Why did New York yoke mental health and violence prevention together?

Mental health services are absolutely terrible in this country, a plain fact that I don’t think I need to tell you. Generally, people only talk about this issue in the wake of an act of mass violence, under the belief that only ‘crazy‘ people do things like that, and we should all be forcibly medicated and locked up. In fact, every single piece of evidence surrounding mental health and violence indicates that we are more at risk of experiencing violence than the general population, and are in fact targeted for it because we’re viewed as easy victims. Moreover, we are statistically less likely than sane people to commit violence: I would, in other words, prefer to be in a room with 100 crazy people holding guns than 100 sane people doing the same, not least because the sane people would likely shoot me for being crazy.

However, because mental health services only come up when someone has committed a crime — crazy or not — there’s a weird tension that arises. Should we be happy that people are talking about them at all, and use such situations as leverage to talk about how we are suffering in the medical system and push for better care, in the awareness that this further contributes to mental health stigma? Or should we firmly push back and say that this is about violence, not mental illness, and that people shouldn’t use violence as an excuse to discuss mental health? I favor the second, perhaps unsurprisingly, because I talk about mental health services and why they are terrible all the time, and so should everyone else.

Which brings us to New York’s NYC Safe initiative, and the fact that it explicitly yokes mental illness and violence. The programme must sound nice to sane people: It identifies and tracks mentally ill people, uses mobile treatment teams, compels people to get medication. These are things that we find chilling, though, because they are an abridgment of bodily autonomy and civil liberties. Which is really unfortunate, because other aspects of the programme are actually quite excellent, like full-spectrum access to mental health services, mental health diversion programmes that connect people with social workers instead of funneling them to law enforcement, more clinicians at homeless shelters to address the fact that many mentally ill people are homeless, because SMI makes it hard to function, and this country tolerates and in some senses cultivates SMI by criminalising us.

I was asked about this programme when it started, and I have the same opinion now that I had then: If this initiative was focused on improving access to mental health care in the city, and was focused on public health interventions centred on the needs of patients, I would be all for it. However, the mix of solid public health practices and stigmatising mentally ill people is not acceptable, and this programme contributes to the problem, rather than being part of the solution. Why should mentally ill people trust a system that explicitly says the public needs to be protected from them?

The very name of the programme underscores the notion that mentally ill people are dangerous and ‘we, the public,’ need to be protected from us — despite the fact that 20 percent of the population experiences mental illness. 4.2 percent of the population has severe mental illness, the very diagnoses and disorders disparaged and demonised in the media. ‘We, the public,’ are mentally ill. A not insignificant percentage of the public has severe mental illness, the same diagnoses namechecked in announcements about NYC Safe.

Those of us who survive, sometimes nominally, avoid being caught up in this programme only through happenstance and privilege. We were diagnosed early. We lived in a setting where seeking mental health care was not stigmatised and we were able to access it. Our families supported us. The environments around us provided accommodations for mental illness. Not all of us are out about it — and it’s still very dangerous to be out — but we are in a better position to live safely, to advocate. That said, many of us are still at risk of becoming untreated, of developing treatment-resistant mental illness, of sinking into struggles of our own. We are still at risk of being shot by police, of being raped, of being beaten, because of our illnesses.

NYC Safe, and the way it is structured, is an example of the systems that explain why these risks and concerns are pervasive. I have absolutely no reason to support a programme like this, which is a pity, because were it structured and presented differently, it could be a powerful tool. It could get help to people who need it, and it could break down stigma around mental illness, turning it into just another aspect of people’s lives that some people need a little help with, instead of a scary boogeyman.

Already, the program is showing signs of cracks, and the way people talk about these cracks is troubling. Recently, there was an incident in which someone who was not mentally ill was subjected to an involuntary hold after he became ‘combative,’ after being told that he was being assessed and would be kept at a hospital indefinitely. The media thinks this case is troubling because, gosh, people who aren’t crazy could be caught up in a system for crazy people, and what a civil rights violation! I think this case is troubling because this is how the media approaches it, that involuntary holds and compulsory treatment are only a problem when they involve ‘normal’ people.

Image: New York Cabs, Sakeeb Sabakka, Flickr