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(6-2-20) Guest blog by Joseph Meyer.
We Need To Thank the Black Lives Matter Movement
The Black Lives Matter movement is leading the protests about the death of George Floyd in Minneapolis at the hands of police officers. Obviously, BLM is primarily laser-focused on the experiences of persons in the African American community, as its name indicates. But, on the BLM website, its leadership asserts “we work vigorously for freedom and justice for Black people and, by extension, all people.”
The site specifically mentions ageism, expresses support for the broad membership of the GLBTQIA community, and in a summary statement acknowledges the problems faced by other groups: “We are guided by the fact that all Black lives matter, regardless of actual or perceived sexual identity, gender identity, gender expression, economic status, ability, disability, religious beliefs or disbeliefs, immigration status, or location.”
There it is—disability—and, although BLM does not specifically mention mental illness, the BLM movement has time and again been outspoken and active in standing up for the rights of persons with mental illnesses when other advocacy organizations have been mostly silent. So I want to thank the BLM movement because I believe it has done a better job than any of the mental health advocacy organizations at peacefully, yet emphatically, calling attention to deadly threats faced by the seriously mentally ill – especially persons of color – in our communities at the hands of the police.
When James Boyd, a mentally ill and homeless white person, was killed by police in Albuquerque, it was the BLM movement that helped lead protest marches that drew hundreds of participants. Mental health advocacy organizations were silent for the most part. Questioned about why the BLM movement cares about a white person, Nikki Archuleta, founder of the Girls of Color Coalition, responded in part, “BLM is standing with James Boyd’s family. BLM advocates for any human being who has lost their life to police brutality. They [BLM] are aware of police brutality amongst poor people, the homeless, amongst the mentally ill, the LGBTQ community and communities of color.” (https://newmexiconewsport.com/black-lives-matter-abq-elections/)
In Florida, Charles Kinsey, a black caregiver for a white autistic adult was lying on his back with his arms in the air. The police had just arrived, while he was trying to calm his autistic client who was fiddling with a toy. Kinsey was shot by a police officer, who later claimed to have been aiming at the autistic person who the officer thought had a gun ( https://www.wlrn.org/post/black-lives-matter-stage-sit-file-complaints-north-miami-police-station#stream/0)
Again, the BLM movement was there to call attention to how badly the situation had been handled.
Here is Patrice Cullors, cofounder of the BLM. “Right now, in Los Angeles and in most cities across the country, the first responders for people in a mental health crisis is law enforcement. We, unfortunately, have created a system in which those who are suffering the most are harassed, arrested, and often abused — instead of supported.” She continues, “I want those of us whose families manage severe mental illness to be able to rely on a mental health care system that is no longer intertwined with law enforcement.” (Seehttps://www.mic.com/p/black-lives-matters-patrisse-cullors-on-the-criminalization-of-mental-illness-19209822).
NAMI, MHA and Advocates need to step up their activism
Why are mental health advocacy organizations like the National Alliance on Mental Illness (NAMI) and Mental Health America (MHA) not loudly protesting when those they represent die at the hands of law enforcement? They are quiet and meek when BLM outspokenness is needed. They worry about the shame (i.e., stigma) of having a mental illness when discrimination is the actual issue.
How much progress would the gay rights movement have achieved if they had stayed quiet, instead of hosting gay pride events and Halloween parades? How much attention would the BLM movement have generated if they spoke about the shame (i.e., stigma) of being black?
A gay friend and tenured faculty member taught me about the importance of being out of the closet many years ago. He felt compelled to speak on behalf of those who experienced discrimination at a time when it was difficult and risky, especially for non-tenured faculty and other employees to do so—he was disgusted by gay faculty members who were securely tenured, but due to stigma refused to be ‘out’ and outspoken on behalf of those who could not afford to be outspoken for a legitimate fear of retribution.
Instead of Protesting Discrimination, We Turn Our Backs on the Most Sick
I am disgusted by successful mental health advocates who are willing to throw their more seriously ill brothers and sisters under the bus, ignoring them because they find them embarrassing. There are exceptions, including the late Dr. Fred Frese, who said emphatically in a speech to what was then the U.S. Psychiatric Rehabilitation (USPRA), “Yes, I’m schizophrenic and I absolutely refuse to be ashamed!” Dr. Kay Redfield Jamison, who in addition to her earned doctorate in psychology holds honorary doctorates from at least 8 universities, also called for highly successful professionals with mental illness to be more outspoken and to use the word ‘discrimination’ instead of stigma in a speech at John Hopkins University where she is employed.
