothes makes you invisible. He went walking down the street. Listen to what happened to him this time. A CIT trained officer came up to him and said, hey, what you doing walking down the street naked? Let's go to the emergency room. Don't handcuff me. That's when I got tasered. I didn't do a crime. Fine, get in the back of the car. What kind of radio do you like to listen to? Rap turned on the radio, got to the hospital. My son said, gosh, this is better than a taxi ride. He went in. And when that doctor said to the CIT officer who stuck around, he said, well, walking around naked is not a sign of dangerousness. The officer said, really, Dr. Smith? Huh, I'm gonna drop him off in your front lawn. All of a sudden my son was admitted in that hospital. And then what happened? He got a case manager. A case manager really cared. A case manager managed to talk to him. Do you know my son's seven psychiatrist? Only two have bothered to learn anything but his name and diagnosis. And that's because they're only gonna be paid for 15 minute med check and just tell him to take the pill and go out the door. He got a doctor actually talked to him and said, why don't you take your medication? I've gained 50 pounds. It makes me sluggish. We'll work together. We'll find a medication that really works. They found something worked. Then the case manager said, you shouldn't live with your dad. You're old enough to have housing. She found him a place with two guys with schizophrenia where they had housing. It gave him independence, all right? Then she said, what do you wanna do with your life? He said, what can I do? I have a mental illness. Knock it off, control the illness. Don't let it control you. She got him a job, college educated. He was the guy in Home Depot running around pushing carts, getting carts. He was depressed. All his friends were moving on with his life. One day his therapist is there. He says, Kevin, you're doing a great job. You're doing wonderful. He thought he was mocking him. He said, no, you come to my class. How many of your friends would be doing well if this was they went through what you went through? How many of them would be working? Do you know how rare you are? He went, he talked, he liked it. He liked helping people. It gave him a purpose. Case major said, I got the perfect program for you. Peer to peer, a person with mental illness, helping someone with mental illness. Today my son's a peer to peer counselor on a jail team. He goes out and helps people all brag briefly because my time is up, but I wanna brag briefly. Guy over 300 pounds living in the basement of his parents' house hasn't been out for months. He goes over. He'd be frenzy. They go out. They go to McDonald's, not the best place to go. In my opinion, would they go? No, that's not much, unless that's your son. Unless that's your son. People can recover if you give them the right tools, you give them the right resources. He works full-time today. He's going to graduate school. What finally helped my son? He got the services he needed. He was respected. He was given hope. He was given a purpose in life. He was loved, and most of all, he finally engaged in his own treatment. And that, my friends, is the toughest issue we face as parents, healthcare companies, insurance companies. It's how do you get someone who's not thinking clearly to engage in their own recovery? If you get nothing else from my speech, remember that. Remember, you're not widget makers. You have chosen to make a difference in people's lives. Margaret Mead said it best when she said, never doubt a small group of thoughtful committed citizens can change the world. Indeed, it's the only thing that ever has. I believe every moment creates an opportunity for each of us to fix this system. Let me repeat that. Every moment creates an opportunity for us to fix this broken system. Today, let's start fixing it. Thank you. Sure. Thank you so much. I mean, it's obviously a compelling set of stories that you tell and deep passion about what's broken, but hope as well. I mean, you seem to have a view that we can do things differently, and you've seen it. We should. So let me remind people, because Megan's going to say, hey, you didn't tell people. There's actually microphones on stands up in the front and one in the back. So if you want to ask some questions, please do so. And so we will have a little discussion while people think about their questions. So in terms of, I mean, it is fascinating to see the way this interaction with the judicial system and the prison system got engaged here, the long story of where we, I mean, you actually did a beautiful job of telling the story of how we got to this point. Is there a way, I mean, you seem to have thoughts on how we can pull this thing apart, but it goes back to community-based services. So can you talk a little bit more about that? Of course, we closed down all the state institutions because we felt like most of them were horrible institutions because they weren't funded. And so we set up this community system. We've never really financed. If you look at my book, you'll see that in Miami, there were 5,000 people who were in 650 supportive housing units. 