MENTAL ILLNESS AND JUSTICE ISSUES

MENTAL ILLNESS

AND

JUSTICE ISSUES



“As individuals and as a nation, therefore, we are called to
make a fundamental "option for the poor". The obligation to
evaluate social and economic activity from the viewpoint of the
poor and the powerless arises from the radical command to
love one's neighbor as one's self. Those who are marginalized
and whose rights are denied have privileged claims if society
is to provide justice for all. This obligation is deeply rooted in
Christian belief.”
THE CHURCH IN THE MODERN WORLD, #69, SECOND
VATICAN COUNCIL





Deacon Tom Lambert
Catholic Archdiocese of Chicago – Commission on Mental Illness






1

---

Scope of the Issue



Mental illnesses include such disorders as schizophrenia, schizoaffective disorder,
bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and
other severe anxiety disorders, borderline personality disorder, and other severe and
persistent mental illnesses that affect the brain.

o “These [mental illnesses] can profoundly disrupt a person's thinking, feeling,
moods, ability to relate to others and capacity for coping with the demands of
life. Mental illnesses can affect persons of any age, race, religion, or income.
Mental illnesses are not the result of personal weakness, lack of character, or
poor upbringing. Mental illnesses are treatable. Most people with serious
mental illness need medication to help control symptoms, but also rely on
supportive counseling, self-help groups, assistance with housing, vocational
rehabilitation, income assistance and other community services in order to
achieve their highest level of recovery.”1

Mental illnesses are common in the United States and internationally.

o “An estimated 26.2 percent of Americans ages 18 and older — about one in
four adults — suffer from a diagnosable mental disorder in a given year.”2
One in 17 suffers with severe mental illness.

o Mental [illneses] are the leading cause of disability (lost years of productive
life) in the North America, Europe and, increasingly, in the world. By 2020,
Major Depressive illness will be the leading cause of disability in the world
for women and children.3
o Mental [illnesses] account for 4 of the 10 leading causes of disability in the
United States.4
o In 2002, 31,655 (approximately 11 per 100,000) people died by suicide in the
U.S, 90% have a diagnosable mental [illness]. 5

o Each year, almost 5,000 young people between the ages 15 to 24 take their
own lives. The rate of suicide for this age group has nearly tripled since 1960,
making it the third leading cause of death in adolescents and the second
leading cause of death among college-age youth. 6

o At least six million American children have difficulties that are diagnosed as
serious mental [illness], according to government surveys — a number that
has tripled since the early 1990’s. 7






2

---

THE DIGNITY OF THE INDIVIDUAL.


Catholic social teaching calls us to recognize that each person has dignity and all life is
sacred. In Pope Benedict XVI’s message for the 2006 World Day of the Sick he
specifically addresses the issue of mental illness. He states “Every Christian, according to
[their] specific duty and responsibility, is called to make [their] contribution so that the
dignity of these brothers and sisters may be recognized, respected and promoted.”8
Pope John Paul II’s 1997 message to healthcare workers states that “Whoever suffers
from mental illness 'always' bears God's image and likeness in [themselves], as does
every human being. In addition, [people with mental illness] 'always' have the inalienable
right not only to be considered as an image of God and therefore as a person, but also to
be treated as such.”9
One of the greatest obstacles for people with mental illness and for their families is
overcoming the stigma the general public associates with mental illness. Stigma erodes
the dignity of the person and hinders us from seeing a person as an image of God.


Stigma detracts from a person’s dignity and keeps people from receiving the
treatment and care they need for recovery.

o The Surgeon General's recent report on mental health argues that the stigma
around mental illness is one of the most significant challenges to the
development of effective mental health policy10

o This stigma has intensified over recent decades, despite the advancement of
scientific knowledge about the causes of mental illness and the effectiveness
of certain treatments; studies show that a greater portion of people associated
mental illness with violence in the 1990s than the general public did in the
1950s.11

o Nearly two-thirds of all people with diagnosable mental [illness] do not seek
treatment12

o Stigma pushes people to the margins of our society. People fear what they do
not know and the stigma of mental illness exacerbates the misconceptions
people have about who the person really is.

