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.

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.