Health

Treating Mental Illness With Care, Not Punishment, Goes Beyond Defunding Police

We need to remove all the ways that government deters people from seeking treatment.

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After Lynette Phillips voluntarily checked herself into a hospital in March 2013 to help with adjusting to a change in anxiety medication, state agents came to her home and seized her husband's guns. Hospital records had incorrectly recorded her as an "involuntary" admission, curtailing her civil liberties under California law. While her family's property was eventually returned, the traumatic experience offers a cautionary tale as Americans rightfully discuss "unbundling" encounters with mentally ill people from the responsibilities assigned to armed, arrest-oriented police officers.

As it turns out, improving help for people with mental illness requires not just getting cops out of the mix, but also removing other government-imposed pitfalls that make it risky to seek treatment for mental health issues.

"Newer approaches involve sending mental health professionals along with—or instead of—police into situations involving mental health emergencies," The Washington Post points out in coverage of the "defund police" movement. In Eugene, Oregon, the CAHOOTS program is considered pioneering in that field, usually sending crisis workers instead of cops in an effort to reduce violent outcomes.

But beyond the over-use of police, there are a host of liberty-threatening and privacy-violating legal barriers to improving the treatment of mental illness that need to be swept away. Only when that's done will the country have really decriminalized psychological issues and adopted a supportive, not punitive, approach.

Barriers to seeking treatment for mental health issues or substance-abuse concerns don't have to be as dramatic as Lynette Phillips' experience; a bureaucratic ordeal can be awful enough. Thomas Skelton, a graduate of the John Marshall Law School at the University of Illinois at Chicago, is asking the U.S. Supreme Court to consider whether Illinois officials discriminated against him when they refused to allow him to practice law because he is undergoing mental health treatment.

"Mr. Skelton candidly provided evidence and responsive information to the hearing panel at every turn, even discussing and allowing his treatment providers to discuss the most intimate details of his counseling sessions," says his certiorari petition. "That evidence was then used to further stigmatize Mr. Skelton."

If voluntarily placing yourself under care for mental health concerns can knee-cap a licensed career before it even gets off the ground, there is a huge potential for deterring people from seeking help at all. For sufferers, serious concerns about depression, anxiety, or other issues have to be balanced against worries about lost employability. And, yes, research says that's exactly what happens.

"Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure," found a 2016 study that covered all 50 states plus the District of Columbia. "Our findings support that [medical licensure application questions] regarding mental health conditions present a barrier to physicians seeking help," the authors concluded.

Lying to official interrogators is one possible countermeasure. I'm plugged into the medical community and I've met providers treated for psychological concerns as well as (frequently related) substance abuse issues who hope for the best as they fib to save their careers. For them, there is a balance of risks as they deal with a bureaucracy that would punish them for doing the right thing and, sometimes, going without help seems like the safer bet.

"Restricting rights of people who are living with a mental illness or possibly may be diagnosed with a mental illness just further perpetuates people not receiving or seeking the treatment that they need to get better," Jessica Cruz, of the National Alliance on Mental Illness, told Reason at the time of Lynette Phillips's ordeal.

That's worrisome enough when it comes to professions that involve a small percentage of the population, but seeking care for mental health issues can also stand in the way of the driver's licenses than most Americans need for everyday life. "Within the past two years, have you been diagnosed with, been hospitalized for or are you now receiving treatment for a psychiatric disorder?" asks the Texas driver's license application. Virginia asks applicants if they have a "physical or mental condition which requires that you take medication?"

Grace Klam, an aspiring teenage driver in Texas, was initially turned away when she honestly answered the question with details about her depression. Another applicant told the Houston Chronicle that he avoids problems by lying about his condition—although that potentially carries criminal penalties.

