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.
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.
What mental health really is: Blaming no one or nothing for your own feelings, thoughts or mental state. Taking full responsibility and not counting on an external system to do your introspection for you. That’s the unpalatable truth. Pointing your finger at stigma is just one more reason people make up to continue avoiding the hard work of facing their own minds and deflecting responsibility on the system rather than becoming fully self accountable. People will do anything to defend their mental habits and maintain unhelpful conditioned mind patterns. That’s not on stigma, that’s on the person.
Actually, there is a difference between mental health and mental illness that most people fail to understand. Based on your comment here, you or anyone close to you has ever experienced a mental illness thus far. Unfortunately, like so many other people on this planet, you voice an opinion on a topic you know absolutely nothing about.
1 in 5 Americans experience not only a mental illness condition in a given year but also suffer from the effects of the MH Stigma. Mental illness is NOT a result of personal weakness, lack of character, or poor upbringing (in most cases). It can be caused by a variety of things such as genetics, environmental, or brain chemistry.
People do not volunteer to experience trauma, which leads to mental health problems such as PTSD if left unresolved/untreated. That would be like saying “You were asking to be raped being dressed or acting that way” or in my case, I didn’t exactly ask to be molested by someone I knew at 5 years old. Do you know anyone serving in the US Military? If they’ve been to war, they most likely experience PTSD to some extent.
Here’s my story…I mentioned the traumatic event that happened to me. Of course at 5 years old I don’t quite understand what is happening to me, I just do what I’m told. Nobody knows how long it went on before I said something to an adult. My parents and the doctors did everything they could to make sure my brain buried those memories for the rest of my life. Unfortunately, I was about 12-13 when I started having these dreams/nightmares about the last time it happened. I was confused about the fact I couldn’t remember that day yet the whole scenario felt strangely familiar. It took me a few months to approach my mother about it. I also didn’t ask my mother to have a one night stand with someone she barely knew and get pregnant with me without getting his medical history report. My biological father has schizoaffective with bipolar disorder. Schizophrenia has affected quite a few generations of that family. Between him being a first degree relative to me and I was his first born child, I have a great risk of developing a form of his condition between my early 20s to early 30s. I am currently 27 and suffer the effects of bipolar disorder. Lastly, I did not ask my boyfriend of 6 years to become abusive sexually, mentally, and physically out of the blue for no reason. I endured almost a year of that before I found a safe way out.
So instead of having a prejudice outlook on things such as mental illness or mental health, find some freaking compassion and empathy and just maybe educate yourself on it a little better. You never know what someone has gone through (especially behind closed doors) so don’t make them more ashamed of the things they cannot control.
Autism, OCD, ADHD, Anxiety, Depression, Phobias, Schizophrenia, Bipolar, Borderline Personality Disorder, Panic disorder, Dissociative Identity Disorder, PTSD, Dysthymic Disorder. These are examples of mental illnesses people can experience and the effects vary from person to person. Many of them, like Autism, people are born with…it’s just a matter of timing as to when the symptoms start showing.
I have personally experienced mental illness on a few different levels, I have watched it affect others around me, and now I work in a Mental Health office. I am tired of feeling ashamed for my mental condition because of people such as yourself who believe I can just “get over it” and choose how my brain’s chemicals work.
Your response doesn’t make any sense! More than stigmas, I think the bigger problem is lack of education about mental illness which results in ignorance. People like you who choose remain uneducated about mental illness are the problem. You are part of the stigma and the problem. The millions of children who suffer from mental illness and the millions of people who were born with mental illness conditions, you’re saying that all of these children and people who have mental illnesses are only suffering because they would rather point their finger at stigmas and that the problem is a result of themselves. There are people that suffer from mental illness (NOT a choice) and then there’s people like you who are uneducated and ignorant (IS a choice). Your describing people like yourself in your post, but I’m sorry to tell you that stupidity and ignorance are not medical mental illnesses. You can break yourself free that by learning about mental illness so you’ll be able to know what you’re talking about. Good luck!
There are so many ill effects caused by the stigma to an individual who already affected by mental depression or mental illness.the medical persons have termed stigma into two different types, “public stigma” and “self-stigma,we have to create awareness about this,keep sharing with us.
I am living 48 years Bipolar 1,OCD,SAD but I have seen in my life violation of patient rights in the ER being violated because there is no way to have access to MH to the point of suicidal/homocidal may or not get meds or an appointment 3-6 months out. The biggest issue is violation of basic and human rights across disabilities. La. and US are the worst at addressing mental health. The brain is an organ “Mental Health as a Physical Health issue.
Stigma will never disappear until the insurance industry is forced to stop discrimination. Health plans, despite parity laws still place utilization reviews for medical necessity on claims for mental health treatment. When this happens while you are depressed or have anxiety, how are you supposed to fight back? Life insurance companies are a dark beacon when it comes to mental health history. If you can get approved for a policy at all, it will cost you substantially more with a mental health history. Nobody explains this as you are shepherded into mental health treatment and your electronic records are shared with your health plan (and employer if your plan is an erisa employer self funded plan). Good luck keeping that job even if your insurance claim is rejected. Now you are mentally ill, on the hook for all costs out of pocket and maybe out of a job and no more health plan unless you also pay high COBRA rates for that plan that does not cover needed treatment.Yes I know HIPAA prevents that by refering to a firewall between health plans and employer- newsflash!!! There is no firewall. Now Trump and republicans want to dismantle the ACA along with required mental health coverage. Good luck finding a new health plan when that happens, too. I read article after article about how people suffering mental illness do not seek help. I wonder why? I sure won’t until the insurance industry is finally forced to stop discrimination and no longer reuqire mental health records for claims.
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