450 of those housing units couldn't pass the basic standard operators boarding home. They had to have a special license. One of them had a just it would have been illegal to put anybody but someone with a mental illness in there. They had a hole in the roof, rain came down, medications were scattered on a kitchen table. None of the caregivers spoke English. None of the people who were tenants spoke Spanish. Meals were rice and beans. There was no treatment. There was nothing. We never have developed this community-based system. But we have to dig deeper. The reason those homes operate is because we don't pay them money to operate. There's not enough money there. And not only do we have to understand where the money is going to come from, because you can issue a report like the Perryman Report says, $1 spent will save $7 in cost shifting. And I go down to Virginia legislature. And I say, look, you get this person out of Fairfax County Jail, $72,500 a year to keep them there. You can provide them services for $12,000, housing first in an act team. You've saved all this money. And the guy comes up to me and says, oh, have we? The county pays for the jail. The state pays for the medical. So why do I want you in my pocket? So we have to think, and hopefully this ISMIC committee will think in a broader term, we have to figure out rewards. I'm sorry, I'm a cynical reporter. If the money is not going to be there, that's what helped cause this in the problem. We've got to think about money. We've got to think about fair compensation to folks like you and others who provide the services. But we also have to deal with the reality which we refuse to deal with because of our history. And that's civil commitment. Nobody wants to force anybody to do anything. And force often doesn't work. It didn't work with my son. It caused resentment. But we have to look at our bar of dangerousness because what we do now is use that as an excuse not to provide services. Then we really turn it over to the criminal justice system. And we have to come up with a more thoughtful, better way to protect human rights but also intervene early enough to get people help before they reach stage four. So in terms of, I really love the way you concluded talking about the opportunities for peer counseling and finding purpose in life. How can we make that go better? How can we facilitate more of that? I think that what, I mean, we have examples out there. If you go to San Antonio, they have a restoration center. It's not part of the hospital. It's not part of the jail. You can go in if you have a, even if you're, you're just drunk. You can go in and try to get the China help. The real secret is what Tom Insel said. He said, trying to get into a person's mind, find the healthy part, and get them engaged. And this is why I always get frustrated with this argument. Look, I was on the committee that helped rewrite Virginia's imminent danger criteria after the Virginia Tech shooting. And I thought if we just make it easier to get people and force them into treatment, we'll solve the problem. Well, you know what? It didn't work. All right? So on one hand, here's my son. He has a family, loves him, accessed good medical care, psychiatrist. He has all these love, everything, a good future. And he's still sick. So I forced him in the hospital. And what happens? He stays stable. It helps him. It gets him going. And then as soon as the judge's order ends, he stops it because he resents it and he gets sick. So what finally was the core? And with each person, it's an individual thing. And with him, he wasn't going to get to see our granddaughter anymore. A doctor scared the hell out of him by telling him every time he had a break, he was killing part of his brain. And he also had to admit that he had a mental illness. He woke up one day and said, after five hospitalizations, I could no longer say that I'm not one of those people. I'm one of those people. For him, that got him engaged. As soon as he got engaged and we could get him plugged into services, he recovered. And that engagement is the trickiest part. And we don't like to talk about it. I think peers, which are under attack in some quarters, are part of that. It just makes sense to me. And my son relates to someone. Is that all the answer? No. You need good medication. But you also need all these other things. And I'm proud that some organizations are beginning in Boston. We have a hospital that actually is setting up respite housing. I spent three months with the homeless in DC to do a book that nobody wanted to buy. And it basically showed me, you can't get better if you don't have a house. Living on the street, you're not going to get better. So we have to start with Maslow's hierarchy. And then we have to identify. But even one last thing, and then I will shut up here. I, in California, they have real progressive. They got $1 billion, thanks to their millionaires tax. They have housing first. They have an ACT team. And you still find people scattered in community housing isolated alone because there's no human connectivity. And that's another part of why peers and others need to be part of that. You can give a person a house. You can give them medication. Medication seems to work with my son. But if there's no social interaction, you're just isolating them individually rather than in a giant state hospital. People, you should be asking questions. Nobody has any questions. This is unacceptable. I knew I could count on Nell to ask a question. And Indy. Thank you. I'm Indy Dedegut, the Georgetown Center on Property and Inequality. I'm curious. Some of this was sort of maybe implicit. I haven't read your book. But what did you find was sort of the role of race, some of the people whose stories you've told, at least, are likely non-white? I just love to hear your thoughts on sort of that. Well, the jails are a reflection of our inability