Stigma as a Barrier to Mental Health Care

Over 60 million Americans are thought to experience mental illness in a given year, and the impacts of mental illness are undoubtedly felt by millions more in the form of family members, friends, and coworkers. Despite the availability of effective evidence-based treatment, about 40% of individuals with serious mental illness do not receive care and many who begin an intervention fail to complete it. A new report, published in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, investigates stigma as a significant barrier to care for many individuals with mental illness.

This is a photo of a ladder in a tunnel.While stigma is one of many factors that may influence care seeking, it is one that has profound effects for those who suffer from mental illness:

“The prejudice and discrimination of mental illness is as disabling as the illness itself.  It undermines people attaining their personal goals and dissuades them from pursuing effective treatments,” says psychological scientist Patrick W. Corrigan of the Illinois Institute of Technology, lead author on the report.

“One does not work long on mental health issues before recognizing the additional hardships caused by stigma,” write Former U.S. First Lady Rosalynn Carter, Rebecca Palpant Shimkets, and Thomas H. Bornemann of the Carter Center Mental Health Program in a commentary that accompanies the report.  These problems continue today, they add, in the form of poor funding for research and services compared to other illnesses; structural forms of discrimination; and “widespread, inaccurate, and sensational media depictions that link mental illness with violence.”

In the report, Corrigan and co-authors Benjamin G. Druss of Emory University and Deborah A. Perlick of Mount Sinai Hospital in New York synthesize the available scientific literature, identifying different types of stigma that can prevent individuals from accessing mental health care.

Public stigma emerges when pervasive stereotypes — that people with mental illness are dangerous or unpredictable, for example — lead to prejudice against those who suffer from mental illness.

The desire to avoid public stigma causes individuals to drop out of treatment or avoid it entirely for fear of being associated with negative stereotypes. Public stigma may also influence the beliefs and behaviors of those closest to individuals with mental illness, including friends, family, and care providers.

Corrigan and colleagues note that stigma often becomes structural when it pervades societal institutions and systems. The fact that mental health care is not covered by insurance to the same extent as medical care, and the fact that mental health research is not funded to the same levels as medical research, are two clear indications that stigma targeted at mental illness continues to exist at the structural level.

In the face of these realities, the report identifies approaches to addressing stigma that can help increase care seeking among those with mental illness. These approaches operate at various levels, from promoting personal stories of recovery and enhancing support systems, to instituting public policy solutions that enhance actual systems of care.

Researchers, advocates, and care providers have made gains over the past few decades in increasing the number of people receiving adequate and appropriate mental health care, but stigma remains a significant barrier to care. The new report surveys existing scientific research on mental health care participation as a way of advancing efforts to eradicate this barrier.

“This issue of Psychological Science in the Public Interest makes a strong start in consolidating and disseminating what we now know — that public policy, the law, and media remain our greatest resources to stimulate change and spur action,” Carter, Palpant Shimkets, and Bornemann write in their commentary. “We also need to build bridges to other fields that connect to mental health, such as public health, primary care, and education.”

In taking this integrative, multi-level approach, they are confident that there is hope for the future:

“Together, we can create robust systems and services all along the path of recovery and encourage early intervention and access to treatments without fear of labels or diminished opportunities.  When that is achieved, we will know that our tireless efforts to eradicate stigma have been successful.”

The report, “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care,” and the accompanying commentary, “Creating and Changing Public Policy to Reduce the Stigma of Mental Illness,” are available online for free to the public.

The manuscript was made possible in part by National Institute of Mental Health Grant MH08598 (to Patrick W. Corrigan) and Grant MH075867 (to Benjamin G. Druss).

Comments

I was linked over to this article from a Huffington Post piece about singer Demi Lovato urging people not to let stigma keep them from getting help for mental health issues.

I’m writing on 12/5/2016, and this article has been around for a couple of years, but every time I see a “stigma” article, I think this — and a thousand times louder today — it does not matter whether or not people overcome stigma if they cannot financially access medical care for illnesses such as major depression and bipolar disorder.

I’ve had both of those for 30 years, never had stigma, and always had health insurance through my employer. I’ve also got PTSD now, and some cognitive issues as a result of trauma. I have been on several medications for all these decades, except for a few months about 10 years ago when an error left me unable to see my doctor or have my medication.

I went into a mixed episode, which is the most hellish experience anyone could ever have. I wound up making a serious suicide attempt.

In the years since, I’ve continued to survive as I divorced an abusive spouse, lost my home to foreclosure, declared bankruptcy, watched my father die, and was laid off from my job.

I had Obamacare, but I live in a state where Medicaid was not expanded, so while unemployed I lost it twice. I spent more time trying to get and keep health insurance and continue getting medication than I did looking for a job.

I eventually had a psychotic breakdown and deteriorated to the point where I am now on Total Disability, and still I have had to contact an elected representative to get care, which I had to wait 9 months for. I continued with my meds only by purchasing them illegally.

Now its been almost a week since we’ve learned Trump’s appointees, along with the Speaker, really do plan to overturn the ADA and kill Medicare, Social Security and Medicare. And the process will not be nearly as slow or difficult as most people assume.

The fear of this possibility has impeded my recovery all along, and now here it is. Yet I am having to SEARCH for information about it, to see if anyone is doing anything to stop it.

I was a newspaper reporter and editor for 30 years, and I know how to get information. This issue should be front-and-center. EVERYONE should be talking about this.

Particularly since stopping antidepressant meds and tranquilizers can cause extreme and dangerous withdrawal, where are the nation’s mental health advocacy groups? Where is NAMI? Where is the American Psychological Association?

My God, for 30 years we don’t go a day without hearing something about the abortion issue. But now almost everyone in the nation who has a mental illness, a disability, who is a child, or elderly, or low income, will lose their medical care. And crickets.

Currently my friend says I can keep living with her, and my new doctor will continue to treat me. But if I am looking at living another 35 years with zero medical care and zero income, I have literally no reason not to take my life (successfully this time), and a lot of really rational reasons to do just that.

When I was in my mixed episode, my withdrawal symptoms had gone on for 2 months and were getting worse, not better. I have no idea if they would have ever abated. Anyone who has not experienced it does not understand the hell of it.

Health advocates of all conditions should be out there, but advocates for mental illness should be in front. The results will be devastating if millions have to suddenly stop taking these meds. Now I see why Ryan wanted to pass his “Families” bill to make institutionalization easier!

I feel abandoned and betrayed, and very disappointed I survived the first time.

Hi Teresa, I stumbled on to this article while working on a paper about “Structural Stigma” for my Community Mental Health course. To be honest, I learned much more from your comment than the article above. I never leave comments, but I wanted you to know how much you impacted me-out in CA. You’re right someone (like me) who has not walked in your shoes could not possibly begin to understand the hell you’ve been through and the fear and outrage you’re experiencing now. But i mad as hell too at the current state of our healthcare system…and it’s fueling me to work harder for justice. For what it’s worth I want to say, your story has moved me… Thank you for raising your voice and sharing your fight for recovery…as an emerging mental health clinician and advocate, i will fight for you and others most impacted by this disastrous administration.

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