Support for Human and Civil Rights in Physical Disability, Mental Illness, and Substance Use Disorder

While there is much research on stigma toward marginalized populations, public perceptions regarding deservingness of basic human and civil rights of these groups have not been examined in a nationwide sample of US adults.

To understand the US public's perceptions regarding deservingness of basic human and contested civil rights for people with severe physical disabilities (SPDs), severe mental illness (SMI), and substance use disorders (SUDs).

This cross-sectional study was a nationwide US internet-based quota panel survey of US adults (aged ≥18 years) who completed the survey. Responses were collected from January 17 to February 12, 2025.

Participants rated their support for 5 human rights (adequate standard of living, high standards of health, legal capacity, freedom from torture, living independently) and 3 civil rights (being a parent, running for political office, owning a gun) for people with SPDs, SMI, and SUDs using a 5-point Likert scale, with marginalized subgroups presented to participants in randomized order. McNemar test for paired binary data was used to examine differences in mean support across subgroups, and linear probability regression models were used to identify demographic variables associated with support.

In this survey of 1442 US adult participants (849 female [58.9%]; 588 male [40.8%]; 3 nonbinary [0.2%]; and 2 preferred not to say [0.1%]), the SPD subgroup received significantly higher support across all 5 human rights and 3 civil rights compared with SMI and SUD subgroups. For example, 79.0% (95% CI, 76.9%-81.2%) of participants supported the right to live independently for people with SPDs, while 67.0% supported this right for those with SMI (95% CI, 64.6%-69.5%) and 68.4% supported this right for those with SUDs (95% CI, 66.0%-70.9%). Civil rights received lower support across all 3 subgroups; for example, 40.1% (95% CI, 37.5%-42.6%) supported the right to run for political office for those with SMI and 41.4% (95% CI, 38.8%-44.0%) for those with SUDs compared with 62.7% (95% CI, 60.1%-65.2%) for those with SPDs. Democratic affiliation and lived experience with behavioral health care were associated with higher support for human rights (eg, among those with SUDs, up to 17.1 and 14.2 percentage points higher support, respectively). Male sex and younger age (18-24 years) were associated with greater support for civil rights (eg, male sex with 17.9 percentage points higher support for gun ownership among those with SPDs and age 18-24 years with a 27.1 percentage-point difference among those with SMI).

These findings contribute important evidence to the existing literature on stigma, highlighting discrepancies in public support for basic human and contested civil rights across marginalized subgroups, which can inform interventions to address public attitudes toward people with behavioral health conditions.