Manning Regional Healthcare Center

Erasing the Mark of Mental Illness

Awareness is a great thing. We should all strive for way more of it. So often it seems as if we are caught up in the day to day grind of everyday life and it’s easy to find ourselves closed off to things that don’t affect us daily. This is unscientific of course, but I’m going to guess the majority of readers don’t spend a lot of time thinking about mental illness. Unless you or a loved one are dealing with it personally or professionally every day, it’s easy to ignore how deeply mental illness impacts even those who don’t directly suffer.  

For example, according to the American Psychological Association (APA), up to 25% of the inmates in U.S. correctional institutions suffer from serious mental illness. Anyone who has worked in the prison system will gladly tell you that prisons across the nation have essentially become dangerous defacto mental institutions. To support this, one can find plenty of sources online depicting or describing violent, deranged, and antisocial behaviors perpetrated by severely violent, mentally ill people in U.S. prisons. One stark statistic that cannot be ignored is that in 44 states, a jail or prison holds more mentally ill individuals than the largest remaining state psychiatric hospital. In every state, more seriously mentally ill individuals are incarcerated than hospitalized.   https://www.treatmentadvocacycenter.org/storage/documents/backgrounders/smi-in-jails-and-prisons.pdf

The bleeding hearted hippie in me could go on and on about the deplorable state of mental health care in the prison system, but that’s not quite the aim of this article.
Now… I have to admit something. I just manipulated you a little. A lot really, but stick with me. I did this to make an important point. Thought experiment: try to remember your immediate emotional response while reading the paragraph above; did you begin to question the link I manipulated between criminal behavior and mental illness? Or did you simply allow yourself to accept a perfunctory characterization of mental illness in the U.S.? While the statistics cited are true, they certainly don’t paint the entire picture of mental illness. But data like this does contribute to a stigma that remains.    

Manipulation aside, in part, this characterization was easy to allow because despite all of the progress we have made through the decades, mental illness still carries a stigma in the minds of many people, sometimes even in well-meaning, caring people. As much progress as we have made, there remain inequities in healthcare provision for people with severe mental illness as well. These things I think all illustrate the point that the stigma associated with mental illness remains very real and profound, even among health care providers.
The main objective of this article is to help increase awareness of the ongoing stigmatization of mental illness and ultimately, chip away at it.  
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951586/

Why is it important to increase awareness about stigmatization in mental health?

According to the APA more than half of people with mental illness don’t receive help. There are numerous reasons for this; some don’t receive help due to lack of insurance, or having an insurance plan that skimps on mental health, or a plan that outright doesn’t cover what is needed. People often avoid seeking treatment out of fear of being treated differently (the stigma).
“Differently” is a broad word. Certain manifestations of acute mental illness can be frustrating and even frightening to those who don’t deal with it daily. If you’re a healthcare provider, I’m betting you have witnessed some disparity in treatment. This is not intended as an insult, only to illustrate the point that the stigma is still very real, and not just among the lay public.
People may avoid seeking help out of fear of losing a job or friendships, or being told by ignorant friends or family members: ‘You just need to stop feeling sorry for yourself and pull yourself up by the bootstraps!,’ as if mental illness were a weakness or something to be ashamed of.
This is all because stigma, prejudice, and discrimination against people with mental illness are still very much a problem. And as with other medical conditions, when people don’t seek care their condition typically worsens.  
Stigma, prejudice, and discrimination against individuals with mental illness can be subtle or it can be obvious, and always detrimental. As with any sort of stigma, stigma surrounding mental illness comes from ignorance and/or fear. This ignorance and fear can be bolstered by media portrayals of mental illness, and even sometimes by ill-directed citation of statistics like those mentioned in the second paragraph. Read on to learn about the various types of mental health stigmas.
 
Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate, or violent representations. A study published in April 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent.
The study found that viewing the film “was associated with higher levels of prejudice toward those with mental illness.” Additionally, the authors suggest, “Joker may exacerbate
self-stigma for those with a mental illness, leading to delays in help seeking.”
The stigma of mental illness is universal. A 2016 study on stigma concluded “there is no country, society, or culture where people with mental illness have the same societal value as people without mental illness.” Source: www.psychiatry.org

Why is This Important?

Stigma and potential discrimination can contribute to worsening symptoms and may also keep some people from getting the help they need. A recent extensive review of research found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses.

Effects of stigmatization can include:

  • Reduced hope
  • Lower self-esteem & self-efficacy
  • Increased psychiatric symptoms
  • Difficulties with social relationships and/or social isolation
  • More difficulties at work
  • Reluctance to seek treatment and less likely to stay with treatment
  • Lack of understanding by family, friends, coworkers, or others
  • Fewer opportunities for work, school, or social activities
  • Trouble finding adequate housing
  • Bullying, physical violence, or harassment
  • Increase in suicidal ideation

Source: Adapted from Mayo Clinic


A 2017 study involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years. Source: https://pubmed.ncbi.nlm.nih.gov/28188369/

Addressing the Mental Health Stigma

It comes back to awareness and education. Just knowing a person with a mental illness is one of the best ways to reduce stigma if we are open-minded and willing to ask questions and learn. Just as with addiction, sufferers who share their personal stories of recovery can have a profound impact. When we personally know someone with a mental illness or addiction, it becomes far less mysterious and more real and relatable.
Isn’t that what community is all about? Knowing people, learning to empathize, and seeking growth for the good of the community?
The good news is that a lot of people who have struggled with mental illness are now speaking out, and it seems that a lot of people are indeed listening. Just a generation (or two) ago, it might have been career suicide to speak out about mental illness, but today public figures such as Prince Harry, Dwayne “The Rock” Johnson, Chris Evans, Michael Phelps, Miley Cyrus, Lena Dunham, Emma Stone, Ryan Reynolds and Lady Gaga (to name a few) have opened up and shared their personal stories of mental health challenges and brought the discussion to light.
We have made great strides in diminishing the stigma of mental illness, but there’s plenty still to do. We can do our part by truly listening to people who are enduring mental illness and by showing compassion. Challenge what you think you know, challenge your own biases and then encourage others to do the same.  We can also do our part by speaking out when we encounter damaging stereotypes in the media, or discriminatory practices in business.
Just as they say “every vote counts” in politics, it takes each of us doing our part to help overcome stigma associated with mental illness. As individuals and caregivers, we do this through increasing public awareness of what mental illness is (and what mental illness is not). Mental illness is NOT a choice, or a weakness or a moral failing or the wrath of an angry deity. Mental illness IS a disease that can improve with proper treatment.  
 

The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:

  • Talk openly about mental health, such as sharing on social media.
  • Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences.
  • Be conscious of language – remind people that words matter.
  • Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.
  • Show compassion for those with mental illness.
  • Be honest about treatment – normalize mental health treatment, just like other health care treatment.
  • Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.
  • Choose empowerment over shame: Cara Delevingne (actress & model) said in a 2019 interview; “I used to feel guilty for being depressed, but after realizing I wasn’t alone I was able to begin to recover.” She went on to say: “If you learn to love and accept yourself and not give in to what other people think about you [stigma], you can get better.”

We have made great strides in diminishing the stigma of mental illness, but there’s plenty still to do. We can do our part by truly listening to people who are enduring mental illness and by showing compassion. Challenge what you think you know, challenge your own biases and then encourage others to do the same.  We can also do our part by speaking out when we encounter damaging stereotypes in the media, or discriminatory practices in business.

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