easy to understandinggood grammar
60 contexts.org
t
trends
Mental health advocacy organizations
and public health offi cials have raised
concerns over calling 911 in a mental
health crisis. Police interactions can turn
confrontational, and individuals may be
transported to emergency inpatient treat-
ment––or even jailed––when other treat-
ment referrals may be more appropriate.
Mental health-related calls account for up
to 20 percent of 911 calls. From 2015 to
2016, 25 percent of fatal police shootings
involved individuals with mental illness.
In 2018, Contexts highlighted that, of
these, approximately 81 percent were
initiated by a 911 call, most commonly
made by a family member or friend.
As communities grapple with how
to safely and effectively respond to men-
tal health crises in the context of calls to
defund police and shift funds toward
social services, alternative models of
response could become more available.
For example, by July 2022, a national
number (988) will be launched, con-
necting callers to Lifeline crisis centers
to deliver support by telephone, assess
for additional needs, and coordinate
additional support services if needed.
However, we know little about potential
differences in demand for mental illness
crisis lines versus calling 911, particularly
with regard to race or trust in police.
In late 2020, we surveyed a diverse
sample of people actively involved in
their communities to understand prefer-
ences for different support types during
a mental health crisis––1,609 individuals
from Christian, Jewish, and Hindu con-
gregations in Washington DC, Maryland,
Virginia, and Texas.
Religious communities provide cru-
cial civic spaces and advice, especially in
times of crisis, while religious leaders play
an important role in providing mental
health support and often act as gate-
keepers to accessing professional mental
health services. Furthermore, particularly
in Black communities, pastors are often
viewed as the most important community
leaders.
Our sample is similar to the gen-
eral U.S. population in terms of race/
ethnicity. However, on average, the
sample is slightly older, is predominantly
women, and has higher education levels
and income than the general U.S. popu-
lation. Just over half the sample identifi es
as Democrat. Therefore, while our sample
is not representative of the general U.S.
population in terms of gender or socio-
economic status, it is similar in racial and
ethnic composition, and provides insight
into how actively involved community
members would perceive the police and
navigate mental health crises.
We investigate the links between
race, trust in police, and preferences for
mental illness crisis resources in this sam-
ple. In our survey, we asked, “If a loved
one was experiencing a mental illness and
race, trust in police, and mental health
crisis support
by emma frankham, christopher jacobi, and brandon vaidyanathan
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A memorial vigil for Decynthia
Clements—a Black woman killed by an
Elgin police offi cer—held in April 2018
in Chicago, Illinois.
10
20
30
40
50
60
70
80
90
100
percent
Across all respondents Of those who would call
a mental illness crisis line
Of those who would call
police
Of those who would call
911
Call preferences in a mental health crisis
Source: Mental Health in Congregations Study (2020)
I would call 911 I would call a mental illness crisis line I would call the police
http://crossmark.crossref.org/dialog/?doi=10.1177%2F15365042211035343&domain=pdf&date_stamp=2021-08-13
61S U M M E R 2 0 2 1 c o n t e x t sContexts, Vol. 20, Issue 3, p. 60-62. ISSN 1536-5042. © American Sociological Association.
http://contexts.sagepub.com. 10.1177/15365042211035343.
was threatening to harm themselves or
others, what would you do?” Options
included “I would call 911,” “I would
call the police,” and “I would call a men-
tal illness crisis line.” Respondents were
able to select all that applied––in reality,
people may choose several courses of
action, depending on the urgency of the
situation, so we wanted to capture the
range of options people felt were viable.
The first figure captures the complexity
of respondent’s ability to select all that
applied. We included “mental illness crisis
line” to understand whether respondents
would choose an alternative to the police.
As the National Alliance on Mental Illness
observes, “often crisis situations can be
resolved over the phone, dramatically
reducing the need for law enforcement
intervention.”
We included both calling police and
calling 911 to understand whether there
is a difference in preferences between
calling 911 generally, or specifically call-
ing to request police. Police are typically
first responders to mental health crises
when a 911 call is made, whether or not
the caller requests a medical response.
