This past semester, I took the class Social Problems. I am now in my final year and a half of earning my Bachelor’s degree in Psychology, while minoring in Fine Arts. This was easily one of my favorite courses, as my passion for understanding and speaking up about social justice issues shined through. I am now able to take my learnings from the class to better understand the world around me, as well as apply various theories to global issues occurring — some issues that directly impact myself and my communities and other issues that I deeply care about simply because I want the best for others; I want to see positive, healing change in this world.

This was my final research paper for the class, which I am pleased to share got a perfect mark! (Gentle reminder that grades are not everything! Be proud of your overall takeaways and your application of learnings over the final grade. We are so much more than a number or a letter. I am by no means a “perfect” student and no one has to be.) I hope your biggest takeaway from my essay is that struggling with mental illness is never a choice, but adequately supporting and protecting the mentally ill is.

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The Criminalization of Mental Illness: Stigma Kills

Lexie Manion

The topic of the criminalization and mistreatment of mentally ill people, particularly by police, healthcare workers and society interests me as someone who has been through the mental healthcare system myself growing up. There are indisputable holes in the system and great work to be done in more effectively supporting and protecting mentally ill people. Showing little compassion for people who struggle with mental illness disturbs me as no one chooses to be ill. The criminalization of struggling with one’s health and how very frequently, one’s human rights are stripped away in a matter of moments of a police officer addressing someone in distress, is unforgivable. We have seen that with more mental health training and de-escalation strategies implemented, police and healthcare workers are able to remain the same and people suffering can get the proper help they need. When people are experiencing a psychiatric crisis, law-enforcement does not always know how to effectively act. Most police in the United States have merely just a few hours of training dedicated to mental health, which is stark compared to their lengthy all-encompassing, months-long training. This is alarming as we learn roughly between 21% to 38% of 911 calls are related to mental health, substance use and homelessness; there is a dire need for proper training.

As commonly known, law-enforcement are typically the first-line responders when someone is suffering from a psychiatric crisis. It’s been found that a lack of adequate training, “leads to an escalation in violence, and increased rates of injury and death” (Krameddine, 2014). Offering new mental health training programs shows some promise for a better future for de-escalation strategies carried out addressing those suffering from mental illness crises, although increased crisis intervention training in the United States, United Kingdom and Australia has shown that many issues remain. When we treat the root of the issue, we dig deep and address it fully; however, many more roots of the tree become visible now, so the work must continue. Through emotionally and intellectually engaging officers through a hands-on approach, it’s been found some programs can break through to law enforcement to encourage communication and ultimately, de-escalation. The University of Alberta partnered with Edmonton Police Service in a program for addressing those with mental illness and found, “the average number of mental health calls increased by 40%, emphasizing an enhanced ability of officers to recognize a mental health issue…police officers also spent nearly 20% less time on each mental health call, supporting an improvement in communication, empathy, de-escalation and knowledge of appropriate solutions” (Krameddine, 2014). In time, the rates of mentally ill people may remain steady – or perhaps even increase; however, ideally, perhaps we will see successful intervention being implemented, thus decreasing injuries and fatalities of mentally ill people as we increase the emotional intelligence of first responders.

The Structural-Functional Perspective approaches healthcare as a means that contributes to society functioning well as illness gets in the way of people’s ability to fulfill societal standards, like maintaining a job and receiving an education. While maintaining a job and receiving an education do not always lead to financial security, these factors at the very least can get people out of poverty so they can get on a (somewhat) living wage. This directly coincides with healthcare as insurance is a necessity for any ailments that need addressing. Keeping our health and wellness in check is a job within itself at times, so having the ability to pay for needs like medication, doctor visits, therapy, etc. is vital. Maintaining good health would also ensure that we are limiting hospital visits, ideally interacting with law enforcement less frequently, thus staying safe. People with mental illness need to consider these predicaments when caring for themselves. It is concerning to me that if one day I were to be unwell again, a police officer could harm me simply because they lacked the training and compassionate, ethical care. I work hard to keep well, but the fear lingers over my head. As said before, we never choose to be unwell. The hope is that we can choose recovery. What we hope for first responders and hospital personnel is to treat us with respect – until one day soon, we can hopefully care for ourselves again. In addition to safety concerns when being mentally ill, we have also seen some studies track homelessness and mental illness where housing is provided for homeless adults. In a study examining the influence of group or individual housing placement among formerly homeless mentally ill people, it was found, “more than three-quarters of the homeless individuals with severe mental illness who participated in the study were still living in community residences at the end of 18 months” (Goldfinger, 1999). It would be interesting to see this study replicated today and see if anything has changed. My idea is that though the results were not what we may have wanted to see, the study proves a crucial need for homeless mentally ill people to receive help now — and to receive continued help; the government often helps in one effort and then abandons people soon-after. Previous administrations have mass-closed mental health hospitals, rendering countless mentally ill people and families abandoned by the system with nowhere to go and no follow-up care. Going through the process of supporting mentally ill people, step by step – though it would be a burden we cannot undertake financially – is the most ethical and necessary way to give people a chance at continued wellness. To even consider finding a job or going to school, we must be secure in our other needs – financially, mentally and physically.

