The Expressway to Mental Health

by David Lilley

 The purpose of this article and my intention is to address the individual and societal stigmas of mental illness. We've made progress since the mid-20th century lock-ups and asylums; however, the blight of stigma still permeates our society, especially the mental-health community.
   Patients often find therapeutic comfort in the aesthetic decor of present-day mental health facilities, only to later face a discharge into a hostile environment with residual social stigma--a silent, empty stress. Much remains to be done to erase that which has been done.

What is Stigma?

   Ancient Greeks used the word stigma to refer to body marks or brands on people to be avoided.

 "There is a great stigma surrounding mental illness. When someone appears to be different we attach a stigma to them, we do not do it to be cruel, we simply do not understand their differences. Stigma is a reality for people with mental illness, and their greatest barrier to a complete and satisfying life." 1

   People who were different used to be shunned and stoned. Today the media is the worst culprit of shunning and stoning. When the news broadcasts that a person charged with murder was found mentally ill, it casts a stereotype that encompasses millions of people and inflicts a subliminal stigma. "....characters are usually portrayed as aggressive, dangerous and unpredictable--70 % of the television characters with a mental illness are violent." 2
   The news of repeated domestic violence and homelessness often has undertones of mental health. A large segment of our society thrives on "psycho" thriller movies. There are those in our legal professions who are quite adept at bargaining the insanity plea. These trivial everyday occurrences merely scratch the surface of societal stigma.

The Highway

   Conversely, organizations such as The National Alliance for the Mentally Ill, The National Institute of Mental Health, The National Institute of Health, and The Canadian Mental Health Association have developed vigorous educational programs and advocacy groups to battle stigma.
   The roads we travel in the treatment of mental-health stigma can be compared to a conventional-transportation network of roads and highways. Let's take a look at some of the main arteries first.

NAMI The National Alliance for the Mentally Ill 

A recent NAMI newsletter reads, "With more than 220,000 members, NAMI is the nation's largest organization dedicated to improving the lives of persons affected by serious mental illness." 3
   They are a multi-faceted organization which places emphasis on education and awareness with a relentless campaign against stigma.
   Perhaps the branch of NAMI getting the most attention and drawing the most awareness is "Stigmabusters". My latest research shows a membership in stigmabusters in excess of 8500. Their membership advocates around the world seeking to fight innacurate representations of mental illness. Stigmabusters campaign message reads, " Stigmabusters' goal is to breakdown the barriers of ignorance, prejudice, or unfair discrimination by promoting education, understanding and respect." 4
   Equally important is the education sector of NAMI. They offer patient and family education courses. Have education courses geared to children, adolescents, school violence, and even offer education on how to cope after a terrorist attack.
   The research and policy branch fights stigma by working with patients doing research on treatments or participating in clinical trials. They participate in trials and compile lists of trials. They may also do studies on ethical issues in regards to research of mental illness. NAMI publishes fact sheets and reports on-line.
   The NAMI also has a legal and public policy center which advocates for the mentally ill. They work on an individual basis, as well as, with private lawyers and other organizations. Part of their mission statement reads....
.."sector is the main arm of advocacy for the mentally improve the lives of people with serious mentall illness and the caregiving efforts of their loved ones". 5

President's New Freedom
Commission on Mental Health

   On April 29, 2002 at the Uniiversity of New Mexico, United States President George W. Bush announced the creation of The President's New Freedom Commission on Mental Health. Within his address the President said,

 "Stigma leads to isolation, and discourages people from seeking the treatment they need. Political leaders, health care professionals, and all Americans must understand and send this message: Mental disability is not a scandal; it is an illness. And like physical illness, it is treatable, especially when treatment comes early." 6

   We should eagerly anticipate forthcoming developments from this commission because of the President's early reference to the obstacle of stigma. An aggressive monthly schedule occupies them at least until April-2003.

The National Institute of Health's (NIH)

   While nearing completion of this article, the deadline for stigma research and global health research is only a few weeks away. At present the National Institute of Mental Health (NIMH)
and the Canadian Institues of Health Research (CIHR) have made applications for presentations concernimg mental health stigma.

