Educating the public about mental illness in an effort to reduce stigma has proven a double-edged sword. Research shows that as people have increasingly accepted that mental illnesses are biologically based, they continue in their discomfort with or outright fear of people with these diseases. On the one hand, understanding the role of biology has gained more empathy for people with depression, but has actually worsened the image of people who have schizophrenia. Many people still feel that schizophrenics may become violent and are hopeless to treat.
This is not something that an anti-stigma brochure is going to help. The former president of the American Psychiatric Association, Steven Sharfstein, said in 2012 that negative attitudes toward persons with serious mental illnesses are unlikely to decline “as long as there are untreated, delusional, disheveled, threatening homeless individuals on our streets and in high-profile media examples of violence.”
Nearly half of Americans blame a faulty mental health system for the violence we hear about in the media. Yet, as mental health advocates keep reminding us, the seriously mentally ill are more likely to be victims of violence than to be violent themselves. Although it is a complex problem, research shows exposure to abuse and violence early in life are much greater risk factors for violent behavior in adulthood. As researcher Dr. Jeffrey Swanson* notes, this kind of trauma is not something you solve by having someone take a mood stabilizer.
Public Education Has Limits
Reducing stigma is clearly more difficult than advocates perhaps anticipated. While Americans have come to recognize the disease model, the majority still say they wouldn’t want to work with a mentally ill person or have one marry into their families. Some mental health advocates have called into question whether the resources that were spent on traditional public education programs were worth it, considering the results.
So what does work when it comes to reducing stigma? Research shows that meeting someone with a mental illness face-to-face is two to three times as effective in reducing stigma as an informational program. Engineering a solution along these lines, however, seems impractical and again raises the question of whether resources would be better spent on treatment or research.
Ironically, most of us are already related to, working with, or socializing with the one in four Americans who have diagnosable mental illnesses. These folks don’t fit a stereotype and that is why we don’t recognize them. Of the one in four, many do not understand their own symptoms and might react badly to the suggestion that they need help. This is the major reason 57 percent of Americans with diagnosable behavioral health disorders are not receiving treatment. And therein lies the problem. Stigma isn’t just an impolite response. Overcoming it isn’t a matter of political correctness. Stigma discourages people from seeking help and from following a course of treatment.
To get around this, innovative models are being used that realign first encounters with the mental health system. Telephonic interventions in the privacy of a person’s home seem to make discussing personal issues less threatening. These start with conversations about immediate health concerns and goals, which may uncover indicators of underlying mental illness. Introducing mental health concepts as part of a whole-person health conversation reduces stigma and supports an eventual in-person diagnosis and treatment follow-through.
Other telemedicine solutions hold promise, but technology itself is not the answer. The skill and empathy of a trained clinician make all the difference. Compassion will always be the essential ingredient in bringing mental illness out of the shadows and into the sunlight.
Dr. Toney is chief medical officer and executive vice president of clinical integrity for Health Integrated.
*Swanson is a medical sociologist and professor in psychiatry and behavioral sciences at the Duke University School of Medicine.