Mental Health Matters
Forensic Edition
September 2010
 Published by: Lepage Associates 


The Stigma of Mental Illness in American Culture

One of our psychologists recently completed the portion of Crisis Intervention Team (CIT) training that includes an explanation of symptoms and treatment of major mental illness. CIT training teaches police officers how to interact with individuals with a mental illness and divert them to mental health treatment rather than the criminal justice system. Her portion of the training always occurs on the first day so it is often their first exposure to really understanding mental illness.
She starts off by telling the audience, there is an estimated 14.8 million adults with a serious mental illness. That represents 7.3% of all adults! Fifteen to seventeen percent of people coming into the jails have a serious mental illness. Prisons hold three times more people with a mental illness than do psychiatric hospitals. She also discusses how a mental illness does not necessarily mean someone will become violent but it may mean someone behaves in a manner where they don't have the complete ability to manage their own behavior.
This most recent training revealed a number of concerns about how mental illness is being treated in the criminal justice system. There is a sense that if someone has a mental illness it is being used as an 'excuse' to get people out of trouble. However, only about 1% of all cases attempt to use a plea of not guilty by reason of insanity and only about 1% of those cases are actually successful. 
This viewpoint about mental illness is representative of the general stigma regarding mental illness in American culture. Why does stigma surround mental illness? Our society and culture feel uncomfortable about mental illness and perceive it as something different than a more tangible form of illness, such as cancer. The public holds inaccurate views about mental illness and these views are reinforced by social beliefs and perpetuated through the media. Novels, television, and movies attribute their dangerous and aggressive characters to products of mental illness. Mental illness seems only to receive news coverage when related to violence. For example, the recent Discovery Channel gunman who took people hostage is being labeled as someone with paranoid schizophrenia (Carollo, 2010). Thus, violence and mental illness become directly related even though this correlation is not always correct. These misrepresentations emphasize incorrect perceptions, discriminatory and offensive language, and ultimately can hinder a person's road to recovery (Mental Health Works, 2010). 
An American View of Mental Illness
A 10-year Retrospective Study (Mental Health America, 2007) researched American attitudes on specific mental illnesses. Regarding the most physically observable debilitating mental illness (addiction), at least 57% of Americans view alcohol or drug problems as personal or emotional weaknesses rather than seeing them as behavioral health problems.
Another study investigated specific attitudes towards mental illness (Journal of the American Medical Association, 2010). Most adults, 88.6%, agreed with a statement asserting that treatment can aid in helping people with mental illnesses lead normal lives. However, only 57.3% agreed with the assertion that people are generally caring and sympathetic towards people with mental illness. Among adults with mental illnesses, 77.6% agreed with the first statement, while only 24.6% believed that people are caring and sympathetic towards them. 
Why does this matter?
When individuals are interacting with the criminal justice system, we have to remember that we're relying on individuals who hold similar views. Police officers, attorneys, and judges are the general public. Therefore, if you have a client who has a mental illness, it is imperative to make sure they are appropriately cared for within the criminal justice system.
If you are a criminal attorney, this may involve a psychological evaluation to determine if they are competent to stand trial or to determine their mental state at the time of their commission of a crime. It may involve an evaluation of mitigating circumstances to determine the need for treatment. Or, it may require an expert who can conduct a violence risk assessment, explain the individual's treatment history, and the impact it may have on their behavior in the past, present, and future. Risk assessments can also help explain why someone has not been fully engaged in treatment and the likelihood of relapse or recidivism. At times, an explanation of stigma itself can be incredibly insightful for the court. 
Do you want help figuring out what to do with your case? Contact Dr. Tina Lepage at
Mental Health America (2007). 10-Year Retrospective Study Shows Progress in American Attitudes About Depression and Other Mental Health Issues. Retrieved from
Journal of the American Medical Association (2010). Attitudes Toward Mental Illness--35 States, District of Columbia, and Puerto Rico, 304(2):149-152. Retrieved from

Carollo, K. (2010). Gunman James Lee's Possible Diagnosis: Paranoid Schizophrenia. Retrieved from

Mental Health Works (2010). Stigma and Mental Illness. Retrieved from
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