What is Mental Health Stigma?
by Rebecca Neili Wolverton, MS, APRN, FNP-C
As a family nurse practitioner, I see countless patients suffering from a variety of mental health conditions including situational depression, anxiety, post-traumatic stress disorder, postpartum depression and/or anxiety, and much more. These individuals are struggling, yet extremely reluctant to seek help.
They often feel alone in their struggle — as if everyone else has it together — and more times than not, the patient verbalizes some form of shame that they are suffering from. I often hear patients express the guilt surrounding their mental health issues, making comments like, “I don’t know why I’m feeling like this because things really aren’t that bad in my life,” or “I shouldn’t be complaining because others have it worse than me.” This self-minimization and embarrassment around their struggle is often a significant hindrance to getting treatment.
It is up to us as a community and as healthcare professionals to break that barrier down.
Mental illness is defined as a mental, behavioral or mood disorder that can range in severity from having no impact on daily function to having serious functional impairment that interferes with major life activities. Patients who suffer from mental illness have a 40 percent increased risk of heart disease or metabolic disorders and are more likely to suffer from substance abuse, unemployment or homelessness or to be incarcerated. While this issue of under-treatment or lack thereof is a complex issue involving a multitude of factors, personal and public mental illness stigmas contribute to patient unwillingness to seek treatment.
Prevalence of Mental Illness in the United States
In 2018, approximately 47.6 million adults in the United States were diagnosed with a mental illness, and 11.4 million adults were diagnosed with severe mental illness.
This accounts for one in five adults with a mental illness and 1 in 25 adults with serious mental illness. The highest prevalence of mental health disorders was major depression episodes (17.7 million) and anxiety disorders (approximately 48 million). Unfortunately, only 43 percent of adults with mental illness and 64 percent of adults with serious mental illness received mental health treatment that same year. The largest demographics of Americans with mental illness were as follows:
- Lesbian, gay or bisexual: 37.4%
- Non-Hispanic mixed/multiracial: 26.8%
- Non-Hispanic white: 20.4%
- Hispanic or Latino: 16.9%
- Non-Hispanic black or African-American: 16.2%
- Non-Hispanic Asian: 14.7%
Young adults (ages 18-25) accounted for the highest prevalence of both any and severe mental illness out of all adult age groups, yet this age group accounted for the lowest number of individuals to receive treatment. Because of this, suicide is the second leading cause of death in this age group and the tenth leading cause of death in the United States.
Mental Illness Stigma
Mental health stigmas are multifaceted processes that dehumanize and endanger people. This takes shape in many ways, such as negative attitudes toward people with mental illness increasing the likelihood of avoiding contact with them, or negative views toward the cause, treatment and prognosis of mental illness.
Stigma toward mental illness often leads to personal shame, humiliation, rejection and social exclusion. Student service members and veterans reported higher levels of personal and public mental health stigmas, which included feeling that they would not be accepted by someone if that person knew they suffered from mental illness; that mental illness was a sign of personal failure; that individuals with mental illness were less trustworthy; and that people would be less willing to have a close friend with mental illness. However, these participants also were more skeptical of mental health therapy and counseling than non-service members or veterans. In one study, 75 percent of patients preferred to see a psychologist in a primary care setting, yet the mental illness stigma held by primary care providers was higher than providers in a behavioral health clinic.
As a provider, I find this shocking. It highlights the critical importance of all clinicians recognizing their own personal biases toward mental illness.
How Does Mental Illness Affect You?
Mental illness affects millions of Americans, yet mental illness stigmas continue to be a problem in today’s healthcare system. Mental illness stigmas are not only detrimental to individuals with mental illness, but also to those who hold such stigmas. Raising public awareness of mental illness and providing better care for those individuals will help reduce these stigmas and allow for better healthcare outcomes. The Colorado Children’s Hospital created a short, relevant video regarding mental health stigmas that I recommend. You can view it here.
As family practice providers we are the first line in establishing trust and understanding, and we must be willing to not only discuss mental health with our patients but also to treat it appropriately based on each patient’s needs. Behavior therapists (or as I like to call them, “personal trainers for our mental health”), group therapy, exercise and/or medications are all resources available to appropriately treat mental illness. I encourage my patients to find someone they trust and can be open and honest with, and I tell them that it is OKAY to be a little selfish. If someone would be more comfortable being seen by a female provider or a clinician of their own race or ethnicity, we must make sure they are empowered to make that decision! At the end of the day, we must open those lines of communication so together we can head toward effective treatment and live a joyful life.
If you or someone you know is suffering from mental illness or if you are concerned about your mental health, please reach out to your family practice provider or community mental health resources. If you are a healthcare provider who is struggling with mental illness, please do not be ashamed or hesitant to seek help. The hardest step is the first one, but it is the most important. Know that you are not alone, and things will get better.
If you or someone you know has thoughts of death or suicide, call the National Suicide Prevention Lifeline 800.273.TALK (800.273.8255) or 9-1-1 immediately. You can also text DBSA to 741-741 or contact a medical professional, clergy member, loved one, friend or hospital emergency room.