Exacerbating the Problem: Our Failure to Embrace Mental Health is Hindering Acceptance, Increasing Stigma, and Reducing Access - Justin Nyborn

“A clear and complete insight into the nature of madness, a correct and distinct conception of what constitutes the difference between the sane and the insane has, as far as I know, not been found.” -Schopenhauer, The World as Will and Idea (as cited in Barlow & Durand, 2000).

Introduction

Open a scholarly journal or the health section of any newspaper in the U.S. and find a collection of highly debated and controversial health topics. The media uses its power of persuasion to dictate trendy and controversial topics and therefore has a powerful influence over the public health opinion of public health issues. Public health practitioners, themselves, the media’s source of public health information, have failed to focus on critical issues in public health. For instance, there are numerous interventions in public health aiming to prevent and treat chronic or infectious disease, but very little is being done to prevent mental illness. In the media, we hear and read about public health wars on drugs, tobacco, and obesity, but we never hear about a war on depression, schizophrenia, or bipolar disorder. We are currently not embracing mental illness with the same vigor and deserving attention as physical disorders. 22% of the U.S adult population has one or more diagnosable mental disorder in a given year and 10 million children in the US have a mental disorder that causes some level of impairment (MMWR, 2005). With numbers as high as these, it is clear that mental health must not be ignored, and further, public health practitioners must scrutinize why mental illnesses have not effectively been treated. Although organizations like the CDC, the nation’s premier public health agency, have begun to address and allocate funding for mental health with its public awareness campaign World Mental Health Day and its collaboration with the World Federation for Mental Health to address stigma, their efforts are secondary compared to their efforts in preventing and treating chronic physical diseases (MMWR, 2005).

Additionally, the failure of public health practitioners to treat mental illness also reflects their inability to treat physical diseases. The mentally ill tend to have higher rates of “all cause” morality (Osborn, 2001). In accordance, it is suggested that individuals with depression and psychosis such as schizophrenia have higher risk for cardiovascular disease (MMWR, 2005; Osborn, 2001). Individual health behaviors such as substance abuse, tobacco abuse, physical inactivity and increased rates of suicide are also correlated with mental illness (MMWR, 2005; Osborn, 2001). Pubic health practitioners spend time and resources searching for causes and treating these physical health conditions, but they ignore a large portion of the population that is at risk for these harmful health behaviors or illnesses.

The failure of public health to embrace mental health has resulted in negative consequences for individuals with a mental illness. The mentally ill feel a lack of acceptance by society and there is a stigma attached to mental illness, which has resulted in discrimination in these individuals (Corrigan, 2004; Barlow & Durand, 2000; Byrne, 2000). This lack of acceptance and discrimination has exacerbated the mental health problem and reduced the access to treatment in the population. Research by authors such as Kessler et al. (2003) have suggested that although there has been an increase in treatment of the mentally ill in the last decade, most mentally ill patients still do not receive treatment. Social and behavioral sciences such as education and psychology are necessary to explain why the failure of public health practitioners to embrace mental health is enhancing stigma associated with mental illness, hindering acceptance of mentally ill individuals, and creating barriers to accessing treatment which is making the problem worse.

Failure to Embrace Mental Health Hinders Acceptance of Individuals with Mental Illness

How does the failure to embrace mental health contribute to lack of acceptance?

Part of the problem with the failure to embrace mental illness is the fact that the public does not visualize themselves in the shoes of the mentally ill. The general public is not accurately informed of the daily struggles, obstacles, or level of functioning in these individuals. Public health practitioners need to further observe these individuals and take the time to understand their feelings and struggles that cause them to engage in negative behaviors or withdraw from society.

The theories of humanist psychologists Carl Rogers and Abraham Maslow explain the behavioral consequences when human beings feel a lack of acceptance. Their theories emphasize human needs one must satisfy to become a whole and adjusted individual (Carver & Scheier, 2000). Rogers believed that there is potential healthy growth in every living creature called self-actualization if there are no strong opposing influences inhibiting one’s potential. If one can maintain self-actualization, it enhances the self towards congruence and minimizes disorganization or incongruence (Carver & Scheier, 2000). This theory encompasses the belief that all individuals have the need for “positive regard”, or love, friendship, and support of others. (Carver & Scheier, 2000). Abraham Maslow elaborated on Rogers’s ideas to form his theory of the hierarchy of needs. The theory implies that all humans have a hierarchy of needs beginning at the most basic level of physiological needs such as food, air, and water leading to the need for self-actualization as the highest level of needs (Carver & Scheir, 2000). Similar to Roger’s positive regard, the third level of the hierarchy is love and belongingness including companionship and acceptance from others. If individuals fail to master the need for love and belongingness, they can’t reach the self-actualizing level of acceptance of self and others and this can result in a breakdown of the unity of self or anxiety.

