Introduction

In the United States, 1 in 4 adults suffers from mental illness. Oftentimes people suffer from more than one. The thing that sets aside physical illnesses from mental illnesses is the fact that most mental illnesses are invisible. It is hard to tell when a person is suffering, as this pain is usually experienced through mental anguish. Societal stigma often encourages those with mental health concerns to stay silent. Stereotypes about people with certain mental illnesses persist, and the past and present abuse of patients in mental health facilities makes people hesitant to reach out for help. Even if a person decides to seek help, it can be very hard to acquire. Things like lack of openings, geographical region, socioeconomic status, and many more all impact a person’s ability to get treatment. While some try to muddle through alone, many mental health disorders are chronic, they won’t just go away without proper treatment. Mental illness is so prevalent in fact, that mental wellness should be considered a privilege. Being mentally well generally requires a few prerequisites: being financially stable, having a solid group of friends or family one can rely on, feeling fulfilled in one's career. Mental wellness isn’t something one simply has or doesn’t, it is determined by a plethora of intersecting factors that fit together like a puzzle to determine a person’s mental state. As the rate of reported mental illness continues to rise across the nation, we as a society must shift our focus to improving our quality of life by prioritizing mental health. This page will be exploring topics such as the variety barriers preventing people with mental health conditions from getting the help they need. It will also be exploring possible solutions to these barriers through educating the public and advocating for more ethical practices by mental health professionals. Lastly, the page will discuss how justice for people impacted by mental illness can be achieved. Mental illness can be a scary thing to talk about, but by taking a well-rounded, empathetic approach, this page intends to open a dialogue about the issue.

Scholarly Debates

Mental health is an incredibly wide field but some topics tend to be discussed with regularity in this subject: social barriers to treatment, ethical practices, and public education. For better or for worse, we are typically irrevocably consumed by the society we are born into. Most societies have a set social hierarchy, where some types of people are viewed with higher regard than others. This regard often determines factors like access to resources and general treatment. So, it is unsurprising that the people viewed as lower on the societal totem pole are often last in line to receive things that encourage mental wellness, and resources to aid with mental health problems.

Social Barriers: One demographic of people who are almost constantly neglected from the mental health discussion are the homeless. Many experts argue that a large proportion of homeless people are homeless because of factors having to do with their mental state (Skosireva et al. 2014). Mental illness makes it harder for people to keep jobs, obtain a steady income, and even afford shelter. When mental health professionals, those who are supposed to help patients regardless of their background, lack empathy and a genuine desire to help homeless patients, they have a very hard time escaping the source of their marginalization: poverty (Skosireva et al. 2014). It is imperative that health care professionals treat all of their clients the same and make a genuine effort to help them in all the ways they are equipped to. This scenario goes to show that marginalization is nearly inescapable even in a professional setting such as healthcare. This illustrates just why mental health is such a privilege, the resources to achieve mental wellness are not afforded to all members of society equitably. Oftentimes, the people that need mental health resources the most are the ones that are forced to go without. Another demographic that is largely underrepresented when we talk about mental health are inmates. The rate of mental illness in prisons is much higher than that of general society, but prisons have shockingly poor mental health resources (James & Glaze 2006). It is estimated that as many as 64% of incarcerated people claim to struggle with symptoms of mental illness (James & Glaze 2006). This is more than double the rate of mental illness occurrences in the general public. This statistic is startling by itself, but when we consider the inadequate care provided to inmates it is even more alarming. Prisons are supposed to rehabilitate criminals so that when their sentence is over, they can reintegrate into society. When those who are incarcerated aren’t given proper access to the resources they need to better themselves, which for many is mental health services, reintegration is stunted. Society is essentially harming itself by neglecting the needs of inmates. Many will rejoin society eventually, and if their time spent in prison was defined by fighting a serious mental illness without professional help, they may face less success in rejoining society. Time and time again, the mental health field fails the people that need help the most. We can’t pretend that our society is just if people who need resources the most are those who are being deprived. Justice demands equity, so while every individual does not need help with mental health conditions, those who do should be able to receive it. This is why many experts emphasize the importance of non-discriminatory care, better access to mental health care, and better public education. These areas are central to experts’ debates in bettering the mental health crisis that America is facing. 

Ethical Practices: Equity originates at both the micro and macro levels. One macro-level solution is ensuring that mental health care providers follow ethical practices. As we talked about before, providers may treat patients differently based on social factors like homelessness. But some research suggests that this issue is not concentrated in a few providers, but it is a widespread issue that favors certain people over others. One study found evidence that providers choose to offer their services to people based on factors like race, class, and gender (Kugelmass 2016). While these factors are largely recognized as arbitrary and are generally not acceptable reasons to favor some people over others, they are still prevalent in the medical field. The study found that providers favored middle class clients over those in the working class (Kugelmass 2016). It also found that racial disparity was most prevalent in the middle class, where providers were more likely to offer white patients appointments than black patients (Kugelmass 2016). Lastly, there was a slight difference in gender. While both genders were equally likely to be offered an appointment, women were more likely to be given an appointment in the time slot they requested (Kugelmass 2016). The experiment studied results from how potential patients were treated by three hundred twenty psychotherapists. This illustrates that the issue of provider bias in the healthcare field isn’t based on a few bad apples, it is a field-wide issue. This shows a need to educate mental health professionals on how their biases impact patients and the need to be aware of their own internalized prejudices. 

