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

Jessica Williams; Mia Kouveliotes; Nev Jones; Morgan C Shields

doi:10.1001/jamahealthforum.2026.3431

. 2026 Oct 2;7(10):e263431. doi: 10.1001/jamahealthforum.2026.3431

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

Jessica Williams ¹, Mia Kouveliotes ^2,³, Nev Jones ⁴, Morgan C Shields ^3,^✉

¹Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri

²College of Arts and Sciences, Washington University in St Louis, Missouri

³School of Public Health, Washington University in St Louis, Missouri

⁴School of Social Work, University of Pittsburgh, Pennsylvania

Accepted for Publication: July 21, 2026.

Published: October 2, 2026. doi:10.1001/jamahealthforum.2026.3431

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License, which does not permit alteration or commercial use, including those for text and data mining, AI training, and similar technologies. © 2026 Williams J et al. JAMA Health Forum.

^✉

Corresponding Author: Morgan C. Shields, PhD, Washington University in St Louis, One Brookings Dr, MSC 1196-251-46, St Louis, MO 63130 (mshields@wustl.edu).

Author Contributions: Ms Kouveliotes and Dr Shields had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Williams, Jones, Shields.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Williams, Kouveliotes, Shields.

Critical review of the manuscript for important intellectual content: Williams, Jones, Shields.

Statistical analysis: Williams, Kouveliotes.

Obtained funding: Shields.

Administrative, technical, or material support: Shields.

Supervision: Shields.

Conflict of Interest Disclosures: Dr Williams reported grants from the National Institute on Drug Abuse Supported through T32DA015035, which provided protected research time during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Shields was supported by grant K12DA04144908 from the National Institute on Drug Abuse (NIDA) during the conduct of the study. Dr Williams was supported by grant T32DA015035 from NIDA.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2.

^✉

Corresponding author.

PMCID: PMC13633534 PMID: 42826030

This cross-sectional study reports on US public attitudes toward deserved rights of people with severe physical disabilities, mental illnesses, or substance use disorders.

Key Points

Question

How do US adults perceive deservingness of rights in people with severe physical disabilities, mental illnesses, and substance use disorders?

Findings

In this cross-sectional study using a national survey, 1442 US adult participants endorsed more support for rights of people with severe physical disabilities compared with people with severe mental illness or substance use disorders. Participants supported human rights (eg, adequate standard of living) more than civil rights (ie, running for office); political affiliation, lived experience, age, and gender were associated with support ratings.

Meaning

Results of this study suggest that public support for the allocation of rights varies based on characteristics of the right, the rater, and the marginalized person.

Abstract

Importance

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.

Objective

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).

Design, Setting, and Participants

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.

Main Outcomes and Measures

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.

Results

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).

Conclusions and Relevance

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.

Introduction

Human rights frameworks establish that every person is entitled to dignity, autonomy, and participation in society, regardless of identity, circumstance, or health status,¹ while disability rights frameworks call for equality, accessibility, and nondiscrimination for people with disabilities.² Yet, people with substantial disabling limitations, such as severe physical disabilities (SPDs), severe mental illness (SMI), and severe substance use disorders (SUDs), have historically faced exclusion from society, such as through involuntary institutionalization and discrimination.^3,4,5,6 While the United Nations’ 2006 Convention on the Rights of Persons with Disabilities (CRPD)^2,7 aims to combat such exclusions worldwide, there is minimal knowledge of how these rights are perceived and supported by the public. Research is particularly limited in the US,^8,9 which signed the CRPD in 2009 without having since ratified it.¹⁰

Public attitudes influence perceived legitimacy of human rights protections, shape policy adoption and implementation, and can reinforce stigma and discrimination.¹¹ Stigma-focused research has found hierarchies in how these groups are viewed: people with SPDs are generally viewed more favorably than those with SMIs, who are viewed more favorably than those with SUDs,^4,12,13 reflecting historical exclusion of these groups from disability rights discourses. Such patterns may also be seen with human rights, where public attitudes are shaped by social hierarchies¹⁴ and perceptions of deservingness.^15,16,17,18 Understanding community sentiment toward human rights for these groups is imperative amid policy debates over coercive measures addressing homelessness,¹⁹ mental illness,²⁰ and substance use,²¹ all of which can challenge the balance between autonomy and safety of marginalized groups and the public.

Beyond fundamental human rights, several civil rights—that is, rights held as a citizen or resident under a particular governance—remain highly contested for people with SPDs, SMIs, and SUDs, including rights to be a parent, to run for political office, and to own a gun. While parental rights are often conceptualized as human rights related to reproductive freedom, the right to raise children involves civil considerations around custody, family autonomy, and state intervention. These issues altogether have become particularly salient as questions arise about how these rights can be exercised without jeopardizing federal disability benefits^22,23 or public safety.²⁴ Currently, statutes in 42 states and Washington, DC, retain parental disability as grounds for termination of parental rights,²⁵ often without evidence of abuse or neglect. Mental illness is frequently blamed after mass shootings,²⁶ despite research consistently showing that psychiatric conditions are poor predictors of gun violence.^20,27,28 Although substance use is commonly cited in family separation,²⁹ many parents have little or no access to effective supports, and mandated interventions³⁰ delivered without regard to family context can be harmful.³¹ These challenges reveal how stigma and policy intersect and highlight the need to empirically examine how the public views deservingness of rights for marginalized populations.

This study examines US public attitudes toward 5 human rights outlined in the CRPD (selected for their international consensus) and 3 contested civil rights (ie, parenting, running for office, and gun ownership; selected for their timeliness to current affairs). Given prior evidence on stigma variation, we hypothesized that people with SPDs would be viewed as more entitled to such rights than people with SMIs or SUDs. We further posited that support would be greater for the human rights evaluated than for the civil rights, as the latter more directly involve others and raise concerns about risk, liability, and public safety. We provide insight into perceptions of rights for marginalized groups, expanding on insights from stigma-focused research.

Methods

Data

We conducted a cross-sectional national survey of US adults from January 17 to February 12, 2025, using the Qualtrics’ research panel, which recruits from online participant pools using quota-based sampling to approximate national demographic census estimates by gender, age, race, ethnicity, income, education, and region^32,33 (eAppendix in Supplement 1). Participants were shown an initial survey page with study information and consented to participate by selecting the “Next” button. This study was approved by the Washington University in St Louis Institutional Review Board. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies was followed.

Measures

Primary Outcome

Participants were asked to rate their level of support for 8 total rights for individuals with SPDs, SMIs, and SUDs. Prefacing each subgroup, “severe” was defined in the survey as “conditions that substantially limit a person in at least one area of life.” The 5 CRPD-derived human rights were adequate standard of living; enjoyment of the highest attainable standards of physical and mental health; exercise legal capacity and the right to personal liberty and security of the person; freedom from torture or cruel, inhumane, or degrading treatment or punishment and from exploitation, violence, and abuse; and live independently and be included in the community. The 3 civil rights included being a parent, running for political office, and gun ownership. Participants indicated their support for each right on a 5-point Likert scale. For analyses, ratings were dichotomized into a binary outcome: strongly support/support vs unsure/do not support/strongly do not support. To control for ordering effects, subgroups (SPD, SMI, SUD) were presented to participants in a randomized order.

