Untreated Mental Illness: A Matter of Life and Death

Policy makers must not be guided by crisis, but must overcome it. President Kennedy was right. Perhaps, his vision of recovery was ahead of its time. Yet, if timing is everything, it is beyond time to end our nation's mental health crisis -- it is a matter of life and death.
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I have written about the intersection of untreated mental illness and loss. The loss of freedom, the loss of dreams, the loss of life. I recently wrote a blog entitled, "The State of Mental Illness in America: Crying for a Cure." This article focused on the death of 25-year-old Lavar Hall from Florida who was shot and killed by police. According to news reports, his mother called police for help. She told police that her son, diagnosed with schizophrenia, was recently released from a local psychiatric facility and needed to go back. According to police, Lavar was brandishing a broomstick and refused to follow commands.

This week, The Washington Post published "Distraught People, Deadly Results," an investigative report on excessive use of force and police shootings in 2015. The findings raise concerns, not simply about police training and response strategies, but again about the state of mental illness and substance use in America and the salient barriers, including stigma and the intersection between prejudice and public health.

According to The Washington Post, "of the 462 people shot and killed by police in the U.S. this year, 124 were known to be or reported in the throes of a mental health or emotional crisis." These individuals were overwhelmingly male, died close to home, and half were suicidal. Investigators point out that most of these men were armed, many with "some kind of weapon less lethal than a firearm." As noted by The Washington Post, "six had toy guns, 3 carried a machete or a knife, and 1 had a broomstick." The Washington Post found, in a majority of cases, police were not responding to criminal acts "but calls by concerned family members, neighbors or bystanders about erratic behavior."

The question of whether or not America's policy makers have reached consensus on how best to respond to a mental health system in crisis has yet to be answered. In my view, deep social divides exist on how to view this vexing problem. Is it a criminal justice problem or a public health problem which has taken a risk-avoidance approach? Perhaps it is a bit of both, but to what degree are these problems a direct result of stigma, prejudice, under-funded and highly dysfunctional systems of community mental health care?

It has been more than 50 years since President John F. Kennedy signed the landmark Community Mental Health Act in 1963. The first of a series of federal mental health laws intended to lead major public health transformation in America. The goal was to shift resources away from constitutionally flawed and inhumane state psychiatric hospitals. This noble de- institutionalization and civil rights movement was grounded in dignity, principals of inclusion, and the vision of rehabilitation, now known as recovery.

The goals of the Act were never realized, and we are a nation in crisis. As stated by the Young Minds Advocacy Project, the early vision of President Kennedy 'to challenge a social quarantine" must be achieved. It is also fair to say this massive policy failure has morphed into a more complex social problem, where stigma has taken on a more pronounced role, as media sensationalizes acts of violence, mass shootings and now police shootings. What if the Community Mental Health Act of 1963 had been fully implemented and realized? What would the state of mental illness be in America? Would stigma and prejudice be mitigated by recovery and wellness?

I am reminded of a famous law library scene in the film Philadelphia. There, Tom Hanks' character Andrew Beckett reads aloud from a disability rights court decision on AIDS and speaks about the negative impact of stigma. He states that "AIDS is protected as a handicap under law, not only because of the physical limitations it imposes, but because the prejudice surrounding AIDS exacts a social death... which precedes the physical one." He continues, "this is the essence of discrimination: formulating opinions about others not based on their individual merits, but rather on their membership in a group with assumed characteristics."

One can argue that marginalization and stigma which torpedoed President Kennedy's vision has caused enough damage. In addition to the well-known and negative consequences of untreated mental illness in America, such as family erosion, homelessness, incarceration and suicide, we could add police shootings to the list. No one denies there are people with mental illness who may also commit crime or who are unable to live safely in the community. Public safety is a paramount consideration, along with victim's rights. Rather than focus on crisis, why are policy makers not focusing on prevention and recovery?

When will the essence of recovery be the building block from which subsequent mental health policies flow? For example, in 2003, The President's New Freedom Commission for Mental Health performed an analysis and review of the mental health system through a recovery lens. The goal was for consumers to live, work, attend school and engage in the community.

Policy makers must not be guided by crisis, but must overcome it. President Kennedy was right. Perhaps, his vision of recovery was ahead of its time. Yet, if timing is everything, it is beyond time to end our nation's mental health crisis -- it is a matter of life and death.