One conclusion of the decade-long epidemiological Global Burden of Disease Project is that five of the top 10 disease “burdens” the world will face by 2020 will be related to mental disabilities. Therefore, developing social policy and community responses to the ways that people with mental disabilities are treated is becoming an important focus for community practitioners, political activists and legislators. The author explores some of the dynamics of our culture’s approach to dealing with difference, especially when manifested in disenfranchized individuals. He discusses a community development project created by a New York City advocacy and social policy organization following the 1999 murder of a woman by an individual whose mental health disability was never treated. Parallels are drawn between the civil rights and community mental health movements, which created a precedent for the 1990 Americans with Disabilities Act. Also examined are the ways in which community mental health systems manifest social policy that alternately resists, repeats and colludes with power operations. The unexamined assumptions that drive this dynamic are examined as ableism or disability oppression.
KeywordsAbleismAssertive Community TreatmentCivil RightsDisabilityKendra’s Law
H. Giroux, “The Abandoned Generation: Democracy beyond the Culture of Fear,” Palgrave Macmillan, New York, 2003.
S. Zizek, “Organs without Bodies,” Routledge, New York, 2004.
N. Gilbert and A. Etzioni, “Transformation of the Welfare State,” Oxford University Press, 2002.
E. Huber and J. D. Stephens, “Development and Crisis in the Welfare State,” University of Chicago Press, 2001.
D. Swank, “Global Capital, Political Institutions, and Policy Change in Developed Welfare Nations,” Cambridge University Press, Cambridge, 2002.
A. Price-Smith, “Plague and Politics: Disease and International Policy,” Palgrave Macmillan, New York, 2001.
C. D. Mathers and D. Loncar, “Projections of Global Mortality and Burden of Disease from 2002 to 2030,” PLoS Medicine, Vol. 3, No. 11, 2006, p. e442.
World Health Organization, “Primary Health Care: Now More than Ever,” World Health Organization, Geneva, Switzerland, 2008.
P. Duckett, “It’s War, and It’s Official: Repositioning Impairment and Disability into the Society for Community Research and Action,” The Community Psychologist, Vol. 37, 2004, pp. 10-14.
J. A. Haagsma, A. H. Haavelar, M. F. Janssen and G. J. Bonsel, “Disability Adjusted Life Years and Minimal Disease: Application of a Preference-Based Relevance Criterion to Rank Enteric Pathogens,” Population Health Metrics, Vol. 6, 2008, pp. 345-368.
K. Lee, “Health Impacts of Globalization,” Palgrave Macmillan, New York, 2003.
R. Casteneda and M. Peters, “Ableism,” In: M. Adams, W. J. Blumenfeld, R. Castaneda, H. W. Hackman, M. Peters and X. Zuniga, Eds., Reading for Diversity and Social Justice: An Anthology on Racism, Antisemitism, Sexism, Heterosexism, Ableism, and Classism, Routledge, New York, 2000, pp. 310-325.
D. Blackwell, “Colonialism and Globalization: A Group- Analytic Perspective,” Group Analysis, Vol. 36, No. 4, 2003, pp. 445-464.
P. Abberley, “The Concept of Oppression and the Development of a Social Theory of Disability,” Disability, Handicap and Society, Vol. 2, No. 1, 1987, pp. 5-20.
D. Ferguson and S. Taylor, “Interpreting Disability,” Teachers College Press, New York, 1992.
S. Stefan, “Unequal Rights: Discrimination against People with Mental Disabilities and the Americans with Disabilities Act,” American Psychological Association, Washington, DC, 2001.
United States Department of Justice, “ADA Legal Documents: Public Law 101-336,” U.S. Department of Justice, Washington, DC, 1999.
J. Swan, S. French and C. Cameron, “Controversial Issues in a Disabling Society,” Open Universities Press, Buckingham, 2003.
J. Monahan, M. Swartz and R. J. Bonnie, “Mandated Treatment in the Community for People with Mental Disorders,” Health Affairs, Vol. 22, No. 5, 2003, pp. 28- 38.
K. H. Shelton, P. J. Taylor and M. van den Bree, “Risk factors for Homelessness: Evidence from a Population- Based Study,” Psychiatric Services, Vol. 60, No. 4, 2009, pp. 465-472.
