The 1999 Surgeon General’s Report on Mental Health said that “shame, stigma, and discrimination are major reasons why people with mental health problems avoid seeking treatment.” Offering such help in nontraditional settings like primary care clinics encourages participation by people wanting to avoid the stigma surrounding mental health treatment. Studies have shown that most people initially turn to primary care clinics, not specialty mental health facilities, with their emotional problems. So it makes sense to ease access and avoid stigma by embedding counseling in this neutral setting. Several studies buttress this contention by demonstrating that primary care clients are much less likely to follow up on behavioral care referrals made to specialty mental health services than they are to in-house programs. See Effects of Stigma.
To lessen the stigma surrounding mental health treatment, many clinic professionals have adopted more neutral, universal terminology like “coping skills” “counseling” and “stress” rather than using stigma-laden terms like “psychiatric problems” and “mental illness” when interacting with their clients [see “Warm Hand-off” script and Behavioral Consultant Introductory script]. Behavioral health staff are referred to as consultants or counselors rather than, say, psychologists or mental health specialists and their focus is on encouraging behavioral and attitudinal changes rather than on pathology.
Among the many excellent resources for information about reducing stigma and discrimination is “Eliminating Stigma and Discrimination Against Persons with Mental Health Disabilities”, promulgated by the California Mental Health Services Oversight and Accountability Commission (MHSOAC) in June, 2007. SAMSHA’s “Developing a Stigma Reduction Initiative” (2013) offers practical advice about launching local, reghional and statewide programs to address stigma.
The Integrated Behavioral Health (IBHP)Team fielded a workforce survey of 590 behavorial and physical health providers and students to assess the attitudes about working in integrated care. One finding of this survey, contained in the paper “Stigma and Attitudes Toward Working in Integrated Care” (2013), suggests that there is a disconnect between the literature, which indicates a strong tie between integrated services and stigma reduction, and provider knowledge about the impact of integration on stigma.
The American Journal of Public Health has devoted an entire issue to the stigma surrounding mental illness, framing it as a public health problem. Former First Lady Rosalynn Carter was among those responsible for this May, 2013 issue, which explores stigma from several perspectives, including the role of integrated health in reducing stigma. Among the papers is an account of “California’s Historic Efforts to the Reduce Stigma of Mental Illness”.
An articleby Thu-Huong Ha entitled “How Should We Talk About Mental Health” discusses basic recommendations for stigma-busting, including:
- Avoid correlations between criminality and mental illness
- Avoid words like “crazy” or “psycho”
- Don’t define a person by his/her mental illnesses
- Separate the person from the problem
- Sometimes the problem isn’t that we’re using the wrong words, but that we’re not talking at all
- Recognize the amazing contributions of people with mental health differences
Other organizations that help combat stigma are listed in the Resources section.