#JamesDonaldson On #MentalHealth – How #Stigma Prevents People From Accessing #MentalHealthCare And What Can Be Done About It

By Hannah Furfaro Seattle Times staff reporter

The #MentalHealthProject is a #SeattleTimes initiative focused on covering #mental and #behavioralhealthissues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The #SeattleTimes maintains editorial control over work produced by this team.

In the days after Jennifer Stuber’s husband Matt died by #suicide, she had a realization. The issue she’d dedicated much of her career to studying — #mentalhealthstigma — was partially behind her husband’s death.

“#Stigma is what killed him,” said Stuber, an associate professor of social work at the #UniversityofWashington. “His actual thing he said about himself was, ‘Who wants a lawyer with a broken brain?’” 

Matt’s struggle with #anxiety and #depression was debilitating enough that he felt he needed to step away from his profession as an attorney. Taking a break from his career, which was so important to him, led to dangerous patterns of thinking, Stuber says. Peers at his law firm “thought no less of him,” Stuber says; she knows, because she spoke with them. But Matt’s self-worth evaporated. He felt the cultural expectations of his duty as a father — and the pressures that came with a high-octane corporate law job — closing in.

Stuber has since dedicated her career to #suicide research and advocacy. #Suicide is the most serious potential consequence of #mentalhealth #stigma. But stigma’s effects are pervasive: For example, research suggests that #stigma is a significant barrier to seeking out and benefiting from #mentalhealthtreatment.

#Stigma is complex. It can keep families from talking about a loved one’s #mentalillness, and can normalize feelings of #isolation and #loneliness. It can show up in the way individuals act and feel toward themselves — which is known as self-stigma — and can spring from cultural messaging and societal norms.

Experts say that last piece — societal norms — allows #stigma to persist. #Stigma is rooted deeply in medical and social structures that can perpetuate discrimination and fear. It can prevent someone from securing housing, landing a job or receiving adequate medical attention. #Stigma can result in bullying and harassment. #Mentalhealthadvocates say it’s also tied to consistent underfunding of #mentalhealth research and treatment development. The #NationalInstituteofMentalHealth, for instance, receives a third as much as the National Cancer Institute and less than other national institutes dedicated to research on diabetes, neurological conditions, allergies and infectious diseases, among many others. Like many agencies under the #NationalInstitutesofHealth, #NIMH faced a nearly $200 million cut to its $2 billion annual budget this fiscal year.

The #SeattleTimes spoke with Stuber and other experts about where #mentalhealth #stigma comes from, how it manifests and how it keeps people from accessing care. 

We’d like to hear from you.

The #MentalHealthProject team is listening. We’d like to know what questions you have about #mentalhealth and which stories you’d suggest we cover.

Get in touch with us at mentalhealth@seattletimes.com.

What is #stigma?

There’s no single definition of #stigma. It was originally thought of as a mark that discredits someone as a person and reduces them to someone who is tainted.

But over time, many experts have formalized how we think of #stigma by describing it as a complex process. The first step is when society recognizes an individual or a group as “different,” says Pamela Collins, professor of #psychiatry and #behavioral sciences and global health at the #UniversityofWashington. The second step is labeling that group. Next, society or specific communities attach stereotypes to the people who fall under a certain label. These stereotypes can support a rationale for devaluing, dehumanizing or discriminating against people with a #mentalhealthcondition. 

“#Stigma really happens in the context of power,” Collins said. And it can lead to “terrible outcomes” for those with #mentalhealth issues, such as a lower life expectancy or inadequate medical treatment, Collins said. As an example, she said, someone struggling to breathe might visit an emergency department for care. But because the #physician on duty sees the #patient has a preexisting #anxiety diagnosis, they might make #stigma-based assumptions and assume a heart attack is a panic attack, for example.

#Stigma can also be expressed in a variety of ways, depending on a person’s cultural context, Collins said. Researchers have studied how a person’s attributes, like their #race, #gender and #sexualorientation, are associated with the #mentalhealth stigmatization they experience in society, the level of stigmatizing beliefs they hold, and the actions they might take.

Where does #stigma come from?

#Stigma is rooted in fear, Collins said. Research suggests that #stigma is universal, though the extent to which people report feelings of #mentalhealth #stigma varies by where they live and their cultural background.

#Stigma, unfortunately, emerges from many corners of society. Media has a long history of portraying people with #mentalillness as violent, unpredictable or unable to recover. Certain religions and workplaces dissuade people from acknowledging or treating their #mentalhealth concerns. This is true even in the medical field: #physicians, for instance, have historically been discouraged from seeking #mentalhealthcare through medical licensing policies and their own fear that doing so might compromise how they’re viewed by peers or managers. 