Public Education: Although mental illness is hugely prevalent, the knowledge surrounding mental health issues is worryingly low. Surveys conducted around the world by the World Health Organization show a concerning trend. “National surveys of mental health disorders… have shown that the prevalence rates of disorders are high but that many people affected do not seek professional help or they delay seeking help for many years” (Jorm 2012). The surveys found that depending on the mental disorder a person had, they may wait anywhere from 1-30 years to seek treatment after symptoms arise (Jorm 2012). The article posits that this issue is from an enormous lack of education in the area of mental illnesses. The article found that in all countries surveyed by the World Health Organization, 28 in total, lacked knowledge about the signs of mental illness, what treatments were available, and how to seek treatment (Jorm 2012). This is incredibly worrying because it shows that millions of people are unnecessarily suffering from treatable mental health issues. Another area where this deficiency originates is the stigma surrounding mental health. The World Health Organization survey found that there is a significant amount of stigma surrounding the subject of mental health (Jorm 2012). The author argues that mental health is largely a Western Idea and that developing nations may not recognize this as a health care problem the way Western Nations do. However, there is also stigma in developed Western Nations, often more present in minority populations (Jorm 2012). To properly deal with this stigma, we must also acknowledge the cultural roots in which it originates. While this issue is more prevalent in developing nations and minority communities of developed nations, it is a problem in every community. Another source identified two main issues inhibiting Americans from seeking mental health care: public stigma and personal stigma. Public stigma refers to the overall cultural beliefs surrounding mental illness, including negative stereotypes about people who suffer from mental illness (Wu et al. 2017). Personal stigma refers to what happens when these negative ideas are internalized. This can be especially harmful to people with mental illnesses as this often inhibits them from seeking treatment (Wu, et al, 2017). There are many significant issues preventing people with mental illness from both seeking treatment and accessing treatment. Many of the current scholarly debates are around which barriers should be dealt with first and how to break them down. In order to live in a more just society, we must ensure that everyone receives the medical help they need, regardless of if that help is regarding the body or the mind. 

Real Life Solutions

One great agency that offers mental health services is the Promise Resource Network based out of Charlotte, North Carolina. The organization self-identifies as “consumer run” as the founder and employees of the agency have all been affected by mental illness and traditional mental health systems (Rishel 2020). The organization was founded in 2005 by Cherene Caraco, who aspired to create a new form of mental health services. The agency offers numerous services, such as mental health classes, a respite for people experiencing a mental health crisis, and a “warm line” (Rishel 2020). They offer three classes a week about various topics surrounding mental health including finding healthy coping mechanisms, classes offering support, and ways to achieve a healthy lifestyle. The respite is a beautiful home owned by the organization, where people experiencing mental health crises can stay, often as an alternative to forced hospitalization or imprisonment (Rishel 2020). Their “warm line” is a contrast to the so-called “suicide hotline” as it offers people someone to talk to, even if they aren’t experiencing a mental health emergency. If a person is dealing with stress or struggling with any mental health concerns, they can call this 24-hour helpline (Rishel 2020). This organization helps not only their community but the world with their revolutionary strategy. Instead of making people with mental illnesses feel “sick” or coercing them into treatment, the organization is run by people who have experienced mental illness and seeks to empathize and give those who are struggling multiple treatment options. This organization is the epitome of mental health justice as it actively tries to dismantle harmful mental health practices by exemplifying a better, kinder way to treat those struggling with mental illness. Many of the problems that surround the conventional mental health system are due to provider biases and lack of access to resources. This organization helps to fix these problems as they offer treatment to everyone, including the homeless, and those who have been convicted of crimes or spent time in prison. The Promise Resource Network doesn’t just talk about change, they show that there are positive and effective changes that can be implemented in the mental health system by enacting these changes themselves. Justice in the mental health field demands that people with mental illness are given the resources they need, have agency, and are treated with dignity. This is exactly what the network does and why their work is so important. The organization is changing the field from the inside out, just click on the “our initiatives” page on their website to see how. They recognize how intersectional identities impact mental health and treatment, and some of their many goals include education, policy change, and criminal justice reform (Rishel 2020). So many mental health services fail to recognize how complex the issue of mental health is, but it bleeds into nearly every part of one’s life. By recognizing the many nuances surrounding mental health, the organization gives its clients well-rounded care. To truly achieve justice, we must recognize all the topics surrounding a specific issue, or else the problem will not be ameliorated in full. The Promise Resource Network takes a micro-level approach by helping individuals but creates macro-level change by bettering society through its practices. This is the goal every mental health organization should have. 