As Church we are called to counter the sinful effects of stigma by:

o Using “people first” language to reinforce the dignity of the person, e.g.,
“people with a mental illness” not “the mentally ill.” This allows people with
mental illness to be recognized as a person not a disease.

o Recognizing that everyone has something to contribute. We value the
individual for who they are and what gifts he or she brings to the community.


3

---

o Debunking myths and mental illness characterizations that portray people by
generalizations that have no basis in fact and are negative and demeaning.

o Welcoming and including all people into our faith community and treating
each person with dignity and respect. Finding ways to proactively include
people.

o Educating and informing faith communities about the facts concerning mental
illness



PREFERENTIAL OPTION FOR THE POOR

Another theme of Catholic Social teaching is our priority for those who are most
vulnerable and pushed to the edges by society. A basic moral test for our or any
society is how the most vulnerable members are treated. Our society is flawed by a
widening gap in health care and services between the rich and the poor. We look to
the story of the Last Judgment which instructs us to put the needs of the poor and
vulnerable first -
….Lord, when did we see you hungry and feed you, or thirsty and give you
drink? When did we see you a stranger and welcome you, or naked and clothe
you? When did we see you ill or in prison, and visit you? And the king will say to
them in reply, Amen, I say to you, whatever you did for one of these least brothers
of mine, you did for me. (Mt 25:37-40

Prisons and Jails have become the largest deliverers of mental health services in the
United States

o Largest mental health “provider” in the country is Los Angeles County jail

o At midyear 2005 more than half of all prison and jail inmates had a mental
health problem, including 705,600 inmates in State prisons, 70,200 in Federal
prisons, and 479,900 in local jails. These estimates represented 56% of State
prisoners, 45% of Federal prisoners, and 64% of jail inmates.13

o Very few prisoners in general prison and jail populations receive the treatment
they need

Only ---- “Over 1 in 3 State prisoners and 1 in 6 jail inmates who had a
mental health problem had received treatment since admission.14

Death penalty

o The majority of countries except the U.S. prohibits the death penalty for
people with mental illness

o Although precise statistics are not available, it is estimated that 5-10 percent
of people on death row have a serious mental illness.

4

---

o In 1986, the Supreme Court ruled that people with mental illness can be
executed if they understand the punishment that awaits them and why they are
being put to death. This ruling has prompted some states to provide
psychiatric treatment to offenders with mental illness on death row in order to
“restore their competency.” Also some states are medicating defendants
involuntarily in order to make them competent either to stand trial or to be
executed.

Homelessness

o Deinstitutionalization of public “mental hospitals” created an increase in
homelessness because of poorly funded community programs.

o Lack of an array of services and affordable housing in the community adds to
the mental health crisis.

o At least 20 to 25% of homeless people have a mental illness.15 Mental illness
among people who are homeless is generally acknowledged as much higher.

As church

o We are called to change the systemic problems that result in prisons and jails
being the largest mental healthcare provider in the country. In addition to
individual acts of compassion and caring for people with mental illness we are
called to work for better laws and polices that end discrimination and
marginalization of people with mental illnesses, cause homelessness, and add
to the high recidivism rate for people who are in prisons and jails.


FUNDAMENTAL RIGHT TO LIFE AND A RIGHT TO THOSE THINGS
REQUIRED FOR HUMAN DECENCY.

Another major theme of Catholic social teaching is that human dignity can be protected
and a healthy community can be achieved only if human rights are protected and
responsibilities are met. Every person has a fundamental right to those things required for
human decency including healthcare. It is our responsibility to protect these rights.
The mental healthcare system in the United States is often described as dysfunctional and
uneven in its care for people with mental illness. Mental Illness is a treatable brain
disease with better success rates than many other diseases. Studies have shown that
proper diagnosis, medication, and an appropriate range of community psycho-social
rehab support services will deliver cost effective results that are actually less expensive
than the current disconnected delivery system now in place. Yet the needs of many go
unmet which is unconscionable.

Poor Health Care systems foster continuous “cycles of crisis” for people with mental
illness and their families.

