UNDERSTANDING STIGMA AND DISCRIMINATION IN MENTAL HEALTH, A QUALITYRIGHTS INQUEST (3)

Intentional Structural Discrimination and its effect on Rights of Persons with PIC Disabilities.

A good example of intentional structural discrimination from the public sector is state legislatures that enact laws restricting the rights and opportunities of people with psychosocial, intellectual, and cognitive disabilities. A look through the laws of several developing nations and even some states in acclaimed democratic havens like the United States of America have shown that legislators have passed laws restricting the civil rights of persons with psychosocial, intellectual, and cognitive disabilities in areas such as voting, holding elective office, serving jury duty, parenting, and remaining married. Examples may be adduced here in Ghana either directly or implied. The Ghanaian legislative provision, (C. I. 15 of the Public Elections Regulations, 1996 ) clearly states that persons eligible to vote in national elections and those who seek to present themselves for elected positions in the governance of the state must all be of sound mind. Yet, to ask the least, who determines who among the citizenry is of sound mind and of what classification is one adjudged to be of sound mind at any point in time. What we are unsure of is whether the intent of these laws was targeting “mental illness” as a term the public seems to use as a general descriptor of people with psychosocial, intellectual, and cognitive disorders, or  “incompetence” as a legal term defining people who are unable to meet a community standard based on their mental health conditions.

Withholding the right to vote seems especially harmful given the significant debate in the legal community about whether this restriction is even appropriate for convicted felons. It is also apparent that even greater limitations are evident in the family domain. In the United States alone, between 42 and 52 percent of States limit the right of people with mental illness to remain married. Additionally, more than 40 percent of States limited the child custody rights of parents with mental illness.

Institutionalized stigma and discrimination in the broader society (Private sector)

Intentional structural discrimination may also emanate from private sector-dominated sections, for example in the predominantly negative representations of people with mental illness in the news media. The media as mass communication sources have provided fundamental frameworks through which most persons around the globe come to perceive and understand the contemporary world. Unfortunately, when the news media portray a group in a negative light, they propagate prejudice and discrimination. Most studies have shown that various media outlets frequently frame mental health conditions and other forms of intellectual and cognitive disabilities in a stigmatizing manner. Several articles, broadcast, and online publications discuss people with mental illness in terms of dangerousness or violent crime. Some studies have recorded as much as 86 percent of stories dealing with mental illness that focus on violence. Modern research however suggests that these kinds of stories are becoming less prevalent, with at least a third of stories still focusing on dangerousness. Also, the vast majority of remaining stories on persons with psychosocial, intellectual, and cognitive disabilities focus either on other negative characteristics related to people with the disorder as unpredictability, unsociability or on medical treatments. Notably absent are positive stories that highlight the recovery of many persons with even the most serious psychosocial, intellectual and cognitive disabilities. Although the reduction in the proportion of negative stories is positive in itself, the over-representation of stories that perpetuate the stereotype of dangerousness is nevertheless an example of institutional stigma. These stories reflect informal industry norms applied by news editors and reporters choosing to promote sensationalistic representations of mental illness and violence.

Flipping the coin, however, one may wonder if media outlets do present a biased and erroneous view of mental illness or one that reflects reality. Some studies have supported the assertion that frequent stories on mental illness and violent crime are not stigmatizing but rather reflect the actual level of danger inherent in people with some psychopathologies, especially psychotic disorders. A study completed in the US and UK shows a 2 to 6-fold increase in the rate of violence in samples of people with mental illness compared to samples of people without mental illness drawn from the general population. Yet when considering these numbers in terms of base rates, however, one finds mental illness to be a poorer predictor of violence compared with demographic variables like age, gender, and ethnicity. The discrepancy between reality and perception must be better understood if institutional discrimination in the news media is to become a potent and useful construct in understanding the harmful impact of stigma on people with mental illness.

Permissible Restrictions in a structural discrimination context

It is important though to appreciate that some people with psychiatric disabilities may not qualify for some privileges and opportunities as long as the disability is manifest. The caveat is to define situations where the restriction of rights or privileges because of disability may serve a larger social good. For instance, a person who is paranoid and disoriented should probably not qualify for a gun permit, neither should a person with grossly substandard hygiene probably not be hired for a job that requires food handling. When examining instances of structural discrimination against people with mental illness, there is the need to keep in mind that sometimes the restriction may be justified and therefore not qualify as an example of baseless discrimination. It is on this premise that one will need to distinguish between limitations on the rights of individuals based on disability and limitations based on mental illness labels.

Several examples of discrimination may arise out of the use of the term “mentally ill” to restrict rights. The term, as used in several legislative drafts, reflects the negative effects of a label and not any measurable incompetence. This paves the way for people with relatively benign psychiatric illnesses such as adjustment disorders and phase of life problems, as well as those with more serious disorders/disabilities who are adequately managing their conditions, to lose rights.