Variables

Demographic characteristics were assessed to evaluate potential differences in public support ratings. All demographic information was self-reported. Participants were asked their age (18-24, 25-34, 35-44, 45-54, 55-64, ≥65 years), sex or gender (male, female, nonbinary, prefer not to say), race (selected all that applied from American Indian/Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, White, other), ethnicity (non-Hispanic, Hispanic), income (<$25 000, $25 000-$49 999, $50 000-$74 999, $75 000-$99 999, $100 000-$149 999, ≥$150 000), educational level (less than high school, high school diploma, some college/trade school [still working], some college/trade school [not likely to finish], trade school or associate’s degree, 4-year degree, some graduate school, graduate/professional degree), political affiliation (Republican, Democrat, Independent, no preference, other), and region (Northeast, Midwest, South, West), and prior experiences with behavioral health care services (either personally or through a loved one).

Statistical Analysis

Descriptive sample characteristics were weighted on demographic factors used in quota sampling to account for residual differences in representativeness compared with national census estimates. Mean support for each right across subgroup (SPD, SMI, SUD) was then described as percentages with 95% CIs, and differences were examined using McNemar test for paired binary data using unweighted data. The within-person design controlled for potential confounders that might explain differences in responses across marginalized subgroups not attributable to the subgroup descriptions themselves. Fully adjusted multiple linear probability regression models were run using unweighted data for each marginalized subgroup outcome to estimate independent associations between demographic characteristics and support for each right. Because the support outcome was interpreted as binary, each β coefficient represents the absolute difference in the probability of supporting a given right relative to the reference category and is reported in the text as a percentage-point difference (ie, β × 100), facilitating direct comparison between demographic groups and easier interpretation for policy implications.³⁴ Sensitivity analyses included running the adjusted linear models using survey weights and using the Benjamini-Hochberg procedure to control the false discovery rate (FDR). Statistical significance was assessed at P < .05. All P values were 2-tailed. SPSS statistical software version 31 (IBM Corporation) was used for analyses.

Results

Sample Characteristics

The study sample included 1442 respondents across the US. Overall, 64.6% of participants (n = 931) ranged from ages 25 to 64 years, with 31.8% (n = 458) aged 65 years and older and 3.7% (n = 53) aged 18 to 24 years. Participants were largely of non-Hispanic or Latino ethnicity (1314 [91.1%]) or White race (1127 [78.2%]); other race and ethnicity categories included American Indian or Alaska Native (19 [1.3%]), Asian (45 [3.1%]), Black or African American (176 [12.2%]), Latino or Hispanic (128 [8.9%]), Native Hawaiian or Other Pacific Islander (8 [0.6%]), multiracial (>1 race; 36 [2.4%]), and other (31 [2.1%]). There were 849 females (58.9%), 588 males (40.8%), 3 nonbinary (0.2%), and 2 who preferred not to say (0.1%); 1276 (88.5%) participants reported being heterosexual. Educational attainment was distributed approximately in thirds: high school or less, some college or trade school, and 4-year college degree or higher. Almost two-thirds of the participants reported annual household incomes under $75 000. Unadjusted weighted sample characteristics are reported in Table 1. Although the sample approximated national benchmarks on several dimensions, the unweighted sample differed notably from census estimates³⁵ in age composition (adults aged 18-24 years were underrepresented [3.7%; 95% CI, 2.7%-4.7% vs 11.7% weighted] and those aged 65 years and older were overrepresented [31.8%; 95% CI, 29.4%-34.2% vs 21.1% weighted]), as well as in educational attainment, income, and Latino/a/x ethnicity (8.9%; 95% CI, 7.43%-10.37% vs 17.6% weighted).

Table 1. Demographic Characteristics of the Study Population.

Variable	No. (%)
Variable	Unweighted (n = 1442)	Weighted
Age
18-24 y	53 (3.7)	168 (11.7)
25-34 y	249 (17.3)	251 (17.4
35-44 y	252 (17.5)	244 16.9)
45-54 y	250 (17.3)	223 (15.4)
55-64 y	180 (12.5)	253 (17.5)
≥65 y	458 (31.8)	303 (21.1)
Sex and gender
Female	849 (58.9)	735 (51.0)
Male	588 (40.8)	707 (49.0)
Nonbinary/third gender	3 (0.2)	0
Prefer not to say	2 (0.1)	0
Race^a
American Indian or Alaska Native	19 (1.3)	18 (1.2)
Asian	45 (3.1)	94 (6.6)
Black or African American	176 (12.2)	189 (13.2)
Native Hawaiian or Other Pacific Islander	8 (0.6)	WNA
White	1127 (78.2)	1105 (76.8)
Multiracial (selected >1 race)	36 (2.4)	32 (2.2)
Other	31 (2.1)	0
Ethnicity^a
Latino/a/x or Hispanic	128 (8.9)	254 (17.6)
Not Latino/a/x or Hispanic	1314 (91.1)	1188 (82.4)
Sexual orientation
Heterosexual	1276 (88.5)	WNA
Bisexual	64 (4.4)
Gay/lesbian	31 (2.2)
Other^b/prefer not to disclose	71 (4.9)
Educational level
Less than high school	44 (3.1)	458 (31.8)
High school diploma/GED	378 (26.2)	458 (31.8)
Some college or trade school	286 (19.8)	381 (26.4)
Completed trade school or an associate’s degree	223 (15.5)	381 (26.4)
Completed a 4-y degree	304 (21.1)	358 (24.8)
Some graduate school	36 (2.5)	245 (17.0)
Completed a master’s, JD, or other professional	171 (11.9)	245 (17.0)
Income
<$25 000	292 (20.2)	204 (14.1)
$25 000-$49 999	294 (20.4)	248 (17.2)
$50 000-$74 999	368 (25.5)	226 (15.7)
$75 000-$99 999	207 (14.4)	175 (12.1)
$100 000-$149 999	185 (12.8)	589 (40.9)
≥$150 000	96 (6.7)	589 (40.9)
Prior lived experience with behavioral health care settings^c
Participant had lived experience	448 (31.1)	WNA
Participant’s loved one had lived experience	620 (43.0)	WNA

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Abbreviations: GED, General Educational Development; JD, Juris Doctor; WNA, weights not applied.

^{^a}

Race and ethnicity were ascertained by self-report. For race, participants could select all that applied, including "Other."

^{^b}

“Other” options included fluid, pansexual, queer, questioning/unsure, same-gender-loving.

^{^c}

Characteristics not mutually exclusive.

Perceived Entitlement of Human and Civil Rights Across Marginalized Subgroups

Across human and civil rights, participants endorsed significantly higher support for those with SPDs compared with those with SMI and SUDs (Figure). For example, the right to live independently for people with SPDs was supported by 79.0% (95% CI, 76.9%-81.2%) of participants compared with 67.0% (95% CI, 64.6%-69.5%) for those with SMI and 68.4% (95% CI, 66.0%-70.9%) for those with SUDs.