While NAMI was founded by the parents of children diagnosed with schizophrenia, and the organization does an honorable job of providing educational materials and information to parents, they are remarkably reserved and even quiet when it comes to outspoken advocacy on behalf of the mentally ill victims of tragic outcomes. They want to be a big-umbrella organization that encompasses the 40% who will experience some kind of mental health issue in a lifetime. Most of those in the 40% do not have serious mental illnesses and will never experience an encounter with law enforcement officers. If advocacy organizations want to represent the interests of all persons living with mental illness, they have to use their communication and negotiating skills to bridge the divide between those with serious and less serious symptoms. The silence of mental health advocacy organizations and Disability Rights offices in each state after tragedies involving the mentally ill is all too often glaring and difficult to understand.
There are many excuses for this timidity: fears about increasing stigma, worries about civil liberties, and a desire to engage with consumer organizations in partnerships. Sadly, prejudice plays a role in the silence. Many of those without a serious mental illness, or with a serious illness that is well-controlled, do not like being associated with those who have such illnesses and are not well. They fret that being associated with the sickest creates a stigmatizing obstacle to social acceptance and employment, goals that are incompatible with the problems of psychosis, mood instability, and homelessness that go along with serious mental illness when it is chronic. They disapprove of those who have not achieved a level of recovery, believing that since they achieved recovery, others should be able to do the same.
Why the Reluctance to Criticize Police? Deaths of Mentally Ill by Police Have Not Decreased
Advocates also are afraid of offending community partners. NAMI closely partners with local police departments in promoting Crisis Intervention Teams (CIT) and hesitates to be critical of the police for fear of damaging that relationship. How has that worked out? The Memphis Model of CIT has been in place for more than 30 years, yet only a tiny fraction of police officers have been trained in de-escalation techniques. Fewer departments still have dedicated Crisis Intervention Teams and those that do are only able to respond to a small fraction of mental health calls. Why? Perhaps it’s because, as we have heard some police leaders say, they don’t think it is their responsibility. A recent study, “Effectiveness of Police Crisis Intervention Training Programs” published in The Journal of American Psychiatry and the Law concluded there is little evidence that CIT is effective in a broad sense. There has been little high-quality assessment of such programs and few efforts to hold police departments accountable with solid data. (See http://jaapl.org/content/early/2019/09/24/JAAPL.003863-19)
If The Washington Post database of police shootings is criticized for being non-scientific, it must be acknowledged that police departments have resisted accountability based on more scientific data collection. Based on the admittedly flawed data in that database, nationwide deaths of mentally ill persons at the hands of police have not decreased, yet there appears to be a great amount of variation in mortality rates from one city to another. While there is some evidence that some police departments have done a better job than others of adopting and even enculturating de-escalation with positive results, the evidence is scarce. Even in San Antonio, home to the award-winning documentary about “Ernie and Joe,” the police chief was nearly run out of town (https://www.expressnews.com/news/news_columnists/brian_chasnoff/article/Union-proves-vote-against-McManus-is-political-6885530.php) when he spoke of adopting the recommendations of the Dr. Chuck Wexler and his Police Executive Research Forum (PERF) on de-escalation (https://therivardreport.com/sapd-leads-talks-in-crisis-training-vehicles-for-hire/). The overwhelming support from the City Council and other community leaders may be what saved his job (https://www.expressnews.com/news/local/article/McManus-city-leaders-reject-police-union-call-7044822.php).
Passing the Buck
Too many advocates support local police officials who state that mental illness is a problem for healthcare organizations to solve, that they should be relieved of that responsibility, an easy position for them to take. They hesitate to hold the police responsible for heavy use of force, writing that police step in when the mental health system has failed. But the truth is that our society has designated the police as first-responders for such events and it is their responsibility until that changes. It is not the responsibility of healthcare providers to provide treatments that are 100% effective when no such treatments exist; it is not their responsibility to predict violence when studies have shown it is impossible to do so; it is not their responsibility to pass red-flag laws to keep firearms away from individuals with a history of instability; it is not their responsibility to detain persons indefinitely because a tiny percentage of them will become violent upon release. These are problems for our legislators and justice system to address, because they make and enforce the laws. It is the responsibility of clinicians to conduct research and improve treatments.