Although the theories of Rogers and Maslow are merely conceptual and fail to explain all aspects of behavior or behavioral intentions, they both reinforce the idea that acceptance, love, and support from others are crucial for individuals to live healthy and well-adjusted lives. If the mentally ill can’t find love and acceptance or “positive regard”, they are left with only satisfying the most basic needs. Therefore, the failure of public health to embrace mental health contributes to a lack of acceptance, which prevents mentally ill individuals from living healthy lives with strong social support systems.

How does lack of acceptance contribute to decreased access to treatment?

The lack of acceptance of mentally ill individuals has led to barriers for these individuals to access medical care (Kessler et al., 2005; Druss & Rosenheck, 1998; Druss et al., 1998). Druss and Rosenheck (1998) found that the rates of those uninsured or having a primary care provider were the same between those with and without a mental illness, but those with a mental illness were twice as likely to report being denied insurance because of preexisting condition or having stayed in their job for fear of losing their health benefits. Thus, many mentally ill individuals feel they are denied insurance because of their condition. If individuals with a mental illness are unable to obtain love and acceptance, it is logical that they will fail to take the initiative to access medical care. If these individuals felt more fulfilled, congruent, and like equal members of society (i.e. more at ease at their place of employment), they may feel more comfortable and trusting accessing the medical health system. Although researching the access to medical care is of paramount importance, it does not explain why mental health is not embraced. We must first understand the contextual risk factors for why mentally ill individuals continue to engage in what society labels as irrational behavior. If mentally ill individuals feel accepted without a low self-esteem or self-worth, they may be more willing to access care with trust.

Failure to Embrace Mental Health Enhances Stigma Among Individuals with Mental Illness

How does the failure to embrace mental health contribute to increased stigma associated with mental illness?

The failure of public health to embrace mental health has contributed to discrimination and stigma of the mentally ill by their family members and friends, which is largely a reflection of how mental illness is portrayed through mediums such as the media. This continued discrimination is a reflection of the failure by public health practitioners to educate the public. Each culture and society has “norms” or rules of expected or proper behavior (Myers, 2002). These norms are a reflection of how we have been raised and socialized as members of society. Along with social norms is often labeling which leads to stigma and stigma results in stereotypes and often prejudice. The public views mental illness as sign of weakness (Corrigan, 2004). If society creates the label that the mentally ill are weak, it is easy for these individuals to internalize this message and behave according to the norm. In other words, once individuals are labeled, they may identify with the negativity associated with the label (Barlow & Durand, 2000). Human beings should never be affiliated with labels such as “dangerous”, “worthless”, or “dirty”. In order to embrace the mentally ill, public health practitioners must analyze how we can alter our negative social norms.

The failure of public health to embrace mental health has also led to increased stigma from friends and family of the mentally ill. As a result, these individuals feel alienated with a reduced social support networks (Byrne, 2000). Therefore, there is a public stigma of mental illness, which can perpetuate a self-stigma. Public health practitioners have failed to reach the families of the mentally ill to understand how they are torn by the social norms cast by society and their feelings for their loved ones. How are less informed members of society going to change their opinions of mental illness if family members and friends of individuals with a mental illness often feel ashamed of their loved ones? Education will be necessary to erase labels and stereotypes and change social norms.

What is the primary source for mental illness information? Media attention and portrayal of mental illness is largely responsible for why the world has adopted negative associations with the mentally ill and why public health practitioners have not embraced it. Walh (2003) found that in newspapers, the most common source of information about the mentally ill, the numbers of negative stories greatly outnumbered the positive stories. Other research discovered that mentally ill individuals are typically portrayed as violent, a seductress, maniac, or narcissistic parasite (Hyler et al., 1991; Diefenbach, 1996). It is undeniable that the media has extreme power and influence over the opinions of society and for many individuals, television and magazines are their only resources of gaining insight about public health information. The research of public health practitioners is where the media extracts their information. Therefore, the media has a great responsibility to alter their portrayal of the mentally ill as weak and dangerous. Public health practitioners must provide the media with anti-stigma research and effective modes of positively viewing the mentally ill, which they have failed to do. If we can’t change the prejudice and negative behavior of society, we can’t positively change the behavior in mentally ill individuals.