Mental Health and Broader Theories of Justice 

The corrective model of justice is arguably one of the best models to remedy mental health injustice. Threadcraft’s proposition of corrective justice in Intimate Justice proposes that resources should be focused on communities that have lacked them in the past (Threadcraft 2018 158). While she proposes this as a solution for racial injustice, it can also be applied to mental health injustices. Not every person has a mental illness or will need access to mental health treatments. Considering this fact, limited mental health resources should not be given to everyone equally. Similarly, in the community of those who have a mental illness, not everyone needs as much treatment as others. Some who experience mental health struggles already have regular access to treatment like therapy and medications. While their needs should be recognized, they should not be the focus when considering the distribution of treatment resources. This conversation should focus on those who experience barriers to treatment for whatever reason. Some possible barriers include lack of health insurance, not having a mode of transportation, and shame surrounding seeking treatment. Justice for people who face these struggles might include state funded mental health resources with no insurance or copay required. Vouchers for car-sharing resources could help people get to appointments. Creating more mental health treatment centers would also decrease the geographical burden as people would be more likely to live near a facility offering treatment. Better education surrounding mental health to both combat stigma and to help people identify signs of mental illness in their loved ones and themselves would create profound improvements in the way people perceive mental illness. While these solutions should be available everywhere, to embody the corrective justice model, they should be focused on areas that lack mental health resources and where many go untreated. Justice, especially in the area of mental health doesn’t require equality, it requires equity. To best help people suffering from mental illness, we shouldn’t prescribe a one-size-fits-all solution, the fixes should be tailored to communities and people. This concept is reminiscent of author Norman Daniels' reasoning in his article Justice, Health and Healthcare “We may think of the goal of meeting the varied needs of the population of patients under reasonable resource constraints as characterization of the common or public good” (Daniels 2001). He is certainly correct in his assessment of mental health justice as a form of the common good. Many philosophers argue that in a just society, the common good must always be considered. This relates to Locke’s Second Treatise of Government. Locke posits that a just society will not make its citizens subordinate to the government, but the government should always consider the good of the public, what he calls the general will (Locke Chapter IX). I think the general will in regards to mental health is that those who need treatment should have access to it regardless of their socioeconomic condition or other arbitrary factors. When a person with mental illness has access to treatment it not only betters their life, but their society. Because such a large demographic of the global population suffers from mental illness, this population is large enough that creating government systems to help them is in the interest of the general will. When thinking about something as complex as mental illness, theorizing what solutions will be most feasible and effective can seem overwhelming. However, if we take pertinent parts of already established theories, we can constructively consider this issue and find reasonable solutions to the prevalence of mental illness in the world. 

Conclusion

Achieving justice often seems like a near impossible task. There are innumerable theories surrounding the topic and sifting through all the possible solutions can be daunting. This difficulty is multiplied by the complexity surrounding the topic of mental health. This topic is still taboo in most countries, so one may ask: how do we fix a problem that many people aren’t ready to talk about? We can do this through a mixed methods approach in which we emphasize education and encourage treatment. Societal change rarely happens overnight, but by being persistent and having conviction in our goals, we can achieve justice for those impacted by mental illness. Movements take time, and so long as people contribute to large movements, while also trying to positively impact the people around them, our society can and will change for the better. The world has already grown kinder towards those with mental illness over the last decades, and if we keep this momentum going, the world will change to be a more understanding place where mental health is not only recognized but prioritized. 

References  

Skosireva, Anna et al. 2014. “Different Faces of Discrimination: Perceived Discrimination among Homeless Adults with Mental Illness in Healthcare Settings.” BMC health services research 14(1).      http://dx.doi.org/10.1186/1472-6963-14-376.

Dorris J. James. and Lauren E. Glaze "Mental Health Problems of Prison and Jail Inmates" Bureau of Justice Statistics NCJ 213600 

  https://bjs.ojp.gov/content/pub/pdf/mhppji.pdf

Kugelmass, Heather. 2016. “‘Sorry, I’m Not Accepting New Patients’: An Audit Study of Access to Mental Health Care.” Journal of health and social behavior 57(2): 168–83.      http://dx.doi.org/10.1177/0022146516647098.

Jorm, Anthony F. 2012. “Mental Health Literacy: Empowering the Community to Take Action for Better Mental Health.” The American psychologist 67(3): 231–43.

 http://dx.doi.org/10.1037/a0025957.

Wu, Ivan H. C. et al. 2017. “Stigma, Mental Health, and Counseling Service Use: A Person-Centered Approach to Mental Health Stigma Profiles.” Psychological services 14(4): 490–501.      http://dx.doi.org/10.1037/ser0000165.

Rishel, Becky. 2020. “Promise Resource Network.” Promiseresourcenetwork.org.

https://promiseresourcenetwork.org/ (December 12, 2021).

Threadcraft, Shatema. 2018. Intimate Justice: The Black Female Body and the Body Politic.

 New York, NY: Oxford University Press.

Daniels, N. 2001. “Justice, Health, and Healthcare.” The American journal of bioethics: AJOB 1(2): 2–16.

 http://dx.doi.org/10.1162/152651601300168834.

Locke, John. 2021. The Second Treatise of Government by John Locke the Second Treatise of Government by John Locke.

  Independently Published.