Stigma against people with mental health conditions has a significant impact that extends beyond stereotypes. Fellow CDP'er Dr. Paula Dominici’s blog article a few weeks ago detailed some specific ways Service members with mental health conditions are affected by social perceptions about their fitness for duty, as well as how their own self perceptions impede help seeking and negatively impact emotional wellbeing.
More broadly, in surveys about attitudes toward people with mental illness, those with mental illness are more often perceived by others as unpredictable, dangerous and untrustworthy on the basis of diagnostic status. This is true regardless of whether the person knew someone with a mental illness or had a family member with mental illness, and astoundingly, it was true whether or not the person belonged to a group or professional class who should know better like teachers, school staff or physicians (Connolly et al., 1992; Crisp et al., 2000; Moses, 2010; Wallace, 2010).
Lawmakers, entertainers and newsmakers are not different in this regard. It is difficult to listen to headlines without running across derogatory and inaccurate characterizations of people with mental illness, nor is it uncommon to hear slang terms and slurs for mental illness applied to political opponents or public figures as a way of invalidating their beliefs or positions. This is an unfortunate and effective political strategy since public perceptions tend to align with negative stereotypes about mental illness.
Though people with mental illness are more likely to be victims of violence, they are more often blamed for violence. During a psychological crisis, people with mental illness are more likely to have contact with law enforcement than with a medical provider, and while contact can sometimes result in compassionate care and treatment referral, it can also result in violence, incarceration and even death. According to the National Alliance for the Mentally Ill (NAMI), there are more people with mental illness in jail or prison than in hospitals.
It is not difficult to draw parallels between stigma associated with mental health and prejudicial beliefs associated with membership in other demographic and social groups, so much so that many advocates call for refocusing the discussion around discrimination rather than stigma, pointing out that while the word “stigma” is associated with a mark of shame for the individual with mental illness, “discrimination” more correctly places responsibility for unequal treatment on the individuals and systems that discriminate (Holmes, 2017).
This point of view makes sense when you consider that unequal treatment of mental illness relative to other illnesses, is codified into US law. Consider the following: Medicaid law specifies that funds may be used for hospitals treating physical conditions but generally not for mental health. Until the affordable care act required health exchanges to provide equal coverage, many private health insurance plans routinely excluded mental health coverage as well. Even though equal coverage for private insurers is now the law, Medicaid is exempt from that law and continues, for example, to have a lifetime limit on hospital care for psychiatric conditions. Medicare and Medicaid typically pay less for inpatient mental healthcare than for medical care leading former congressman Patrick Kennedy to call the mental health system a “separate and unequal system,” resulting in death and disability due to inadequate care.
The result of unequal reimbursement is fewer hospital beds, fewer providers and poor follow-up when a person is forced to seek treatment in an emergency room. In fact, many with unmet treatment needs find themselves in the untenable position of being too sick to work or manage their lives, but not “sick enough” for one of the few emergency hospital beds available. Many patients can find help only after they have become psychotic, or attempted suicide. Former Congressman Kennedy likens this to providing diabetes treatment only after a person has had an amputation.
Language is important. Attitudes are important. Stigma shapes the way we interact with people who have a mental illness, prevents us from confronting our own inaccurate beliefs, and justifies unequal treatment, preventing us as a nation from addressing the systematic ways that we discriminate against people with mental illness. We need to work to change the way we talk about and think about mental illness. We also need to provide training and education for first responders, teachers, healthcare workers and the like, including ourselves since many studies show that those who should know better, often don’t.
And finally, if we are really serious as a nation about helping those with mental illness, about equal access to care, and about fair treatment of people with disabilities, we need to change laws that allow insurance companies and providers to treat people with mental illness differently from those who suffer from other kinds of health issues.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kelly Chrestman, Ph.D., is a licensed clinical psychologist working as the lead for online consultation services at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland