NPR: America's Mental Health Crisis Hidden Behind Bars

For future reference I'm capturing this important report aired by NPR Morning Edition today. 

America's Mental Health Crisis Hidden Behind Bars

February 25, 20205:01 AM ETHeard on Morning EditionBy ERIC WESTERVELT & LIZ BAKER, NPR Senior Producer
Marisa Peñaloza contributed to this story.

It's recreation time at a Los Angeles County jail known as the Twin Towers. Nearly a dozen disheveled young men stand docilely as they munch on sandwiches out of brown paper bags.

They're half-naked except for sleeveless, thick, blanket-like restraints wrapped around them like medieval garments.

All are chained and handcuffed to shiny metal tables bolted to the floor.

"It's lunchtime and they're actually [in] programming right now," says a veteran guard, LA County Sheriff's Deputy Myron Trimble.

Programming, in theory, means a treatment regimen. But it's difficult to determine what treatment they're actually receiving.

A whiteboard nearby tracks how many days since guards on this floor had to forcibly restrain anyone: 54. These inmates haven't been violent, he says.

So why are all of the men shackled to tables for recreation?

"Just to make sure that they're not walking around," Trimble says. "If they don't take their medications, they could be deemed unpredictable."

No one is under the illusion that shackles are helping mentally ill inmates get well.

"I think everyone can agree that it's rather inhumane to have the inmate handcuffed while out," says LA Sheriff's Capt. Tania Plunkett, with the Twin Towers' Access to Care Bureau. "However, because of spacing and the lack of programming, we're not able to really focus on getting the inmate better to eventually lead to having them in a program without being handcuffed."

New inmates with a mental illness arrive daily in the LA County jail system. It now holds more than 5,000 inmates with a mental illness who've had run-ins with the law. Some 3,000 are held in the jail's Twin Towers.

"By default, we have become the largest treatment facility in the country. And we're a jail," says Tim Belavich, the director of mental health for the Los Angeles County jail system. "I would say a jail facility is not the appropriate place to treat someone's mental illness."

In the past decade, the number of inmates housed at the Twin Towers has skyrocketed.

"When I started in 2013, mentally ill inmates were only housed on the seventh floor and the sixth floor right below it," Capt. Plunkett says. "To date, the entire facility consists of mentally ill inmates." (The adjacent Men's Central Jail houses regular inmates.)

Across the country, there are dozens of places like Los Angeles' Twin Towers, warehousing people in settings with inadequate staff, services and support.

It's a culmination of decades of policies affecting those with a mental illness. Many of the nation's asylums and hospitals were closed over the past 60-plus years — some horrific places that needed to be shuttered, others emptied to cut costs.

The idea was that they'd be replaced with community-based mental health care and supportive services. That didn't happen. Ensuing decades saw tougher sentencing under aggressive "war on drugs and crime" policies as well as cuts to subsidized housing and mental health. It all created a perfect storm of failed policies driving more of the mentally ill into the nation's jails and prisons.

Many were left to fend for themselves. Substance abuse and homelessness sometimes followed, as did encounters with police, who often are called first to help deal with the effects of or related to mental crises.

It has put the jails in an awkward position. Today the three biggest mental health centers in America are jails: LA County, Cook County, Ill. (Chicago) and New York City's Rikers Island jail. Without the support needed, conditions have created new asylums, advocates say, that can resemble the very places they vowed to shut down.

"Local jails and prisons have become the de facto mental health institutions," says Elizabeth Hancq, director of research at the Treatment Advocacy Center, a national nonprofit that works to eliminate barriers to treatment for people with severe mental illness. "It's really a humanitarian crisis that if you suffer from a severe mental illness in this country, you almost need to commit a crime in order to get into the system."

Almost one-third of people with a mental illness get into the treatment systems through an encounter with a police officer, studies show. The lack of available treatment beds nationally means more people with a mental illness are stuck in jails until one becomes available, often for painfully long periods.

It's hard to quantify just how big the problem really is. No organization or agency keeps close nationwide tabs on the number of inmates in county and city jails who have a mental health problem or their average length of stay.

That has made it that much harder for experts and lawmakers to evaluate potential policy solutions to help fix this nationwide crisis.

"Without adequate and appropriate data collection and analysis on serious mental illness in our jails and prisons," Hancq says, "there can't be real accountability and oversight into what's going on."

As The Atlantic recently reported, no one is carefully tracking how many people are held over the legal limit set in their state for being evaluated for mental competency or transferred to a state hospital once declared incompetent to stand trial.

Thousands of people who've been declared incompetent to stand trial and who need mental health treatment, the magazine reports, are today warehoused in jails for unconstitutionally long periods before they are convicted or even tried for any crime.

In LA, well over half the inmate population is awaiting trial or sentencing. For many living with a mental illness, even a day or two in jail following a breakdown can have horrendous long-term consequences. Studies show that brief jail stays for low-risk individuals with a mental illness can more than double recidivism rates.

"It demolishes them," says Steve Leifman, a judge with Miami-Dade County's 11th Judicial Circuit. An expert on the topic, Leifman has worked for more than two decades to reform how the justice system treats people with mental health problems. "They are cut off. Most of these people have very serious trauma issues. If they have housing, they're going to lose it. If they have a job, a day off is a big, big problem." The nation's mental health system today, Leifman says, "is not only fundamentally broken, it's cruel and unusual."

Can't get well in a cell?

LA's Twin Towers jail was not built for treatment. There are no group rooms, no confidential spaces, really no privacy.

It doesn't have enough counselors. Ten psychiatrist jobs have gone unfilled for two years.

"We used to have a psychiatrist see [the more acute patients] every two weeks," says social worker Luis Peña, the jail's mental health clinical program manager. "But because of the lack of psychiatrists in the jail, we have to see them [once] every month."

If lucky, the inmates on this floor will see a social worker once a week.

The jail needs about 200 inpatient treatment beds for acute cases, officials here say. It has only about 40 to 50 available daily.

"We have more than 140 individuals on any given day who could use an inpatient bed that we just cannot provide at the moment," Belavich says.

By default, there's more of an emphasis on medication — critics say over-medication — and less on individual or group therapy. There's really no room for that. On several floors, bunk beds and makeshift living areas pack what should be "common use" areas.

"We have to scramble. We have to do whatever we need to do," social worker Peña says, "whether the individual is suffering from schizophrenia, psychosis, provoked by drugs or whatever, this is population that we get, the population that we need to target to provide the best that we can."

Outside the cells there's a ready supply of suicide restraints. They are heavy beltless garments with Velcro, akin to the thick blankets movers use, and are stacked on shelves like office supplies.

Along one cellblock, an inmate gestures frantically at a small window. He has carefully piled garbage in a corner of his cell, like some grim abstract sculpture. A door note warns guards that he's "a runner."

There are other notes on other doors. One inmate is deemed "hostile." Another, "suicidal." And guards track on boards who's a "gasser" — meaning an inmate who has thrown blood, urine or feces.

There's often a smell of urine and dank water. In several areas toilet water is seeping out of cells.

"Looks like he clogged the toilet and continued to flush it, which resulted in it overflowing," Capt. Plunkett says, pointing to an inmate who is known to act out. "Unfortunately, with the design build, drains weren't incorporated. So it will collect water, sometimes an extensive amount of water, on the floor."

Cell flooding, guards say, is a daily occurrence.

Despite the major strains, the jail tries to find creative workarounds, says Belavich, the mental health director. He introduced new programs specifically aimed at the most severely mentally ill, but concedes significant hurdles remain.

"We continue to try to address those challenges," he says. "However, without certain resources, we won't be fully successful."

Over the years, the Los Angeles County jail has been forced to address the treatment and reduce the criminalization of people living with a mental illness. Most action was spurred by lawsuits and subsequent court settlements including the landmark Rosas decision. That legal case, which centered on accusations of abuse and beatings by guards throughout the county's jail system, led to court-appointed monitors to improve civilian oversight and better training.

Reported use-of-force incidents are down since Rosas. Security conditions are better, "but compared to what?" asks staff attorney Sarah Clifton with the ACLU of Los Angeles. She monitors the Twin Towers as the group's jails policy and conditions coordinator.

"A lot of times in jail settings, you'll see improvement in one area and then backsliding in another. And I think one of our biggest goals is to avoid backsliding" on use of force and treatment shortcomings, Clifton says. "We are pushing for more community treatment, a decentralization of care and not using the jails as warehouses for people with mental health issues."

That's what activist and artist Patrisse Cullors wants, too. She founded the group Reform LA Jails and helped co-found Black Lives Matter. Her older brother was diagnosed with schizoaffective disorder, mania and depression. It's led to many encounters with the criminal justice system.

"The first time I saw my brother in the [L.A] county jail system he was in terrible condition," Cullors says. "And I just kept thinking — why would our society allow for someone who's sick to be treated this way, to not be given the kind of care they deserve?"

During one manic episode more than a decade ago, her brother took off in his mother's car. He ended up in a high-speed chase and was arrested for fleeing the scene. In LA's north detention center, Cullors says, he was beaten by guards while experiencing psychosis. Later, during her brother's time in the Twin Towers, she says, his condition only worsened. "They need to be in adequate mental health facilities. We have a slogan in our campaign — you can't get well in a cell."

Last year, LA County Supervisors finally agreed. Under public pressure, they scrapped a $1.7 billion plan to build a jail-like mental health center partially on the site of the current Men's Central Jail complex where the Twin Towers sit.

Critics called it a rebranded jail that would continue to criminalize people living with a mental illness.

"I don't know how anybody gets well in there," says LA's District Attorney Jackie Lacey, who has supported efforts to find alternatives to the Twin Towers. "It's noisy, it smells terrible, even when you're meeting with your mental health professional you're chained to a bench. There are people swirling all around you, some of them are rocking back and forth and talking to themselves."

Lacey, who's running for re-election, has pushed to expand community-based mental health treatment and housing through a special diversion court. It aims to stop mentally ill homeless people cycling through jail, court and the streets.

"If you can release some of that pressure to that people aren't doubled and tripled up in cells [in the Twin Towers] and you have people in a setting that's truly therapeutic but safe for the public, that's really something that all of us should support," Lacey says.

Belavich welcomes that. "Many of these individuals [in the Twin Towers] may not need to stay with us at all or may be able to stay with us for a much shorter amount of time until we can stabilize them and find them resources in the community," he says. However, he warns, the county has a very long way to go. "If we are able to divert a lot of these individuals, we have to have some place to divert them to."

Alternative court

On a recent morning LA Superior Court Judge Karla Kerlin is thankful for the day's relatively light load — just three dozen files on her desk. On some days the stack obstructs her courtroom view. Kerlin oversees the city of LA's diversion and reentry housing court.

"Who has the files on Barclay?" she asks, taking up the case of Angie Barclay, 57, whose long arrest history, according to court records, includes theft, narcotics possession and prostitution. And there's her latest charge.

"Assault with a deadly weapon, in this case a knife, this is a felony, and a serious felony — which means it is a strike," Kerlin tells Barclay.

Barclay sits stoically in the defendant's chair in a blue jail jumpsuit. In any other courtroom, she would likely continue to cycle between jail and the streets.

But today, Judge Kerlin wants to try to end that pattern. She calls the courtroom psychiatrist to the bench for a sidebar talk.

"So her diagnosis is bipolar 1 disorder," the psychiatrist tells her quietly. "She's doing well, actually, a little blunted but improving."

Barclay's taking her medications, the psychiatrist adds.

Despite objections from the prosecutor, Kerlin decides to give Barclay a chance at the housing and treatment program. It's a relatively new effort by the county to try to get more people with mental illness who are homeless diverted from jails and off the streets by funneling them into treatment and supportive housing.

The stakes are high: If the person successfully completes this two-year diversion program, his or her case will be dismissed. If not, the criminal case will be reinstated. If the person is kicked out or doesn't finish, they don't get "credit" for time served in the diversion program.

"All right Ms. Barclay," Kerlin says loudly, moving swiftly through her case. "Just let me confirm that this is what you want to do because it's a lot more extensive than being on regular probation. First, you would be conditionally released, which means you don't just walk out of jail, someone comes and picks you up from jail and brings you to housing. You get housing!" Kerlin tells her.

There's no strict lockdown, "but I want you there every night," Kerlin says, adding that Barclay has to take all her medications and attend all her counseling sessions.

Barclay agrees to the terms with a firm but quiet "yes."

"Any questions? OK, good luck to you. I hope it works out, OK?," the judge says. "Welcome to the program!"

This is, right now, LA's main plan B for reducing the population of mentally ill inmates in the Twin Towers. It's the more humane alternative to warehousing people with a mental illness there.

But this diversion court and housing program is risky. Some in it have committed serious crimes that still need to be addressed.

"They're mentally ill and not medicated, they come up on someone and whack them with a metal pole or something, that's a very common fact pattern," Kerlin says, sitting in her chambers after the morning's session. "So it's very dangerous."

But Kerlin says she and the LA judicial system have to daily assess whether it's safer and more effective to have these people in a fledgling program where they get housing and the treatment they need, or the cycle of jail likely followed by homelessness.

"Someday they'll be released and back on the streets unmedicated," Kerlin says. "So which is safer?"

Supportive housing

At a large house in a central LA neighborhood, some of the 22 men who live here are watching TV or just hanging out.

Nearly 80% of the people in this diversion and housing program are living with at least one serious mental health disorder. About 40% have both mental health and substance abuse disorders.

Here, treatment looks very different from the Twin Towers.

"Everybody is connected to a case manager and a therapist once they come in," says the program's housing director, Ryan Izell. The concept is simple, he says: humans need community, a home and — when ill — quality care. "There are clinicians and psychiatry on site, as well as nursing staff on site to provide support to people taking medication, as well as additional staff to just supply day-to-day support to make sure the house is operating well."

There are no locked gates or guards at the door, only a binder for signing in and out.

"If someone chose to stop taking their medication, they could walk out," says Lacey, the county's district attorney. "But the good news is, that really only occurs in less than 20% of the cases we divert."

And unlike the Twin Towers, the house has calm, quiet and privacy.

Halel Feldman, a 21-year-old who goes by Finn, is reading in his room. He has been in the program about a year.

Like all the men at this house, Finn was judged incompetent to stand trial. His felony charges include assault and vandalism.

At age 16, Finn says, he was diagnosed with schizophrenia. "I saw a lot of different visual hallucinations that really affected my day to day life. My head wouldn't stop shaking. My head doesn't shake anymore, thank God, because of the medication they have me on."

Finn is getting, in the words of the court, "restored" to mental competency here instead of in a jail or a state hospital. If he continues to make progress, his pending criminal case will be dropped.

"I don't go through the suicidal thoughts that I used to," Finn says. "I don't go through voices as much. Like, I'm in a very good headspace," he says adding, "better than jail."

Finn's roommate is 19-year-old Craig Reid, who says he struggles with bipolar and obsessive compulsive disorder, and ADHD.

"When I first got here, I was a little wild," Reid says.

Before entering this program, Reid was jailed on the upper floors of the Twin Towers, where the inmates with more severe mental health problems are mostly confined in cells under strict lockdown. There was limited treatment.

Now, Reid says, he feels better, more alive. "I'm a rap artist. I like poetry, I like to write."

And Reid and Finn have become friends. "I read the book of Mormon with him," Reid says, "and go to church with him sometimes."

So far, the program shows promise. And it's saving money. The county says jail costs almost five times more than this kind of inpatient housing. It also has, so far, a much lower recidivism rate than county jail.

The biggest challenge is scaling it up to meet the massive need. Most of the county's diversion programs were launched four years ago. So far, these programs have helped transition more than 4,600 people from jail and into community services, including housing.

But remember there are currently more than 5,000 inmates identified with some type of mental illness now cycling in and out of LA's county jail system.

"I think that the average person must see that something needs to change. It's so apparent that the numbers are growing," says psychiatrist Kristen Ochoa, the Office of Diversion and Reentry's medical director.

ODR and the Rand Corp. did studies that suggest that nearly 60% of those behind bars with a mental illness could go to diversion court or similar nonjail alternatives.

"We think that more than half of them would be eligible for interventions that would release them from jail and put them into care and housing, if those services existed," Ochoa says.

She says the county estimates they'd have to add at least 3,000 beds the first year alone to begin to start to meet that need. Ochoa and others say that will take more money and political will — but also more compassion.

Next month in its final report, the county's Alternatives to Incarceration Work Group will call for expanding and scaling these kinds of housing and diversion programs, among other recommendations for increasing community-based care.

Judge Kerlin acknowledges the diversion program doesn't work for everyone. She sometimes sees the same faces in her court. She sees some of them wipe out.

"I'm very disappointed when someone I know picks up a case or something happens or we've had a couple deaths, and it's heartbreaking," Kerlin says. "And there have been people I've had to terminate from the program as well, and that's heartbreaking too."

Then there are the successes, Kerlin says, "And they make you see that this can be done and is worthwhile. And people's lives matter."

Social Security or Individual Security?