Examining preferences for both allows
us to identify whether respondents
understand this. We found 65 percent
of respondents would call 911, 19 per-
cent would call the police, and 62 percent
would call a crisis line (see the left side
of the first figure). Of those who would
call police, 88 percent would also call
911. However, the reverse is not true––of
those who would call 911, only 26 per-
cent would also call police––suggesting a
majority of those who would call 911 are
not seeking a police response.
We also asked respondents, “In
general, to what extent do you trust the
following people? (Police officers).” We
created this survey question to directly
assess respondents’ trust in police. Trust
in police was generally high: 11 percent
of respondents trust police “completely,”
64 percent trust police “quite a lot,” 24
percent “a little,” and only 1 percent
“not at all.” In line with national public
opinion polls, we find diverging views
by race (Figure on the top left)––White
respondents trust police “completely”
or “quite a lot” (82 percent combined)
more than other respondents, with Black
or African American respondents trusting
police the least (40 percent combined).
We also examined how trust in
police is associated with respondents’ call
preferences if a loved one was experienc-
ing a mental health crisis. We find lower
levels of trust in police are associated with
fewer respondents willing to call 911
or police––reinforcing that respondents
understand calling 911 leads to a police
response, which some don’t want.
Figure on the bottom left shows
that
among respondents who trust police
“completely,” 70 percent would call 911
versus 62 percent of respondents who
trust police “a little.” Of respondents
who trust police “completely,” 21 per-
cent would call the police versus only
13 percent who trust police “a little.”
We don’t examine call preferences of
respondents who trust police “not at all”
because there are too few responses to
reliably provide insight.
Conversely, lower levels of trust in
police are associated with respondents
preferring a mental
illness crisis line.
The figure on the top left shows that
among respondents who trust police
“completely,” 50 percent would call a
percent
Trust in the police by race or ethnicity
Source: Mental Health in Congregations Study (2020)
Not at all
A little Quite a lot Completely
10 20 30 40 50 60 70 80 90 100
White
Black or African American
Hispanic or Latino
Other
10
20
30
40
50
60
70
80
90
100 percent
I would call 911 I would call a
mental illness crisis line
I would call the police
Trust in police and call preferences in a mental health crisis
Source: Mental Health in Congregations Study (2020)
A little Quite a lot Completely
Lower levels of trust in police are associated
with fewer respondents willing to call 911 or
police
62 contexts.org
mental illness crisis line versus 67 percent
of respondents who trust police “a little.”
Finally, we jointly examined trust in
police and race––is trust in police a proxy
for underlying racial or ethnic differences?
There are too few respondents who trust
police “completely” to include an analysis
of their call preferences by race, so we
examined preferences of those who trust
police “a little” or “quite a lot.”
As shown in the figure above, there
is a positive association between trust in
police and preferences to call police. For
example, while only 15 percent of Afri-
can Americans who trust police “a little”
would call police, 30 percent of African
Americans who trust police “quite a lot”
would do the same. However, there are
important differences by race and eth-
nicity: when taking into account trust in
police, Whites are less likely than African
Americans or Hispanics to want to call
police. For example, only 8 percent of
Whites who trust police “a little” and 20
percent of Whites who trust police “quite
a lot” would call police.
The inverse is true for preferences
to call a mental illness crisis line: higher
levels of police trust are associated with a
lower likelihood that a respondent would
call a mental illness crisis line. However, as
with preferences to call police, there are
differences by race and ethnicity––when
taking into account trust in police, Afri-
can Americans are less likely than Whites
or Hispanics to want to call a mental
illness crisis line.
How policy makers fund, support,
and publicize mental illness crisis lines for
individuals seeking alternatives to a police
response is critical. Communities of color,
in particular, experience a lack of access
to good quality mental health care which
can lead to a cycle of “more severe symp-
toms, greater criminal involvement, and
more frequent arrest.” African Americans
disproportionately face barriers to mental
health care, including a lack of insurance
and not receiving appropriate informa-
tion about services, as well as deterrents
including a lack of culturally competent
providers, and being less likely than
Whites to receive guideline-consistent
care. As a result, African Americans are
less likely than Whites to access mental
health specialists. Only one in three Afri-
can American adults who needs mental
health care receives it, and––as our data
show––African Americans are less likely
than Whites or Hispanics to want to use
a mental illness crisis line.