Lying as a means of privacy protection and self-defense doesn't necessarily stop there. For those needing care, subterfuge can extend to relations with psychiatrists, psychologists, and social workers who are subject, in many states, to mandatory reporting laws. Anybody desiring help has to worry that excessive frankness, or a misunderstood statement, can get them referred to the powers-that-be as potential dangers to themselves or others. These laws also put doctors in an awkward position as quasi-agents of the state, subject to rules that can come into conflict with their professional judgment and create tensions in terms of their obligations to patients.

"If we put doctors in a position of acting on behalf of the government or acting on behalf of social control then that undermines the therapeutic mission," Steven K. Hoge, a Columbia University psychiatrist, told Reason with regard to the Phillips case.

Even some of the lawmakers who created the problem acknowledge the danger. "Mandatory reporting laws, say some professionals, may discourage people from seeking professional help or fully disclosing their intentions," admits the National Conference of State Legislatures, whose members helped turn mental health care into a legal minefield.

So, getting cops out of the business of responding to mental health calls is a great first step. After all, "the police have no expertise in dealing with the mentally ill or with the homeless–jobs like that should be farmed out to other agencies," as George Mason University economist Alex Tabarrok writes.

But ending the punitive treatment of mental illness requires going beyond the badge. Treating those with psychological problems as people who need treatment rather than as criminals, and encouraging troubled people to seek treatment before the situation turns into a crisis, means protecting privacy and liberty. We need to remove all the ways that government attempts to punish anybody who needs psychological help.

NEXT: Justice Thomas (Dissenting) Further Arguing Against Qualified Immunity

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  1. If voluntarily placing yourself under care for mental health concerns can knee-cap a licensed career before it even gets off the ground

    I don’t know if it’s a holdover from the old days, but I know people with DoD clearances that keep this stuff quiet. It used to be that “perception” of mental illness was enough to have a clearance pulled.

    1. That’s odd, I thought mental illness was a prerequisite for working at the DoD. Or is sociopathy not considered a mental illness?

      1. You have the DoD and police confused.

        1. Why can’t it be both?

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          2. It is but leans more towards the FBI. Cops have themselves as friends.

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          2. Umm…never been in the military eh? Try not addressing them as “sir”, especially in basic training – see what happens. LOL

        2. By his or her rank, probably?
          And a Commissioned Officer as either “Sir” or “Ma’am”, dependent on whether the CO is a man or a woman, I’m guessing

  2. I remember when we used to laugh and sneer at Soviet mental institutions as political dumping grounds.

    Fun times, fun times.

    1. The libertarian solution to mental illness is the carnival side show.

  3. “Mr. Skelton candidly provided evidence and responsive information to the hearing panel at every turn, even discussing and allowing his treatment providers to discuss the most intimate details of his counseling sessions,” says his certiorari petition. “That evidence was then used to further stigmatize Mr. Skelton.”

    “Talking about this shit is just *crazy*!”

    1. Catch-22. This is different from the old Catch-22, in that I swapped the two digits.

  4. First we need an objective measure of how aware of their own behavior and its purposes.
    We can’t just blanket excuse sociopaths as though they’re schizophrenic.

    1. Good luck finding anything “objective” in human psychology. If we start locking up people for severe mental illness, Reason will start pumping articles with titles like “The Libertarian Case for Homelessness” and “The Libertarian Case for Eating Your Own Feces”. You can medicate people until they’re passive but I wouldn’t call that a cure for mental illness.

  5. It goes way beyond defunding police. Maybe things have changed in the last decade inside employer plans and larger companies (I doubt it) but there used to be very very good reasons to avoid actually using any mental health access provisions offered by employer plans. It was always OK for execs and their wives/families to ‘talk to someone’ or go to a rehab clinic. But for lower-level – nonononono. Not only was ‘sick leave’ configured to not actually cover mental health treatment that might require some stint away from work (and ‘sabbaticals’ or somesuch has only rarely been offered below a certain pay level) – but even the shortest ‘visits’ would work their way into being known. Not for the specific treatment but for the general ‘mental health’ rather than ‘physical health’. And that has tended to be a career-killer. Not to mention that even providing the coverage has been driven by legislative mandates (MHPA, MHPAEA) – not by employers actually offering the coverage for competitive/market reasons.