Grouped horizontal bar chart of participant percent support for rights by subgroup. Horizontal grouped bar chart with eight labeled rows of rights on the vertical axis and a horizontal axis labeled Participants, percent, with tick marks from 0 to 100 in steps of 10. Each row contains three adjacent horizontal bars with thin black outlines and rightward error bars. A legend in the lower right maps light blue to Severe physical disabilities, light orange to Severe mental illness, and dark teal to Severe substance use disorders. Row 1, Right to adequate standard of living, has bars near 78 percent for light blue, about 74 percent for light orange, and about 68 percent for dark teal, each with short 95 percent confidence interval whiskers. Row 2, Right to enjoyment of the highest attainable standards of physical and mental health, has bars near 79 percent light blue, about 76 percent light orange, and about 72 percent dark teal. Row 3, Right to exercise legal capacity and the right to personal liberty and security of the person, has bars near 78 percent light blue, about 69 percent light orange, and about 68 percent dark teal. Row 4, Right to freedom from torture or cruel, inhumane, or degrading treatment or punishment and from exploitation, violence, and abuse, has bars near 80 percent light blue, about 79 percent light orange, and about 75 percent dark teal. Row 5, Right to live independently and be included in the community, has bars near 79 percent light blue, about 67 percent light orange, and about 69 percent dark teal. Row 6, Right to be a parent, has bars near 67 percent light blue, about 50 percent light orange, and about 49 percent dark teal. Row 7, Right to run for political office, has bars near 63 percent light blue, about 40 percent light orange, and about 42 percent dark teal. Row 8, Right to own a gun, has bars near 45 percent light blue, about 30 percent light orange, and about 29 percent dark teal. Several right labels include small letter markers a, b, and c appended to the text. — The percentages of participants (n = 1442) who supported or strongly supported a given right on a Likert scale for a given marginalized subgroup are shown. The error bars indicate 95% CIs for the estimation of support. Within-participant differences between condition subgroups were examined post hoc using McNemar test for paired binary data. All P values are 2-tailed. Because significance was calculated using a within-participant paired design, the 95% CIs for the overall percentages may overlap even where pairwise differences are statistically significant.

^aSupport for those with severe mental illness was significantly lower than for those with severe physical disability (P < .05).

^bSupport for those with substance use disorder was significantly lower than for those with severe physical disability (P < .001).

^cSupport for those with substance use disorder was significantly lower than for those with severe mental illness (P ≤ .004).

Support for all assessed civil rights was overall lower compared with human rights, although this remained higher for those with SPDs compared with those with SMI and SUDs (Figure). For example, 62.7% (95% CI, 60.1%-65.2%) of participants supported the right of those with SPDs to run for political office compared with a minority of participants supporting this right for those with SMI (40.1%; 95% CI, 37.5%-42.6%) and for those with SUDs (41.4%; 95% CI, 38.8%-44.0%). This pattern was consistent across the other 2 civil rights to be a parent and to own a gun, the latter of which had the lowest support.

The SMI subgroup received significantly more support than the SUD subgroup for 4 human rights and the right to be a parent, where the maximum difference (5.7 [95% CI, 3.40-8.00] percentage points; P < .001) was regarding the right to an adequate standard of living (eTable 1 in Supplement 1).

Variables of Support for Human and Civil Rights

In the SPD subgroup (Table 2), all human rights received more support from Democrats compared with Republicans by at least 5.4 (95% CI, 0.6-10.3) percentage points, with the right to live independently showing the greatest difference at 8 (95% CI, 3.0-13.0) percentage points (P = .002). Participants who had lived experience with behavioral health care showed more support for human rights by at least 5.9 (95% CI, 1.6-10.2) percentage points, where the right to freedom from torture received more support by 6.9 (95% CI, 3.0-10.9) percentage points compared with participants without personal lived experience with behavioral health care (P < .001). Male participants compared with female participants differed significantly in their support ratings for civil rights of those with SPDs: more males endorsed support for the right to be a parent by 7.4 (95% CI, 2.1-12.8) percentage points (P = .007), the right to run for office by 7.8 (95% CI, 2.3-13.2) percentage points (P = .005), and the right to own a gun by 17.9 (95% CI, 12.5-23.3) percentage points (P < .001).

Table 2. Variables of Support for Human and Civil Rights of People With Severe Physical Disabilities^a.

