Let’s talk about mental health stigma

Mental illness is extremely common. One in four US adults has a mental disorder, such as depression, anxiety or substance abuse, according to the Centers for Disease Control and Prevention (CDC). It’s likely that you know someone with a mental illness, even if you don’t have one yourself. So why is it so hard to talk about mental health issues?

The history of mental illness stigma still affects us today. Society has always had difficulty dealing with the realities of mental health problems. In the past, mentally ill people were shuffled off to asylums instead of receiving support. In the modern day, some people still refer to mentally ill people as “crazy” and throw around slurs related to mental health. It’s not surprising that not everyone wants to discuss mental illness, especially if it’s something they live with.

Here’s how mental health stigma causes harm.

FAQs

Q. What is stigma in mental health?

So what is mental health stigma? It's negative beliefs and attitudes about mental health problems. This has a negative impact on those dealing with mental health issues. Some mental health stigma examples:

• a health system that may focus on physical health over mental wellbeing
• family and friends who discourage seeking treatment for mental health
• acquaintances acting as though certain mental health conditions make a person inherently dangerous
• the use of words like "crazy," "loony bin," or "psycho"

Public stigma comes from people outside yourself, but there's also self-stigma. Self-stigma happens when a person internalizes negative attitudes from others and views their own condition with shame, fear, and/or distaste.

Q. What does the stigma around mental health conditions look like?

There are many examples of mental health stigma in everyday life. The representation of mental illness in film is one example. Many scary movies and video games feature a violent mentally ill person as an antagonist. Scary ‘mental patient costumes’ for Halloween can have a negative effect on real-life people with serious mental illnesses too. People may perform online searches for "scary mental disorders," "violent mental disorders," or "scary psychological disorders," out of fear that mental illness is dangerous to themself or others.

A more subtle version of mental health stigma also exists though. Some people act as though a positive attitude can cure depression, for example. Others may tell people with anxiety to "face their fears" or just get some exercise. While exercise for mental health does have benefits, severe mental illness deserves the same concern as physical conditions. That means treatment plans from qualified mental health professionals that may feature medication or talking therapy. Remember, people do not choose to be mentally ill and they cannot simply choose not to be ill.

Q. How has the treatment of mental illness changed?

Breaking the stigma of mental health includes acknowledging the controversial past of mental health treatment. For centuries, isolation was considered the only option for people with mental illness. The trend of scary asylum movies didn't emerge from nowhere. Negative attitudes can often be rooted in a lack of understanding. For a long time, people in the United States had a lot of misconceptions about mental illness, some of which are still common today. Luckily, mental health care is moving towards being more open and accepting. And mental health professionals are learning more about effective treatments every day.

Q. How does stigma affect mental health?

The National Alliance on Mental Illness (NAMI) has articles such as "What to Do When Your Friends and Family Are Unsupportive of Your Depression" and "What People with Mental Illness Want You to Know." These are direct results of social stigma.

The stigma around mental illness can make it hard for people to seek treatment, or even to admit they have a problem that needs treatment. According to the American Psychiatric Association, more than half of people with mental illness don't seek help for their disorders. People can be worried about repercussions at work, judgment from family members or friends, and even judgment from strangers. Someone's mental and emotional health can be made worse simply from wondering how they'll be treated if they open up about how they’re feeling.

Q. How does stigma affect quality of life?

Stigma may prevent someone from seeking treatment. Untreated mental illness can drastically decrease quality of life. Examples provided by the CDC include a young adult who cannot graduate high school due to mental illness. Without a degree, it can be harder to find a job. Without a job, or with a low-paying job, a person has less access to quality healthcare. This makes it harder to get diagnosed and receive proper treatment. Someone who's unemployed may also struggle with isolation or self-esteem issues, which adds to the burden of mental illness.

Q. How does the stigma around mental illness affect different groups?

Some groups can have a harder time than others overcoming the stigma of mental illness. And some mental illnesses are more stigmatized than others. Schizophrenia and Dissociative Identity Disorder are both incorrectly associated with violent outbursts due to poor media representation.

According to the World Health Organization (WHO), mental illness is underdiagnosed. This affects some groups and communities more than others. Symptoms of mental illness can present differently in different genders, leading to mental health conditions not being recognized. People of one gender are more likely to self-report certain mental health symptoms than others.

The relationship between mental health and people of color is also unique. According to the National Council for Behavioral Health (NCBC), although certain communities of color can be at higher risk for mental illness, they can also be at risk for believing they should simply "push through" mental illness. Some communities fail to recognize mental health conditions as illnesses, instead believing them to be a personal weakness.