The Conflict Perspective in terms of mental healthcare addresses its focus on how economic, political and social inequalities impact health and healthcare. The United States is viewed as more of an advanced nation in terms of healthcare, with a glaring fact that our insurance rates and medical bills are too costly for the average American. Amongst these struggles to even afford the meek offerings, drug companies and insurance companies profit off people’s health needs and take advantage of the working class and the poor, “Healthcare problems also put low-income people at a disadvantage in getting access to higher education, vocational training, and good jobs” (Goldfinger, 1999). This perspective illustrates the vast issues of our healthcare system and the turning away from more disadvantaged people. Mental illness festers disproportionately in disadvantaged communities, so it’s apparent we turn away from properly helping them — as well as punishing them for struggling in the first place. Insurance companies and pharmaceutical companies reap the rewards of the disadvantaged. As someone working in pharmaceuticals, I see firsthand people who are struggling with their health already — mentally and physically — and how they must turn down paying astronomical co-pays for the medications that were prescribed by doctors and hospitals, which they already cannot afford. To be well mentally through the Westernized way of being medicated is a pipe dream for many, as insurance rates increase along with co-pays. Those living in poverty do not have the same opportunities as those with insurance, jobs and homes, but we cannot ignore that even those who have obtained those privileges struggle living even paycheck to paycheck. We are a country failing our people on all fronts — healthcare, living wages, rent and more.

The Symbolic-Interactionist Perspective addresses the “meanings and definitions associated with health, illnesses and healthcare, and how these are communicated among people and modified over them in space” (DeFronzo, page 252). How these elements are socially constructed also depends on people’s tolerance of others. For instance, being gay was once clinically a mental illness. Homosexuals were subject to the death penalty in all British colonies in 1776. We have seen some progress with LGBTQ+ people being accepted by society, but homophobia persists with threats like the “Don’t Say Gay” bill and constant violence against LGBTQ+ people. Homosexuality once being considered a mental health disorder is alarming and the lack of acceptance for LGBTQ+ people is unconscionable. Stigma regarding mental illness continues to be perpetuated in harmful ways that make mentally ill people appear perpetually out of control, violent and worthless. Law enforcement and civilians perpetuate these fears of mentally ill people with their quick judgments and stigmatizing views. Even twenty years ago, stigma and the criminalization of mental illness was just as pervasive – if not even more notably damaging and incriminating. We see an increase in people with mental illness speaking up about their conditions, therefore destigmatizing what it means to have a mental health condition and giving hope to survivors of mental illness, as well as to their loved ones. Stigma is a persistent issue in society, and we often see it presented as, “distinguishing between groups, labeling, and separating ‘us’ from ‘them’…social psychology has identified different cognitive, emotional, and behavioral aspects of public stigma: stereotypes, prejudice, and discrimination” (Rüsch 2020). Public stigma is the driving force, in which outsiders label those who are different (mentally ill) as “crazy”, “deficient” or “worthless”. Self-stigma comes about from this outside force – leaving us feeling we are the assumptions they pin to us. Looking at the Symbolic-Interactionist Perspective, we can begin to shift these ideals and customs in our culture by speaking up and advocating for ourselves and others when stigma is used as a weapon. As people unlearn harmful ways of the past, we begin to see a future where people are no longer defined or boxed in by the color of their skin, the size of their body, their financial burdens, or even their health status.

Solutions I would propose to alleviate these injustices of stigma and lack of proper and affordable mental healthcare include redesigning our healthcare system so those who are disadvantaged can receive proper care, providing nationwide much-needed training programs to law enforcement to ensure they are properly trained in de-escalating mental health crises and offering increased education to the public on what mental illness is and is not. While the other proposals may not be possible to achieve in my lifetime, I strongly believe education is key in helping each other as humans. The term “mentally ill” carries its negative connotations and pointed shame, but if we continue to see more of a shift in society and a more compassionate stance taken by the public, we could see less mentally ill people harmed or suffering in silence. We have seen some success in dispatching crisis teams to a mental health crisis instead of police. While we do not have the means or capacity to always provide proper crisis teams, we are seeing this slow shift towards meaningful change. A macro-analysis would be fitting to study this issue more in depth as we would see on a large scale how stigma and the criminalization of mental illness is impacting countless lives. We need more data on what is occurring to potentially involve the government to have more of a driving force in supporting people with mental illness moving forward. An experimental study could be telling of what issues remain today as we would see a community’s behavior up close. Some potential research studies could be measuring the degree of stigma. For instance, maybe we could measure the number of times a person in public is helped or ignored if they have apparent signs of mental illness or are in crisis. Will onlookers help? Will anyone call for help? Will the police be called, or will someone try to encourage them to call 988? Does the clothing a person wears matter – or the color of the skin or their gender? Human behavior is fascinating as we could hypothesize certain individuals would be ignored – or worse. I’d like to carry out this study with the intention of proving to others that these seemingly minor discriminations can greatly harm those struggling, that struggle is struggle and that everyone is worth helping – no matter how they present. It’s a myth that mentally ill people are the most violent; in fact, people with mental illness are disproportionately victims of violence – with a mere 3% of mentally ill people being the perpetrators of violent crimes.

As an avid mental health advocate and writer, those supporting me benefit when they learn more about my struggles and how to help me. Humanizing the sufferer and uplifting the voices of advocates and professionals in the community progresses us forward towards a country that believes and uplifts those suffering — rather than isolating and punishing them as many do now. Proper education of mental illness shows us, “It is critical that we understand that various marginalized people are more profoundly impacted by eating disorders (and in different, nuanced ways) than those who carry more privilege” (Manion, L. 2022, “5 Ways to Support People in Recovery: Uniting Eating Disorder Survivors and Loved Ones”, Project HEAL). Understanding that marginalized people, such as those who are poor, living in a larger body, disabled, BIPOC or LGBTQ+, are under much greater scrutiny of their health will help us be more compassionate in their lapses of wellness – and sanity. Wellness is not something we are simply born with or can so easily acquire; it is a privilege to be well. Those who are unwell are often at the hands of a failing healthcare and toxic, inevitable familial and community systems than a true moral failure. I look forward to the day where stigma is a thing of the past so those with mental illness can freely be a part of and contribute to the betterment of society. We must work to eradicate the limiting systems in place that hinder our growth as we begin to actively choose freedom over fear.

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