and inadequacy to deal with cultural issues. But it's really tough when you talk about the mental health world. I ran into this more with Cho, who's the Virginia Tech shooter, went to school with one of my kids. And you have to somehow, one of the things I'm proud about NAMI about, I don't know about Mental Health America, is translating into Spanish. But you also have to be culturally aware. And that's particularly true in the African-American community, which you're going to have more encounters by please. Fairfax County, we had a real problem over there. That's where I live. When you have, I forget the exact percentage of African-Americans, but in the jails and prisons, you have almost 47%. I mean, cultural, there's a big cultural part of this that we need to address in the mental health community, along with engaging those people. And again, that's why I think peers can be very useful. There are those that argue there are no scientific proofs, no metrics that show that peers make any difference. And there's a theory that if you're not an educated doctor, you can't make a difference. But I've always felt that if you have somebody who's gone through a similar experience, you can identify with them. And that's especially true in a cultural environment, I think. It's what AA is based on. Go ahead. Did Miami-Dade make any changes after your book was released and possibly the same answer? But are there any cities that you think have really done an extraordinary job? You talked a little bit about San Antonio and Boston having positive programs. But anyone who's just hit it out of the park? Yeah, there's several who have hit it out of the park. Miami-Dade, Judd Leifman, it took him almost 15 years, but he closed down the ninth floor. He's setting up a huge, fabulous system down there. They're even doing predictive analytics, trying to figure out when people are going to go off their meds, when they're going to get sick. San Antonio is the gold standard. But again, we're addressing this from the criminal justice side. And those are the biggest advocates. And I'm afraid we're going to reach a tipping point where jails and prisons are going to get tired, getting beaten up about this kind of stuff, and they're going to create a better mental health system in the jails and prisons. I was just in Alabama, and that's what they were talking about. If you want help, get arrested. Well, that's wrong. So we have to get outside that. And those systems are harder to find because of funding. We're much better at funding problems than we are stopping problems. And that's in a nutshell. That's kind of the simplified journalist answer to that. If you can set up early education, I mean, my wife's a teacher. You can identify some of these problems. Early intervention. We have all these raised studies that show the fact. Look at my own son's story. And I know anecdotal evidence is not always the best to base it on. But he didn't object to going to a psychiatrist. He was a psychiatrist that rejected him. And then what happened? Then he gets arrested. I mean, the whole system was boom, boom, boom. It was punishment rather than, and that just built up more prejudice and hints behind about stigma. Yeah. Thank you. Thank you for your work. I echo everything you said. I'm a research scientist and national committee for quality assurance. I work on mental health quality measures. So my question for you is, what do you think are the roles of the payers to help to develop the mental health system as well as needed social service systems? And that, of course, is the big problem. Why should Kaiser Permanente be paying for housing? So what we have to do is we have to get this federal system in shape first. And we had to break down the barriers between it because we have, and that's hopefully what ISMIC is doing. You've got to see the total health. And to do that, you've got to recognize that, I mean, you have to recognize that these people who are frequent utilizers, who you're going to be punished because they keep coming back to the hospital, this is other steps that they need. So first of all, you had to start thinking outside the box in that way. And that's scary because, and this is where I'll get in trouble, I blame the psychiatry industry because we're trying to throw out such a wide net. Everybody has a psychosis and the insurance company should pay for everything. And there, I've stepped on that one. We have to identify what really we can do and we have to target how we're going to do it in those broad sense. I focus on the seriously mentally ill people, schizophrenia, bipolar, that kind of thing because they use so much services and they're the ones in jail. But we have to think of it, I think the insurance industry has a right to say, wait a minute, I'm not going to pay just because you need a best friend. At the other end, we need to say, OK, you got to keep paying for someone with schizophrenia. And we also have to make, since I'm sending everybody on fire here, they also have to make an acknowledgement here. Everybody wants to believe in recovery. I believe in recovery because I don't know who will recover and who won't. I remember seeing my son tasered, hugged tight on the floor and thinking it was better. He'd never been born. And look at him now. But we also know the four-quarter rule. And one-fourth of people with schizophrenia don't get better and we don't know how to help them. And we shouldn't just abandon them on the streets. Incredible. OK. Pete, thanks for joining us. My pleasure. OK. Thank you.