Wednesday, December 13, 2006

Stigmatization of Mental Health Services by Public Health Professionals and the Resulting Underutilization of Mental Health Care – Melissa Kent

Mental health disorders affect 57 million Americans and 450 million people worldwide (Palpant). While this is a staggering number even more people go undiagnosed (Mental Health). It is currently estimated that one half of people suffering are not getting treatment (Mental Health). In a time when mental health treatment has made astonishing advances, why are public health officials and health care professionals ignoring the diseases of mental health among so many? Much of this public health crisis stems from the stigma surrounding mental health disorders in society, healthcare and public health. Many people refuse to believe they have a mental health disorder, and many others refuse to believe it can be treated. Throughout history there has been a negative connotation of patients suffering from mental health disorders as being seen crazy that persists in society today. In addition, while certain health professionals are committed to treating mental illness, they are also fighting against a society that stigmatizes patients and the professionals that help them. In order for public health professionals to change people’s views and opinions about mental heath, they need to start by better identifying and defining that mental health stigma exists and it is affecting the implementation and use of preventative care and treatment.

Recent work done by the National Institute of Mental Health on identifying the problems of mental health stigma and discrimination has made headway in understanding the underlying processes of stigma and attitudes about mental illness ( This type of work needs to be done to better educate society on this issue. By identifying the roots of the stigmas, public health officials can start to implement programs in society and health care to overcome the barriers and help health care professionals and patients see that there is a large incidence of mental illness and there are ways to decrease it. There are currently a few preventative mental health programs in place, but the quality and effectiveness of these programs are low (Palpant). Preventative services, such as routine screenings and education, have been shown to reduce the incidence of certain mental health disorders as well as reduce overall health care costs (Healthcare Access). Using preventative mental health services saves, on average, $2,776.85 per child in inpatient costs over the course of a year (Healthcare Access). A study on depression in the workplace has found that depression causes a loss of $44 billion each year in both presenteeism and absenteeism (Palpant). Establishing preventative mental health services, such as screening programs in the work place or in primary care facilities could be a helpful intervention to decrease depression or other mental health disorder incidences.

The stigma attached to mental health disorders is affecting the care given to patients and general emphasis of mental health in health care. Currently doctors are not seeing a need for mental health services, because of the perceived stigma of mental illness. There is current proposal for a national network of depression centers, modeled after the advent of cancer centers for treatment and recovery (Stolper). This proposal is based on the fact that the awareness and treatment of mental illness is not taken as seriously as physical illness (Stolper). The current lack of mobilization of mental health services can be attributed to the stigma’s affect on health care professionals.

Preventative mental health services are also limited because of mental illness’s stigmas. Screenings for depression or other mental disorders are not commonly practiced. A study investigating the Primary Care Evaluation of Mental Disorders (PRIME-MD) system, a structured screening and diagnostic system for mental disorders in primary care settings, found that 48% of 287 patients with PRIME-MD diagnosis were not diagnosed first by their own primary care provider for a mental disorder (Spitzer). Another study conducted on exploring primary care physician’s experiences on diagnosing and treating depression found that Physicians said they needed an efficient but effective means of diagnosing depression and that they did not have enough time with the patient to provide a correct diagnosis (Thomas). This data shows that physicians do not feel comfortable providing preventative mental health services, and this can be attributed to the fact that previous and current health care trends do not put and emphasis on educating public health or medical professionals about the importance of mental illness.

Due to this lack of awareness of mental health issues by public health and health care providers, stigma causes two major problems in identifying patients suffering from mental health illnesses. First, there are not enough mental health professionals entering the field, and it is hard for other health care providers to screen or treat for mental illness (Asarnow). Even if preventative programs exist, it is difficult to staff them properly and provide quality care to patients once diagnosed. If doctors are influenced by the stigma of mental health disorders, how are the people affected supposed to get help? This has the potential to negatively affect the care the doctors are providing. If they do not know how about mental health diseases or choose not to accept them as treatable, patient’s will go undiagnosed and untreated. Also, even if doctors are willing to screen and treat, they may not have the tools they need, because health care in general is affected by the stigma.

