Recently, the Washington Post uncovered a Trump administration proposal to monitor the smartphones of people with mental illness, under the guise of detecting and preventing violence before it occurs. This new strategy is consistent with a slew of remarks Trump has given in recent months targeting people with mental illness, including an explicit call to expand institutionalization.
However, President Trump is not alone in targeting people with mental illness in the aftermath of gun violence instead of focusing on access to guns. New York Gov. Andrew Cuomo and Texas Sen. Ted Cruz, among others, have done the same. If they’re successful, it will be another hard hit against marginalized communities during an administration when they are already under attack.
The American legal landscape is a complex web of laws that subject mentally ill people and those experiencing acute crisis or suicidality to surveillance and restrictions of their rights, which most notably includes the right of states to involuntarily commit a person with mental illness or to mandate outpatient treatment. Undergirding this legal framework is the presumption that people with mental illness are prone to violence (whether against themselves or others).
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This is sanism: The system of institutionalized oppression that systematically disadvantages people perceived or determined to be mentally ill, while granting privileges to those considered sane.
The legal link between violence and mental illness is so strong that the United States often uses institutionalization as part of the broader carceral system. Among the most glaring examples of this are the insanity defense, people who are deemed incompetent to stand trial, and sex offenders who are confined to mental institutions even after the completion of their criminal sentence.
Technically, people charged under these laws are not sent to prison. However, institutionalization functions as a form of medical incarceration; patients are not free to come and go, and are often confined in hospitals for a longer period than they would have been confined to jail or prison. In fact, the population of forensic patients in state psychiatric hospitals has grown so rapidly that many state institutions are at or beyond capacity, with some patients held for decades or even indefinitely.
The specific legal criteria for involuntary civil commitment vary across states, but most states rely on the dangerousness criterion. In theory, it assesses if a mentally ill person poses a threat of danger to themselves or others to determine whether to initiate civil commitment proceedings. However, states generally do not distinguish between the danger posed to oneself and the danger posed to others in determining the appropriate interventions. The law affirms that states, pursuant to their parens patriae power, or the authority to act as a guardian for those unable to act on their own behalf, have a substantial interest in subjecting people with mental illness to involuntary commitment to ensure their safety or their community’s safety.
So even when no crime has been committed, people can be medically incarcerated. In a country that guarantees a constitutional right to liberty and due process, that poses a serious problem.
Trump’s call for increased institutionalization, therefore, bears a striking similarity to the cruelty of his other policies: It capitalizes on widespread anxiety about community safety in order to justify expanding carceral control of “deviant” groups. People of color and other historically marginalized populations will bear the brunt of any such expansion. People of color are more likely to be found incompetent to stand trial, and Black people are three to four times more likely than white people to be diagnosed with psychotic disorders. Black and Native people are disproportionately impacted by institutionalization and are more likely to be mandated to receive involuntary outpatient treatment.
Much like the proposal the Trump administration is weighing today, previous policies meant to reduce gun violence ultimately increased surveillance and criminalization of people with psychiatric disabilities. For example, 43 states currently require or authorize that people flagged by the state due to certain mental-health adjudications have their names reported to the FBI’s National Instant Criminal Background Check System (NICS). Four more states require such collection in an in-state database, each of which place people who have been involuntarily committed on lists alongside those convicted of violent crimes to bar them from purchasing firearms. Following the shootings at Virginia Tech, mental health related reporting to NICS spiked by 700 percent in just under seven years.
This becomes increasingly important as a focus on suicide becomes a larger target in gun violence prevention. While politicians have previously been met with skepticism for pinning mass shootings on mental illness, they have found support when focusing on the danger that people with mental illness are presumed to pose to themselves. This allows politicians to dodge the issues underpinning mass gun violence, instead targeting a population of people with much less political capital (people with mental illness) rather than the main perpetrators of mass shootings (straight white men). In that sense, they are leveraging sanism to protect white supremacist patriarchy.
As a result, the focus on suicidality is likely to increase the number of people who are institutionalized, without decreasing the number of mass shootings.
The American mental health system is violent. People with mental illness, particularly people of color with mental illness, are increasingly subject to punitive coercive treatment instead of community-based models for healing and care. The national fixation on mental illness which inevitably follows mass shootings is harmful not only because it does nothing to curb gun violence, but because it is a pretext for entrenching and expanding oppression.
Each time gun violence and mental illness are discussed together, we ultimately reinforce the discriminatory assumptions which animate our laws and justify dehumanizing treatment and oppression of psychiatrically disabled people.