Variable	Human right										Civil right
	Adequate standard of living		Highest attainable standards of physical and mental health		Exercise legal capacity and the right to personal liberty and security of the person		Freedom from torture or cruel, inhumane, or degrading treatment of punishment and from exploitation, violence, and abuse		Live independently and be included in the community		Parenting		Running for office		Gun ownership
	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value
Constant	0.66	<.001^b	0.74	<.001^b	0.64	<.001^b	0.72	<.001^b	0.68	<.001^b	0.73	<.001^b	0.74	<.001^b	0.66	<.001^b
Lived experience (self/loved one)
No lived experience	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Lived experience	0.06	.005^b	0.06	.002^b	0.07	.002^b	0.07	<.001^b	0.06	.007^b	0.04	.14	0.07	.01^b	0.05	.06
Region
Northeast	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Midwest	0.02	.46	0.05	.12	0.03	.40	0.06	.04^b	0.03	.44	0.00	.99	−0.02	.62	0.03	.42
South	−0.02	.47	0.00	.98	−0.04	.17	0.01	.61	−0.01	.69	0.02	.69	−0.01	.72	0.06	.11
West	−0.03	.33	0.01	.86	−0.01	.85	0.01	.77	0.00	.90	0.03	.54	0.02	.64	0.01	.79
Political affiliation
Republican	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Democrat	0.05	.03^b	0.07	.005^b	0.07	.008^b	0.06	.009^b	0.08	.002^b	0.04	.21	0.04	.24	−0.06	.08
Independent	0.03	.26	0.07	.007^b	0.05	.07	0.07	.01^b	0.05	.06	0.00	.92	0.01	.73	−0.01	.70
No preference	−0.06	.28	0.03	.49	0.02	.77	0.00	.94	0.02	.68	−0.09	.15	−0.17	.008^b	−0.19	.003^b
Other	−0.01	.93	−0.02	.82	−0.06	.54	0.06	.54	−0.21	.03^b	−0.06	.63	−0.01	.91	−0.21	.09
Income
>$25 000	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
$25 000-$50 000	0.05	.15	0.04	.21	0.03	.39	0.02	.49	0.01	.70	0.06	.17	0.08	.05^b	0.03	.47
$50 000-$75 000	0.02	.51	0.04	.23	0.06	.06	0.03	.32	0.02	.49	−0.02	.53	0.04	.31	0.04	.35
$75 000-$100 000	0.03	.43	0.04	.25	0.05	.18	0.02	.56	0.02	.70	0.03	.54	0.05	.28	0.03	.53
$100 000-$150 000	−0.01	.82	−0.03	.47	0.04	.33	0.01	.89	0.08	.05	0.02	.77	0.10	.05	−0.03	.52
≥$150 000	−0.03	.51	−0.05	.27	−0.01	.82	0.02	.75	−0.02	.70	0.00	.98	0.03	.60	−0.02	.73
Age
18-24 y	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
25-34 y	−0.10	.09	−0.17	.003^b	−0.09	.12	−0.14	.01^b	−0.10	.10	−0.05	.50	−0.11	.13	−0.04	.62
35-44 y	−0.07	.26	−0.09	.10	−0.06	.30	−0.08	.13	−0.05	.38	−0.05	.54	−0.12	.12	−0.06	.41
45-54 y	−0.02	.75	−0.05	.37	0.02	.81	−0.04	.52	0.01	.92	−0.02	.84	−0.08	.26	−0.11	.14
55-64 y	0.04	.54	−0.01	.81	0.06	.32	0.01	.86	−0.01	.82	−0.06	.46	−0.16	.04^b	−0.18	.02^b
≥65 y	0.05	.37	0.02	.76	0.06	.29	0.05	.37	0.02	.79	−0.11	.12	−0.13	.09	−0.19	.01^b
Ethnicity^c
Hispanic	−0.10	.01^b	−0.07	.07	−0.09	.02^b	−0.12	.001^b	−0.09	.04^b	0.04	.44	0.00	.97	−0.09	.09
Not Hispanic	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Sex and gender
Male	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Female	0.00	.93	0.01	.75	0.00	.98	−0.01	.76	0.02	.50	−0.07^b	.007	−0.08	.005^b	−0.18	<.001^b
Nonbinary	0.16	.47	0.17	.44	−0.18	.41	−0.18	.41	0.15	.51	−0.32	.25	−0.01	.96	−0.24	.40
Prefer not to say	−0.23	.40	0.22	.42	0.26	.35	0.20	.43	0.15	.60	0.29	.39	0.30	.38	−0.04	.90
Educational level
Less than high school	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
High school diploma	0.06	.31	0.02	.73	0.05	.41	0.04	.53	0.05	.42	−0.05	.54	−0.12	.12	−0.09	.27
Some college/trade school, still working	0.14	.07	0.12	.09	0.14	.06	0.11	.13	0.04	.57	−0.04	.64	−0.08	.41	−0.05	.59
Some college/trade school, not likely to finish	0.08	.23	0.03	.66	0.08	.19	0.05	.47	0.04	.60	−0.03	.76	−0.07	.39	−0.02	.82
Trade school or associate’s degree	0.12	.06	0.06	.32	0.11	.10	0.04	.51	0.05	.44	0.00	.98	0.00	.97	−0.06	.51
4-y Degree	0.14	.03^b	0.07	.25	0.10	.12	0.08	.20	0.08	.23	0.00	.97	−0.02	.78	−0.06	.44
Some graduate school	0.12	.18	0.03	.70	0.03	.77	0.02	.79	0.01	.95	0.02	.86	−0.04	.76	0.06	.60
Graduate/professional degree	0.19	.005^b	0.09	.20	0.14	.04^b	0.09	.15	0.10	.18	0.03	.71	−0.05	.59	−0.01	.88
Race^c
American Indian/Alaska Native	0.02	.82	−0.01	.95	0.01	.90	−0.01	.88	−0.10	.30	0.00	>.99	−0.01	.97	0.10	.37
Asian	0.07	.27	0.03	.61	−0.07	.22	−0.10	.08	−0.07	.29	−0.09	.21	−0.08	.30	−0.12	.12
Black	−0.06	.06	−0.11	<.001^b	−0.04	.26	−0.06	.04^b	−0.08	.02^b	−0.03	.50	−0.08	.07	−0.05	.24
Multiracial	0.05	.44	0.04	.46	0.02	.79	0.02	.69	0.10	.12	0.02	.81	0.12	.13	0.02	.83
White	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Other	0.01	.86	0.01	.89	0.01	.90	0.04	.55	0.05	.52	−0.26	.007^b	−0.17	.08	0.00	.98

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Abbreviation: NA, not applicable.

^{^a}

Models were estimated using unweighted data. β Represents the absolute change in the probability of supporting a given right (0-1 scale) relative to the reference category. All P values are 2-tailed.

^{^b}

Statistically significant coefficient (P < .05).

^{^c}

Race and ethnicity were ascertained by self-report. For race, participants could select all that applied, including "Other."

For the SMI subgroup (Table 3), having lived experience with behavioral health care was associated with more support by at least 9.3 (95% CI, 4.7-14.0) percentage points for all 5 human rights compared with participants without such experience, with a 10.6 percentage-point spread (95% CI, 6.3-14.9) for the right to high standards of health (P < .001) and an 11.4 percentage-point spread (95% CI, 6.6-16.3) for the right to exercise legal capacity (P < .001). Participants aged 65 years and older showed 19.6 (95% CI, 8.2-31.0) percentage points more support for the right to freedom from torture compared with the group aged 18 to 24 years (P < .001). Conversely, the 18- to 24-year age group compared with participants aged 65 years and older, showed more support for all civil rights, with a 15.2 (95% CI, 7.0-29.7) percentage-point spread for the right to be a parent (P = .04), an 18.9 percentage-point difference (95% CI, 5.1-32.6) in the right to run for office (P = .007), and a 27.1 percentage-point difference (95% CI, 15.1-39.2) in the right to own a gun (P < .001).

Table 3. Variables of Support for Human and Civil Rights of People With Severe Mental Illness^a.