Therefore, if resources intended to
divert people in crisis away from a police
response will be successful, work needs
to be done to raise awareness of alterna-
tives and encourage conversations about
mental health. As the National Alliance
on Mental Illness argues, “we need bet-
ter access to care and crisis services for
Black people with mental illness. One
way we do that is by giving communities
another option to call when a neighbor or
loved one is experiencing a mental health
crisis… When 988 finally goes live, let’s
all be mobilized and ready to greet it.”
This study was funded by the John
Templeton Foundation (#61107). A full
list of recommended readings can be
found in the online at www.contexts.org.
Emma Frankham is a writer and researcher who
received her PhD from the University of Wisconsin–
Madison. She publishes on mental illness, incarcera-
tion, and policing. Christopher Jacobi is a Research
Scholar in the Sociology Department at The Catholic
University of America and a DPhil student at Nuffield
College, University of Oxford. He is interested in mental
health research, organizational research on the Catho-
lic priesthood, and statistical methodology. Brandon
Vaidyanathan is an Associate Professor and Chair
of Sociology at The Catholic University of America. His
research examines the cultural dimensions of religious,
commercial, medical, and scientific institutions.
trends
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A protest sign at the April 2018 vigil for
Decynthia Clements.
10
20
30
40
50
60
70
80
90
100 percent
54%
A little Quite a lot A little Quite a lot A little Quite a lot A little Quite a lot
White Hispanic or Latino OtherBlack or African
American
Racial or ethnic differences in trust in the police and call preferences
in a mental health crisis
Source: Mental Health in Congregations Study (2020)
I would call 911 I would call a mental illness crisis line I would call the police
How policy makers fund, support, and publicize
mental illness crisis lines for individuals seeking
alternatives to a police response is critical
46 contexts.org
Fl
ic
kr
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C
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S
am
F
el
d
er
by kerry dobransky and eszter hargittai
people with
disabilities
during
COVID-19
The spread of COVID-19 across the globe hit everybody hard, bringing
to the forefront concerns for the lives of older adults, those living in
elder care facilities, and those with existing medical conditions, groups
for which the pandemic poses a particularly high risk. While mask
mandates and public service announcements from celebrities and
politicians are peppered with pleas for these vulnerable populations,
others argue freedom and economic recovery are worth risking their
lives. What is now a very public debate has been played out behind
the scenes long before this current crisis. People with disabilities are
used to having their worth questioned, their value and cost to society
weighed, their risk calculated, all with relatively little voice themselves.
What is it like to live with this increased risk during a pandemic? In this
piece, we compare the experiences of people with disabilities (PWD)
with those without during the Coronavirus pandemic.
http://crossmark.crossref.org/dialog/?doi=10.1177%2F1536504220977935&domain=pdf&date_stamp=2020-12-14
47FA L L 2 0 2 0 c o n t e x t s
Findings revealed distinct vulnerabilities to COVID-19 for PWD
and those around them. We learned that in some ways their
experiences mirror those of the wider society, but in others,
PWD’s marginalized status was reflected in their concerns and
fears during a societal crisis.
social worth in a pandemic
People with disabilities are accustomed to living life through
the paradox of invisibility and hypervisibility. Erving Goffman
long ago laid out the discomfort “normals” feel when they are
confronted with stigmatized individuals in interaction, leading
to awkwardness for both sides. To avoid this, people at times
will go out of their way to ignore people with disabilities, what
Spencer Cahill and Robin Eggelston refer to as “nonperson
treatment.” On the other hand, Cahill and Eggelston point out
that some people will assume the paternalistic right to “help”
those with impairments in ways they did not ask for or need.
Many people with disabilities make use of assistance from
others to carry out their daily activities. From a disability rights
standpoint, however, the assistance should be directed by the
impaired individuals themselves.
