For much of history, psychosis was considered a result of demon possession. In many ways that view is still evident today.
In the United States, slaves were diagnosed with disorders such as draptomania, described as a condition that caused black slaves to flee captivity. People with mental illness were routinely imprisoned and only later put in primitive treatment facilities where many were subjected to barely tolerable hot- and cold-water baths among other things.
Obviously, mental health care has improved with time. With advances in neuroscience and increased emphasis on the worth of people, individuals began to receive relatively targeted medication.
Nevertheless, the mental health challenges facing communities in Texas remain stark. In fact, the state ranks near the bottom when it comes to per capita mental health spending. And it’s a grim likelihood that future generations will look at our present systems of care with the sort of shock and regret with which we view the past.
In other countries — places with less technology and fewer resources than are found here — individuals are cared for with strong family support and sometimes experience better health outcomes. In the U.S., family members often are separated from patients, who receive advanced treatments but still experience worse outcomes.
Unemployment and homelessness among people with mental illness are common. More disturbing, those with mental illness are too often demonized as a source of community violence even though they are far more likely to be victims than perpetrators.
These issues are especially relevant to people of color, who suffer unacceptable disparities in mental health. African Americans are more likely than whites to receive the least optimistic diagnoses.
Schizophrenia is consistently over-diagnosed, while more manageable conditions such as depression or post-traumatic stress disorder are often under-recognized or misdiagnosed — resulting in higher incidents of seclusion, use of restraints and involuntary commitment, and lower levels of support for patients and their families.
This is a big reason why African American and Hispanics are far more likely to be arrested and incarcerated than whites, and why jails have become such tragically overused centers of mental health care. It contributes to the deaths of Africans Americans, some of whom appear to have mental disorders, at the hands of law enforcement officers. And it helps explain why, at times, these generations of mental health advances feel so illusory.
So what can we do?
Unfortunately, despite evidence to the contrary, too many people still believe that people struggling with mental health issues are to blame for them — that dangerous is rampant, recovery is rare and treatment is ineffectual.
Ignorance about mental health issues remains widespread. We need a nationwide effort to reduce the negative perception of those with mental disorders. Similar efforts have reduced the stigma associated with conditions as diverse as cancer and autism.
It’s time for a conversation to counteract the charged, uninformed movies, political statements and other cultural touchstones that portray mental illness as a menace. I do not think it is a coincidence that similar fears regarding young black men have contributed to long prison sentences and acts of violence against people accused of little more than wearing a hoodie.
Polls continue to show that the public still wrongly blames patients and their families for these issues. And it’s too easy for governments at every level to cut funding for mental health services, especially in the face of unavoidable increased costs for the homelessness and crime that results from sick people being unable to find treatment.
The good news is that the concept of recovery — that these individuals will not stay ill forever — is gradually becoming appreciated by the community. Large-scale studies are showing that early interventions can create marked improvements in outcomes for these patients.
Color should not determine care. Governments should embrace new, cost-saving interventions. Family members should remain engaged and receive encouragement to do so. And communities should embrace ill patients who need help, not run away from them.
Mental health should be treated more sensibly, humanely and equitably than it is now. We need to move toward that future as quickly as possible.
William Lawson, M.D., Ph.D., DFAPA, is associate dean for health disparities at the Dell Medical School at The University of Texas at Austin.
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