The medical field also has a dark history of treating people with #mentalhealth concerns using restrictive, punitive and abusive methods. #Stigma shows up in policing practices, arrests and sentencing policies, too. A lack of #mentalhealthtraining — or negative attitudes toward those with #mentalillness — among police, jurors and judges contributes to an overrepresentation of people with #mentalillness in jails and prisons. 

At the same time that societal institutions have allowed or promoted #mentalhealthstigma, #mentalhealthadvocates argue that institutions also have the responsibility and power to change the conversation.

What is the difference between external and self-stigma, and how are they related?

Stuber describes #stigma as a feeling of “thwarted belonging.” A person with #mentalillness might perceive that others have negative thoughts about them — even if it’s not true — and “as a result, they internalize those perceptions.” 

Her point is this: #stigma manifests in an “external” way through the systems and attitudes that exist outside of an individual with #mentalillness. But #stigma can grow internally inside someone who feels less-than or discriminated against based on those external cues and their own internal thoughts. In some people, this can tied to feelings that their symptoms will never improve.

Self-stigma, she said, is challenging to “separate from external #stigma, prejudice, discrimination and societal stereotypes and conceptions.” This challenge is one reason why it can be difficult to end #mentalhealthstigma. It also highlights the importance of addressing #stigma on an individual basis — and at its cultural roots.

How can #stigma influence people’s decision to seek #mentalhealthcare?

Hospitals and clinics are supposed to be the places people turn for help, said Dr. Joshua Bess, a #psychiatrist and medical director at SeattleNTC who uses electroconvulsive therapy and other methods to treat people with #depression. 

But, he said, “there is in many ways more intense #stigma there, or more intense negative feelings toward people either in #mentalhealthcrisis or who have a #mentalhealth history.” 

#JamesDonaldson notes:

Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.

Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.

Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle

He has a pile of stories, he said, from #patients who’ve reported feeling they’re not listened to or taken seriously during health care visits. If someone is having a panic attack or experiencing #psychosis, he said, “the way that they’re treated [while seeking care at an emergency department], I find horrifying sometimes,” he said. 

Bess calls this “institutional” #stigma, which can result in people avoiding #mentalhealth care because of past experiences with #medicalproviders. 

Meghan Romanelli, assistant professor of #socialwork at the #UniversityofWashington, said this can be particularly true among #LGBTQ+ people, who face additional barriers to care because of their #genderidentity or sexual orientation. 

#LGBTQ+ stands for #lesbian, #gay, #bisexual, #transgender and #queer/questioning, with the + denoting everything along the #gender and sexuality spectrum.

“People can be flat out denied and refused care. People can be asked really invasive questions that aren’t even related to the reason why they are there. People can be exposed to harsh or abusive language,” Romanelli said.

In what ways can society and individuals break down #stigma?

Here are some #stigma prevention strategies recommended by the #AmericanPsychiatricAssociation, #mentalhealthexperts and advocacy organizations like the #NationalAllianceonMentalIllness:  

• Governments can hold campaigns to raise awareness about #mentalhealth #stigma and its consequences.
• Workplaces can train managers to identify when employees are in distress. They can welcome accommodations for employees experiencing a #mentalhealthcondition.
• Professional organizations can change licensing and other policies to make access to #mentalhealth care a priority.
• Law enforcement agencies can require employees to undergo comprehensive #mentalhealth training. 
• #Healthcare training programs, like those for #nurses, can create specialties for those who anticipate working in #mentalhealthcare settings.
• Schools can devise #mentalhealthawareness curriculum.

Individuals can drive change, too:

• People with a #mentalhealthcondition can benefit from talking with peers who are also experiencing #mentalhealth symptoms. Making connections with support groups can help. 
• Be careful about the words you use to describe #mentalillness. For example, avoid language that portrays people as weak or less-than.
• Actively speak out against #mentalhealth #stigma. Talk with friends, relatives and your community about the consequences. 
• Normalize #mentalhealthtreatment. Talking openly with a loved one about seeking #mentalhealthcare can reduce self-#stigma. 
• Educate yourself. Learning about #mentalhealth can help you intervene when others discriminate against someone with a #mentalhealthcondition.

How to find help

If you are experiencing suicidal thoughts or have concerns about someone else who may be, call the #NationalSuicidePreventionLifeline at 800-273-TALK (8255); you will be routed to a local crisis center where professionals can talk you through a risk assessment and provide resources in your community. More info: suicidepreventionlifeline.org. Or reach out to Crisis Text Line by texting HOME to 741741 for free, 24/7 crisis counseling. More info: crisistextline.org.

Hannah Furfaro: hfurfaro@seattletimes.com; on Twitter: @HannahFurfaro.