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The New Year is a Time for Decision and Action

January 02, 2020
Ron Manderscheid
By Ron Manderscheid, Executive Director, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

As we savor the warmth, cheer and camaraderie of our family and friends during the winter holidays, we also must spend some time reflecting on the new year and what awaits us just around the corner. For each of us, 2020 likely will be a year for making very difficult decisions and a year for taking necessary but very difficult actions.

In the new year, a series of complex issues will converge at a very convoluted crossroads. Because 2020 also coincides with a presidential election, these issues will be framed in extreme and simple terms, greatly accentuated, discussed frequently and often confused.

Below, I have separated several key issues, each of great concern to our field, in order to discuss them. However, it is very important to recognize they interact with each other, and decisions and actions about one will affect each of the others.

Personal rights for all: In our country, we pride ourselves on our personal rights, some of which are enshrined in the Declaration of Independence and the Constitution’s Bill of Rights. Yet, we also must recognize that these rights are neither absolute nor unconditional. Let me state just a few of the difficult choices we will confront in 2020: How far should our right to freedom from search and seizure be limited? How far should our right to communication privacy be limited? How far should our right to gun ownership be limited by the community’s right to safety from mass shootings? Clearly, many, many more questions of this type could and will be posed in 2020.

Social justice for many: How we frame our personal rights, together with the premise that all persons are created equal, will determine how we realize the concept of social justice. In its essence, social justice seeks to promote equity by moving resources from those who are more fortunate to those who are poor or disabled, in order to increase the wellbeing of the latter. Here are just a few of the likely 2020 issues: How far should we promote social justice for those who are poor and disabled at the expense of other urgent community needs? How far should we promote social justice for one group at the expense of social justice for another group when resources are limited? How far should we promote equity in health status at the expense of cost containment for health?

Life chances for a few: Unfortunately, the life chances of persons with mental illness, substance use conditions or intellectual/developmental disabilities already are limited by our concepts of personal rights for all and social justice for many. They are limited further by negative stereotypes and stigma that persist to this day. Here are just a few difficult choices for 2020: How far should we support self-determination for care for some at the expense of others with behavioral health or intellectual/developmental disability conditions who receive no care at all? How far should we support better life chances for persons with mental illness at the expense of the life chances of other groups with disabilities? How far should we support better personal rights for persons with behavioral health or intellectual/developmental disability conditions at the expense of community rights?

Clearly, each of these issues presents a thicket of thorny difficulties. However, as a field and as a society, we must find the appropriate balance on these issues. Such balance generally will depend on identifying the appropriate pivot points between personal rights and community rights, and between rights for all and rights for a subgroup.

Here are a few principles to guide us as we ponder our 2020 decisions and actions:

  • Persons with mental illness, substance use or intellectual/developmental disability conditions should have the same personal rights as all other Americans.
  • Persons with mental illness, substance use or intellectual/developmental disability conditions should have access to social justice resources and initiatives in a manner equitable with all other groups with disabilities.
  • Decisions at one level should not adversely affect those at another. For example, efforts to limit personal rights around gun ownership for everyone should not become the occasion to inappropriately target the life chances for persons with mental illness, substance use or intellectual/developmental disability conditions. Gun control is a societal issue affecting everyone.

As the volume of the dialogue increases in 2020, we must not let the noise drown us out. Rather, we must stand our ground morally and verbally. We also must ask: Where does each presidential candidate stand on each of these questions? Where do our representatives and senators stand? Where do our state and county officials stand? Where do we ourselves stand?

Our decisions and actions could not be more consequential in 2020.

Which way will you go? What actions will you take?

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