This is a blog post from 2005.

As the national debate about Social Security heats up (or maybe we need to change the name to Individual Security, since many of the arguments I am reading aim to torpedo any "Social" aspects of the program) it gets harder to see through the smoke and mirrors. I sense yet another polarization in progress, very much like the debates about gay marriage, abortion and the war in Iraq: if you ain't fer it, then you must be agin' it.

I'm biased because my own experience witnessed my parents with nothing to show for a lifetime of work by my father and a lifetime of homemaking by my mother, other than Medicare, Medicaid and Social Security, supplemented by the resources of my sister and me in our parents' declining years.

I feel assured that our safety nets will probably not be disturbed by the current debate. Politicians have learned that any problems they create will be ticking bombs that only detonate after they are no longer around to catch the flack. Can you say "social security"?

Yesterday I received a billet doux from the Social Security Administration summarizing my "account" (with only the last four digits printed, incidentally, "to help prevent identity theft") and spelling out what my "benefits" would be under various scenarios. This morning I came across a helpful on-line "calculator", sponsored by the Heritage Foundation [link has since vanished] to calculate the startling improvements that would be available to owners of private accounts when compared with the dismal results to be obtained by the current system of Social Security.
I came by this site via another site called The Fly Bottle, attracted by a headline that read How Much Does SS Screw You? [another vanished link] I read the comment...

Now, what's supposed to be the problem with this, exactly, especially when much poorer folk than me can also expect to be doing a lot better? Why are so many people so eager to oppose a program that makes almost everyone better off? I find it truly baffling.

I next checked the source. Will Wilkinson. Policy analyst for the Cato Institute. Smart young man, born in 1973, worked at George Mason U. Interested in a bunch of important-sounding, challenging intellectual stuff...

My areas of philosophical interest as I write are metaethics, political philosophy, the philosophy of the social sciences, the cognitive sciences, and evolutionary psychology. I am especially interested in contractarian moral and political theory, the nature of moral progress, and the relation of findings in the cognitive sciences to the theory of rational choice. My historical interests include, inter alia, Aristotle, Hobbes, Kant, Reid, Hume, Nietzsche, and Sidgwick. My contemporary-ish philosophical influences include W.V. Quine, Friedrich Hayek, David Armstrong, Robert Nozick, David Gauthier, and John Rawls. I have a longstanding interest in libertarian political theory, especially the development of libertarian conceptions of equality and positive liberty.

Metaethics? Hmm...new word for me. Have to look that one up.

I've learned to watch out for that word libertarian because I really like most of what they talk about. Problem is, I read Atlas Shrugged in high school, when it was all the rage, and it struck me as wildly over-romantic, fantastical, and pretty unrealistic, with all that hand-shaking going on to clinch deals, with no witnesses or lawyers pouring over the details, and spectacular results deriving from clever people making all the right choices. I never read that entire speech of John Galt in detail, because I could see that a droning litany such as that would never catch the imagination of simple people on the sidewalk any more than the inscrutable remarks of Alan Greenspan when he talks to Congress.

Have I said enough to reveal all my biases? I hope so. Because what I say next is not spin. It is reality. Easy to grasp ideas and numbers that are not misleading in any way. Please follow me...

This fellow Will Wilkinson is certain that Social Security is one of the evil remnants of our unhappy past. Otherwise that title reference to "screw you" would not have been the idiom of choice. He must further believe that the Heritage Foundation's calculator is a reliable tool for analytical purposes or he would not have linked to that site. I would like to respectfully disagree with both of those points.
I am more impressed with the WSJ column Thursday by David Wessel [link still active for subscribers] who interview David Gremlich, a former Fed governor who once served on a Social Security advisory commission. Mr. Gremlich is in favor of encouraging people to save, but doesn't think that a 100% tax credit, dollar for dollar, against Social Security contributions is the way to do it.

(I think that's what's being proposed...earmarking individual tax dollars for those from whom they were collected, thus upsetting the actuarial benefit of their untimely early demise by passing those earmarked assets to their respective estates rather than using them as part of the collective safety net for survivors. The next step, not being discussed at this point, of course, will be the proportional reduction of survivor benefits for those whose estates have been awarded to survivors. Otherwise, survivors of individual accounts would fare better than those who failed or opted not to participate in any proposed plan.)

He said:

I'd like to protect the basic benefits, but we need more saving. We need it because people don't save enough for retirement. We need it to finance the benefit system we have. And need it for the nation's macroeconomics. One way to get new saving is to raise payroll taxes. I didn't think that was either politically feasible or necessary. Another way is to mandate that people save a bit on top of Social Security. This differs from a tax increase because they would ultimately get the money back, but the main motivation is to increase national saving. Increasing national saving implies reducing consumption. It's not a surprise that this is a hard sell.

He added a dose of reality when he said...

With carve-out individual accounts, we erode social protections at a time when we also seem to be witnessing the collapse of the corporate defined-benefit pension system. If we go to a retirement system that is entirely individual accounts, we also lose opportunities for income redistribution.

Two comments.
First, anytime the phrase "income redistribution" is used out loud, in public or in print, with no sense of shame or apology, I know that the person using it may as well be advocating Communism. I have been labeled Socialist and worse myself, so we'll just have to let the matter pass without further comment on my part. I have no interest in debating the phrase, but I want plainly to admit that I recognize the inflammatory effect that the phrase has on a good many people. People who have no problem with large estates being passed to heirs who never hit a lick at a snake in their life but thanks to an accident of birth can enjoy a lifetime of self-indulgence if they choose. "Income redistribution" in that instance takes the form of pissing it all away.

Second, a more important point about "the collapse of the corporate defined-benefit pension system" that he mentioned.