5

---

o Over 40 million people in the United States have no healthcare insurance

o While effective treatments exist for most common mental [illnesses], studies
have shown that many consumers seen in primary care settings do not receive
them. Even in the1990s, most adults with depression, anxiety, and other
common mental [illnesses] did not receive appropriate care in primary care
settings. Older adults, children and adolescents, individuals from ethnic
minority groups, and uninsured or low-income patients seen in the public
sector are particularly unlikely to receive care for mental [illnesses].16

Reasons for not receiving care vary:

• Stigma

• Lack of Insurance

• Lack of services in the community

• Ineffective services

• Lack of knowledge about the illness

• cultural

o Quality treatment and flexible supports for adults with a serious mental illness
lead to employment and recovery, reduced substance abuse and incarceration,
and greatly improved quality of life.……..Multiple Barriers Impede Access to
Effective Treatments, Services and Supports. The array of programs that
deliver or pay for treatments, services and supports are offered by multiple
levels of government and the private sector. The varying missions, settings
and financing of these health, housing, disability and employment programs
create a mental health maze instead of a coordinated system. Navigating this
maze is left to the people with the mental illness and their families, who are
least equipped to deal with the complexities of the system. As a result, it is
often impossible for families and consumers to find the care that they urgently
need. Overall, one in two people who need mental health treatment does not
receive it. For ethnic and racial minorities, the rate of treatment is even lower
than that for the general population and the quality of care is poorer…… The
Commission has identified five barriers in the interim report that needlessly
impede access to care: "Fragmentation and Gaps in Care for Children,
Fragmentation and Gaps in Care for Adults, High Unemployment and
Disability for People with Serious Mental Illness, Insufficient Attention to
Older Adults, and Mental Health and Suicide Prevention are not yet National
Priorities." 17

o Since the Healthcare system is inadequate people do not receive the continuity
of Care needed to remain healthy. The range of services varies widely from
community to community, from urban settings to rural settings.


6

---

Need to offer full array of services in all communities

Need to overcome the “not in my backyard” syndrome that keeps
people from getting services and housing close to their families and in
their own neighborhoods.

NAMI, National Alliance for the Mentally Ill, in a 2006 survey rated
the United States with a “D” for it’s care of people with mental
illness18

o Parity legislation

People with mental illness deserve the same coverage as people with
physical illnesses. Currently many insurance plans discriminate against
people with mental illness by limiting benefits for mental health care.

Housing

o Affordable housing for people with mental illness is a major problem. If a
person is unable to work, obtain a job with a decent wage, and/or on disability
housing options are very limited.

o In 1999, the Court ruled in Olmstead v. L. C. by Zimring. that Title II of the
ADA requires individuals with mental disabilities to be placed in the least
restrictive treatment possible, since excessive treatment can be stigmatizing
and is a form of discrimination. 527 U.S. 581. While the Olmstead decision
was qualified (i.e. there must be a doctor’s order that the individual is
appropriate for less restrictive treatment and program resources are to be taken
into account) the decision was still a benchmark in the history of protection
from discrimination.19 Although the Supreme Court decision outlined what
should be done it did not set a timetable leaving the states to work out the
implementation. This requires advocates to push for change as funding and
change is at a slow rate.


Employment

o People with mental illness need supportive employment opportunities so they
can make the transition to full recovery.













7

---

THE ROLE OF THE CHURCH IN JUSTICE FOR PEOPLE WITH MENTAL
ILLNESS AND THEIR FAMILIES




The people of God, the church, are called to be communities of compassion, hope and
justice for people with mental illness and their families.

o As Church, we are called to respond to Pope Benedict XVI’s message for the
2006 World Day of the Sick “I therefore encourage the efforts of those who
strive to ensure that all [people with mental illness] are given access to
necessary forms of care and treatment…….. I commend pastoral workers and
voluntary associations and organizations to support in practical ways and
through concrete initiatives, those families who have [people with mental
illness] dependent upon them. I hope that the culture of acceptance and
sharing will grow and spread…”

o As people called to witness Christ to the world we must first examine our own
views and actions toward people with mental illness and their families. Do we
have misconceptions, prejudices, or attitudes toward people with mental
illness that are based on irrational ideas or myths unsupported by fact?