Polite interaction is one thing, but when people with dis-
abilities enter healthcare contexts, issues of risk and worth
come to the fore. The stakes can be life and death. Angela
Frederick has shown how pregnant women or mothers with dis-
abilities are subjected to the “medical stare.”
While their own needs for accessible care
remain invisible, they are seen as a risk to their
(future) children simply by having a disability,
with no clear medical risk evident. Moreover,
their pregnancy itself can be seen as wrong
because they could pass their disability on
to their children—implying (or stating) that
such a child should not be born. As Frederick points out, all
of this occurs while relatively little effort is made to make the
mothers’ own medical care accessible. Both David Sudnow and
Stefan Timmermans have demonstrated how such estimations
of worth can translate into the likelihood of death in health care
settings. As the recent statement by Laura Mauldin and others
in the American Sociological Association’s Footnotes newsletter
highlights, these issues show how disability is a major axis of
inequality that is highly salient during this pandemic.
The social worth of the vulnerable such as people with
disabilities was raised through debates and protests regarding
state lockdown policies. In addition to protesters displaying
homemade signs about needing haircuts, trusting in Jesus, and
governmental overreach, one person in Tennessee held a sign
demanding, “Sacrifice the Weak | Reopen TN.” A California city
commissioner spelled out the sentiment in even more detail in a
Facebook post: “A herd gathers it [sic] ranks, it allows the sick,
the old, the injured to meet its [sic] natural course in nature.
[..] Then we have our other sectors such as our homeless and
other people who just defile themselves by either choice or
mental issues. This would run rampant through them and yes i
am sorry but this would fix what is a significant burden on our
Society [sic] and resources that can be used.” The post garnered
comparisons to Nazi eugenicists and led to the commissioner’s
removal. Nevertheless, the Lieutenant Governor of Texas, Dan
Patrick, argued that many grandparents, including himself,
would be (or should be) willing to sacrifice their lives to reopen
the economy, adding, “So my message is let’s get back to work,
let’s get back to living. Let’s be smart about it and those of us
who are 70-plus, we’ll take care of ourselves.” After his National
Economic Council Chairman Larry Kudlow stated that reopening
the economy would entail “some difficult tradeoffs,” President
Trump acknowledged that the death toll is “bad,” but nonethe-
less insisted that the country should reopen.
These discussions about the priority of protecting the vulner-
able play out in the context of scarcity resulting from the social and
economic upheavals of the pandemic. Hoarding and supply-chain
issues surrounding food, toiletries, medications, and other basic
necessities favor those with the resources and mobility to hunt
them down. Even worse, when healthcare resources are stretched
thin, official policies are referenced to determine who has priority
to life-saving care. Unfortunately, as media producer and activist
Alice Wong, who herself lives with disabilities and regularly uses a
ventilator, put it, “The ethical frameworks for rationing often put
people like me at the bottom of the list.” The U.S. Department of
Health and Human Services Office of Civil Rights issued a bulletin
alerting medical providers that rationing medical care based on
disability is discriminatory and illegal. However, prominent medical
scholars such as Ezekiel Emanuel and others have justified such
rationing, and guidelines that do so remain in place in some
healthcare organizations and state policies.
Such considerations have historically been made without
input from people with disabilities themselves. Too often, the
need for assistance has been equated with childlike dependence
on the paternalistic whims of service providers and politicians. As
Sharon Barnartt and Richard Scotch have pointed out, the hard
work of disability activists has led to changes, but as the pan-
demic has underlined, there is still work to be done in ensuring
PWD are given voice in the decisions that impact their lives. One
step in addressing our current crisis is to document the experi-
ence of those impacted by it, especially when such experience
is discounted or silenced. This is what we did.
surveying americans during lockdown
In early April, we surveyed a national sample of US adults
One step in addressing our current crisis is to
document the experience of those impacted
by it, especially when such experience is
discounted or silenced.
Contexts, Vol. 19, Issue 4, p. 46-49. ISSN 1536-5042. © American Sociological Association.
http://contexts.sagepub.com. 10.1177/1536504220977935.