The Pension Benefits Guaranty Corporation did not just blossom into existence because a lot of politicians in Washington had a fit of generosity one session and decided to do something nice for folks. It was a political response to thousands of employees losing retirement benefits because the outfits for whom they worked went out of business with no safety net for those liabilities. It didn't happen because of the depression, by the way. It happened decades later when that great American economic engine we call Free Enterprise had plenty of time to prevent and protect against disasters like "How can we protect our people in case we go out of business?"

If memory serves, I think that a lot of companies didn't even officially "go out of business." There was an era of mergers and acquisitions, hostile takeovers and the like that also contributed to the problem, with a lot of "private" pension benefits' being leveraged out of existence or liquidated outright, also resulting in pensions evaporating before the eyes of people whose only remaining pinch of the economy became their Social Security income.

Today, as the man said, companies are figuring all kinds of ways to get out from under company paid (read defined benefits) pension plans by shifting the responsibility of retirement security (I almost used the word "burden", but I wouldn't want anyone to think I want companies to be overburdened on the way to the bottom line just because they were obsessed with the security and future well-being of employees.) to individual, employee-paid plans.

I'm not going to repeat the last paragraph just to help dull readers catch on.

I know it is full of sarcasm, as well as ideas not yet in the public debate. Trying to paint it another color isn't going to make it any easier to read and understand. It's up to the reader to do the homework.

Finally, a word about that Heritage Foundation calculator [as I said, the link no longer works].

It asks for only two pieces of data. First, your age.
Second, if you are Male or Female.
When you click the magic button it announces...

You can expect to pay [Big Dollar Amount here] in Social Security taxes over your working life for retirement and survivors benefits.

I would love nothing better than to "expect to pay" that amount over my working lifetime, but in my case I have barely come close. And that includes all the contributions matched by my employers and what I will likely earn in the remaining years until I can claim full benefits. The document I got from Social Security fell way short of the amount indicated, and as the years unfold, I can reasonably expect that the amount will never reach the target. That calculator seems to presume that everyone using it will earn the social security maximum during their "working life"! 

Just a few questions...
How many people consider their employer's matching taxes as part of their earnings? (Yeah, I know self-employed and educated people do, but in a random population of a thousand people from the street, how many think in those terms? 800? 500? 100? 10? Any?)
How many people will earn the Social Security cap during their lifetimes? And for how many consecutive years?
In fact, how many people even know that a cap exists?

In fairness, the calculator has a way to customize results by keying in variable data (ZIP, gender, etc.) and it carries a disclaimer.

This calculator is intended to be used solely as an educational tool to help citizens better understand public policy issues associated with Social Security. It is not intended for use as a retirement planner. The data, assumptions and formulas used in this calculator are based on information currently available to The Heritage Foundation.

"...not intended for use as a retirement planner..."
Damn right. But I don't think that will be a problem with most people using that site.

Update...

Here we are six months later and Mr. Wilkinson seems to have some up with a good suggestion:

Hey liberals! Since you insist on talking about social insurance, why not stop dissembling and plump for a system that is actually sort of like insurance? Why not not defend a disability insurance model of old-age insurance, where you get it only there is some actual threat of immiseration? We can fund it with a dedicated payroll tax and everything. It really will not function like a pension at all. It will be a safety net for people who need it funded by people who don't. Isn't this exactly what liberals should want?

He's bright enough to understand that any such plan would be D.O.A. in today's political climate, but I, for one, would be very much in favor. His suggestion, of course, is clearly tongue-in-cheek, but it shows that at some level he is smart enough to see the need.

Since my post was first written a rising tide of companies have announced their inability to meet pension plan obligations. United Airlines, notably, is among the biggest. In a competitive environment that no longer even pretends to look out for its employees' retirement security, old-line companies that cling to that quaint old notion can't afford to stay in the game. We are seeing the unintended consequences of IRA's, Roth's and 401-K plans -- and the corresponding termination of defined-benefits pension plans.

Problem is the tired and flawed old FICA system with all its shortcomings is all we have, and an uninterrupted string of Congresses and Administrations have misappropriated that revenue stream from the beginning.

Deinstitutionalization Hasn’t Worked

These notes are relevant to the growing problem of homelessness. 

Here is a quote I captured at my old blog in 2007 which was eight years old even then. I have no idea where it came from because the link no longer works and I can't find it with my browser. 

Hundreds of thousands of vulnerable Americans are eking out a pitiful existence on city streets, under ground in subway tunnels, or in jails and prisons due to the misguided efforts of civil rights advocates to keep the severely ill out of hospitals and out of treatment. The images of these gravely ill citizens on our city landscapes are bleak reminders of the failure of deinstitutionalization. They are seen huddling over steam grates in the cold, animatedly carrying on conversations with invisible companions, wearing filthy, tattered clothing, urinating and defecating on sidewalks or threatening passersby. Worse still, they frequently are seen being carried away on stretchers as victims of suicide or violent crime, or in handcuffs as perpetuators of violence against others. 

All of this occurs under the watchful eyes of fellow citizens and government officials who do nothing but shake their heads in blind tolerance. The consequences of failing to treat these illnesses are devastating. While Americans with untreated severe mental illnesses represent less than one percent of our population, they commit almost 1,000 homicides in the United States each year. 

At least one-third of the estimated 600,000 homeless suffer from schizophrenia or manic-depressive illness, and 28 percent of them forage for some of their food in garbage cans. About 170,000 individuals, or 10 percent, of our jail and prison populations suffer from these illnesses, costing American taxpayers a staggering $8.5 billion per year. 

In 1965, Congress excluded most payments to state psychiatric hospitals and other "institutions for the treatment of mental disease" (IMDs) from Medicaid because the Federal Government did not intend to take over what historically had been a state responsibility, and because it intended to implement a system of community mental health centers that would replace the state psychiatric hospital systems.