A. Barton, “Sentenced to Treatment: Criminal Justice Orders and the Health Service,” Critical Social Policy, Vol. 19, No. 4, 1999, pp. 463-483.
A. Bradley, “Treatment and Testing Orders,” Criminal Justice Matters, Vol. 31, 1998, pp. 21-34.
J. Swanson, “Psychiatric Advance Directives: An Alternative to Coercive Treatment?” Psychiatry, Vol. 63, No. 2, 2000, pp. 160-172.
M. Perlin, “The Hidden Prejudice: Mental Disorder on Trial,” American Psychological Association, Washington, DC, 2000.
J. Swanson, “Three Risk Factors Cited in Violent Behavior among People with Severe Mental Illness,” American Journal of Public Health, Vol. 92, 2003, pp. 1523-1531.
M. B. Borg, Jr., “The Avalon Gardens Men’s Association: A Community Health Psychology Case Study,” Journal of Health Psychology, Vol. 7, No. 3, 2002, pp. 345-357.
M. B. Borg, Jr., “Venturing beyond the Consulting Room: Psychoanalysis in Community Crisis Intervention,” Contemporary Psychoanalysis, Vol. 40, No. 2, 2004, pp. 147- 174.
M. B. Borg, Jr., “A Zombie Storms the Meathouse: Approximating Living and Undergoing Psychoanalysis in a Palliative Care Culture,” Psychoanalysis, Culture and Society, Vol. 9, 2005, pp. 212-233.
M. B. Borg, Jr., “Community Psychoanalysis: Developing a Model of Psychoanalytically-Informed Community Crisis Intervention,” In: N. Lange and M. Wagner, Eds., Community psychology: New directions, Nova Science Publishers, Happague, NY, 2010, pp. 1-66.
M. B. Borg, Jr., E. Garrod, M. R. Dalla and J. McCarroll, “Can Psychoanalysis Exist outside the Consulting Room? In: B. Willock, R. Curtis and L. Bohm, Eds., Taboo or not taboo: Forbidden Thoughts, Forbidden Acts in Psychoanalysis, International Universities Press, Madison, 2009, pp. 193-207.
R. Bellah, R. Madsen, W. Sullivan, A. Swindler and S. Tipton, “Habits of the Heart: Individualism and Commitment in America,” University of California Press, Berkeley, 1985.
A. Etzioni, “A Responsive Society,” Jossey-Bass, San Francisco, 1991.
D. Bell, “The Cultural Wars: American Intellectual Life,” Wilson Quarterly, summer 1992, pp. 74-107.
A. Samuels, “Politics on the Couch: Citizenship and the Internal Life,” Karnac, New York, 2001.
N. Ellin, “Postmodern Urbanism,” Princeton Architectural Press, New York, 1999.
F. Richardson, B. Fowers and C. Guignon, “Re-envisioning Psychology: Moral Dimensions of Theory and Practice,” Jossey-Bass, San Francisco, 1999.
C. Taylor, “The Ethics of Authenticity,” Harvard University Press, Cambridge, 1992.
S. Clarke and P. Hoggett, “The Empire of Fear: American Political Psyche and the Culture of Paranoia,” Psychodynamic Practice, Vol. 10, No. 1, 2004, pp. 89-106.
J. Garrison, “America as Empire: Global Leader or Rogue Power?” Berrett-Koehler, San Francisco, 2004.
C. Johnson, “The Sorrows of Empire: Militarism, Secrecy, and the End of The Republic,” Metropolitan Books, New York, 2004.
S. Clarke, “Social Theory, Psychoanalysis and Racism,” Palgrave Macmillan, New York, 2004.
H. Giroux, “Stealing Innocence: Corporate Culture’s War on Children,” Palgrave Macmillan, New York, 2000, p. 69.
A. Schultheis, “Regenerative Fictions: Postcolonialism, Psychoanalysis and the Nation as Family,” Palgrave Macmillan, New York, 2004.
G. W. Knox, “An Introduction to Gangs,” Wyndham Hall Press, Bristol, 1995, p. 3.
E. Said, “Culture and Imperialism,” Alfred A. Knopf, Inc, New York, 1993.
W. Ryan, “Blaming the Victim,” Vintage, New York, 1971.
E. Seidman and J. Rappaport, “Redefining Social Problems,” Plenum, New York, 1986.
M. R. Warren, “Dry Bones Rattling: Community Building to Revitalize American Democracy,” Princeton University Press, Princeton, NJ, 2001.
