Large-Scale Effort Needed to Stop Mental Illness Stigma

The United States needs a federally led, far-reaching strategy to reduce the continuing stigma associated with mental health disorders and substance use disorders, according to a new report from the National Academies of Sciences, Engineering, and Medicine (NAS).

"Stigma" refers to a range of negative attitudes, beliefs, and behaviors related to the disorders, and it tends to rise with closeness to the situation — rejection is higher for a depressed person who marries into the family than for a neighbor with depression, according to the report, Ending Discrimination Against People With Mental and Substance Use Disorders: The Evidence for Stigma Change.

This is true even though understanding, knowledge, and willingness to talk about the disorders have risen dramatically, state the authors of the report, who are members of NAS's Committee on the Science of Changing Behavioral Health Social Norms.

Stigma continues to be high, especially regarding schizophrenia and substance use disorders. And even with increased knowledge and awareness, "beliefs about the underlying causes of substance use disorders have shifted away from the idea of illness in the direction of blame," the committee writes.

Stigma affects a significant number of Americans. Estimates show that 25% will experience a mental health problem or will misuse alcohol or drugs at some point in their lives. Fewer than 1 in 10 of the 28 million Americans in 2013 who needed treatment for an alcohol- or drug-related problem received it.

At an institutional level, courts, school systems, businesses, social service agencies, universities, and the government all stigmatize those with mental health or substance use disorders, the report states. One consequence is that those with the disorders "are overrepresented in the criminal justice system," said the NAS committee.

The public, educators, employers, journalists, and members of law enforcement also stigmatize and stereotype individuals with mental health disorders or substance use disorders. In addition, individuals with mental health disorders self-stigmatize, avoiding disclosure of their conditions or not seeking treatment for fear of being labeled.

"Mental health and substance use disorders are prevalent and among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment," committee chair David Wegman, MD, professor emeritus in the Department of Work Environment at the University of Massachusetts, in Lowell, said in a statement.

"Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders," he added.

Good Role Models

The report was requested by the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services (HHS) and by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The NAS committee studied a variety of antistigma programs. They found several that were effective, said committee member Ruth Shim, MD, MPH, vice-chair of education and faculty development in the Department of Psychiatry at Lenox Hill Hospital–Northwell Health, New York City.

Although many private and public organizations, including eight federal agencies, are conducting antistigma and mental health promotion efforts, these programs are largely uncoordinated and are not well-evaluated, which means stigma continues to proliferate, Dr Shim told Medscape Medical News.

"We know what works ― it's just that what works has never really been implemented large scale," she said.

The strongest programs were multipronged and included education, traditional media campaigns, social media campaigns, legal and policy interventions, and contact-based programs that bring together people with and without behavioral disorders.

Three antistigma campaigns ― Time to Change, in England, Opening Minds, in Canada, and Beyondblue, in Australia — are seen as models. The programs are all supported by their respective federal governments, have taken place over a period of decades, have relied on long-term funding, are being evaluated and monitored on an ongoing basis, and have multifaceted strategies.

Time to Change began in 2008 and brings together individuals with and without the disorders. It has organized a massive social media campaign and offers grants to grassroots organizations.

Opening Minds, which started in 2009, is aimed at 12- to 18-year-olds, the media, healthcare providers, and employers. It uses a contact model.

Beyondblue, which is the oldest program, was started in 2000. It includes training of prominent people to be champions.

The United States needs a similar federally led and government-funded national effort, Dr Shim and the committee said. The programs need to be broad, but also tailored to specific populations, "with a very clear understanding of the unique cultural make-up of those populations," said Dr Shim.

The committee cited the Department of Defense's Real Warriors Campaign, which is a large, multimedia program aimed at facilitating recovery, promoting resilience, and reintegrating returning service members, as an example of such a multipronged, broad, yet tailored program. Real Warriors "gets to the heart of the culture of the military," said Dr Shim.

Recommendations

The NAS issued six recommendations for how federal agencies can move forward in reducing stigma:

1. The HHS should lead the design, implementation, and evaluation of a multipronged, evidence-based national strategy to reduce stigma and to support people with mental disorders and substance use disorders.

2. The HHS should evaluate its own service programs and collaborate with other stakeholders, particularly the criminal justice system and government and state agencies, for the purpose of identifying and eliminating policies, practices, and procedures that directly or indirectly discriminate against people with mental disorders and substance use disorders.

3. SAMHSA should conduct formative and evaluative research as part of a strategically planned effort to reduce stigma.

4. To design stigma-reduction messaging and communication programs, SAMHSA should investigate and use evidence from formative and evaluative research on effective communication across multiple platforms.

5. To decrease public and self-stigma and promote affirming and inclusive attitudes and behaviors targeted to specific groups, SAMHSA should work with federal partners to design, evaluate, and disseminate effective, evidence-based, contact-based programming.

6. SAMHSA should work with partners to design, support, and assess the effectiveness of evidence-based peer programs to support people with mental disorders and substance use disorders along the path to recovery and to encourage their participation in treatment.

Dr Shim has disclosed no relevant financial relationships.

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Cite this: Large-Scale Effort Needed to Stop Mental Illness Stigma - Medscape - Apr 21, 2016.