Here is an excerpt from Chapters 1, 3 and the Appendix of: Out of the Shadows: Confronting America's Mental Illness Crisis by E. Fuller Torrey, M.D. (1997)

Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions; it has been a major contributing factor to the mental illness crisis. (The term also describes a similar process for mentally retarded people, but the focus of this book is exclusively on severe mental illnesses.) 

Deinstitutionalization began in 1955 with the widespread introduction of chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication, and received a major impetus 10 years later with the enactment of federal Medicaid and Medicare. Deinstitutionalization has two parts: the moving of the severely mentally ill out of the state institutions, and the closing of part or all of those institutions. The former affects people who are already mentally ill. The latter affects those who become ill after the policy has gone into effect and for the indefinite future because hospital beds have been permanently eliminated. 

The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history. In 1955, there were 558,239 severely mentally ill patients in the nation's public psychiatric hospitals. In 1994, this number had been reduced by 486,620 patients, to 71,619, as seen in Figure 1.2. It is important to note, however, that the census of 558,239 patients in public psychiatric hospitals in 1955 was in relationship to the nation's total population at the time, which was 164 million. 

By 1994, the nation's population had increased to 260 million. If there had been the same proportion of patients per population in public mental hospitals in 1994 as there had been in 1955, the patients would have totaled 885,010. The true magnitude of deinstitutionalization, then, is the difference between 885,010 and 71,619. In effect, approximately 92 percent of the people who would have been living in public psychiatric hospitals in 1955 were not living there in 1994. Even allowing for the approximately 40,000 patients who occupied psychiatric beds in general hospitals or the approximately 10,000 patients who occupied psychiatric beds in community mental health centers (CMHCs) on any given day in 1994, that still means that approximately 763,391 severely mentally ill people (over three-quarters of a million) are living in the community today who would have been hospitalized 40 years ago. That number is more than the population of Baltimore or San Francisco. 

Deinstitutionalization varied from state to state. In assessing these differences in census for public mental hospitals, it is not sufficient merely to subtract the 1994 number of patients from the 1955 number, because state populations shifted in the various states during those 40 years. In Iowa, West Virginia, and the District of Columbia, the total populations actually decreased during that period, whereas in California, Florida, and Arizona, the population increased dramatically; and in Nevada, it increased more than sevenfold, from 0.2 million to 1.5 million. The table in the Appendix takes these population changes into account and provides an effective deinstitutionalization rate for each state based on the number of patients hospitalized in 1994 subtracted from the number of patients that would have been expected to be hospitalized in 1994 based on that state's population. It assumes that the ratio of hospitalized patients to population would have remained constant over the 40 years. 

Rhode Island, Massachusetts, New Hampshire, Vermont, West Virginia, Arkansas, Wisconsin, and California all have effective deinstitutionalization rates of over 95 percent. Rhode Island's rate is over 98 percent, meaning that for every 100 state residents in public mental hospitals in 1955, fewer than 2 patients are there today. On the other end of the curve, Nevada, Delaware, and the District of Columbia have effective deinstitutionalization rates below 80 percent. 

Most of those who were deinstitutionalized from the nation's public psychiatric hospitals were severely mentally ill. Between 50 and 60 percent of them were diagnosed with schizophrenia. Another 10 to 15 percent were diagnosed with manic-depressive illness and severe depression. An additional 10 to 15 percent were diagnosed with organic brain diseases -- epilepsy, strokes, Alzheimer's disease, and brain damage secondary to trauma. The remaining individuals residing in public psychiatric hospitals had conditions such as mental retardation with psychosis, autism and other psychiatric disorders of childhood, and alcoholism and drug addiction with concurrent brain damage. The fact that most deinstitutionalized people suffer from various forms of brain dysfunction was not as well understood when the policy of deinstitutionalization got under way. 

Thus deinstitutionalization has helped create the mental illness crisis by discharging people from public psychiatric hospitals without ensuring that they received the medication and rehabilitation services necessary for them to live successfully in the community. Deinstitutionalization further exacerbated the situation because, once the public psychiatric beds had been closed, they were not available for people who later became mentally ill, and this situation continues up to the present. Consequently, approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment 

Deinstitutionalization was based on the principle that severe mental illness should be treated in the least restrictive setting. As further defined by President Jimmy Carter's Commission on Mental Health, this ideology rested on "the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services." This is a laudable goal and for many, perhaps for the majority of those who are deinstitutionalized, it has been at least partially realized. 

For a substantial minority, however, deinstitutionalization has been a psychiatric Titanic. Their lives are virtually devoid of "dignity" or "integrity of body, mind, and spirit." "Self-determination" often means merely that the person has a choice of soup kitchens. The "least restrictive setting" frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.

AI Prose Generators Are Getting Better

I can't discover if this link is from a real person or an AI web generator, but I suspect the latter. In any case, I'm noting it for future reference because it serves to explain the behavior of the American president. Here is part of the Abstract of Misfitness: the hermeneutics of failure and the poetics of the clown - Heidegger and clowns

CLOWN PHILOSOPHY

Once, when I was a little boy, marching with my class in the Independence Day parade, my mother came to me afterwards and said: “Well done, Marcelo. You were the only one marching in the right way. The rest of the class got it all wrong!”. I start this article with this personal anecdote because it shows that I always had a tendency of not fitting in to communal practices, such as marching like soldiers during the military dictatorship in Brazil. From an early age, I felt like a misfit, always awkward in the world. Little did my mother imagine that her rose-tinted spectacles of maternal love encouraged me towards a lifelong practice of standing out through being different, or in the eyes of all the other mothers, simply getting it wrong. Inadvertently, following the Heideggerian principle of an object becoming noticeable through failure to perform as expected, when I marched differently to the rest of the parade and thereby failed to fit in, I gained some kind of stage presence through my unique failure. This might be the main philosophical approach in this article that is related to the field of Performance Philosophy. This tendency of mine of not fitting in found its professional outlet in 1982, when I met a group of clowns and we created the Circo Teatro Udigrudi, a clown company that is still in activity today. After almost forty years of performing as a clown and four years of research at the Royal Central School of Speech and Drama, University of London, I write this article about the philosophy of the clown based on my own experience as a misfit clown.

