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The Mental Health Needs of Special Populations

The history of mental illness in the United States and in New York State in particular amongst special populations is a very complex one, having within it all the politics, economics of a hierarchal, power centric, race constructed society. What are the key issues for practitioners who wish to incorporate an antiracist/social justice analysis within their work with specific client populations? In the space of this article, we cannot fully address such broad topics as these, but we hope to propose some key issues for mental health practitioners working with particular populations: clients living in poverty, children in the welfare system, and the mentally ill incarcerated.

Clients Who Live in Poverty

People living in poverty are generally underserved by the mental health fields, both in terms of their access to services and also the ability of conventionally trained mental health professionals to serve them usefully. As the result of Whites’ historical domination of American wealth-creation, people of color are disproportionately represented among people living in poverty, underscoring the fact that class-aware mental health practice must simultaneously be informed by an antiracist framework.

Appropriate services for poor communities begins with the acquisition of knowledge about structural oppression, social class, the race-class intersection, and poverty – training that many practitioners do not receive as part of their graduate curricula. Professionals can begin to attend to their own continuing education in this area through the work of scholars, listed in the resource bibliography, who have addressed the intersections of racism and classism. Moreover, when poverty and oppression are addressed, it often is presented from a “helping the needy” point of view. Certainly, there is nothing wrong with intentions to be helpful, but when practitioners are working with clients who occupy oppressed social locations, the idea of help is more complicated than may immediately be apparent. The opening quote directs us to a position that as humans we must assist each other’s liberation. This notion was also expressed by Dr. Martin Luther King, Jr. shortly before his assassination, and weeks before the intended launch of his Poor People’s Campaign:

“On the one hand, we are called to play the Good Samaritan on life’s roadside, but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life’s highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.”

In other words, when clients live in the context of oppression, true help must extend beyond charity to effect change in the edifice – in society – itself.

How can practitioners incorporate anti-classist, antiracist movement within their practice? To accomplish this, clinicians must broaden that discourse and find meaning and practice that is aligned with an anti-racist agenda. It is suggested that after supplementing their own knowledge base with regard to the race-class intersection, they can work to analyze and modify their practices accordingly. Such re-imagined anti-oppressive therapeutic models and techniques fall under the headings of multicultural, social justice, liberatory, and/or emancipatory approaches, and include the Stone Center’s Relational-Cultural Therapy, multicultural counseling and psychotherapy and anti-oppressive social work practice. Such approaches incorporate therapeutic roles and techniques that directly challenge the power-over dynamics inherent in conventional therapeutic dyads as they subvert the voicelessness and internalized oppression that can accompany life in social location that are marginalized by both racism and classism. Practitioners can furthermore initiate community-based interventions that feature actual activist components as they promote psychological well-being, such as participatory action research. Finally, as individuals and as members of a professional field, practitioners can organize and advocate with regard to public policy issues that affect all poor and working-class clients, such as the replacement of the minimum wage with a living wage, and the rights of all people to organize in the workplace.

Children in the Welfare System

The vast majority of parents facing child maltreatment charges in Family Court are charged not with abuse, but with neglect, most often related to poverty. A very small number of parents place their own children in foster care voluntarily.  For the most part, foster care is a “service” that devolves to those families most powerless to resist it.  Addiction, mental illness, domestic violence, and parent / adolescent conflict cut across all racial, economic, ethnic, and geographic lines. In addition to reporting bias, privileged families have the resources to retain attorneys, hire nannies, enter private rehabilitation facilities, or send children to boarding schools. The fewer options available to families, the greater the likelihood that family crises, magnified by poverty, will trigger a downward spiral ending in permanent dissolution.  People of color living in poverty are exposed to greater public scrutiny than the wealthy. They are more likely to live in public housing, and to use public schools, healthcare, and daycare facilities.  They are more likely to be accused of child abuse, more likely to be found culpable once accused, more likely to have their children removed to foster care thereafter.  Once their children are in care, conditions that never would have constituted valid legal reasons for removal become insurmountable barriers to reunification—their incomes are too low, their apartments are too small, their neighborhoods are too dangerous.  Their children remain in care longer, the parents’ rights are more likely to be terminated.  No explicit animosity towards people of color is necessary; this is simply the system’s default setting.

