AMERICA’S MENTAL HEALTH CRISIS: TREATING THE MENTALLY ILL AS CRIMINALS
Most recently, Pete Earley wrote for the Washington Post: “Americans with mental illnesses make up nearly a quarter of those killed by police officers.” He has highlighted mental illness as a specific issue that many experts believe is crucial to reducing police-related violence. One major reason is that very often police officers, rather than mental health professionals, are the first to respond to mentally ill individuals displaying socially disruptive or violent behavior.
To understand why we have come to such an abnormal situation, I recommend reading Insane: America’s Criminal Treatment of Mental Illness published in 2018 by Basic Books, New York, NY. The author, Alisa Roth, states: “There’s an epidemic of police shootings of people with mental illness.” The book is an exposé of the mental health crisis in our courts, jails, and prisons. America has made mental illness a crime: Jails in New York, Los Angeles, and Chicago each house more people with mental illnesses than any hospital; as many as half of all inmates in America’s jails and prisons have a psychiatric disorder.
To gain a historical perspective, let me also draw on my experiences as a clinical psychologist with state mental hospitals. Back in the 1960s, these hospitals were places of hopelessness, where inmates were commonly locked up in smelly wards and given no effective treatment. The one I worked in was a monstrosity with more than 5,000 inmates, passive, resigned, and in despair.
More than half a century later, prisons have in large measure become our mental asylums: The Bureau of Justice Statistics estimates that some 365,000 American adults with serious mental illness are behind bars and an additional 770,000 are on probation or parole. Mentally ill Americans are behind bars because, too often, they have nowhere else to go. Two generations of policy have led to the mass closing of state mental hospitals (such as the one I worked in)—without providing adequately for community backup mental health services.
Back in the 19th century, Dorothea Dix, influenced by Quaker reformers, fought a heroic battle for “lunacy reform” to obligate the government to provide humane care for the mentally ill in large-scale asylums. Today, some thoughtful mental health professionals are calling for a return of the asylum or, to use a much better term, “therapeutic community.” What irony! We really haven’t made any progress in almost two centuries; meanwhile, the mentally ill have suffered more indignities.
The Mental Health Crisis in America
According to the National Institutes of Health, “Nearly one in five U.S. adults live with a mental illness (46.6 million in 2017).” Suicide mortality rates per 100,000 people have risen consistently from 1999 to 2016; the corresponding rise in the number of deaths resulting from drug overdose is more dramatic. In 2017, 47,000 Americans died by suicide and 70,000 from drug overdoses. Researchers Anne Case and Angus Deaton have grouped together deaths caused by suicide, drug overdose, and alcoholic liver disease as “deaths of despair.” The effect of these deaths is so large in America that life spans have decreased since 2015.
These figures are alarming. And when they are gauged against the enormousness of the American mental health establishment, a great irony stares us in the face. According to the United States Department of Labor’s Bureau of Labor Statistics (2011), there were over 552,000 mental health professionals practicing in the U.S. whose main focus is the treatment and/or diagnosis of mental health or substance abuse concerns. In particular, the psychological establishment dwarfs all those in other countries. The record of accomplishment, however, can only be depicted as collective impotence.
As a professor of clinical psychology, I have attended to this great irony in my 2019 book Rewriting Psychology: An Abysmal Science? In what follows, I discuss two themes: the limitations of psychologism and the values underlying mental health practice.
The Limitations of Psychologism
Witness the deadly shooting in Las Vegas on October 11, 2017, the latest in a seemingly unending repetition of senseless mass slaughters in American society. One noteworthy—and perverse—the reaction was the rise in stock prices of firearm companies following the shooting, which means that more people will die from mass shootings in the future. In contrast, gun-control laws enacted in Australia have resulted in a dramatic decline in firearm-related deaths, especially suicide.
Confronted with such psychosocial pathologies, psychologists have no effective answer. Here again, is a paradox: A society that has an army of psychologists appears nowhere near to solving its psychosocial problems. In particular, a country that has more therapists (and other mental health professionals) than the rest of the world combined is also unable to solve its mental health problems.
Meanwhile, an industry of health promotion has emerged on an unprecedented scale. Transcendental meditation, yoga, and mindfulness-based stress reduction, and the like, all originating from Asia, appear to have gained more popularity in the United States than in Asia itself. Repackaged, they are now promoted in an organized business fashion, but devoid of their religious-philosophical roots.
Why does psychology have such a poor record of solving societal and mental problems? Partly because psychologists, preoccupied with micro phenomena, tend to neglect macro problems relevant to the human condition. Misguided by psychologism, they expend their energies on curative measures (e.g., psychotherapy) rather than on preventive actions (e.g., community-based programs aimed at enhancing the health of individuals and of communities, strategies for conflict resolution, and tension reduction).
