What does it mean for a state to provide every plausible protection it can to the population it governs? Many argue it means basic human rights such as food and water, while others advocate for more, including universal health care or a universal living wage. Reasonably then, we can expect that the primary job of the state is to ensure the safety of all citizens.
When then does a governing body become responsible for an alarming number of overdose and suicide deaths of the citizens it is meant to protect? This is the moral, political and legal gray area the United States is currently traversing. There is little discussion of the lasting effects the state continues to have on the overall health and livelihood of millions of individuals dealing with addiction and mental health issues.
The Centers for Disease Control and Prevention recently demonstrated that the overall life expectancy nationally has declined for the second time in three years. The reason for this decline? Suicides increased 3.7 percent in 2017 and drug overdose deaths increased 9.6 percent. Overdose deaths attributed specifically to synthetic opioids other than methadone increased 45 percent. Moreover, drug overdose deaths in 2017 surpassed, even at their peaks, deaths due to traffic accidents, HIV and gun violence. Increases in suicide and drug overdose deaths are inextricably linked and should be discussed in terms of the unwillingness of the state to protect millions of citizens. One in five Americans experience mental health issues and one in five youth (age 13 to 18) are diagnosed with a severe mental disorder in their lifetime, according to the National Alliance of Mental Illness.
These individuals diagnosed with severe mental disorders are more likely to live in poverty and live 25 years less on average than comparatively “mentally healthy” Americans. One in four homeless Americans experience mental illness. Finally, research demonstrates a link between mental illness, drug addiction and subsequent suicides. Many will ask, “Why should we hold the state responsible for personal decisions made by those who ingest drugs or ‘choose’ suicide?” This argument refuses to take into account the state’s culpability in stripping away mental health and addiction social services, while increasing incentives for doctors to recklessly prescribe opioids. Narrow-sighted state policies such as those that focus on opioid supply continue to fuel rises in opioid overdoses and suicides, which lead to a declining national life expectancy rate.
The absence of social services and support programs for people facing trauma, mental illness, addiction and suicide is not a new phenomenon. Upon his arrival to the White House in 1981, President Reagan signed the Omnibus Budget Reconciliation Bill, which dramatically diminished federal funding for state community health centers provided under President Carter’s Mental Health Systems Act, in lieu of defense spending. This led to the withdrawal of state-by-state funding, setting the foundations for funding cuts of other social programs used to support people with mental illnesses and addiction. This created additional barriers for people willing to seek out mental health support. The combination of this process with subsequent neoliberal policies set the stage for the level of damage to come.
Funding cuts worked in tandem with the abandoning of other related programs as part of various, punitive legislation focused on the war on drugs. Consequently, citizens now face weakening support services to confront their mental health issues. Now, the absence of these formal supports has led many to experiment with criminalized self-medication measures. In reality, the process of self-medicating is not inherently destructive or problematic. However, tied with the criminalization process of war on drug policies, the state views some self-medication techniques as problematic. Thus, the absence of social services alongside the rise in relatively unregulated opioid distribution has sharply increased untreated mental health issues, addiction and subsequent suicides. Many reports continue to demonstrate that a lack of support and funding are the main barriers to services for those facing these hardships. Even the Trump administration’s recent attempts to repeal the Affordable Care Act and to cut funding to the Drug Policy Office demonstrates the methods in which the state seeks to continue to reduce support for these programs.
So, we return to our original question: Should we hold the state responsible for the rise in overdose and suicide deaths in the United States? We think so. The continued funding cuts for mental health and addiction treatment programs demonstrate the state’s culpability in the legal and social processes that harm citizens. Whether it is under the guise of cost efficiency or social stigma, without oversimplifying a very complex issue, the lack of available programming and support structures for US citizens plays a significant role in the increases in the number of deaths the country continues to see.
The state should be held accountable. It is important that, as a society, we realize how many of our most vulnerable citizens are left to fend for themselves through the stripping of these resources. It is imperative that we continue to advocate for significant increased funding for harm reduction policies that could drastically shift the narrative of those facing these issues and provide them with stable support systems. Harm reduction policies should focus on developing community mental health services disconnected from the criminal legal system. These policies would provide supports without concern for legal interventions designed to criminalize individuals seeking help. Finally, we could take realistic steps in creating a single-payer health care system that includes quality mental health and addiction treatment programs to support those in need without fear of stigmatization or criminalization.