Unveiling Privilege in Mental Health Recovery

BY MARGARET STUTT

As a nationally recognized recording artist and philanthropy professional, Margaret Stutt values storytelling as a means for empowering others. Her career and spiritual practice is anchored in gratitude, with the goal to foster connection, hope and purposeful community building. She credits her psychiatric hospitalization and diagnosis as being the “reset button” that provided her with the self-knowledge and tools to live a stable and fulfilling life. “Hitting rock bottom is one of the best things that happened to me. Yes, it was extraordinarily painful and requires steady management, but it also catalyzed profound growth, empathy and an appreciation for small wonders. Receiving a diagnosis better positioned me to live fully and pursue my dreams.”    

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When I first became a public mental health advocate, I was solely focused on the message that it’s possible to bounce back from a mental health crisis and manage — thrive, even — with a diagnosis such as Bipolar 1. My ambition was relatively modest, thinking that perhaps I would reach someone else who received an intimidating diagnosis and felt ostracized and “doomed.”

At the time, my public speaking centered on my personal pathway to stability: a regular routine of therapy, medication, exercise, nutrition, social support and stress reduction practices. The primary venue for these talks was a testimonial panel at The Wright Institute, a graduate school for psychology clinicians in Berkeley, California.

The other people on the panel did not share such a positive message of hope and recovery, and I became self-conscious that maybe I experienced a course of conditions and privilege that influenced my rosy outlook on mental health outcomes. I began to shift my message that recovery is possible to one that included the caveat that this requires access to resources and care. I was aware that I had the benefit of employer insurance which opened the door for regular therapy and medication. And while health insurance is critical for someone to manage a health condition, I’ve learned that there’s more to the story than that.

Around the same time, I was working at UCSF Benioff Children’s Hospital Oakland and had the privilege of meeting Dayna Long MD, who introduced me to the concept of social determinants of health: how your zip code is more predictive of health outcomes than your genetic code. In Communities in Action: Pathways to Health Equity (2017), social determinants of health identify the following factors that lead to differences in health outcome:

• Education
• Income and Wealth
• Employment
• Health Systems and Services
• Housing
• Physical Environment
• Transportation
• Social Environment
• Public Safety

When I think about my experience with managing a mental health condition, I have numerous examples of how these have played out in my favor. Looking at public safety, for example, I think about the very beginning of my recovery journey, when I was in crisis, and how it might have played out differently. 

It was the summer of 2012 in Wind Point, Wisconsin. I was sitting outside someone else’s house on their Adirondack chair, and was reported for unusual behavior. The village policeman arrived, covered me with his jacket, called my parents, and brought me to the emergency room. From there, I was transferred to an inpatient hospital for psychiatric treatment. 

Contrast that with the experience of Dontre Hamilton twenty-two miles north in Milwaukee, two years later: Hamilton, who lived with schizophrenia and paranoia, was asleep on a park bench. Police arrived and conducted an “out of policy pat down” which led to a scuffle. Hamilton grabbed the policeman’s baton, and Hamilton was shot 14 times. He died.

Does a Black man have an equal chance for positive mental health outcomes as a White woman? Considering that many, if not most, mental health crisis response is conducted by police, I doubt it. As mentioned in Communities in Action: Pathways to Health Equity, the United States has seen a disproportionate, large-scale expansion of incarceration of Black and Brown people in the last 40-50 years, “which contributes to the breakdown of educational opportunities, family structures, economic mobility, housing options, and neighborhood cohesion…communities with high levels of incarceration have higher rates of lifetime major depressive disorder and generalized anxiety disorder.”

I have had access to resource-rich communities that had respectful interactions with authority and power, likely because my family also shared that status. Beyond my initial mental health entry into treatment, I received culturally competent care. I was able to establish a trusting relationship with my provider. Further, I had a statistically higher chance of receiving a call back from a psychologist compared to someone who has a POC-sounding name (similar to employment screenings). I can easily think of an overwhelming list of examples of ways my privilege factored into my recovery equation. But of utmost importance, at the very start of my diagnosis, I was afforded the chance to simply remain alive long enough to get treatment.

My recovery success began decades before the symptoms started: the moment I was born into an upper middle class, educated, white family in a de facto segregated neighborhood. Yes, I have worked hard for my wellness. Yes, I am vigilant about sleep routines and medication and therapy. But also, and maybe more importantly, I am learning how the cards have always been stacked in my favor, and how we should do more to ensure everyone, regardless of their identity or background, has equal chances for compassionate treatment and positive health outcomes.

Can we ethically be mental health advocates without acknowledging racial discrimination, mass incarceration, generational trauma; the inequal distribution of power and resources across lines of race, gender, class, sexual orientation, gender expression and other dimensions of identity? Yes, recovery is possible, but for whom and why?

It’s not enough for me to spread hope to people like me. I want this chance of life and wellbeing to be possible for anyone, especially those who have been disadvantaged in an inequitable society from birth.

I believe in recovery. I have hope because others had hope for me. I ask that we all maintain hope while working for more inclusive and compassionate systems so that everyone has the opportunity for stability, wellbeing, good health and joy.