In the U.S., awareness of mental health problems as a common public health challenge has grown. An important example of societal support and awareness of the need for access to mental health services is reflected in the Mental Health Parity Act (MHPA) of 1996 and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Both the MHPA and the MHPAEA improved insurance coverage of mental health conditions by requiring insurers who offer mental health and addiction services benefits to do so at the same benefit level as medical and surgical benefits. In other words, insurance plans could not offer both medical illness coverage and mental health coverage and not offer comparable coverage for the mental health and addiction services.
Other indications of growing awareness of the prevalence of mental health problems can be seen in public media: there are more public service announcements than ever for suicide prevention, depression awareness, and symptoms of mental illness as well as advertisements for treatment facilities for various mental health problems and addiction services. Certainly in the military, the focus on suicide prevention has become a concern that is reflected in a large volume of scholarly literature and an almost daily public news article about. We know that the rate of suicide in the military has increased since 9-11. However, the U.S. civilian rate of suicide has also been on the rise since 1999, and certain demographic groups have risen particularly sharply. For example, adolescents are now represented among suicide decedents in the U.S. more than ever, and the reasons for this are unclear. What we can assume, however, is that mental health stigma, which impacts all demographic groups, interferes with help-seeking behavior among teens like it does adults. So, while our society has made progress in recognizing the existence of mental health problems and the need for access to treatment, we still have a long way to go.
Mental health stigma can be seen in pejorative descriptions of people with mental health problems, inaccurate and inflammatory depictions of mentally ill individuals in movies, and in the lyrics of songs on the radio every day. These messages are not lost on people who are struggling with mental health problems, including teenagers, and the underlying harmful theme is that mental health problems reflect weakness and/or character defects that physical health problems do not.
These newspaper articles describe the action that some teenagers in Oregon are taking to combat mental health stigma in their communities. They introduced a bill that was signed by Oregon Gov. Kate Brown last month which allows students to take days off from school for mental health reasons without a doctor’s note. Specifically, students can miss up to five days in a three-month period for mental health reasons. One of the leaders of the group, Hailey Hardcastle, is a recent graduate of a Portland high school, and she says that she and her peers were inspired by the action taken by the students after the Parkland shooting. They realized that teenagers can have a strong voice among lawmakers and influence policy which impacts them directly.
The rationale for the bill, according to the group, is that they want to send the message that it is “as OK to take care for mental health reasons as it is for a broken bone or a physical illness.” They point out that society is very accepting of the idea of taking a day off for a cold or the flu or some other physical ailment, but taking a down day to restore one’s mental health has historically not been accepted. According to Hailey and her group, this encourages teenagers to try and “push through” mental health symptoms and/or possibly lie in order to avoid negative attention or unexcused absences. The results: perpetuated stigma and, more importantly, lower likelihood of teenagers seeking the mental health care they may need.
Critics of the bill argue that it encourages young people to miss school, and this is particularly relevant in a state that that has one of the highest rates of school absenteeism in the U.S. On the other hand, proponents of the bill note that Oregon also has a suicide rate that is significantly higher than the national average making it the perfect state for such a law. (Reasons for this higher-than-average suicide rate in Oregon are not completely understood, but high rates of gun ownership and easy gun access; a largely rural environment with less access to mental health services; and a rugged individualistic mindset--leading to low help-seeking--are some possibilities.) Another possible criticism of the law may be that missing school may worsen mental health problems—in other words, is withdrawal from routine responsibilities (e.g., school, work, social contact) often recommended as a helpful intervention for problems like low mood or anxiety? Not usually. While it seems important to not encourage an avoidant approach to mental health, the law does put limits on the number of days students can miss, such that an avoidance strategy is not encouraged. In addition, it seems that teenagers’ ability to honestly report the need for an absence due to mental health reasons may outweigh this concern about avoidance since honest communication will bring the problem to the surface and to the attention to adults like parents and school personnel who can assist the teen with getting help.
Hailey Hardcastle and her team have done inspiring work in making changes in their state to reduce mental health stigma and promote help-seeking. Like teen activism in other areas of social concern, their persistent efforts and voices are being recognized and resulting in policy change. Hopefully, this will continue in Oregon and other states through additional efforts to improve how our society views mental health problems and responds to them. With additional laws such as this, teenagers and adults will be more likely to tend to their own mental health through self care and/or seek professional help when needed—all without shame or fear of negative educational and occupational consequences.
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.
Regina Shillinglaw, Ph.D., is a Senior Military Behavioral Health Psychologist with the Center for Deployment Psychology at Uniformed Services University of the Health Sciences in Bethesda, MD. Dr. Shillinglaw is located at Wright-Patterson AFB in Ohio.
Houser, K. (2019, July 22). New Law Lets Students Miss School For “Mental Health Days” Futurism. Retrieved from https://futurism.com/students-miss-school-mental-health-days
Matias, D. (2019, July 22). Feeling Blue? Oregon Students Allowed To Take 'Mental Health Days'. NPR. Retrieved from https://www.npr.org/2019/07/22/744074390/feeling-blue-oregon-students-allowed-to-take-mental-health-days
Zimmerman, S. (2019, July 22). A new law in Oregon allows students to take “mental health days” just as they would sick days. AP News. Retrieved from https://apnews.com/b2ce8f6a019846f7844f59af449ad567