“Saving the Lives of the Invisible”
By: Madhuri Jha, LCSW, MPH (she/her/hers) – Director, Kennedy-Satcher Center for Mental Health Equity
Since George Floyd’s murder, our media cycle has forced the behavioral health equity movement to be wrought with conflicting points of urgency, as we reckon with the field’s own contribution to oppression in practice. According to the Harvard Political Review, people with mental illness are more than 4.5 times more likely to be arrested than the general population. The Treatment Advocacy Center found that people with untreated mental illness are 16 times more likely to be killed during a police encounter. This population accounts for almost 50% of the people who are fatally shot by police. And yet, the George Floyd Justice in Policing Act has now spent a full year stalled in the Senate. This stall validates a long-standing discomfort our system has in acknowledging the historical intersection between mental illness, oppression, and the criminal justice system. It compels me to focus my dissection of policies on whether they are upholding one’s civil right to live.
If asked, I would not be able to count how many patients, primarily patients of color, I have seen the system fail. Patients who cycle in and out of mental institutions, prisons, and homelessness. Patients who die of suicide, addiction, violence, or face long-term sentences for crimes commit during a psychiatric crisis. I often ask myself: how did we get here? If we look at policies that led to the creation of asylums in the early 19th century, the zeal for their expansion in mental health care was based in the idea that treatment plans could only work if patients and staff shared common values and culture. A deeper look, however, shows us that these markers for success could not be sustained through the influx of immigration and urban immigrant poverty due to industrialization, the sociopolitical aftermath of abolitionism, and the advent of laws geared toward the erasure of native heritage. The inevitable increase in diagnoses of “insanity” amongst free black people, American Indian/Alaska Natives, and immigrants led to overpopulation of these groups in asylums and ultimately, penitentiaries. That reality remains for these groups today.
Our news cycle is currently reminding us of the horrific consequences of “compulsory attendance” laws. Passed in 1891 in the US and Canada, these laws enabled federal law enforcement to forcibly take native children from their reservations, under the justification that they were being rescued from poverty. Children were placed at boarding schools aimed at changing legal identification and physical appearance, teaching “life skills” that undid generational native traditions and forcing assimilation into western lifestyles. ABC News reported recently that the unmarked graves of almost 1000 (and counting) native people, mainly children, have been found at former boarding school sites that were formed by these attendance laws.
1000 unmarked graves and counting.
I am pleased to see the urgency to re-examine our emergency response protocols and prioritize the prevention of fatal law enforcement outcomes. Modeled after the CAHOOTS program in Eugene, Oregon, many cities are adopting mental health emergency response systems that remove police presence and dispatch a joint response between EMS and social workers, when someone is in psychiatric crisis and not violent. Recent evaluations of these programs are showing that they are indeed reducing fatality and increasing access to care. This comes in conjunction with the forecasted 2022 roll-out of 988, a national mental health emergency number that will replace the suicide prevention hotline. As the implementation plan of 988 is finalized, we have a critical opportunity to demand thoughtful emergency response and give visibility to communities that have not been given this privilege historically. This should include a look at things like rural access to mental healthcare, and the location of some native reservations that are so remote they are only accessible via helicopter. As we consider culturally attuned care, our policies have an opportunity to go beyond just acknowledging the effects of institutional oppression, by embarking on attention to detail that prioritizes the saving of human life.
While we continue to say the names of George Floyd and Breonna Taylor, we must also say the names of lesser-known victims. Like Ricardo Muñoz, aged 27, living with unstable paranoid schizophrenia, killed by police in 2020 in Lancaster, PA. Six weeks earlier, Walter Wallace, Jr. a black man having a psychotic episode, killed by police in Philadelphia. In 2017, Paul Castaway, a member of the Sicangu Lakota tribe, living with mental illness and addiction, killed by police in Colorado. We must give voice to those human lives that have been historically invisible to federal policies and demand that these policies rectify past systemic traumas. The momentum is there; it is on us to capitalize on it. Behavioral health equity cannot just address standards for treatment and care, it must also promote the equitable standards we uphold to keep all people alive.