There is room for improvement in all agencies that interact with the mentally ill, but mental health advocacy groups have typically failed to point that out, just as they have failed to point out senseless tragedies and call for practical reforms that are based on a balanced evaluation of evidence. The ignorance, territorialism, inertia, and outright hostility toward reform is overwhelming. I heard an EMT serving on a committee say he did not know why he was on the committee since it was his job to respond to medical emergencies and not mental problems, as if mental health is something other than a medical issue. I heard an emergency room physician on the same committee lament that first responders fail to sort drug addicts from the mentally ill before bringing them to the ER and that it would be helpful for them to take addicts directly to detox, as if a police officer should be able to tell one from the other. And, I watched as a coalition of the Scientology-supported Citizens Commission on Human Rights, anti-vaxxers, homeschoolers, and the League of United Latin American Citizens signed onto and submitted a letter urging the Governor of Texas to veto a bill that would have allowed psychiatrists to detain a mentally ill person up to four hours, long enough to seek a court order for treatment, as if they have the expertise to make an informed recommendation about mental illness policy. They were successful, prompting the veto of a bill passed by what was a veto-proof majority of Representatives and Senators on the last day of the Texas legislative session, when there was no time remaining for a vote to override the veto.
Blaming Parents. Where Are Faith Leaders?
Instead, so-called mental health advocates often favor a trauma-informed narrative that is used by some to blame parents for the illnesses of their children. Federally supported Disability Rights organizations provide free legal support for adults with mental illness to avoid hospitalization, opposing the wishes of parents, and sometimes leading to homelessness and death. Some mental health advocacy groups write policies that serve the interests of higher-functioning persons with mental illness, but are anathema to the involvement of parents who more often than not are the primary caregivers for persons with serious mental illness. In contrast, the BLM writes, “We make our spaces family-friendly and enable parents to fully participate with their children.”
Finally, as a family caregiver, I believe church leaders bear some responsibility for poor leadership in influencing societal attitudes and approaches toward mental illness. Rather than urging their flock to focus on love and forgiveness, they too often focus on punishment and that feeds into our incarceration problem. Shortly after one of my family members was diagnosed, a neighbor said her pastor believed persons with psychotic experiences were born to devil worshippers. But, as I’ve lived the experience of caring for the family member as a child and adult, I have come to see it as an opportunity for personal growth—it is a challenging and difficult calling to be less judgmental, more forgiving, and more openminded about the causes of aberrant human behavior. Seek first to understand, before judging. If you are only nice to the person who is nice to you, what good is that? Anyone would do the same.
The Black Lives Matter movement knows about caged birds and strange fruits. How can we keep the mentally ill out of cages and in therapeutic settings? What are the fruits of silence by mental health advocates in the face of ignorance and hostility? Here are just a few examples:
- (1) Emergency medical responses that depend primarily on the police for mental health crises while every other type of medical emergency elicits a response by unarmed clinicians.
- (2) Mentally ill who are over-represented in homeless populations, the incarcerated including those on death row, and those killed in police confrontations.
- (3) U.S. Supreme Court rulings that shifted the burden of proof in insanity defenses from the prosecution to the defense, eliminated the death penalty for those who were under 18 at the time of a crime while preserving it for those with serious mental illness, and recently endorsed state governments removing the option of an insanity defense entirely.
In recent days, the BLM movement has spoken about how important it is for all of us, not just African Americans, to be outspoken on behalf of the victims of violence. It is time for mental health advocates to do the same. Okay, NAMI and MHA. What are you going to do about these problems? When are you going to speak up loudly and repeatedly against violence? We’re listening.
About the Author: Joseph Meyer is an assistant vice president at Texas State University where he is wrapping up a 30-year career in higher education research. Because of his family experiences and an educational background in biostatistics, he also has strong interest in mental health advocacy. He is a member of the National Alliance on Mental Illness (NAMI) where he has presented at both state and national conventions. He lives in Austin, Texas and serves on local advisory committees with representatives of the judicial system, law enforcement, and mental healthcare providers.
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