48 contexts.org
about their experiences with COVID-19. Hosting the survey on
the Qualtrics platform, we contracted with the online survey
company Cint to reach 1,374 American adults. We set quotas
for age, gender, education, and region to match U.S. Census
figures. Cint’s panel has a double opt-in format: people have to
sign up for inclusion in the panel and then verify their interest in
participation, an approach that has been shown to result in few
or no significant differences compared to traditional modes of
sampling. To be sure, our study would have missed people in the
most severe of circumstances, e.g., fighting COVID-19 on respi-
rators in hospital beds, but those are the types of people unlikely
to be represented in other types of survey projects as well.
At the start of our data collection, over 300,000 Americans
had tested positive for COVID-19, and over eight thousand
had died. We asked respondents whether they had various
long-lasting conditions, and overall, just under 16
percent
of
respondents had one or more, matching figures from the U.S.
Census Bureau’s Current Population Survey (our questions about
disabilities are similar to the ones they use). We asked about
the following communicative disabilities: blindness or severe
vision impairment even with glasses or contact lenses; deafness
or a severe hearing impairment even with a hearing aid; and
serious difficulty having their speech understood. Such people
make up somewhat less than six percent of the total sample.
We also asked about serious difficulty walking or climbing stairs,
dressing or bathing, and typing on a traditional computer key-
board. These we grouped together as physical disabilities; such
people account for a bit over eight percent of the entire sample.
We asked if respondents had serious difficulty concentrating,
remembering, or making decisions (hereafter, cognitive impair-
ments), a group that makes up five percent of the total sample.
Finally, we asked if people experienced serious difficulty going
outside the house alone, which three percent of the sample
indicated. We then looked at whether there are differences
between each of these groups compared to the rest of the
sample when it comes to personal experiences with COVID-19,
elevated worries since the outbreak, and the pandemic’s effects
on home circumstances. Here is what we found.
PWD reported COVID-19 as featuring much more promi-
nently in their personal lives and social circles than people
without disabilities (Respondents’ personal experiences with
COVID-19). Among PWD, 64 percent reported health conditions
that put them in the medically high-risk category for COVID-19
compared to under a third of those who have no disabilities.
One in ten PWD in our sample reported having been diagnosed
with COVID-19 compared to just one case among the 1160
participants without impairments. PWD were also much more
likely to know others with the novel coronavirus: 23 percent of
PWD said they knew someone. This compares to 14 percent of
people without disabilities reporting they know someone with
COVID-19. PWD were also much more likely to know people
who have died from the disease: 13 percent with any disability
reported this compared to four percent of others. It is clear from
these statistics that PWD had very different personal experiences
with the pandemic. Next, we turn to how these were reflected
in their home situations.
home circumstances
We asked respondents: “How does the current Coronavirus
pandemic affect your circumstances at home?” inquiring about
both positive aspects like having more calmness and relaxation
as well as negative repercussions like feeling trapped. PWD
expressed notable experiences on both ends of the spectrum
(Reported pandemic effects on home circumstances). Thirty-five
percent reported their family relationships were stronger during
the pandemic, and 24 percent reported more calmness and relax-
ation, compared to 27 percent and 20 percent of those without
impairments, respectively. Especially notable here are people
with communicative disabilities, of whom 29 percent reported
experiencing more calmness and relaxation. On the other hand,
nearly a third (30 percent) of PWD reported more conflicts at
home and over half (51 percent) reported feeling trapped, with
Respondents’ personal experiences with
COVID-19
20
40
60
80
100 percent
Any disability No disability
Is high risk Knows someone
with COVID-19
Knows someone
who died of
COVID-19
Has COVID-19
Reported pandemic effects on home circumstances
20
40
60
80
100
Any disability No disability
Feeling
trapped*
Lack of
personal
space**
More
conflict**
More
personal
time
Stronger
family*
More calm
Negative effects Positive effects
*p<.1 **p<.001
percent
49FA L L 2 0 2 0 c o n t e x t s
19 percent and 45 percent of those without disabilities saying
these characterized their home situation. Two thirds of those with
cognitive impairments (66 percent) and 57 percent of those who
had difficulty leaving home reported feeling trapped, perhaps not
surprisingly as these are two groups particularly likely to feel the
impact of limited physical contact with others outside the home.