Variable	Human right										Civil right
	Adequate standard of living		Highest attainable standards of physical and mental health		Exercise legal capacity and the right to personal liberty and security of the person		Freedom from torture or cruel, inhumane, or degrading treatment of punishment and from exploitation, violence, and abuse		Live independently and be included in the community		Parenting		Running for office		Gun ownership
	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value
Constant	0.66	<.001^b	0.60	<.001^b	0.39	<.001^b	0.58	<.001^b	0.66	<.001^b	0.67	<.001^b	0.55	<.001^b	0.54	<.001^b
Lived experience (self/loved one)
No lived experience	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Lived experience	0.09	<.001^b	0.11	<.001^b	0.11	<.001^b	0.10	<.001^b	0.10	<.001^b	0.08	.005^b	0.07	.009^b	0.02	.277
Region
Northeast	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Midwest	−0.02	.55	0.01	.7	−0.01	.71	0.01	.85	−0.01	.77	−0.06	.14	−0.07	.10	−0.04	.294
South	−0.06	.05^b	−0.03	.4	−0.04	.20	−0.03	.39	−0.02	.51	−0.04	.31	−0.04	.24	−0.01	.77
West	−0.04	.36	−0.04	.2	−0.02	.67	0.02	.52	0.03	.50	−0.04	.35	−0.06	.12	−0.02	.62
Political affiliation
Republican	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Democrat	0.13	<.001^b	0.10	<.001^b	0.10	<.001^b	0.05	.07	0.08	.006^b	0.01	.66	0.04	.18	0.00	.99
Independent	0.03	.27	0.03	.24	0.02	.59	0.02	.43	0.01	.70	−0.06	.10	−0.03	.43	−0.04	.13
No preference	0.00	.97	−0.01	.81	−0.05	.41	−0.02	.73	0.02	.79	−0.04	.55	−0.06	.33	−0.06	.28
Other	0.00	>.99	0.15	.13	−0.08	.50	0.16	.10	−0.10	.39	0.07	.59	−0.05	.68	−0.19	.05
Income
<$25 000	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
$25 000-$50 000	0.03	.48	0.01	.86	0.03	.49	0.05	.12	0.00	.95	−0.07	.11	−0.05	.22	−0.07	.03^b
$50 000-$75 000	0.01	.71	0.00	.94	0.03	.37	0.04	.16	−0.02	.66	−0.09	.03^b	−0.07	.05^b	−0.05	.12
$75 000-$100 000	0.00	.95	0.02	.64	0.02	.68	0.02	.53	0.02	.71	−0.01	.85	0.01	.82	−0.05	.20
$100 000-$150 000	−0.04	.42	−0.04	.28	−0.03	.52	0.04	.29	−0.01	.83	0.00	.99	−0.03	.52	−0.07	.09
≥$150 000	−0.02	.68	0.02	.67	0.02	.67	0.15	.003^b	0.08	.21	0.02	.70	0.02	.76	0.03	.58
Age
18-24 y	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
25-34 y	−0.12	.06	−0.05	.43	0.05	.50	0.01	.93	−0.06	.44	0.00	.96	−0.02	.78	−0.05	.41
35-44 y	−0.08	.20	0.06	.31	0.09	.19	0.08	.18	0.02	.77	0.07	.37	−0.02	.79	−0.07	.26
45-54 y	−0.01	.83	0.05	.40	0.12	.08	0.12	.04^b	0.05	.52	0.04	.64	−0.02	.84	−0.10	.12
55-64 y	−0.06	.36	0.11	.09	0.17	.02^b	0.16	.01^b	0.04	.64	0.01	.87	−0.07	.38	−0.18	.006^b
≥65 y	−0.03	.68	0.13	.04^b	0.10	.13	0.20	<.001^b	−0.06	.39	−0.15	.04^b	−0.19	.007^b	−0.27	<.001^b
Ethnicity^c
Hispanic	−0.05	.31	0.02	.67	0.01	.85	−0.06	.17	−0.09	.07	0.09	.08	0.15	.002^b	0.04	.36
Not Hispanic	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Sex and gender
Male	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Female	−0.01	.70	−0.03	.26	−0.01	.74	−0.01	.78	−0.06	.02^b	−0.06	.02^b	−0.07	.005^b	−0.11	<.001^b
Nonbinary	0.16	.52	0.19	.42	0.19	.46	0.22	.33	0.21	.45	0.12	.67	−0.43	.11	−0.08	.73
Prefer not to say	0.25	.42	0.21	.45	0.38	.24	0.21	.44	−0.25	.46	−0.10	.77	0.00	>.99	−0.39	.18
Educational level
Less than high school	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
High school diploma	0.03	.67	0.02	.71	0.09	.23	−0.04	.56	−0.03	.65	−0.14	.09	−0.08	.29	−0.05	.50
Some college/trade school, still working	0.12	.16	0.11	.14	0.19	.03^b	0.04	.59	0.03	.79	−0.02	.88	−0.06	.52	0.01	.86
Some college/trade school, not likely to finish	0.07	.34	0.07	.31	0.14	.06	0.06	.39	0.00	.98	−0.12	.15	−0.12	.13	−0.10	.15
Trade school or associate’s degree	0.11	.14	0.07	.32	0.18	.02^b	0.04	.55	0.02	.78	−0.10	.25	−0.01	.86	−0.04	.52
4-y Degree	0.11	.12	0.07	.29	0.17	.02^b	0.01	.94	−0.03	.69	−0.11	.20	−0.01	.87	−0.02	.76
Some graduate school	0.02	.83	−0.10	.26	0.07	.50	−0.01	.91	−0.16	.15	−0.25	.03^b	−0.16	.14	−0.08	.40
Graduate/professional degree	0.15	.05^b	0.10	.15	0.17	.03^b	−0.01	.84	−0.01	.90	−0.14	.11	−0.05	.54	−0.08	.25
Race^c
American Indian/Alaska Native	0.06	.54	0.09	.33	−0.07	.52	−0.09	.31	−0.09	.42	−0.08	.49	−0.04	.71	0.03	.75
Asian	0.00	.98	−0.07	.29	0.01	.84	−0.01	.83	−0.04	.61	0.08	.30	0.07	.35	−0.03	.69
Black	−0.02	.54	0.01	.88	0.01	.83	−0.02	.54	−0.03	.53	0.13	.002^b	0.08	.06	0.06	.10
Multiracial	0.08	.23	0.06	.34	−0.04	.60	0.07	.22	0.00	>.99	−0.11	.16	0.01	.88	−0.02	.73
White	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Other	−0.12	.18	−0.10	.23	−0.13	.16	−0.15	.047^b	−0.03	.73	−0.19	.05	−0.29	.002^b	−0.02	.84

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Abbreviation: NA, not applicable.

^{^a}

^{^b}

Statistically significant coefficient (P < .05).

^{^c}

Race and ethnicity were ascertained by self-report. For race, participants could select all that applied, including "Other."

When considering those with SUDs (Table 4), having lived experience with behavioral health care or a loved one with such experience was associated with participants’ higher likelihood of supporting the 5 human rights by at least 5.8 (95% CI, 0.7-11.0) percentage points (P = .03), with a 14.2 percentage-point spread (95% CI, 9.4-18.9) for the right to enjoy the highest attainable standards of health (P < .001). Democrats compared with Republicans were more likely to support all 5 human rights by at least 11.7 (95% CI, 5.7-17.7) percentage points (for the right to live independently; P < .001) with the maximum spread being for the right to an adequate standard of living (17.1 [95% CI, 11.2-22.9] percentage points; P < .001). Republicans compared with those with no political preference were more likely to support the right of those with SUDs to be a parent (14.8 [95% CI, 2.1-27.4] percentage points; P = .02), to run for office (14.1 [95% CI, 2.1-26.1] percentage points; P = .02), and to own a gun (17.8 [95% CI, 7.3-28.3] percentage points; P < .001). When analyses were adjusted using the Benjamini-Hochberg FDR procedure, comparisons between Hispanic and non-Hispanic groups, educational levels, and US geographical regions were no longer significant. In a sensitivity analysis applying survey weights to the fully adjusted models (eTables 2-4 in Supplement 1), the direction and significance of key findings were largely consistent with the unweighted models.

Table 4. Variables of Support for Human and Civil Rights of People With Severe Substance Use Disorders^a.

