By Katherine Ponte, JD, MBA, CPRP
Discrimination against people with mental illness is widespread. It can be highly detrimental to reaching and staying in recovery. At times, as sad as it may be, the best way for us to manage discrimination is to know it exists, be prepared for it and know how to safeguard our rights.
People living with mental illness should have access to the same opportunities as everyone else. However, while protected by law, enforcing those rights is not always logical, orderly or friendly. Our community often faces two layers of discrimination — the original act of discrimination and the discrimination we may deal with when trying to enforce our rights.
Despite these issues, pursuing your legal rights and protections is the most effective way to combat systemic discrimination and change laws. Here are a few examples of mental illness discrimination and ways to challenge unfair practices.
Medicaid and Medicare laws discriminate against people with mental illness. For example, one law prohibits federal Medicaid funding for non-elderly adults receiving psychiatric care in a treatment facility with more than 16 beds. No physical health conditions have this limitation. Medicare beneficiaries are also limited to 190 days of lifetime inpatient psychiatric hospital care. According to the National Association for Behavioral Healthcare, “No other Medicare specialty inpatient hospital service has this type of arbitrary cap on benefits.” This is particularly harmful for people living with chronic serious mental illness (SMI) who often need more than 190 days of hospital care.
Health insurance companies’ refusal to cover certain medications is another form of potential discrimination. However, you can appeal these refusalsto legal and regulatory agencies. Some State Attorney General’s Offices have a hotline for filing appeals.
Discriminatory regulations and laws can be the most difficult form of discrimination to challenge. To change laws, we need political advocacy and community action. You can take action on the local, state and federal levels. Join the advocacy efforts of your local NAMI affiliate and NAMI, the Kennedy Forum, The Bazelon Center for Mental Health Law and Treatment Advocacy Center, among others.
People living with SMI die an average of 25 years earlier than the general population. Most us die from physical conditions and discrimination in the health care system may play a role. Evidence has shown that health care providers are liable to display negative attitudes and stereotyping behavior toward people with mental illness and incorrectly attribute physical symptoms to a person’s mental illness.
One study found that health care providers who stigmatize were more likely to think patients with mental illness would not adhere to treatment, and therefore less likely to refer them to a specialist or refill their prescriptions. Even some psychiatrists hold stigmatizing views against people with mental illness, which can significantly impact treatment outcomes.
Local and state mental health government offices can sometimes help in health-care related discrimination. There may also be state-specific bodies that investigate complaints against doctors and other licensed professionals.
Employment is the one of the most important factors for sustained mental health recovery. A literature review found that people with mental illness remain unemployed or underemployed at significantly higher levels compared to the general population. Among additional findings, people with mental illness were shown to be perceived as incompetent and less promotable, receive lower wages and have less access to quality jobs. Even in terms of supporting existing employees with depression, about 25% of managers reported they did not feel confident in doing so effectively.
The American with Disabilities Act (ADA) and Rehabilitation Act of 1973 offer protections for job applicants and employees with mental illness. The ADA is enforced by several government agencies, notably the Equal Employment Opportunity Commission and the U.S. Department of Justice. You can file a complaint with these agencies if you feel discriminated against on employment matters. You may also be able to file a complaint with your state’s Fair Employment Practice Agency.
Access to adequate housing is another critical component of recovery in which people with mental illness may experience discrimination Despite protections, people with mental illness tend to face discrimination when searching for housing according to a U.S. Department of Housing and Urban Development report. People with mental illness were less likely to receive a(n):
Many also received adverse treatment when asking for reasonable accommodations.
In cases of housing discrimination, you may be able to file a complaint under the Fair Housing Act. Local, state and federal levels often offer protections against housing discrimination.
People with mental illness experience higher rates of incarceration, disproportionate shares of prison populations and a lack of access to mental health treatment during incarceration.After being booked into jail, people with SMI stay 2-3 times longer in pretrial and face longer sentences. They are less likely to make parole and more likely to cycle through the system or die by suicide.
Three times as many people with SMI are housed in prisons and jails than in hospitals. Yet, only one in three prison inmates receive any form of mental health treatment. Lack of care can worsen mental illness and lead to higher recidivism rates. A criminal conviction can severely limit access to resources needed to reach recovery. This is especially true for people with SMI who experience extremely high rates of co-occurring disorders. Challenges include securing a job, housing assistance, educational financial aid and other government benefits.
Criminal matters are complex and appropriate legal representation may be critical. You may find a criminal lawyer in the Martindale Hubbell Legal Directory. State Bar Associations may be able to refer you to a legal services association that can offer low or free cost help. Another great source of assistance can be law schools, which sometimes have legal aid clinics where supervised law students provide guidance on legal matters. In some cases, it can be very beneficial to receive press coverage, but it is something you must consider carefully.
Discrimination is an unpleasant reality for our community, but there are established ways and resources to combat it. It’s essential to consider the risks and your chances of success before committing to legal action. However, advocating for your rights can be empowering and help you feel that you have some control over your life.
Each one of us must stand up to it to the best of our abilities. Action can benefit not only you, but all of us.
This article is for informational purposes only and does not constitute legal advice.
Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City.
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