F. Fanon, “The Wretched of the Earth,” Grove, New York, 1068.
P. Freire, “Pedagogy of the Oppressed,” Continuum, New York, 1970.
P. Saperia, “Hearing on Oversight: Supervision of Outpatient Mental Health Services,” Coalition of Voluntary Mental Health Agencies, New York, 1999, p. 3.
J. G. Bock, “Towards Participatory Community Appraisal,” Community Development Journal, Vol. 36, No. 2, 2001, pp. 146-153.
M. Swartz, J. Swanson and J. Monahan, “Endorsement of Personal Benefit of Outpatient Commitment Among Persons with Severe Mental Illness,” Psychology, Public Policy, and Law, Vol. 9, No. 1-2, 2003, pp. 70-93.
L. A. Bell, M. Adams and P. Griffin, “Teaching for Diversity and Social Justice,” Routledge, New York, 2007.
M. L. Korn, “Approaches to Assertive Community Treatment,” Medscape, 2004. http://www.medscape.com/ viewarticle457029
C. Tam and S. Law, “Best Practices: A Systematic Approach to Management of Patients Who Refuse Medications in an Assertive Community Treatment Team Setting,” Psychiatric Services, Vol. 58, No. 4, 2007, pp. 457- 459.
P. Backlar, “Consumer, Provider, and Informal Caregiver Opinions on Psychiatric Advance Directives,” Administration and Policy in Mental Health, Vol. 28, No. 6, 2001, pp. 427-441.
J. S. Lamberti, R. Weisman and D. I. Faden, “Forensic Assertive Community Treatment: Preventing Incarceration of Adults with Severe Mental Illness,” Psychiatric Services, Vol. 55, No. 11, 2004, pp. 1285-1293.
H. Herinckx, R. Kinney, G. N. Clarke and R. Paulson, “Assertive Community Treatment Versus Usual Care in Engaging and Retaining Clients with Severe Mental Illness,” Psychiatric Service, Vol. 48, No. 10, 1997, pp. 1297-1306.
R. E. Drake, H. H. Goldman and H. S. Leff, “Implementing Evidence-Based Practices in Routine Mental Health Settings,” Psychiatric Services, Vol. 52, No. 2, 2001, pp. 179-182.
Institute of Medicine, “Envisioning the National Health Care Quality Report,” National Academies Press, Washington, DC, 2001.
J. F. McCarthy, M. Valenstein, L. Dixon, S. Visnic, F. C. Blow and E. Slade, “Initiation of Assertive Community Treatment among Veterans with Serious Mental Illness,” Psychiatric Services, Vol. 60, No. 2, 2009, pp. 196-201.
C. Liachowitz, “Disability as a Social Construct,” University of Philadelphia Press, Philadelphia, 1998.
M. McClintock and L. Rauscher, “Ableism Curriculum Design,” In: M. Adams, L. Bell and P. Griffin, Eds., Teaching for Diversity And Social Justice, Routledge, New York, 2007, pp. 198-229.
T. Shakespeare, “Cultural Representations of Disabled People: Dustbins for Disavowal,” Disability and Society, Vol. 9, No. 3, 1994, pp. 283-300.
D. DeLillo, “The Names,” Alfred A. Knopf, New York, 1982, p. 317.
J. L. Murray and A. D. Lopez, “The Global Burden of Disease: Comprehensive Assessment of Mortality and Disability from Disease, Injuries, and Risk Factors in 1990 and Projected into 2020,” Harvard University Press, Cambridge, 1996.
S. Aronowitz, “The Death and Rebirth of American Radicalism,” Routledge, New York, 1996
. I. Illich, “Medical Nemesis: The Expropriation of Health,” Pantheon, New York, 1976.
M. Foucault, “Discipline and Punish: The Birth of the Prison,” Vintage, New York, 1977.
P. Griffin, H. Steadman and J. Petrila, “The Use of Criminal Charges and Sanctions in Mental Health Courts,” Psychiatric Services, Vol. 53, No. 10, 2002, pp. 1285- 1289.
J. L. Murray and A. D. Lopez, “The Global Epidemiology of Noncommunicable Disease,” Harvard University Press, Cambridge, MA, 2004.