  6. We have a long way to go in treating and addressing mental illness and one article won’t cover the problems. In large part it is a problem of the sigma associated with the condition. While we have overcome many of the sigma’s of physical illnesses (not all of course) we are a long way from that with mental illness. Licensing is one of those problems. We assume the person can not do there job because of the MI. In fact the person may do a wonderful job at work 9 to 5, then go home and fall part on their own time. Imagine a work environment where we know Tom is diabetic, Sue is recovery from breast cancer and Bill suffers depression. We support all our coworkers and accept that they are dealing with illnesses and conditions.

    1. Stigma, very different than sigma. Used once may be a typing error, used twice…

      Sigma is the 18th letter of the Greek alphabet and is equivalent to our letter ‘S’. In mathematics, the upper case sigma is used for the summation notation. The lower case sigma stands for standard deviation.

      Stigma is a mark of disgrace that sets a person apart from others. When a person is labelled by their illness they are no longer seen as an individual but as part of a stereotyped group.

  7. One of the ways the government deters people from seeking help is with involuntary commitment laws. When you hear the many accounts of people being held against their will, being brutalized or held until their insurance runs out, you tend to not seek out any of that kind of “help”.

    Until these involuntary commitment laws are gone or in line with people’s 4th amendment rights, the police, psychiatrists and other mental health “professionals” who do these legal kidnappings, will be held in fear and contempt by the public.

  8. All the good and decent people in “society” will regard your mental illness the same as a physical illness, and NOT stigmatize you for it? Well, they will TELL you that, that that’s what they’ll do, and then do the opposite! It behooves you to tell almost absolutely NO ONE about your MI! Keep it the the ABSOLUTE minimum! So says the science and the books by the learned folks, not just poor little ol’ me!

    See details below…

    From “Cracked, Why Psychiatry is Doing More Harm Than Good”, by James Davies, see https://www.amazon.com/exec/obidos/ASIN/B00B1B1VHI/reasonmagazinea-20/

    This book is mostly focused on the abuses and deceptions (excessive pill-pushing) of the pharmaceutical companies, and on the totally made-up (not scientific or rational) nature of the DSM, or “shrink’s Bible” of definitions of ailments. Mental ailments are radically differently defined, from culture to culture, as James Davies shows, as well. Ailments, to some degree at the very least, run in fashions and trends. For example, bulimia and anorexia became MUCH more popular / fashionable / prevalent in the era or Princess Diana. The whole thing (mental illness) is less “scientific, biochemical” and more “social, in your head” than we seem to want to think or admit.

    Anyway, I want to transcribe a section, and then discuss it. So here goes, starting at page 221 of the paperback:

    “So the myth we embrace affects how we read and experience our psychological states. This means that changing the ‘myth’ through which we understand such states can be just as therapeutic as taking a pill or undergoing therapy. Consider, for example, another significant change many patients report once they reject the psychiatric view: they often no longer experience the stigma that accompanies being identified as psychiatrically unwell. This is an important point, because a popular justification for the biological vision of our emotional troubles is that it reduces the stigma of mental disorder. After all, if a patient has a biological disorder they cannot be blamed for the way they are.” (My Melvin insertion here: This is an important crux here… Some people think that if I go into a giant manic fling of delusions of grandeur, I am completely NOT to be blamed for it, because “my biochemicals made me do it”. It would be too harshly judgmental and insensitive for me to be told to “get a grip”, or “live in the real world”, or, “Fer Chrissakes, develop a wee tad of HUMILITY, will ya?!?” The shrinks and counselors are flat-out WRONG, here; these are EXACTLY the right things for a person with “delusions of grandeur” to be told! OK, back to quoting the book).