The World Federation for Mental Health (WFMH)

   The WFMH is scheduled to hold their biennial congress Feb.21-25, 2003 in Melbourne, Australia. The congress is to include 16 keynote speakers from eight different countries and is being hosted by The Mental Health Foundation of Australia.
   MHFA's core statement for the congress emphasizes stigma by making
the following statements:

 "The policy of The Mental Health Foundation of Australia (MHFA) is built on the principle that partnerships of local and international community stakeholders provide the synergy integral to promote awareness of mental illness and barriers created by the related stigma.....The Foundation aims to educate the community to promote the maintenance of mental health and positive attitudes. Early intervention practices to prevent mental illness and to remove the stigma associated with mental illness are a priority." 7

   There are many efforts in motion at the national and global levels along the highway to eradicate mental-health stigma. Only a few major agencies and groups have been mentioned here.
   In order to be effective; however, we must get off the highway to carve inroads and distribute the education and advocacy. Only then, can we adequately begin to restore self-esteem to those affected by the stigmas associated with mental-health afflictions.

Inroads and crossroads

   On a CMHA website of frequently asked questions about mental illness,
one of the Q-A's reads as follows:

   "Q-Why do so many people fear mental illness?"

   "A- It is human nature to fear what we do not understand. As such, mental illness is feared by many people and unfortunately still carries a stigma. Because of this stigma many people hesitate to get help for a mental health problem for fear of being looked down upon". 8

   This brings a question to my mind.....well....I guess we have to educate both the observer and the observed. An excerpt from an article by Conneticut Clearing House reads:

 "Stigma is not just the use of a wrong word or a wrong action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier and discourages individuals and their families from getting the help the help they need due to the fear of discrimination. An estimated 50 million Americans experience a mental disorder in any given year and only one-fourth of them actually receive mental health and other services." 9

   This estimate of only one fourth holds true in other parts of the world as well. A survey in Edmonton, Alberta, Canada showed that only 28.1 percent of individuals who met criteria for a diagnosis in the previous year sought help for their problem. (SIEC) (Bland et al, 1997 937-940)
   Estimates of treated versus untreated persons contrast greatly because of the shame factor of prejudicial stigmas. Almost every person afflicted with a mental disorder will encounter some degree of stigma. This silent discrimination is slowly gaining attention.


   Legal rights, discrimination laws, and human rights vary depending on one's residence. There is worldwide activity concerning mental health stigma's legal issues, prevention and treatments.
   Research on the medical front is necessary to provide quality treatment, medicines, and implementing possible prevention. To overcome stigma, we need to consider mental illness as a medical illness, and present that fact in public-education information to erase the existing misconceptions.
   Talking more openly about mental illness in the work place and in public will alleviate some of the mystery and gradually erode the stigma that surrounds mental illness. The road still winds through education, private industry, health insurance, and governmental sectors of society. We must continue its development and maintenance.
   Medicine, Psychiatry, and Social Services have traversed a huge expanse since the era of the straight-jacket and insane asylums. Each route we take leads us closer to optimum treatment and less stigma. All the off-ramps and intersections require a decision, a change in direction, maybe a detour, or sometimes to stay the course.
   A mere change in viewpoint might be the push that gets things rolling again and frees us from the quagmire. Major efforts to reduce mental-health stigma are in process. Let education be our map, and humanity our navigator on the roads we've yet to travel. Directly, or indirectly, nearly all of us will play a part in erasing the "marks" which were once presumed indelible.

Tp 11/02



Quotes, Works Cited, Links












Works cited:

          Canadian Mental Health Association-
Thunder Bay Branch

          Conneticut Clearing House

          Mark L. Levy M.D., F.A.P.A.

          National Alliance for the Mentally Ill          

          National Stigma Clearing house

          President's New Freedom/Commission on Mental Health

          Suicide Information and Education Center (SIEC)

          Victoria's Mental Health Services

           World Federation of Mental Health



   The following links were not used for this article but are
   recommended for additional information.

          MIND- England

          Mental Health Foundation (UK)

          Mental Health Foundation (NZ)

          World Health Organazition

Disability Rights Advocates (DRA)

          National Empowerment Center

          National Mental Health Self-Help Clearing House




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