Variable	Human right										Civil right
	Adequate standard of living		Highest attainable standards of physical and mental health		Exercise legal capacity and the right to personal liberty and security of the person		Freedom from torture or cruel, inhumane, or degrading treatment of punishment and from exploitation, violence, and abuse		Live independently and be included in the community		Parenting		Running for office		Gun ownership
	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	β	P value
Constant	0.57	<.001^b	0.47	<.001^b	0.48	<.001^b	0.57	<.001^b	0.71	<.001^b	0.63	<.001^b	0.57	<.001^b	0.65	<.001^b
Lived experience (self/loved one)
No lived experience	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Lived experience	0.10	<.001^b	0.14	<.001^b	0.08	.002^b	0.06	.008^b	0.06	.03^b	−0.01	.85	0.00	.95	0.03	.14
Region
Northeast	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Midwest	−0.05	.21	0.01	.73	0.01	.74	−0.02	.59	−0.01	.76	−0.09	.03^b	−0.06	.10	−0.06	.10
South	−0.05	.12	−0.03	.37	−0.03	.44	−0.05	.09	−0.06	.11	−0.05	.19	−0.02	.50	−0.03	.40
West	−0.08	.04^b	−0.05	.17	−0.03	.48	−0.03	.39	−0.06	.16	−0.10	.02^b	−0.07	.10	−0.06	.12
Political affiliation
Republican	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Democrat	0.17	<.001^b	0.14	<.001^b	0.15	<.001^b	0.12	<.001^b	0.12	<.001^b	0.05	.09	0.08	.005^b	−0.02	.46
Independent	0.08	.02^b	0.04	.19	0.05	.10	0.11	<.001^b	0.02	.49	−0.02	.48	−0.02	.60	−0.05	.10
No preference	−0.03	.66	−0.02	.71	−0.10	.11	−0.06	.28	−0.03	.60	−0.15	.02^b	−0.14	.02^b	−0.18	<.001^b
Other	0.09	.41	0.08	.47	0.01	.90	0.01	.89	−0.07	.55	−0.13	.30	−0.08	.50	−0.25	.01^b
Income
<$25 000	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
$25 000-$50 000	0.05	.20	0.00	.99	0.04	.27	0.05	.17	−0.03	.49	−0.09	.03^b	−0.06	.12	−0.07	.04^b
$50 000-$75 000	0.02	.56	−0.02	.51	0.02	.53	0.08	.02^b	−0.02	.61	−0.10	.02^b	−0.09	.02^b	−0.07	.04^b
$75 000-$100 000	0.00	.94	0.03	.49	0.04	.42	0.07	.06	0.00	.98	−0.08	.08	−0.03	.45	−0.01	.78
$100 000-$150 000	−0.01	.81	−0.03	.45	0.03	.55	0.01	.81	−0.06	.22	−0.07	.17	−0.02	.73	−0.07	.08
≥$150 000	0.04	.54	0.03	.65	0.05	.44	0.05	.39	−0.08	.16	−0.02	.71	−0.02	.76	0.00	.98
Age
18-24 y	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
25-34 y	−0.10	.17	−0.09	.21	−0.06	.37	−0.05	.41	−0.08	.25	0.07	.33	0.00	.96	0.00	.95
35-44 y	−0.08	.24	−0.02	.79	0.00	.96	−0.01	.94	−0.09	.22	0.08	.27	−0.02	.74	−0.09	.14
45-54 y	−0.04	.57	−0.03	.61	0.03	.70	0.03	.70	−0.04	.57	0.09	.24	−0.03	.71	−0.09	.14
55-64 y	−0.04	.56	0.01	.87	0.06	.44	0.07	.32	−0.09	.25	0.02	.79	−0.14	.06	−0.18	.005^b
≥65 y	−0.09	.18	−0.03	.66	−0.04	.58	0.07	.28	−0.18	.01^b	−0.12	.09	−0.20	.004^b	−0.27	<.001^b
Ethnicity^c
Hispanic	−0.05	.29	0.01	.92	0.03	.58	0.00	.93	0.03	.61	0.12	.01^b	0.11	.02^b	0.06	.14
Not Hispanic	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Gender
Male	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Female	−0.03	.35	0.00	.91	−0.03	.21	0.01	.57	−0.01	.72	−0.09	.002^b	−0.13	<.001^b	−0.11	<.001^b
Nonbinary	0.23	.40	−0.10	.70	−0.06	.84	0.20	.40	0.22	.43	−0.55	.05	−0.49	.07	−0.39	.09
Prefer not to say	−0.13	.70	0.30	.35	0.43	.20	−0.14	.64	0.32	.34	0.00	>.99	0.04	.90	0.15	.61
Educational level
Less than high school	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
High school diploma	0.05	.48	0.18	.01^b	0.10	.20	0.07	.31	0.04	.60	−0.05	.55	−0.06	.46	−0.12	.06
Some college/trade school, still working	0.16	.08	0.25	.003^b	0.22	.01^b	0.14	.08	0.13	.17	0.04	.67	0.10	.29	−0.06	.48
Some college/trade school, not likely to finish	0.03	.73	0.17	.03^b	0.07	.39	0.07	.33	0.00	.99	−0.09	.27	−0.05	.55	−0.16	.02^b
Trade school or associate’s degree	0.06	.42	0.16	.04^b	0.12	.13	0.07	.31	0.01	.88	−0.08	.34	0.01	.92	−0.18	.008^b
4-y Degree	0.15	.05	0.19	.01^b	0.12	.12	0.08	.22	0.08	.31	−0.02	.77	0.01	.87	−0.12	.07
Some graduate school	0.06	.56	0.18	.08	0.10	.33	0.06	.55	−0.01	.96	−0.06	.58	−0.10	.33	−0.16	.08
Graduate/professional degree	0.20	.02^b	0.25	.002^b	0.18	.03^b	0.11	.12	0.11	.21	−0.03	.75	0.04	.67	−0.14	.05^b
Race^c
American Indian/Alaska Native	−0.10	.35	−0.13	.19	−0.21	.05	−0.20	.04^b	−0.17	.13	−0.10	.39	−0.02	.86	−0.03	.77
Asian	0.03	.71	−0.01	.87	−0.06	.44	−0.12	.07	0.01	.87	0.12	.11	0.05	.45	−0.06	.36
Black	−0.01	.90	−0.02	.60	−0.01	.72	−0.07	.05^b	−0.02	.55	0.08	.06	0.04	.27	0.10	.004^b
Multiracial	−0.10	.17	0.05	.43	−0.10	.18	−0.01	.83	−0.05	.54	−0.08	.31	−0.04	.54	−0.08	.23
White	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA	[Reference]	NA
Other	−0.17	.07	−0.08	.38	−0.15	.11	−0.07	.41	−0.07	.47	−0.15	.12	−0.13	.16	−0.01	.90

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Abbreviation: NA, not applicable.

^{^a}

Models were estimated using unweighted data. β Represents the absolute change in the probability of supporting a given right (0-1 scale) relative to the reference category.

^{^b}

Statistically significant coefficient (P < .05).

^{^c}

Race and ethnicity were ascertained by self-report. For race, participants could select all that applied, including "Other."