Those with impairments were also more likely to report a lack of
personal space or alone time: over a third (34 percent) reported
this, with only 23 percent of those without disabilities saying
this characterized them. Overall, a larger portion of those with
disabilities reported negative experiences in their homelife, with
63 percent reporting such experiences compared to 56 percent of
people without impairments. There was no statistically significant
difference between people with and without disabilities in report-
ing that they have more personal time, with 42 percent of PWD
versus 45 percent of those without reporting this.
worries
Another question asked respondents: “Since the Coronavi-
rus outbreak, have any of the following been worrying you more
than usual, even if only in a minor way?” Domains we inquired
about included finances, safety, Internet access, as well as future
plans (Reported worries since the coronavirus outbreak). In many
areas, PWD as a whole did not notably depart in their wor-
ries from those without reported impairment: concerns about
finances, safety, Internet, and future plans showed minimal
differences between the two groups. Here we highlight some
of the statistically significant differences we found.
In a time of hoarding, PWD were particularly concerned
about obtaining food or medication: 62 percent mentioned this
concern compared to 48 percent of those without disabilities.
Boredom was another worry disproportionately expressed by
those with impairment, with 45 percent reporting it compared
to 38 percent of those without impairments. Respondents with
cognitive impairments were especially likely to report worries,
expressing higher levels on nearly every worry we asked about.
Unexpectedly, a smaller proportion of people with physical dis-
abilities expressed worry about their future plans: 42 percent
reported this worry, compared to 49 percent of those without
disabilities. Overall, while PWD did not vary that much from
those without in their worries, there is nonetheless a statistically
significant (p<.01) difference in the number of worries they
indicated, which is 3.0 for PWDs compared to 2.7 for others.
People with communicative disabilities stood out from
those with other disabilities in their concerns. While respondents
with these impairments expressed no difference from others in
worries about getting food or medicine, they were particularly
worried about their Internet access (something no other disability
subgroup reported). Twenty-seven percent indicated this worry,
compared to just 17 percent of those who did not report having
a disability. This likely reflects that these types of impairment
do not often require medication but do benefit from assistive
technology—especially in a pandemic where information and
communication technologies are increasingly important for
communicating with others.
listening and acting
Overall, our findings document the experiences and con-
cerns of people with disabilities during the pandemic. We show
that COVID-19 has been deeply relevant to PWD and those with
whom they are connected. In some domains, PWD experienced
the pandemic differently from others. While seemingly everyone
has been affected by this crisis, those with impairments had their
home situations and their relationships impacted more. On the
other hand, PWD shared many of the same worries as the rest
of society. Areas where they stood out (e.g., food and medicine)
relate to the need for assistance and threats to resource access
that has been brought to the fore in the current crisis.
Although the United States has been at the forefront in
many efforts to make society more accessible for PWD (e.g., legal
protections through the Americans with Disabilities Act and the
Individuals with Disabilities Education Act), codified rights do not
necessarily ensure inclusion and support. Such policy gains are
subject to backlash and cuts in funding that may be especially
salient at the time of an unprecedented global pandemic. Support
that is offered needs to attend to the stated needs and concerns of
people with disabilities themselves. We live in a society where PWD
are openly mocked by top leaders. Thus, fears that hard-fought
victories could be fragile, especially during times of national crisis,
are understandable. Given our tumultuous global context, extra
vigilance should be taken to resist attempts to marginalize people
with disabilities, in rhetoric, in services, and in policy.
Kerry Dobransky is in the Sociology Department at James Madison University.
Eszter Hargittai is in the Communication and Media Research Department at
the University of Zurich. Dobransky studies health and health care, disability, and
information and communication technologies. Hargittai is editor of Research Exposed:
How Empirical Social Science Gets Done in the Digital Age (Columbia University
Press, 2020).
Reported worries since the coronavirus outbreak
20
40
60
80
100
Any disability No disability
Food or
medications**
Finances Safety Future
plans
Boredom* Internet
*p<.1 **p<.001 percent
