Federal legislation introduced to change the way the country treats mental illness
by Burney Simpson
WASHINGTON—Misdiagnosis and mistreatment of mental health disorders in African Americans contribute to high rates of incarceration and recidivism, an issue that has led a bipartisan group in the U.S. House to introduce a bill designed to reform the way the country treats mental illness.
Mental illness affects the black community like any other, and a little over 10 percent of the 44 million mentally ill in 2013 were African American, according to the national survey from the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human Services.
The difference is that the historic misdiagnosis of blacks impacts how people are treated, or not treated, for their illness, according to Dr. William B. Lawson, chair of the Howard University Department of Psychiatry and Behavioral Sciences.
Lawson’s research has shown that African Americans showing signs of mental illness are more likely to be diagnosed either with schizophrenia or with no disorder. People with schizophrenia experience hallucinations and social withdrawal. Treatment includes antipsychotic medication and a variety of therapies.
“Schizophrenics are less likely to recover and more likely to have behavioral problems,” said Lawson, who spoke recently at the ‘Individualized Medicine as a Road to Recovery’ series of seminars at Howard in Washington, D.C.
“There is also an assumption that schizophrenics are more difficult to treat and more likely to exhibit violent behavior. That fits the mind set towards African Americans,” Lawson said.
Lawson has found that African Americans with mental illness show symptoms of bipolar disorder, which is experienced by 1.3 percent of all Americans. Bipolar disorders are characterized by mood swings, impulsive behavior which can lead to suicide attempts, substance abuse, and other antisocial behavior, said Lawson.
Bipolar disorders are lifelong conditions that can treated with a combination of drugs and therapy.
The mental health misdiagnosis of blacks is not new. The enslaved that disrespected their owners were diagnosed with something called dysaesthesia aethiopis; recommended treatments included whippings. (See “Black Men Suffer From Mental Illness: How Racism Figures In,” April 12, 2015).
During the Civil Rights era, psychiatrists diagnosed some black activists as violent paranoid schizophrenics, according to the book “The Protest Psychosis: How Schizophrenia Became a Black Disease,” by Jonathan M. Metzl, associate professor of psychiatry and women’s studies at the University of Michigan.
These misdiagnoses have convinced many African Americans that any psychological challenge they may suffer is based largely on a history of being treated as something less than human by whites.
In practice, this may lead to an avoidance of treatment. Those suffering with bipolar disorders that go untreated could be arrested and enter the correctional system where they receive some form of treatment for the first time.
That’s why the three largest mental health ‘treatment centers’ in the country today are correctional institutions — the Cook County Jail in Chicago, the Los Angeles County Jail, and Travis County Jail in Texas, says Lawson.
But the treatment is haphazard and incomplete.
“In jails, treatment is sacrificed to security,” said Lawson. “And when they leave, it is difficult to get treatment and they get into the recidivism cycle.”
Breaking the cycle will take earlier and accurate mental health diagnosis, and greater outpatient services for those caught up in the correctional system.
Congress is looking at ways to address this and other mental health issues.
This month, U.S. Rep. Tim Murphy, a Pennsylvania Republican, and Rep. Eddie Bernice Johnson, a Texas Democrat, introduced the Helping Families in Mental Health Crisis Act 2015, to reform the way the country spends $130 billion annually to treat mental illness.
Johnson is a member of the Congressional Black Caucus and is the ranking member of the House Committee on Science, Space, and Technology.
Johnson and Murphy say that their bill, HR 2646, will add psychiatric beds, train more child psychiatrists and psychologists, reform patient privacy rules that hinder both physicians and family members, and change the reliance on correctional facilities as treatment centers of last resort.
The proposal will create an Assistant Secretary for Mental Health and Substance Use Disorders within the Department of Health & Human Services to lead the nation’s mental health treatment efforts.
Despite the bill’s bipartisan support, passage is not guaranteed. A similar bill from Murphy in 2013 failed to get out of committee.
Opponents contend that HR 2646 will put a government bureaucrat in charge of mental health efforts, open up patient HIPAA (Health Insurance Portability and Accountability Act) records, and lead to a rise in involuntary treatment of the mentally ill in institutions.
Involuntary treatment “always means a more severe diagnosis,” said Dr. Daniel Fisher. “That increases the stigma (of mental illness), and decreases the chance of getting a job and housing, of building relationships.”
Fischer is a psychiatrist and a leader of the National Coalition for Mental Health Recovery, 35 state and national organizations that represent the mentally ill.
Instead, there is a need for more outreach to communities by providers, for more treatment to patients that voluntarily seek help, and for teams of peers, including those with a history of mental illness themselves, to work with the mentally ill, says Fisher.
Despite the opposition HR 2646 has 43 cosponsors and received a hearing by the Health Subcommittee of the Energy and Commerce Committee on June 16. Plans call for further committee hearings.