    “Groups like the National Alliance on Mental Illness in the US and SANE in Britain take this position: the biological myth helps sufferers because it indicates to others that they are not responsible for their predicament. They are like anyone else with a medical condition, and so should not be seen or treated otherwise.

    “While in theory this position is sensible enough, in practice things seem to unfold very differently. Many patients experience negative secondary effects from their diagnosis, either concealing the diagnosis from others out of shame (which can compound their isolation) or becoming so identified with their label that they regularly declare it to others, which can in turn invite real rejection. For example, research now shows that today’s most popular public perception of mental disorder is that it’s biological in origin. This is particularly problematic in light of recent research revealing that patients whose emotional problems are believed to be caused by brain disorders are treated far more harshly by the average person than patients believed to have problems caused by social or psychological factors. A research team at Auburn University revealed this troubling fact by asking volunteers to administer mild or strong electric shocks to two groups of patients if they failed at a given test. The results were alarming: the patients believed to have a brain disorder were shocked at a harder and faster rate than the patients believed to have a disorder that was social or psychological in origin, suggesting that we may attract harsher treatment when our problems are considered in brain-based terms.”

    Source notes for the above section, Mehta, S. (1997), “Is being ‘sick’ really better? Effects of disease view of mental disorder on stigma” Journal of Social and Clinical Psychology, 16(4): 405-19

    Back to the James Davies book, right where we left off…

    “Results like these are obviously alarming but not entirely unexpected. After all, we know from other research that people who are believed to suffer from biological abnormalities are seen by the average person as more unpredictable and dangerous than ‘normal’ people. Such perceptions have also been shown to lead ‘normal’ people to avoid interacting too closely with the ‘mentally distressed’ – an avoidance that can, once again, compound the sufferer’s isolation.”

    (Above is footnoted, too, but I am getting lazy… Go buy yourself the book! Ditto for section below, which immediately follows).

    “Studies like those above show that being diagnosed with a psychiatric condition – with depression, anxiety, or one of the more severe disorders – often comes with powerful cultural baggage, especially when our suffering is perceived as being rooted in our biology. Paradoxically, then, the worldwide psychiatric campaigns whose goals are to reduce stigma associated with mental illness by asserting that it’s just like any other biological disease may well have helped bring about the very opposite of what they intended”.

    (End of book excerpts). Comments: One cannot hardly even change anyone else’s mind about much of anything! When is the last time you “corrected” someone’s opinion in online commentaries, and they changed their minds, and thanked you for it? So, if you have a mental illness, do NOT go around telling everyone that “it’s just like I have a broken arm”, or some such! It’s not going to work! People should be more compassionate and non-judgmental, OK then, but you can’t make them be that way, even if they verbally agree with you!

    More generally, “political correctness” is something foisted BY the politically powerful, UPON the politically weak. The Congressmen and college professors will lecture us all day about women and racial minorities needing more opportunities, but notice than none of them resign their positons of power and appoint minorities and women to take their places! And MOST certainly, ditto for the mentally ill! They still almost ALL fight like weasels in heat, to retain all their powers and paychecks, while telling the lesser mortals to be politically correct, and share power, prestige, and equal paychecks! Racial quotas have been applied to teachers, students, firefighters, etc., but have never been applied to Congressmen and CEOs!

    To delve only fleetingly into raw politics, this kind of thing (political correctness, often very hypocritical) is what got Donald Trump into power. And for the record, I can’t stand The Donald!

    So anyway, back on track now, take your meds, by all means, if they help you! I am not into Scientology! But in addition to taking your meds, toughen up, try your very best to remain in control of yourself! Believe in yourself and your own free will! Your free will is more powerful than your biochemicals! Tell only your VERY most trusted inner circle about your mental troubles! If applying for a job, tell your bosses about it, only AFTER you’ve got the job, if then! And please don’t trot out any lines about it being the fault of your biochemicals, not yourself! That line will NOT work, with the vast majority of people! It is what it is, and may eventually change, but only at a glacial pace, at best!

