What issues do those struggling with mental illness face in today’s society?

Anita Sanz, Psychologist
Answered Oct 29, 2015 · Upvoted by Martijn Sjoorda, Therapist
Stigma

A person with mental illness grows up and lives in a world of people mostly uneducated about mental illness, with a long-standing history of explaining mental illness as an example of spiritual or character weakness.

Although individuals with diagnosed mental illness work in every level of our government, corporate and technology worlds, and educational systems, if one “comes out” as managing a mental illness, they still likely face the perception that they are less stable, less able to function or work effectively, and perhaps cannot be trusted with our children, our loved ones, our safety, or our money.

The stigma surrounding mental illness deserves to die, as the overwhelming majority of those with mental health diagnoses live productive lives, have good friendships and relationships, and do not pose a threat in any way to the well being of others. They are much more likely to cause harm to themselves if their illness is not successfully treated. They carry the pain, shame, and suffering inside themselves, as mental illness is most often an ‘invisble illness,” unknown and undetectable by those around them.

Even though only a tiny minority of the mentally ill are violent, most people perceive people with a mental illness to be more unstable or more likely to become violent.

The lack of understanding of what mental illness is and is not leads to…

Discrimination

People avoid what they feel they have a right to be afraid of and most people will also avoid what they do not understand. If you don’t have a relative, co-worker, good friend who has come out to you as coping with mental illness (because you do have all of those in your life), or if you do not have personal experience with mental illness of your own, you will unfortunately get your information from those who are not able to adequately educate you about mental illness.

Frightening over-the-top images of “violent crazy people” on television or in movies do not help educate about mental illness. That a very small minority of those with mental illness commit crimes doesn’t matter, when perception of the mentally ill as violent or unlawful comes from the media sensationalizing those very few cases.

Lack of (coordinated) care

Mental illness has been treated as the “red-headed step-child” of the medical profession forever, with a long history of lack of funding for mental health treatment. It took until 2008 to be able to get mental health parity laws passed to ensure equal coverage for mental health conditions as are provided for medical conditions. It has required ongoing, expensive lawsuits to get insurers to comply with the new law.

Those with serious mental illness are denied hospital care that would be adequate for their need. According to Mark Covall president and CEO of the National Association of Psychiatric Health Systems, “The Medicare law discriminates against those with mental illness….by limiting the number of days that patients can receive inpatient psychiatric care. Medicare imposes no such limits for physical health.”

Those individuals, for example, who are actively suicidal are typically held in local or state “receiving facilities” for 1-2 days to evaluate their level of danger to self or others, with little to no actual treatment occurring. They are released back to their home or the streets if they are not actively psychotic or self-harming, with follow-up care plans (taking their medications, seeking outpatient treatment) that must be self-motivated at a time in their lives when they are least able to do so. In most states, community mental health follow-up case work dollars have been cut from state budgets. Without a family, work, or community support system in place (which many with severe mental illness do not have or no longer have), they are sent away to try to find or continue treatment on their own.

There is little to no good coordination of care for those with mental illness. Hospitals, psychiatrists, and treating therapists may never communicate with one another, much less develop a treatment plan together or with input from all concerned parties. This is akin to having cancer and your oncologist, cancer treatment center, and primary care physician never consulting or communicating with each other. Certain recommendations following from the Affordable Care Act will attempt to fix this coordination problem.

If your child has a mental illness, the lack of coordination of care will become even more glaringly obvious. Schools, mental health professionals, hospitals, and treatment programs rarely work together to provide a coordinated treatment plan to address, evaluate, treat, and then follow-up on a plan to reduce mental illness symptoms without causing massive upheaval in the child’s home, school, and extracurricular/social life. Parents of children with a mental illness must become their child’s mental health case worker, if they have the time and the ability to do so, in order to get timely care and accountable treatment plans developed and followed.

Difficulty with employment

If the stigma associated with mental illness is not enough to prevent someone with mental illness from being able to get a job, the chances of being able maintain a full-time job with a sometimes debilitating disorder can be difficult. Symptoms of OCD, depression, bipolar disorder, and schizophrenia are usually managed well by medication and therapy. But individuals with these disorders do not always experience smooth and even responses to medication, and even if medications and therapy work well, they can stop working well under increased stress, illness, or trauma.

Our country doesn’t allow for much leeway when symptoms return and behaviors prevent consistent productive work. Disability is an all-or-nothing deal. Few people are lucky enough to have an employer who is educated and understanding and able to work with you if you are managing a chronic mental illness or medical health issue. If your mental illness prevents you from being able to work consistently each day, each week, each month, every year, then you’re likely to be considered a poor risk for an employer, and end up unemployed at best. The process of obtaining disability with only a mental health diagnosis has become extremely difficult, so many with mental illness do no have disability benefits and end up straining the resources of family and friends, live in poverty, or are homeless. It is estimated that approximately a third of the homeless are chronically mentally ill.

Criminalization

Due to stigma, lack of understanding of mental illness, inability to access treatment, and a greater likelihood of living in poverty or on the streets, there is an increased chance that a person with severe mental illness will come into contact with law enforcement. Sometimes the behavior of those with severe mental illness or those untreated for their mental illness meets the standard for adjudication within the legal system. Some states have programs which attempt to provide a diversion to prison for those who would be more appropriate for treatment. Some do not. Approximately 20% of jail inmates have a serious mental illness and in state prisons, the number is 15%. Prisons are notorious for providing less than therapeutic settings for those with severe mental illness to improve.

These are just a few of the issues that those diagnosed with mental illness face in our society. I have focused on the more “macro” issues, as the “micro” issues vary from person to person, but are no less significant and may include discrimination and shunning by families, churches, and communities; concerns about how to share that one has a diagnosable mental illness with a potential partner, concerns about whether to have biological children, and more.

Resources:
Data on behavioral health in the United States

Stigma, discrimination against mentally ill are common

Mental Illness Not Usually Linked to Crime, Research Finds

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