Stigma: Breaking down mental health barriers

Even with increased awareness of mental health and mental illness in recent years, progress has significantly lagged in the areas of social acceptance and linking those in need with treatment services. Although recognition of mental illness symptoms and availability of treatment have both improved, a large percentage of people do not have access to services or avoid seeking them out. In the most recent Substance Abuse and Mental Health Services Administration review on treatment by race, only 7.6% of Blacks, 7.3% of Hispanics, and 6.5% of Asians received any treatment, as compared to 16.6% of whites.

Race-related treatment discrepancies occur for many reasons, not the least of which is social stigma surrounding diagnosis and seeking or receiving help. Last year, a review conducted on thirty years of UK mental health data tried to better understand how stigma impacts help-seeking. The combined data, comprised largely of mental health surveys, identified stigma as the fourth most significant barrier to seeking help. Those surveyed were particularly concerned about disclosure of their illness outside their service provider relationship. The data review also pinpointed ethnic minorities, youth, men, and military or health professionals as the most likely demographics to be deterred by stigma.

Many smaller, more localized studies have examined the same issue and found similar results. For instance, in Ontario, research into hospital admissions due to mental crisis, Chinese and South Asians experience a higher percentage of involuntary admissions and are more likely to be experiencing severe illness at the time of hospitalization. Researchers hypothesize that stigma leads to these crisis-level situations. Strong family bonds among Asian people influence them to keep mental illness hidden. When symptoms become too severe and unmanageable, they have no choice but to seek outside help.

Societal attitude adjustment

It seems that to connect mental illness sufferers with treatment services sooner, the stigma issue must be addressed. But that’s not an easy task. Stigma arises from deeply embedded societal institutions and systems that require daunting adjustments in perspective and attitude. When a society does not promote research funding, adequate insurance coverage, and geographic availability of mental health services, it sends signals to its members that mental health isn’t a real problem deserving of support and solutions.

According to the National Academy of Sciences, anti-stigma and mental health promotion efforts should be conducted at the nation level by federal partners and stakeholders to ensure the highest likelihood of success. NAS recently conducted a review of current anti-stigma campaigns and found numerous private and public organizations, including eight federal agencies, engaged in such efforts. The NAS opined that these efforts were not being maximized and could be leveraged by working with a larger, wider-reaching entity. Pointing to past U.S. HIV/AIDS campaigns and mental anti-stigma campaigns in other western nations as success stories, NAS suggested decades-long funding and federal government support would greatly increase the likelihood of changing societal views on mental illness.

Californian success story

Perhaps a national campaign could learn a thing or two from California’s anti-stigma social marketing efforts. In 2011, the California Mental Health Services Authority began a multi-year, statewide prevention and early intervention programs including a one-hour documentary featuring recovered patients, an interactive stigma and discrimination website, online support forums targeting young adults and teens, and several iterations of radio, online, and print ads. On behalf of CalMHSA, Rand Corporation evaluated the campaign and found that up to 120,000 people had received mental health support as a direct result.

During the Rand’s evaluation, they contacted approximately 1,000 California residents that had previously reported mild to serious psychological distress in a health survey conducted prior to the anti-stigma campaign. Of these residents, 35% confirmed exposure to CalMHSA’s anti-stigma efforts and were more likely to have received mental health treatment during the campaign time period. Further, extrapolation of these results suggests that up to 22% of Californian adults experiencing psychological distress at the time of the campaign received mental health services.

The CalMHSA campaign and Rand findings signal that targeted efforts aimed at addressing mental illness stigma can yield significant change. With organization of a similar efforts at the federal level, the potential to reach many more people dramatically increases. Major mental health organizations and supporters must come together to organize a common message and influence federal action. Perhaps then we can make more substantial progress in addressing the growing mental illness health crisis.

— Embrace hope.

What stigma effects have you personally experienced? Does stigma keep you from seeking out services and support? What changes would make you more comfortable and confident to do so?

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