This is quite a long read, well over nine thousand words not counting end-notes. It seems too perfectly crafted to have been entirely the work of one individual and the result is beautiful. There appears to be a Facebook link associated, Circo Teatro Udi Grudi, with a 10-year old archive.

When I came across this via Twitter (h/t Evgeny Morozov) I thought of the Postmodernism Generator which has been around for years. I first discovered that wonderful link in 2007.

9 Anti-vaxxer Myths Debunked

Via Newsweek, without ads, as a public service announcement.

Anti-vax myths have been around for centuries—at least since British doctor Edward Jenner developed the smallpox vaccine in the 1790s. And they persist even into our so-called scientific era: Following a 30 percent rise in worldwide measles outbreaks, in 2019 the World Health Organization (WHO) named the anti-vaccine movement among the worst health threats facing humanity.

Steps are being taken to halt the spread of anti-vax misinformation: In February 2019, Pinterest updated its search function so that vaccination keywords could no longer return any results and YouTube confirmed it was pulling ads from channels that promote anti-vaccination rhetoric. Meanwhile, health experts have called on Facebook to shut down its many anti-vax pages, which have been viewed millions of times.

To help cut through the noise, we examine the origins of nine of the most prominent anti-vaccine claims and uncover whether there's scientific evidence supporting them.

1. Vaccinations cause autism.

Where the myth comes from: One of the most prominent claims of anti-vaxxers is that vaccines are linked to autism: A child on the autistic spectrum can be diagnosed as young as 12 to 18 months—around the same time the measles, mumps and rubella (MMR) vaccine is administered—leading some parents to assume a causal relationship. Most prominently, British gastroenterologist Andrew Wakefield published a shocking study in The Lancet in 1998 linking the MMR vaccine to autism and bowel disease.

The link between autism and vaccines is repeated often, including by celebrities like Jenny McCarthy, who told Oprah in 2007 that vaccines triggered her son's autism, and President Donald Trump, who claimed in 2015 that after getting vaccinated, a child "got a tremendous fever, got very, very sick, [and] now is autistic." A 2015 Pew poll found that one in ten parents believe the MMR vaccine is unsafe.

The facts: In 2004, the Sunday Times reported on financial conflicts of interest by Wakefield, who was allegedly planning to launch a company that would profit from the boom in medical tests and lawsuits that would follow his report. After it appeared his research was fraudulent Wakefield's co-authors withdrew their support and his stuy was retracted by The Lancet. "The statements in the paper were utterly false," editor Richard Horton told The Guardian, "I feel I was deceived."

In 2009, a British administrative court ruled that "there is now no respectable body of opinion which supports the hypothesis, that MMR vaccine and autism and enterocolitis [a devastating intestinal disease affecting premature infants] are causally linked." Wakefield's medical license was revoked a year later.

2. Vaccines don't really work.

Where the myth comes from: Some vaccine skeptics maintain there's no guarantee a vaccination will prevent against disease. People who are vaccinated still contract the virus, sometimes more of them than unvaccinated people. 

The facts: No medical treatment is 100 percent effective, and that's true of vaccines, too: The flu vaccine is on the lower end of effectiveness—it will probably only immunize you against the flu about half the time. But two doses of the measles vaccine have a 99 percent efficacy rate.
Because vaccinated people greatly outnumber unvaccinated people in the U.S., the small minority of vaccinated Americans who contract a disease during an outbreak can outnumber the total number of unvaccinated people: Imagine 1,000 fully vaccinated people and five unvaccinated people are all exposed to measles. Even if just one percent of the vaccinated people fall ill, that's still more than all the unvaccinated people combined. And even if all the unvaccinated people caught the measles, the majority of victims were vaccinated. That statistic, used in isolation, has been used to "prove" that vaccines are useless. Of course, it doesn't take into account the 988 vaccinated people who were exposed to, but didn't catch, the measles.

3. Vaccines contain toxins.

Where the myth comes from: In addition to a version of the virus its fighting against, a vaccine usually contains preservatives and other chemicals that keep it stable. Thiomersal, a preservative historically used in tetanus and diptheria vaccines, contains trace amounts of mercury. And adjuvants, which help the immune system respond to a vaccine, often have aluminium in them. This has led vaccine sceptics to claim vaccines are filled with toxic substances.
"California Gov says yes to poisoning more children with mercury and aluminum in manditory [sic] vaccines," actor Jim Carrey tweeted in 2015. "This corporate fascist must be stopped."
His tweet, which is still up, has received thousands of likes.

The facts: The level of mercury or aluminum used in any vaccine is too low to pose any danger beyond a mild allergic reaction like redness at the injection site. In 2012, the WHO's Global Advisory Committee on Vaccine Safety (GACVS) found that mercury levels in babies' blood returned to baseline levels a month after vaccination. Even with culmative vaccines, the GACVS determined, mercury amounts never reached toxic levels. It found that studies linking thiomersal to neurodevelopmental disorders were "fraught with methodological flaws." Two years later, an Australian study of more than a million children also found no link between thiomersal in vaccines and autism.

4. Vaccines can overwhelm a baby's immune system

Where the myth comes from: Some anti-vaxxers claim that vaccinations cause specialized immune cells in your brain to activate. Too many vaccinations over a short period of time can over-stimulate these cells, causing them to release toxins that lead to brain damage.