Discussion

This study investigates US adult public support for granting basic human rights and contentious civil rights to marginalized groups. As hypothesized, our findings showed a clear hierarchy, where those with SPDs were considered significantly more deserving of both human and civil rights compared with individuals with SMI or SUDs. Human rights defined by the CRPD were broadly accepted across marginalized statuses, while civically oriented rights proved more contentious, with lower overall support ratings and larger differences between subgroups. Participant characteristics, such as lived experience or political affiliation, were significant variables of support for human rights, whereas age and gender influenced participants’ support for civil rights. Our results affirm earlier theoretical hierarchies of deservingness^36,37 and suggest that an individual’s characteristics might be associated with their support for the rights of marginalized populations.

In our analysis, across both human and civil rights domains, those with SPDs were seen as significantly more deserving of all 8 rights than were people with SMI or SUDs, while those with SMI received marginally more support than those with SUDs in 5 of the 8 rights. This finding aligns with research on stigma,^{4,12,38,39,40} where those with medical illnesses (or SPDs) are subject to fewer discriminatory beliefs than those with SMI who are stigmatized less than those with SUDs.^41,42,43 People with SPDs are likely perceived as more genuine, less responsible for their condition,^41,44 and less threatening than those with SMI or SUDs, which may explain the pattern of divergence in public support for human rights relative to civil rights such as owning a gun. Given this, these findings suggest that people with SMI or SUDs do not experience the same societal supports as those who have medical illnesses or the general public.

As hypothesized, support ratings for human rights, across all 3 marginalized groups, outperformed support ratings for civil rights. This discrepancy is apparent in US law, where protections for people with disabilities primarily safeguard basic rights such as health care access, confidentiality, housing, and treatment in the criminal justice system, whereas rights involving civic participation or potential risk to others (ie, being a parent, running for office, owning guns) are inconsistently protected.⁴⁵ Conversely, those with SUDs and those considered to have mental illness or impairment experience legal restrictions on gun rights in most US states,⁴⁶ and people with SMI continue to experience high rates of criminalization despite minimal evidence linking mental illness to violence.²⁰ Interestingly, the right to own a gun generally garnered the least support across all assessed rights for each subgroup, despite Gallup polls indicating that 79% of US adults do not support restrictive policies on handgun ownership.⁴⁷

Last, political affiliation and lived experience were found to be significant variables of support for human rights of marginalized groups, corresponding to findings found in analogous stigma-focused research. Prior personal or familial experiences with behavioral health care may cultivate greater sensitivity to structural barriers and discrimination faced by marginalized groups, driving stronger support for equitable deservingness of human rights.⁴⁸ Similarly, political ideologies emphasizing social inclusion and justice likely foster greater support for human rights of marginalized groups.^49,50 Conversely, lower educational attainment was associated with less supportive attitudes. People with higher educational attainment may be predisposed to think more critically about societal structures of inclusion and to have more supportive attitudes toward human rights for marginalized groups.^51,52,53 These findings highlight how broad experiences of marginalization do not necessarily translate into support for human rights of other marginalized groups.

Younger age was associated with greater support for civil rights, potentially reflecting generational attitudes toward civil liberties.^52,54 Men were more likely to support the right of these marginalized persons to own a gun, in alignment with established stigma research,^55,56 but they diverged from prior findings⁵⁷ in that they expressed higher support for the groups’ rights to parenthood and political candidacy. These findings may reflect gendered differences in how rights are conceptualized: men may be more likely to support abstract rights principles regardless of the population, whereas women may integrate concerns about caregiving demands or role-specific competencies into their assessments.⁵⁸

Overall, understanding sociodemographic patterns can inform policy design in leveraging empathetic perspectives of those with lived experiences to garner support for human rights. Recognizing demographic trends in civil rights attitudes can help develop interventions that address the concerns of different groups. Future research could incorporate repeated measurements to monitor evolving attitudes,⁵² alter scenario framing (eg, removing the “severe” precedent; specifying “in recovery”) to probe how stigma shifts with perceived status, and examine whether stated attitudes predict policy-related behaviors. International comparisons with countries that have ratified the CRPD could show how national context shapes these attitudes.

Limitations

Findings of this study should be interpreted with a few limitations. The use of quota-based sampling raises questions about representativeness of the national population. Although descriptive characteristics were weighted to approximate census estimates,^32,33 the analytic sample differed from national benchmarks in age, education, income, and Latino/a/x ethnicity. Accordingly, these findings should be interpreted in the context of the present sample. Future research could use probability-based sampling to support population-level inferences. The survey’s cross-sectional design limits our understanding of attitudes to a single point in time. Reliance on self-report may introduce social desirability bias, wherein participants may provide more socially acceptable responses than their true beliefs, although participant anonymity reduces this concern. Some survey terminology (eg, legal capacity) may have been interpreted inconsistently by participants based on level of education or familiarity with the terminology used.

Conclusions

This study provides evidence on US public attitudes toward rights protections for people with SPDs, SMI, and SUDs. Rights for the SPD group garnered the most support, while support for those with SMI was slightly higher than for those with SUDs, reflecting how stigmatizing beliefs shape perceived deservingness. Human rights received higher support ratings than did civil rights, indicating that the US public more readily endorses abstract principles of individual dignity and humane treatment than rights to legal and social participation when those rights directly affect others. Lower support for those with SMI and SUDs compared with those with SPDs suggests that policy-based stigma interventions aimed at increasing rights protections should prioritize addressing stigma around behavioral health conditions, especially SUDs. Ultimately, measuring US public support for rights protections, rather than stigma alone, provides a more complete picture of the landscape for policy reform.

Supplement 1.

eAppendix. Supplemental Methods

eTable 1. Pairwise Comparisons of Support for Rights of Severe Physical Disabilities vs SMI vs SUD

eTable 2. Predictors of Support for Human and Civil Rights of People with Severe Physical Disabilities, Weighted Linear Probability Models

eTable 3. Predictors of Support for Human and Civil Rights of People with Severe Mental Illness, Weighted Linear Probability Models

eTable 4. Predictors of Support for Human and Civil Rights of People with Severe Substance Use Disorders, Weighted Linear Probability Models

jamahealthforum-e263431-s001.pdf^{(671KB, pdf)}

Supplement 2.

Data Sharing Statement

jamahealthforum-e263431-s002.pdf^{(15KB, pdf)}

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eAppendix. Supplemental Methods

eTable 1. Pairwise Comparisons of Support for Rights of Severe Physical Disabilities vs SMI vs SUD

eTable 2. Predictors of Support for Human and Civil Rights of People with Severe Physical Disabilities, Weighted Linear Probability Models

eTable 3. Predictors of Support for Human and Civil Rights of People with Severe Mental Illness, Weighted Linear Probability Models

eTable 4. Predictors of Support for Human and Civil Rights of People with Severe Substance Use Disorders, Weighted Linear Probability Models

jamahealthforum-e263431-s001.pdf^{(671KB, pdf)}

Supplement 2.

