The Expressway to Mental Health
by David Lilley
The purpose of this article and my intention is to address
the individual and societal stigmas of mental illness. We've made progress
since the mid-20th century lock-ups and asylums; however, the blight of
stigma still permeates our society, especially the mental-health
Patients often find therapeutic comfort in the aesthetic decor of
present-day mental health facilities, only to later face a discharge into
a hostile environment with residual social stigma--a silent, empty stress.
Much remains to be done to erase that which has been done.
What is Stigma?
Ancient Greeks used the word stigma to refer to body marks or
brands on people to be avoided.
| "There is a great stigma surrounding mental
illness. When someone appears to be different we attach a stigma to
them, we do not do it to be cruel, we simply do not understand their
differences. Stigma is a reality for people with mental illness, and
their greatest barrier to a complete and satisfying life."
People who were different used to be shunned and stoned. Today the
media is the worst culprit of shunning and stoning. When the news
broadcasts that a person charged with murder was found mentally ill, it
casts a stereotype that encompasses millions of people and inflicts a
subliminal stigma. "....characters are usually portrayed as aggressive,
dangerous and unpredictable--70 % of the television characters with a
mental illness are violent." 2
The news of repeated domestic violence and homelessness often has
undertones of mental health. A large segment of our society thrives on
"psycho" thriller movies. There are those in our legal professions who are
quite adept at bargaining the insanity plea. These trivial everyday
occurrences merely scratch the surface of societal stigma.
Conversely, organizations such as The National Alliance for the
Mentally Ill, The National Institute of Mental Health, The National
Institute of Health, and The Canadian Mental Health Association have
developed vigorous educational programs and advocacy groups to battle
The roads we travel in the treatment of mental-health stigma can be
compared to a conventional-transportation network of roads and highways.
Let's take a look at some of the main arteries first.
NAMI The National Alliance for the Mentally Ill
A recent NAMI newsletter reads, "With more than 220,000
members, NAMI is the nation's largest organization dedicated to improving
the lives of persons affected by serious mental illness." 3
They are a multi-faceted organization which places emphasis on
education and awareness with a relentless campaign against stigma.
Perhaps the branch of NAMI getting the most attention and drawing
the most awareness is "Stigmabusters". My latest research shows a
membership in stigmabusters in excess of 8500. Their membership advocates
around the world seeking to fight innacurate representations of mental
illness. Stigmabusters campaign message reads, " Stigmabusters' goal is to
breakdown the barriers of ignorance, prejudice, or unfair discrimination
by promoting education, understanding and respect." 4
Equally important is the education sector of NAMI. They offer
patient and family education courses. Have education courses geared to
children, adolescents, school violence, and even offer education on how to
cope after a terrorist attack.
The research and policy branch fights stigma by working with
patients doing research on treatments or participating in clinical trials.
They participate in trials and compile lists of trials. They may also do
studies on ethical issues in regards to research of mental illness. NAMI
publishes fact sheets and reports on-line.
The NAMI also has a legal and public policy center which advocates
for the mentally ill. They work on an individual basis, as well as, with
private lawyers and other organizations. Part of their mission statement
.."sector is the main arm of advocacy for the mentally ill.....to improve
the lives of people with serious mentall illness and the caregiving
efforts of their loved ones". 5
President's New Freedom
Commission on Mental Health
On April 29, 2002 at the Uniiversity of New Mexico, United
States President George W. Bush announced the creation of The President's
New Freedom Commission on Mental Health. Within his address the President
| "Stigma leads to isolation, and discourages
people from seeking the treatment they need. Political leaders,
health care professionals, and all Americans must understand and
send this message: Mental disability is not a scandal; it is an
illness. And like physical illness, it is treatable, especially when
treatment comes early." 6
We should eagerly anticipate forthcoming developments from
this commission because of the President's early reference to the obstacle
of stigma. An aggressive monthly schedule occupies them at least until
The National Institute of Health's (NIH)
While nearing completion of this article, the deadline for stigma
research and global health research is only a few weeks away. At present
the National Institute of Mental Health (NIMH)
and the Canadian Institues of Health Research (CIHR) have made
applications for presentations concernimg mental health stigma.