How does increased stigma of mental illness contribute to decreased access to treatment?

As a result of the stigma and discrimination attached to mental illness, the mentally ill often choose not access medical care treatment. Due to negative labels, many mentally ill individuals choose to lead lives of secrecy. Both the public stigma and resulting discrimination (i.e. “I don’t want to work with them”) and self-stigma (i.e. low self esteem, low self-efficacy, shame) contribute to the mentally ill avoiding treatment (Corrigan, 2004).

In order to increase the comfort of the mentally ill to access treatment, public health practitioners need to focus on the positive aspects that mentally ill individuals can contribute to society. Although research is controversial and results are mixed, studies suggest there is a link between mental illness and creativity (Waddell, 1998; Andreasen, 1987). The media and public health practitioners have failed to reach Americans with this message. What about the people with mental illnesses who work for the government, teach at universities, or have won humanitarian prizes? We need to change our outlook and cognitive schema by erasing misconception of mental illness and educate individuals that mentally ill individuals should not be thought of as violent, dangerous, and inferior members of society. By continuing to portray the mentally ill in a negative light, we are only continuing to support the misconception of this stigmatized population and preventing them from seeking treatment.

Increased stigma and decreased treatment are also a reflection of the failure of public health practitioners to educate society about mental illness (Byrne, 2000; Corrigan, 2004). Students should learn about the discrimination of mental illness from youth. If kids or adolescents are not taught the truth about mental illness, their only perceptions are created and distorted through the media. Public health practitioners need to institute the need for education and information about mental illness, so from youth, children and adolescents can obtain a realistic perspective of mental illness. If society is well educated about mental illness it could reduce stigma, and reducing stigma may increase the number of mentally ill individuals willing to access treatment (Corrigan, 2004).

Conclusion

Not to dismiss the importance of focusing public health on physical disease, but the society’s ignorance of mental health and the neglect of public practitioners to address mental health because of the stigma and negative views of society is unacceptable. As human beings, we have lost a sense of altruism and with our neglect of the mentally ill; we have chosen to keep them alienated and labeled inferior simply because society fails to re-shape the image of mental illness. Research focuses on individual risks such as access to mental health care, understanding the brain processes of the mentally ill, or analyzing specific disorders. Although, these are all extremely important contributions to understanding mental health, the problem exists on a much larger scale. The failure of public health to embrace mental health has contributed to the stigma and lack of acceptance associated with mentally ill individuals which results in barriers to necessary treatment. Therefore, public health is exacerbating the mental health crisis by failing to embrace it.

First, we must embrace the individuals who have these disorders. We need to reach out to them and attempt to understand their feelings. They deserve the belongingness and support to feel like integrated and competent individuals. Public health practitioners need to immerse themselves into the community to observe these individuals and learn how they live, what they feel, and why their behaviors prevent them from living healthy lives. Then we can have a better understanding in order to successfully educate society and realistically and positively portray these individuals. We must change the negative attitudes and behaviors of society. We must re-define our social norms for the mentally ill and advocate this change with a positive portrayal through the media. Public practitioners should change their focus on individual risk factors of mental illness and start viewing it as a problem that must encompass social sciences in order to promote health initiatives and efficient and effective intervention strategies. Improving access to mental health will help individuals to seek to healthier lifestyles, but we have to analyze why these individuals choose not to access the care even when they possess the means.

Public health needs to change at the structural level. Health departments should have divisions specifically for mental health awareness and prevention. We must look at improvement of the mental health crisis as societal problem with environmental factors. These divisions can specifically monitor the barriers to improving the health of the mentally ill at the societal level, not just at the individual level. It would be the responsibility of these divisions to educate society on the truth about mental illness and help erase stigma and negative labeling. With structural divisions like this in place working effortlessly to improve mental health at the societal level with the same drive as chronic physical or infectious diseases, we can begin the war on mental illness.

The mentally ill have the right to live healthy lives. Although public health practitioners have their work cut out for them, change is not beyond our reach. However, if public health practitioners continue to fail to embrace public health, a large portion of society will remain stigmatized and unhealthy, which affects the overall health of society.

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