Q. How does mental health stigma affect treatment?

Whether it's the stigma around therapy or seeking medication for mental illness, some people simply won't seek treatment for mental illness. Because of the prevalence of negative attitudes, some people would prefer to struggle rather than admit they have a mental health condition. Some people who do seek treatment suffer from self-esteem issues or isolation from family and peers. The CDC reported that "only about 20% of adults with a diagnosable mental disorder or with a self-reported mental health condition saw a mental health provider in the previous year." Those who didn’t seek treatment cited "embarrassment associated with accessing mental health services" as one of the barriers to getting help.

Q. What are barriers to mental health treatment?

Barriers are anything that can prevent someone from seeking treatment. Money and access are examples of common barriers to medical treatment.

The social stigma of mental illness is one of the biggest barriers. Some people may be actively discouraged from treatment by friends or family members. Just the knowledge of the mental health stigma stops some people from seeking treatment. Young people may be blocked from treatment by guardians.

Q. Do different mental illnesses face different kinds of stigma?

Yes. Some mental health conditions, especially personality disorders, can be (incorrectly) perceived as dangerous by others. Schizophrenia discrimination and Borderline Personality Disorder (BPD) stigma are both based in fear of the person with the condition. People with bipolar are often stereotyped as selfish or wild.

Others face different sigmas. The stigma of anxiety disorders often comes from people thinking those with anxiety simply need to "relax" or "face their fears”. Similarly, "just get over it" is a common refrain in the social stigma of depression. Some people may think they're weak--or others might tell them that they are--for not being able to "just handle" their symptoms. This is common in PTSD, especially since the trauma may make it hard for people to admit they need help.

Stigma can also be greater for disorders that people find it hard to talk about. The stigmas of eating disorders and substance abuse often come from the fact that people find it awkward or unpleasant to talk about these issues.

Q. How can I help end the stigma mental health patients face?

To stop the stigma of mental health, it's important to listen to anyone who talks to you about their mental health. If you're unsure what a mental illness means for you or your loved ones, do your research. Educate others when you can. Advocacy for people with mental health conditions can help more people feel confident enough to talk to a professional and get the support they need. This empowerment also lets people advocate for themselves to doctors or to those who still hold a stigma against mental health issues.

Q. ​What are the benefits of talking about mental health?

Acceptance of mental illness in society starts with educating the general public. The more people know about something, the less likely they are to be afraid of it. With more education, more people will feel comfortable seeking help for their conditions.

Talking about mental health issues also brings more awareness to "invisible" mental illnesses. An invisible mental illness is anything that doesn't have symptoms that others can easily observe. It's common for people with these conditions to go untreated because no one can see that they're struggling. Depression and anxiety are some of the most common invisible mental illnesses.

Q. How to talk about mental health?

It's hard to talk about your mental health, but it's important for your well-being. The more people who openly discuss the realities of mental health problems, the more we can reduce public stigma. Start with talking to a few supportive friends or family members or your partner. You can also get practice talking about mental illness in mental health support groups. Others in the group may have tips on how to talk to the people in your life.

Q. How to talk to your doctor about mental illness?

If you have concerns about mental health, the most important thing is to find a doctor who will listen to you. If your doctor doesn't take your mental health concerns seriously, seek a second opinion from a trusted healthcare professional.

Make a list of questions to ask. Topics of discussion may include the benefits of medication for mental illness, what your symptoms may mean, and how to schedule therapy or psychiatry visits. (A psychiatrist is a medical doctor and can prescribe medication. A therapist can help you to understand your condition and guide you in making changes to your thinking and behavior to help you feel and function better.)

Q. How to talk about mental health in the workplace?

The importance of talking about mental health extends to the workplace. In an American Psychiatric Association (APA) study, about half of the workers said they were worried about talking about mental health at work. A stigma-free workplace means clear and open resources for workers with mental health concerns. Managers should make it clear that discussing mental health issues won't result in backlash from higher-ups.

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References:

1. Attitudes Toward Mental Illness - CDC
2. Learn About Mental Health - CDC
3. Stigma and Mental Illness - Lifespan
4. 9 Ways to Fight Mental Health Stigma - NAMI
5. Mental health: Overcoming the stigma of mental illness - Mayo Clinic
6. Understanding the impact of stigma on people with mental illness - World Psychiatry
7. Stigma, Prejudice and Discrimination Against People with Mental Illness - American Psychiatric Association
8. Women and mental health — NIH
9. Stigma Regarding Mental Illness among People of Color - National Council for Behavioral Health
10. Bipolar Disorder and Stigma - NAMI