Even if preventative health care options were available, they are very difficult for many American’s to access (Healthcare Access). Uninsured people are at a great disadvantage and even people with insurance find themselves at a loss (Perez-Pena). Currently, many health insurance policies do not cover treatment or preventative measures for mental illness (Perez-Pena). Without coverage for services, it is hard for people to afford care. Mental health screening and treatment are not valued at equal levels as other health services (Mental Health, Palpant). The Coalition for Fairness in Mental Illness Coverage is fighting for proper coverage by insurance plans (Mental Health). The stigma against mental health illnesses is a huge barrier in their fight. Insurance providers do not want to cover what limited services are available, because it would increase their costs. This decision is not only negatively affecting American’s health, but is also costing everyone more money than if the insurance companies would just provide proper coverage. According to the Surgeon General, mental illness costs the nation $63 billion in lost productivity and $12 billion because of premature death (Palpant). Overcoming the stigma around mental health issues and providing proper insurance coverage for screening and treatment would decrease these deficits by helping to ensure healthy productive members of society.

The stigma around mental health issues also makes it hard for people to identify themselves as mentally ill or want to get screened. Fewer than half of persons suffering from depression seek treatment (Jacobs). To provide an easier means of seeking treatment, National Depression Screening Day was created. It is a nationwide community based program that partners with colleges, community sites, and primary care offices to provide screening for various mental disorders (National Depression Screening Day). This program is an example of an intervention that helps to reduce the stigma associated with mental illness. Many people do not want to self identify as mentally ill, because of the stigma, and do not attend screenings offered, such as the one mentioned previously. The lack of preventative services and unwillingness of patients to self-screen create a negative feedback loop. If there are no providers to screen or provide treatment then people can not get help, but if people are not willing to come and get help then it is hard to keep preventative programs running.

The stigma around mental health illness prevents people, such as public health officials and health care providers, from seeing these diseases as really harmful and potentially preventable. It limits the amount of care available as well as the health seeking behavior. In order to eliminate this stigma, public health officials need to see that there is a crisis here and the problem needs to be identified. Defining the problem is a good start to finding ways to reduce the stigma and increasing the amount of people utilizing care.

Asarnow JR, Jaycox LH, Anderson M. Depression among youth in primary care models for delivering mental health services. Child Adolesc Psychiatr Clin N Am. 2002;11(3):447-497

HEALTHCARE ACCESS; Federal data show community-based care leads to improved mental health services for children, Mental Health Weekly Digest, June 5, 2006, EXPANDED REPORTING; Pg. 37, 516 words


Mental Health Insurance Crisis Affecting Millions of Americans Suffering From Depression,Other Mental Health Disorders; Half of Americans Who Need Mental Health Treatment Do Not Receive It , PR Newswire US, June 8, 2006 Thursday, 9:04 AM GMT, 633 words, WASHINGTON June 8

National Depression Screening Day-A program of screening for mental health

Palpant RG, Steimnitz R, Bornemann TH, Hawkins, K. The Carter Center Mental Health Program: Addressing the Public Health Crisis in the Field of Mental Health Through Policy Change and Stigma Reduction. Preventing Chronic Disease 2006; 3(2).

Perez-Pena, R. (2006, September 16). Pataki Casts Doubt on Fate of Mental Health Measure Passed by the Senate. The New York Times.

Spitzer RL, Williams JBW, Kroenke K, et al: Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA 1994; 272:1749-1756

Stolper, G. (2006, November 24). Specialized Centers to Treat Depression. The New York Times.

Thomas R, Stoppard J, Miedema B, Tatemichi S. Diagnosing Depression: There is not blood test. Can Fam Physician 2005; 51(8): 1103.


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