Data Sharing Statement

jamahealthforum-e263431-s002.pdf^{(15KB, pdf)}

[aoi260062r1] 1.United Nations General Assembly . Universal Declaration of Human Rights. United Nations; 1948. Accessed September 23, 2025. https://www.un.org/en/about-us/universal-declaration-of-human-rights

[aoi260062r2] 2.United Nations General Assembly . Convention on the Rights of Persons with Disabilities. United Nations; 2006. Accessed September 23, 2025. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities

[aoi260062r3] 3.Stein MA. Disability human rights. In: West R, ed. Nussbaum and Law. Routledge; 2017:3-49. doi: 10.4324/9781315090412-1 [DOI] [Google Scholar]

[aoi260062r4] 4.Committee on the Science of Changing Behavioral Health Social Norms, Cognitive Board on Behavioral, Division of Behavioral and Social Sciences and Education, Engineering National Academies of Sciences . Understanding stigma of mental and substance use disorders. In: Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. National Academies Press (US); 2016. Accessed September 23, 2025. https://www.ncbi.nlm.nih.gov/books/NBK384923/ [PubMed]

[aoi260062r5] 5.Drew N, Funk M, Tang S, et al. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet. 2011;378(9803):1664-1675. doi: 10.1016/S0140-6736(11)61458-X [DOI] [PubMed] [Google Scholar]

[aoi260062r6] 6.Reber L, Kreschmer JM, James TG, et al. Ableism and contours of the attitudinal environment as identified by adults with long-term physical disabilities: a qualitative study. Int J Environ Res Public Health. 2022;19(12):7469. doi: 10.3390/ijerph19127469 [DOI] [PMC free article] [PubMed] [Google Scholar]

[aoi260062r7] 7.World Health Organization . WHO QualityRights tool kit: assessing and improving quality and human rights in mental health and social care facilities. World Health Organization; 2012. Accessed September 23, 2025. https://iris.who.int/handle/10665/70927

[aoi260062r8] 8.Martínez-Medina A, Morales-Calvo S, Rodríguez-Martín V, Meseguer-Sánchez V, Molina-Moreno V. Sixteen years since the Convention on the Rights of Persons with Disabilities: what have we learned since then? Int J Environ Res Public Health. 2022;19(18):11646. doi: 10.3390/ijerph191811646 [DOI] [PMC free article] [PubMed] [Google Scholar]

[aoi260062r9] 9.Steinert C, Steinert T, Flammer E, Jaeger S. Impact of the UN convention on the rights of persons with disabilities (UN-CRPD) on mental health care research—a systematic review. BMC Psychiatry. 2016;16(1):166. doi: 10.1186/s12888-016-0862-1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[aoi260062r10] 10.American Bar Association . Convention on the Rights of Persons with Disabilities. Accessed September 23, 2025. https://www.americanbar.org/advocacy/governmental_legislative_work/priorities_policy/promoting_international_rule_law/conventionontherightsofpersonswithdisabilities/

[aoi260062r11] 11.Parker R. Stigma, prejudice and discrimination in global public health. Cad Saude Publica. 2012;28(1):164-169. doi: 10.1590/S0102-311X2012000100017 [DOI] [PubMed] [Google Scholar]

[aoi260062r12] 12.Barry CL, McGinty EE, Pescosolido B, Goldman HH. Stigma, discrimination, treatment effectiveness and policy support: comparing public views about drug addiction with mental illness. Psychiatr Serv. 2014;65(10):1269-1272. doi: 10.1176/appi.ps.201400140 [DOI] [PMC free article] [PubMed] [Google Scholar]

[aoi260062r13] 13.Werner S. Public stigma and the perception of rights: differences between intellectual and physical disabilities. Res Dev Disabil. 2015;38:262-271. doi: 10.1016/j.ridd.2014.12.030 [DOI] [PubMed] [Google Scholar]

[aoi260062r14] 14.Magee JC, Galinsky AD. Social hierarchy: the self-reinforcing nature of power and status. Acad Management Ann. 2008;2(1):351-398. doi: 10.5465/19416520802211628 [DOI] [Google Scholar]

[aoi260062r15] 15.Skinner N, Feather NT, Freeman T, Roche A. Stigma and discrimination in health-care provision to drug users: the role of values, affect, and deservingness judgments. J Appl Soc Psychol. 2007;37(1):163-186. doi: 10.1111/j.0021-9029.2007.00154.x [DOI] [Google Scholar]

[aoi260062r16] 16.Haeder SF. How long-held perceptions of deservingness continue to shape public attitudes about program eligibility. Polit Policy. 2025;53(3):e70033. doi: 10.1111/polp.70033 [DOI] [Google Scholar]

[aoi260062r17] 17.Fang AH, Huber GA. Perceptions of deservingness and the politicization of social insurance: evidence from disability insurance in the United States. Am Polit Res. 2020;48(5):543-559. doi: 10.1177/1532673X19863439 [DOI] [Google Scholar]

[aoi260062r18] 18.van Oorschot W. Who should get what, and why? On deservingness criteria and the conditionality of solidarity among the public. Policy Polit. 2000;28(1). doi: 10.1332/0305573002500811 [DOI] [Google Scholar]

[aoi260062r19] 19.National Board for Certified Counselors & Affiliates. New executive order targets homelessness through expanded civil commitment: what it means for mental health. Accessed September 23, 2025. https://www.nbcc.org/govtaffairs/newsroom/new-eo-targets-homelessness

[aoi260062r20] 20.Shim RS. Ending the criminalization of people with serious mental illness. JAMA Health Forum. 2025;6(11):e256147. doi: 10.1001/jamahealthforum.2025.6147 [DOI] [PubMed] [Google Scholar]

[aoi260062r21] 21.Becker D. Trump wants to force people into treatment for substance use and mental health issues. NPR. September 11, 2025. Accessed September 23, 2025. https://www.npr.org/2025/09/11/nx-s1-5518306/trump-wants-to-force-people-into-treatment-for-substance-use-and-mental-health-issues

[aoi260062r22] 22.DelRosario F. Can you own a gun while on disability? | Midwest Disability, LLC. February 23, 2021. Accessed October 13, 2025. https://www.midwestdisability.com/blog/2021/02/can-you-own-a-gun-while-on-disability/

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PERMALINK

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

Jessica Williams, MD

Mia Kouveliotes, BA

Nev Jones, PhD

Morgan C Shields, PhD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Main Outcomes and Measures

Results

Conclusions and Relevance

Introduction

Methods

Data

Measures

Primary Outcome

Variables

Statistical Analysis

Results

Sample Characteristics

Table 1. Demographic Characteristics of the Study Population.

Perceived Entitlement of Human and Civil Rights Across Marginalized Subgroups

Figure. Bar Graph Showing Perceived Entitlement of Human and Civil Rights Across Marginalized Subgroups.

Variables of Support for Human and Civil Rights

Table 2. Variables of Support for Human and Civil Rights of People With Severe Physical Disabilitiesa.

Table 3. Variables of Support for Human and Civil Rights of People With Severe Mental Illnessa.

Table 4. Variables of Support for Human and Civil Rights of People With Severe Substance Use Disordersa.

Discussion

Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

Table 2. Variables of Support for Human and Civil Rights of People With Severe Physical Disabilities^a.

Table 3. Variables of Support for Human and Civil Rights of People With Severe Mental Illness^a.

Table 4. Variables of Support for Human and Civil Rights of People With Severe Substance Use Disorders^a.