The World Federation for Mental Health (WFMH)
The WFMH is scheduled to hold their biennial congress Feb.21-25,
2003 in Melbourne, Australia. The congress is to include 16 keynote
speakers from eight different countries and is being hosted by The Mental
Health Foundation of Australia.
MHFA's core statement for the congress emphasizes stigma by making
the following statements:
| "The policy of The Mental Health Foundation
of Australia (MHFA) is built on the principle that partnerships of
local and international community stakeholders provide the synergy
integral to promote awareness of mental illness and barriers created
by the related stigma.....The Foundation aims to educate the
community to promote the maintenance of mental health and positive
attitudes. Early intervention practices to prevent mental illness
and to remove the stigma associated with mental illness are a
There are many efforts in motion at the national and global levels
along the highway to eradicate mental-health stigma. Only a few major
agencies and groups have been mentioned here.
In order to be effective; however, we must get off the highway to
carve inroads and distribute the education and advocacy. Only then, can we
adequately begin to restore self-esteem to those affected by the stigmas
associated with mental-health afflictions.
Inroads and crossroads
On a CMHA website of frequently asked questions about mental
one of the Q-A's reads as follows:
"Q-Why do so many people fear mental illness?"
"A- It is human nature to fear what we do not understand. As such,
mental illness is feared by many people and unfortunately still carries a
stigma. Because of this stigma many people hesitate to get help for a
mental health problem for fear of being looked down upon".
This brings a question to my mind.....well....I guess we have to
educate both the observer and the observed. An excerpt from an article by
Conneticut Clearing House reads:
| "Stigma is not just the use of a wrong word
or a wrong action. Stigma is about disrespect. It is the use of
negative labels to identify a person living with mental illness.
Stigma is a barrier and discourages individuals and their families
from getting the help the help they need due to the fear of
discrimination. An estimated 50 million Americans experience a
mental disorder in any given year and only one-fourth of them
actually receive mental health and other services." 9
This estimate of only one fourth holds true in other parts of
the world as well. A survey in Edmonton, Alberta, Canada showed that only
28.1 percent of individuals who met criteria for a diagnosis in the
previous year sought help for their problem. (SIEC) (Bland et al, 1997
Estimates of treated versus untreated persons contrast greatly
because of the shame factor of prejudicial stigmas. Almost every person
afflicted with a mental disorder will encounter some degree of stigma.
This silent discrimination is slowly gaining attention.
Legal rights, discrimination laws, and human rights vary depending
on one's residence. There is worldwide activity concerning mental health
stigma's legal issues, prevention and treatments.
Research on the medical front is necessary to provide quality
treatment, medicines, and implementing possible prevention. To overcome
stigma, we need to consider mental illness as a medical illness, and
present that fact in public-education information to erase the existing
Talking more openly about mental illness in the work place and in
public will alleviate some of the mystery and gradually erode the stigma
that surrounds mental illness. The road still winds through education,
private industry, health insurance, and governmental sectors of society.
We must continue its development and maintenance.
Medicine, Psychiatry, and Social Services have traversed a huge
expanse since the era of the straight-jacket and insane asylums. Each
route we take leads us closer to optimum treatment and less stigma. All
the off-ramps and intersections require a decision, a change in direction,
maybe a detour, or sometimes to stay the course.
A mere change in viewpoint might be the push that gets things
rolling again and frees us from the quagmire. Major efforts to reduce
mental-health stigma are in process. Let education be our map, and
humanity our navigator on the roads we've yet to travel. Directly, or
indirectly, nearly all of us will play a part in erasing the "marks" which
were once presumed indelible.