Values Underlying Mental Health Practice
Let us examine the application of psychology to mental health. Psychologists are fond of talking about self-actualization. But what is the point of unleashing the individual’s creative potentialities, only to witness that they cannot be fulfilled because of degrading social conditions? How honest is it to say that the individual has unlimited choices, when in fact most people in this world are locked in their situation and are severely limited in what they can choose? Self-actualization is escapism unless it entails active participation in social change.
Psychology has yet to make its mark at the macro level, in dealing with societal problems such as crime, mass shootings, social injustice, the increasing disparity between the haves and have-nots; or with survival problems confronting humankind as a whole such as environmental degradation, mass migrations born of despair, interethnic strifes, and outbreaks of war (civil, regional, or global). Thus, attention should be drawn to the fallacy of pan-psychological approaches to solving recalcitrant problems that have their roots in the pathology of sociopolitical systems.
That is why we must redefine psychology’s boundaries and priorities. We need a clearer delineation of problems that may be dealt with psychologically (e.g., through psychotherapy) versus those to which psychological approaches are irrelevant or non-applicable.
I contend that the potent determinants of mental health and, more generally, the quality of life are located externally in the sociopolitical system, not internally within the individual. Mental health professionals are handmaidens of those with the power to make decisions that have serious bearings on mental health, or caretakers of a society that has failed to meet the mental needs of its members. They promise little more than some emotional release or consolation—transitory, illusory escapes into “mental health”—while social conditions which dictate the quality of life remain unchanged. The idea of mental health then turns into an opiate of the mind—as Marx says of religion. In the face of ugly social reality, we make a travesty of enhancing the individual’s potentialities.
Many lessons may be learned in the light of negative aspects of the American experience. In particular, what are the strategies to be adopted that may abate tragic outcomes such as an increase in deaths of despair? In this connection, first, it is noteworthy to see a Minister of Loneliness appointed in 2018 for the more than 9 million adults who are “often or always lonely” in the U.K.
I would argue strongly that we should allocate more resources to prevention rather than cure: Create, sustain, and vitalize participatory communitarian programs aimed at enhancing the health of individuals-in-relations and of communities. The rationale is that it makes better sense to identify, preserve, and enhance those social institutions (e.g., the family) and lifestyles rooted in the culture that serve our profound needs for intimacy and community, rather than to rely on the artificiality of creating new ones (e.g., sensitivity training, T-groups, encounter groups).
These cutting remarks, please note, are coming from a clinical psychologist who has spent decades of his professional life on teaching and training therapists. When will mental professionals wake up to the fact that relying on curative measures (e.g., counseling or therapy) alone will not fulfill their collective responsibility? People are fundamentally social creatures that do not thrive in loneliness, lack of security, or violence.
Stopping the Police from Killing the Mentally Ill
Finally, how may we reduce police-related violence? The problem with police brutality will not go away unless we confront its root causes: racism, inequality, the pervasive breakdown of the family among minority groups (too many adult men locked up in prison), too many guns around (thanks to the NRA), and relying on “superior firepower” to solve what are basically social problems.
Police in the U.S. are already the most militarized among democratic countries. The so-called “nonlethal weapons” (rubber bullets, flash-bangs, and beanbag rounds) regularly used by law enforcement officials can cause serious, and even fatal, injuries. One analysis found that 15 percent of people injured by rubber bullets and similar objects were left with permanent disabilities. Also, research suggests that tear gas could amplify the spread of the coronavirus.
Equipping the police with nonlethal weapons is very costly. So, one reasonable way of stopping the police from killing the mentally ill suggests itself: Reallocate at least a part of the resources for procuring more and more nonlethal weapons used by police officers to enhance the capability of mental health agencies. Correspondingly, procedural-structural changes have to be made such that mental health professionals, rather than police officers, would be the frontline workers to respond to mentally ill individuals displaying socially disruptive or violent behavior. Instead of dialing 911, another hotline should be provided for the mentally ill and his family, relatives, or friends to ask for help from mental health professionals.
Would police departments object to such a reallocation of resources? Reason would suggest that the answer is no: Police officers are trained to prevent crime, not to deal with the madness. Wouldn’t they gain pride by ridding themselves of the stigma of being killers of mentally ill people? In any case, political leaders in a democracy have an obligation to ensure those police departments operate to protect all citizens, not to kill illegally or unnecessarily.
David Y. F. Ho, the pioneering psychologist who introduced clinical psychology into Hong Kong, has held professorial appointments in psychology and humanities in Asia and North America. He was the first Asian to have served as President of the International Council of Psychologists.