The facts: Only a tiny fraction of a baby's immune system is activated by vaccines. "Children are exposed to more antigens from a common cold than they are from vaccines," says WHO's Flavia Bustreo. "Giving several vaccines at the same time has no negative effect on a child's immune system. It reduces discomfort for the child, and saves time and money."
In addition, children are given vaccinations at a young age because that's when they are most vulnerable to disease. Postponing or refusing vaccinations can have disastrous consequences.

5. Natural immunity is safer than vaccine-acquired immunity.

Where the myth comes from: Catching a disease can leave people with more effective immunity than a vaccination.
In February 2019, White House communications chief Bill Shine's wife, Darla, tweeted: "I had the #Measles #Mumps #ChickenPox as a child and so did every kid I knew - Sadly my kids had #MMR so they will never have the life long natural immunity I have."
The facts: Yes, gaining immunity by surviving a disease is a more effective barrier to later reinfection. But the disease is invariably more painful—and potentially more lethal—than any vaccine, which can cause mild side effects, like a slight fever or soreness at the injection site. But the side effects of diseases like polio and diptheria can include breathing problems, paralysis, heart failure, and even death.
An ounce of prevention is worth a pound of cure: The odds of dying from the measles are one in 500. The odds of having a fatal allergic reaction to the MMR vaccine are one in a million.

6. There are effective natural and homeopathic alternatives to vaccines

Where the myth comes from: In 2017, a former naturopathic doctor told The Atlantic she met a naturopath who suggested elderberry syrup could substitute for the flu vaccine.

Some homeopaths offer alternatives to conventional vaccines: Called "nosodes," they contain infected biological matter—usually tissue, blood or nasal discharge—that has been diluted dozens of times over with either distilled water or alcohol. Nosodes for human use are available for everything from smallpox to Anthrax, at either 30 or 200 dilution.

The facts: There's no scientific evidence that homeopathic vaccines are in any way effective. The extreme dillution means there are basically no molecules of the infected matter still present in the substance. That's probably a good thing, but parents who eschew vaccines in favor of ineffective homepathic remedies leave their children open to deadly diseases.

7. Good nutrition and hygiene will protect you from most viruses.

Where the myth comes from: In the 19th century, improved sanitation, nutrition and hygiene went long way toward combatting rampant viruses and bacteria. Some vaccine sceptics have taken this to mean diet and lifestyle are the only defenses we need.

The facts: Polio cases in the U.S. reached a peak in the early 1950s, well after good sanitation and nutrition had become standard—rich and poor children like contracted the illness, which only disappeared in 1979, a generation after the first polio vaccine strategy was introduced in 1955. And even the healthiest diet won't protect you from tetanus or measles.

8. Vaccines are just a way for doctors and pharmaceutical companies to make money.

Where the myth comes from: The market for vaccines is rapidly growing, according to the WHO, tripling from $5 billion in 2000 to almost $24 billion in 2013. In 2016, drug giant Pfizer's best-selling product was Prevnar, a vaccine that prevents infections caused by the pneumococcus bacteria. This news fed into the popular theory that Big Pharma develops and pushes unnecessary or even harmful vaccines to make huge profits.

The facts: Drug companies do make money on vaccines but thet aren't particularly profitable—especially when compared to drugs used to treat a disease outbreak. Vaccines represent only about 3 percent of the total pharmaceutical market. The recent expansion of the vaccine market is really due to high-population, economically emerging countries like China implementing rigorous vaccination programs for the first time.
Of the top 15 American pharmaceutical money-makers of 2017, Prevnar was the only vaccine to make the list, at 12th place. Drugs treating chronic illnesses are far more lucrative. If anything vaccines are actually underutilized: A 2018 report from the Access to Medicine Foundation criticised Big Pharma for neglecting to develop an infants' vaccine for cholera.

And if the medical community wanted to make more money, they'd fight against vaccines: A 2008 measles outbreak in San Diego that began with an unvaccinated boy and led to 11 cases cost public health officials more than $124,00 to contain, according to a study published in the journal Pediatrics. In addition to the cost of treating each case, public health officials had to spend more than $37,000 to quarantine 48 children who were too young to be vaccinated.

And in 2011, the cost of combating 16 measles outbreaks cost taxpayers between $2.7 million and $5.3 million: "Beyond the impact on local and state public health departments, responses to measles outbreaks also affect hospitals, clinics, as well as non-health public departments such as schools, universities and occasionally local police departments enforcing quarantines," the CDC reports. That's just what the public pays—measles infections frequently require hospitalization, and patient's medical bills can run into tens of thousands of dollars.
Meanwhile the CDC prices a single dose of the MMR vaccine at $21.05.

9. Vaccines aren't necessary

Where the myth comes from: Herd immunity—when enough of a group is vaccinated that a disease can't easily spread—keeps unvaccinated members of society protected. Vaccine sceptics claim this means they don't have to vaccinate their children.

The facts: Its because of dilligent vaccination programs that diseases like measles and polio are so rare: The U.S. saw more than 440,000 measles cases annually before the measles vaccine was implemented in 1963. By 1970, new infections shrunk to a tenth of that. In the past decade, measles infections have dwindled to between 55 and 667 a year.

But herd immunity requires adherance by an overwhelming majority: In a 2019 measles outbreak in Washington State, most of the 65 infected children were unvaccinated. In fact school records shows that only 76.5 percent of kindergartners in the county had all their shots—well below the 95 percent adherence required for herd immunity.
So far, herd immunity has been able to accommodate parents withholding vaccines from their children. But there is a tipping point: To achieve herd immunity for measles, at least 90 percent of the population must be vaccinated. (Between 1988 and 1990, 75 people in California died of the measles after an outbreak sparked by unvaccinated communities.) Polio, which is less contagious, still required 80-85 percent of a population to be vaccinated for herd immunity to work.