The key to antiracist child welfare practice is not simply about more services for poor families; it is about correcting power imbalances and restoring autonomy and self-determination to families and communities.  Federal child welfare policy and spending must be reordered to emphasize safe, proven programs that keep families together. Services of first resort must be more comparable to those which most families would purchase voluntarily, if they had the means.  Just as an overemphasis on child removal and adoption disproportionately harms low income families of color, a system more oriented toward keeping children safely in their own homes will help reduce such discrimination.

On a neighborhood level, public child welfare authorities must meaningfully partner with communities to prevent child maltreatment, with legal mandates to involve community residents in all levels of child welfare service planning, delivery, and evaluation.  It is more productive, humane, and cost effective to help people rebuild their communities than to remove thousands of children from those communities.  In most instances, children at risk are more effectively protected by respecting, enfranchising, and strengthening their families than by separating them from their families. “Child welfare” must become less about pretending to protect children from their parents, more about recognizing, listening to, and supporting parents as, potentially, the best and most dedicated protectors of their own children. How can we as professionals continually fail to acknowledge and join with the enormous strengths of families who have survived and achieved despite a history of slavery, colonization, displacement, and genocide?

Mentally Ill People in Incarceration

Mental health inside of America’s prisons has become a serious problem. Prisons are housing mentally ill patients for crimes that probably would not be committed if they were treated for their mental illness properly within society. A 1999 Bureau of Justice Statistics report estimated that approximately 16 percent of jail inmates, 16 percent of state prison inmates, 7 percent of federal prison inmates and 16 percent of probationers suffer from severe and persistent mental illnesses. Research clearly indicates that people of color are disproportionately represented in the prison population. Blacks are eight times more likely than whites to be incarcerated.

An account of one substance abuse counselor inside of a New York State prison, revealed firsthand the tragedies of mental illness with Black and Latino inmates. Many are not diagnosed or receiving care commensurate with best practices for community mental health care. Staffs are caring but overburden. The need for mental health care is high but funding support for adequate care is limited existed long before current economic fallout.

The incarcerated mentally ill face substantial challenges. Stigma is present in correctional facilities as well as in society. This leads some to refuse mental health services and medication that may be helpful. This population is highly vulnerable. They are likely to be taken advantage of by other incarcerated persons and misunderstood by correctional personnel. These factors lead to victimization and infractions. It is not uncommon for them to be extorted for their personal items and forced to perform sexual favors.

Most of those with mental illnesses have difficulty participating in mandatory programs such as school, vocational training, substance abuse and alternatives to violence. Those that manage to attend groups don’t fully understand the content and context of the information being provided. The therapeutic value of these services is compromised and leads to a repeat of the issues and circumstance that lead back to incarceration. Until those who are mentally ill are given proper care within society, our prisons will continue to be filled with mentally ill patients, who commit crimes when they should be able to live more productive lives. It is time that America to reexamine its role and strategy in dealing with this new epidemic that not only affect the incarcerated person but families and communities as well.

Is it at all a wonder that the mentally ill, particularly mentally ill, people of color find themselves under the direct control a white dominated, punishment system? The unbroken line from slavery, to the convict leasing system to now what is called the prison pipe line or the prison industrial complex started with criminalizing both the Indian and African peoples.

The above glimpses into the depth of the problems connected with special populations, mental health and racism barely scratch the surface. Certainly, one article could never account nor even begin to discuss a remedy for centuries of neglect and mistreatment. It has been said that racism, like oppression, is accomplished by omission and commission. The history of racism with respect to special populations shares that history. We conclude here with the assertion that only a transformed mental health system can undo the racism that created such disparities. Thus, the challenge is how do we as New Yorkers embrace the reformulation of a human rights agenda for not only the special populations with mental illness, but for the society itself. This will require the full disclosure of the role, function and impact of racism on all the associated structures and processes dictating policy, education and practice. It almost seems so daunting that such an effort would prove futile. But we also know that doing the same thing over and over and expecting different results is insanity.

Onaje Muid, MSW, LMHC, CASAC, FDLC, is Clinical Associate Director, Reality House. Laura Smith, PhD, is
Assistant Professor of Psychology and Education Department of Counseling and Clinical Psychology, Teachers College, Columbia University. Michael Arsham, MSW, is Executive Director, Child Welfare Organizing Project. Theresa Lacey, CASAC, is a Substance Abuse Counselor, NYS Department of Corrections.

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