Mental illness was in the news more this year than in recent memory. Until 2020, many people were unaware that calling for help in a mental health crisis summons a police officer instead of an ambulance. After the shooting of Daniel Prude, similar stories emerged, putting mental illness and crisis response in the national spotlight.
News stories also focused on the devastating toll of the coronavirus on our mental health—the so-called “fourth wave” of the pandemic. The public learned that the mental health system is ill-equipped to meet the needs of those feeling the effects of social isolation, economic uncertainty, fear of the virus and loss of loved ones.
Both of these narratives offered an opportunity to delve into the inadequacies of our broken mental health care system and educate the public about the need for reform. Instead, news stories focused little attention on how the system has failed to help the most severely ill for decades.
Most of the reports this year served only to perpetuate misunderstandings about mental illness. As a result, we are left with short-sighted solutions that fail to address the underlying problems in treating the mentally ill.
Here are four things the media got wrong about mental illness this year.
Conflating Mental Health With Mental Illness
This year, news stories focused more on those with mental health concerns brought about by the pandemic than those with serious mental illness. I don’t mean to minimize the effects of the coronavirus—many people are hurting, and the pandemic may indeed lead to more depression, anxiety and substance use disorders. However, no one is talking about helping the most severely mentally ill who have long been suffering.
The Pandemic Relief Bill will offer increased access to counseling to help those with mental health needs. But it will not bring more hospital beds nor eliminate discriminatory laws that prevent access to treatment for people with mental illness. The needs of the most severely ill continue to be ignored.
Part of the problem is that the public conflates mental health with mental illness. The media and even some mental health organizations perpetuate this misunderstanding. On one side are the worried well—those with anxiety and low-grade depression—and on the other are people with severe, disabling brain illnesses.
People with mental health issues are able to care for themselves and meet their basic needs. On the other end of the spectrum, people with severe mental illness—schizophrenia and other psychotic disorders—suffer chronic, unrelenting symptoms that cause devastation to the lives of the sufferer and those around them. Their rational minds are subsumed by delusions and disorganized thoughts.
People with mental health issues can be helped through counseling and self-care. People with severe mental illness need a full continuum of services—from long-term inpatient care to step-down units, intensive outpatient services, community programs, housing and supportive services. This continuum of services does not currently exist, but the media did not cover this angle.
Attributing Police Shootings of the Mentally Ill to Race
A spate of coverage in police shootings this year highlighted the mistreatment of people suffering mental health crises. For the most part, the news media framed this mistreatment as a race issue. However, discrimination against the mentally ill crosses all races.
Statistics show that people with mental illness who died by police gunfire since 2015 were mostly white, accounting for 58 percent of deaths, with Blacks at 16 percent and Latinos at 13 percent. While racism may play a role in some cases, the common factor in all of these deaths is the presence of untreated or inadequately treated severe mental illness.
These individuals were in crisis because of the failure of our mental illness treatment system. When police arrive on the scene, they naturally expect the individual to comply. But if you are experiencing psychosis, your illness may prevent you from obeying commands.
You are not likely to comply if you are suffering from delusions—for example, if you know with every fiber of your being that you are the only one who can save the universe. These delusions are a symptom of brain illness. For the mentally ill, their delusions are every bit as real as the air we breathe. No calming voice, no attempt at reasoning can convince them otherwise.
People with mental illness who encounter police are indeed the victims of discrimination. But their disability is the root of this discrimination, not race.
Trying to Fix the Mental Health System by Improving Crisis Response
Crisis response received national attention this year. Proposed solutions to police shootings of the mentally ill centered on increased training for police and adding social workers to crisis response teams. While a non-law enforcement response is certainly ideal, better crisis response will not solve the problem. Instead, we need to address the root causes of a person devolving into crisis in the first place.
We need a more effective, compassionate system of care for people with brain illnesses. Right now, we have a shortage of inpatient beds, psychiatrists, housing and community services. But beyond that, we have systemic discrimination against people with these disabilities.
We discriminate against the mentally ill by denying treatment until it is too late. To have a person hospitalized, in many states, they are required to meet a standard of dangerousness. By denying them treatment, we are forcing people to deteriorate while their illness goes untreated. As Rep. Tim Murphy says in this wonderfully informative Zoomcast by Healing Minds NOLA, you wouldn’t say to a person with heart disease: we can’t treat you now—come back when your heart stops pumping.
Framing Treatment of Mental Illness As a Choice
Mental illnesses are disorders of the brain—the organ responsible for decision-making, reasoning, daily functioning— everything. Psychosis causes disordered thinking and delusions because it is a brain disease. Yet for some reason the public cannot grasp this concept.
We have no problem understanding that if someone has a broken leg, they will not be able to walk. If someone has a lung disease, it is no surprise that they get short of breath. Yet if someone has untreated schizophrenia—more accurately, an illness that affects the organ that allows us to think—we expect them to be able to think clearly and make rational decisions.
In a recent interview with Terri Cheney, author of the bipolar memoir “Manic,” the interviewer starts a question with, “Some people have someone they love who refuses treatment for their mental illness,” and goes on to ask how to help someone in denial.
But denial is not the problem. Blaming someone with a brain illness for refusing treatment shows a complete lack of understanding of the illness. The inability of a person to perceive their own illness is a common symptom of severe mental illness.
When my brother began his descent into psychosis, he truly had no idea he was ill. He believed at various times that he was a famous basketball player, a doctor and a gifted musician. No amount of reasoning could have convinced him that these were delusions. His reality was as real as yours and mine. That is why he refused my family’s pleas to see a psychiatrist. It was never a question of denial.
Lack of insight, known clinically as anosognosia, is a symptom not only of untreated schizophrenia and bipolar disorder, but also brain injury and stroke. Like a person who suffers a stroke and believes they are fine, so too, a person with psychosis believes they are sane. We do not let a person who suffers a brain injury or stroke refuse treatment. It should be the same for mental illness. Allowing them to refuse treatment is immoral.
Will 2021 Be Different?
As 2020 showed us, there is no telling what the coming year will bring. But I hope 2021 will finally be the year that legislators, the media and the public finally begin to focus on meaningful change for people with mental illness. If not, we will continue to see police shootings, criminalization of the mentally ill, homelessness, and suffering.