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How Stigma Keeps People from Mental Health Care

A new study goes deep on a problem that keeps many millions from seeking help.
September 6, 2014, 9:00am
Image: Sun-anda/Flickr

So many things in the realm of mental illness are looking up. On the one hand is a steady stream of new research and related potential treatments; on the other is the promise of better mental health coverage, at least in the United States, where provisions in the Affordable Care Act (Obamacare) and otherwise have finally forced insurers to cover mental illness just as they do "physical" illness.

So, mental health care is more available and more effective than it's ever been, but that's not enough. People that need care have to seek it out. And a startlingly large percentage of those suffering from mental illness just don't.

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The stigma of mental illness is some huge part of that, though just how big of a part has remained somewhat subject to anecdotal data. A new open-access review study from researchers at the Illinois Institute of Technology aimed to both quantify the role of said stigma in mental health treatment—or the absence of treatment—and to explain the mechanisms, both individual and institutional, behind its persistence.

The IIT study, led by psychologist Deborah A. Perlick, cites a 2011 report finding that over 40 percent of Americans suffering from serious mental illness don't get help.

"From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination," Perlick and team write, "such as excluding people with these conditions from employment and social or educational opportunities."

One of the major points of the new study is that these stereotypes run very deep and permeate most everywhere in society. Stigma even carries through to medical settings as well, where negative stereotypes might make health care providers less likely to focus on the patient than the disease, "endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services," the paper explains. Doctors then become part of the problem.

"Especially egregious beliefs about people with mental illness include being dangerous and unpredictable, to blame for their illness, and incompetent to achieve most life goals, such as a good job or living independently," the researchers write. "Although changing population attitudes is a laudable goal, advocates believe that focus should be on discriminatory behaviors, the actions of others that block the pursuit of independent living goals related to work, education, and other arenas."

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In other words, "'It would be nice if everyone accepted my mental illness, but at the end of the day I don't want someone blocking my right to work and live independently.'"

The IIT researchers came up with the following basic taxonomy:

That's the situation now, based on a wide survey of current research. Seems about right. But fixing the situation is less clear. Mythbusting and education are perhaps most crucial, along with structural changes of the sort already underway, like maintaining equality in mental and general health care.

Until only very recently, health insurance companies were allowed to treat mental heath treatment as a sort of second tier, often offering weaker coverage and making that coverage more difficult to get.

Killing stigma reduces to three main variables: knowledge, culture, and network. The importance of each layer is primarily a function of education. In the paper's words, "mental health literacy includes knowledge about preventing disorders, recognizing them when they develop, pursuing help when disorders become distressing, and using mental health first aid skills to support others in distress."

What we should wind up with is something of a feedback cycle, where decreasing stigma—whether it's in work networks, via family or friends, or as dispensed by pop culture—leads to more people being open about their own mental illnesses, which in turn leads to more understanding and, again, less stigma.

Given an estimated 60 million Americans thought to suffer through some form of mental illness in a given year, according to the National Alliance on Mental Illness, the way forward isn't simple or cheap, but at the very least it's possible to imagine that it's not strictly a Sisyphean task. Someday the climb won't be quite so steep or the boulder so heavy.