  9. Almost all mass killers had been taking mind-altering drugs and have been on these meds in some state of the drugs cycle, we need to ensure the public is protected. Usually, one seeks voluntary or involuntary care they have already been on these drugs through a normal physician for some time. The volume of these drugs are then greatly increased under confinement. I would like to go in the opposite direction and see the use of these drugs as a denial of the purchase of guns. If they seek professional care they need to secure the guns with another or storage facility. At the least, younger than 18 should be denied the ability to access guns till they complete evaluation and off all medical mind-altering drugs.

    The drugs in psychiatry are mind-altering and have their own warning labels that state violence and depression. Some are far worse than others. These drugs function primarily as dopamine receptor antagonists. All have abuse potential, Long term effects, side effects, Tolerance onset, withdrawal. Withdrawal can cause psychosis far worse than the original ailment. Normal doctors hand out many of these drugs without much consultation beyond a minute or two.

    By the time the person seeks actual psychiatry care, they have already been on these mind-altering chemicals. It is estimated 1 in 5 is on these drugs. Some of the most extreme dangers associated with psychiatric drugs include; drug-induced psychosis, tardive dyskinesia, brain volume loss, and dementia. .

    Having daughters with various friends I am shocked at the instability of many of the youth. They are quickly put on these drugs at such young ages. So no I don’t want to end stigma but want to be protected when they are given the mass doses in the hands of institutions.
    The reason for cops being the end-all and thrust into all kinds of societal problems is not lack of money. It is the utter failure of these programs, to begin with. Cops show up and do their best but are not qualified and who is to handle a drugged up mental person. We have 40 years of this. Can anyone do an honest evaluation? If they were successful they would be called and not the cops. So as much as the author wants to hold the line on individual rights, I would not like to have my children shot up by another Johnson like failures of societal mumbo jumbo.

  10. We need to remove all the ways that government deters people from seeking treatment.

    Spoken like a true progressive: “what policies can we adopt that nudge people to do what experts believe is the right thing”.

    State licensing is supposed to be a guarantee to consumers that a service provider is competent and up to the task. Do you want to be operated upon by a schizophrenic surgeon, get an injection from a depressed doctor, or have a suicidal defense attorney? I suspect not.

    Of course, from a libertarian point of view, mental health treatment shouldn’t preclude licensing since there shouldn’t be licensing in the first place. But from a libertarian point of view, clients and insurers should be able to require clear disclosure of any personal, health, mental health, or legal problems of doctors and lawyers, something they also can’t do under current law. And you can bet that in a free, competitive market for professional services, professionals who are truthfully able to state that they are healthy and mentally competent would do so.

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  11. This article signals the end of Reason as a meaningfully libertarian publication.

    Mental health workers are enforcement agents for the state. If no crime has been committed, why have they come? If a crime has been committed, why have they come?

    Reason bear hugs the therapeutic state. RIP.

  12. We have no idea what to do with mental illness. We want people with problems to receive treatment, but we don’t want them to be forced to accept that treatment. We don’t want them to harm anyone else, but we don’t want to confine them so that they are not out in public with people, just waiting for something to trigger them to do something they should not do. We want them to take their medication, but don’t want to force them to take it. We don’t want to harm their ability to work and have professional lives, but don’t want to have anyone with a condition that MIGHT cause them to do something wrong or otherwise harm some other person to be able to do that harm.

    We don’t know what we want. The problem is over-specified, and the specifications are contradictory. Doing the same thing, saying the same things about this issue every time something bad happens, and hoping that the outcomes will change, is the very definition of madness.

    1. Treat everyone the same unless they have an actual diseases which prevents them from being fully capable of self-control. That would include people with dementia and extreme autism. Psychiatric diseases are metaphorical, and metaphorical diseases are no more entitled to unique treatment in criminal justice than are cases of demon possession.

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