o Since mental illness is often hidden, it takes on an even greater urgency for a
proactive ministry - especially since people with mental illness are vulnerable
and discriminated against in the workplace, in housing opportunities, and in
the healthcare system.

o Parishes can address mental illness needs through already established
ministries in the life of the parish and by incorporating mental illness issues
into the ministerial agenda. It is important to recognize that the disease is
rarely talked about due to the stigma associated with the disease and lack of
understanding about mental illness. Therefore it is critical for church leaders
to recognize their own misconceptions and/or prejudices, conscious or
subconscious, toward persons with mental illness. This can be done through
education and training on the facts concerning mental illness. One does not
have to become a mental health professional but it is important to get accurate
information about mental illness in order to effectively minister to and
advocate for those suffering with these diseases.

o It is important that persons with mental illness feel welcomed and supported
within the parish. This requires the purest spiritual outreach, i.e., non-
judgmental love and acceptance of the individual. The more that parishes can
project non-judgmental love, the more its members suffering with mental
illness, or those who have a family member with mental illness, are likely to
acknowledge their needs and overcome their fears of rejection.






8

---

In “THE IMAGE OF GOD IN PEOPLE WITH MENTAL ILLNESS” Pope John Paul II
says “...the church will not hesitate to take up the cause people of the poor and to
become the voice of those who are not listened to when they speak up, not to demand
charity, but to ask for justice.” 20

The church needs to be a sign of hope to persons with mental illness and their families,
supporting them in every possible way with prayer and friendship—welcoming them
unconditionally. Vatican II's document Gaudium et Spes calls us as church to "establish a
political, social, and economic order which will to an ever better extent serve
[humankind] and help individuals as well as groups to affirm and develop the dignity
proper to them."

Persons with mental illness and their families are in need and are asking for the Church,
you and I, to help in their search for Justice. In Mathew’s Gospel story of the final
judgment, Jesus tells us “whatever you did for one of these….you did for me.” Our call is
clear - our response is not optional.




1 NAMI-National Alliance for the Mentally Ill, “About mental illness” website www.nami.org
2 Kessler RC, Chiu WT,Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month
DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General
Psychiatry, 2005 Jun;62(6):617-27.
3 NAMI-National Alliance for the Mentally Ill, “About mental illness” website www.nami.org
4 National Institute of Mental Health. (2001 January). The numbers count: Mental disorders in America
(NIMH Publication No. 01–4584).
5 National Institute of Mental Health. (2001 January). The numbers count: Mental disorders in America
(NIMH Publication No. 01–4584).
6 National Institute of Mental Health. (2001 January). The numbers count: Mental disorders in America
(NIMH Publication No. 01–4584).
7 N. Y. Times, Living with Love Chaos and Haley, October 22, 2006
8 “Message of His Holiness Benedict XVI for the 14th World Day of the Sick”, December 8, 2005
9 “Mentally Ill are also made in God’s image,” L'Osservatore Romano Weekly Edition in English 11
December 1996
10 U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General,
Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Mental Health Services, National Institutes of Health, National
Institute of Mental Health, 1999, p. 6.
11 Little Hoover Commission, Being There: Making a Commitment to Mental Health, Sacramento, CA,
November 2000, p. 31.
12 Surgeon General’s Report, December 13, 1999
13 DOJ Study, Mental Health Problems of Prison and Jail Inmates, September 6, 2006
14 DOJ Study, Mental Health Problems of Prison and Jail Inmates, September 6, 2006
15 SAMSA
16 President’s New Freedom Commission on Mental Health, press release 11/1/2002
17 President’s New Freedom Commission on Mental Health, press release 11/1/2002
18 NAMI-National Alliance for the Mentally Ill, “About mental illness” website www.nami.org
19www.nami.org/Template.cfm?Section=Court_Watch1&template=/ContentManagement/ContentDisplay.c
fm&ContentID=15684
20 “Mentally Ill are also made in God’s image,” L'Osservatore Romano Weekly Edition in English 11
December 1996


9

---