As a society and as individuals, we find it easy to have empathy for someone who is suffering from physical illness. Diseases or conditions affecting the body’s physical structures or systems tend to be visible. Tend to be tangible. Physical ailments can usually be diagnosed through physical examinations. Symptoms can be traced back to known root causes and explained in straightforward terms we can understand.
Since we all have bodies, we can all relate.
Given this common understanding, it follows that public health discussions often default to the physical as well. While a critical aspect of public health, dialogue surrounding mental health is far less common. Unlike most physical disorders, mental health challenges are typically not well understood. This unfamiliarity can breed fear and fear, in turn, creates stigma. Stigma is a mark of disgrace associated with a particular circumstance, quality, or person. It causes negative stereotypes, discrimination, and prejudice against people based on some distinguishing characteristic or condition. Most importantly, stigma is one of the primary barriers to improving mental health outcomes.
Defining Mental Health and Stigma
To better understand stigma and its impact on mental health, we must first understand the broad implications of the term. The World Health Organization (WHO) defines mental health as: “A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” It pertains to cognitive, emotional, and social well-being – how we think, feel, act, relate to others, and handle stress.
Mental health affects one’s ability to think clearly, to learn new skills, and remember things. It involves how we perceive the world, how we process information, how we make decisions and utilize reasoning. Mental health relates to our capacity to handle a wide range of human emotions, both negative and positive, in a constructive way. It involves our ability to feel connected, to have a sense of belonging, to understand social cues and function effectively in social situations, to foster and maintain interpersonal relationships that bring fulfillment to our lives. In short, mental health has profound, multifaceted effects on every moment of every day in our lives. And when mental health is challenged, the impact is usually characterized by a series of negative consequences – many of which arise from the stigmatization attached to mental health disorders.
The stigma surrounding mental health is not just impactful. It has deep and multifaceted roots that vary across cultures and eras. For a significant part of human history, the utter lack of understanding behind mental disorders often led to fear. And what people fear, they often stigmatize or avoid entirely. In many cultures throughout history, those with mental health issues have been ostracized, institutionalized, or persecuted. In some cultures, mental challenges were even associated with curses, sins, or divine punishment, leading already-suffering individuals to be subjected to exorcism or other harmful treatments.
One of the most immediate consequences of stigma is individuals experiencing mental health issues often delay or avoid seeking help for fear of discrimination or being misunderstood. Not seeking help often exacerbates symptoms and leads to more severe health outcomes. Stigma can also diminish an individual’s quality of life by creating additional challenges in relationships, work, and social interactions. People with known mental health conditions often face discrimination in employment, housing, and education. This can lead to economic challenges, increased poverty rates, and fewer opportunities for individuals. To avoid judgment or discrimination, individuals may withdraw from social situations, leading to increased feelings of isolation and loneliness.
Stigma can also influence the priorities of policymakers. A growing number of activists assert that mental health does not receive the attention, funding, or resources it needs, and that stigma hinders the development of effective public health strategies and services. Central to this argument are examples of how stigma contributes to violations of human rights such as unjustified institutionalization or incarceration, denial of employment, or the deprivation of decision-making power in personal matters.
Mental Health Stigma and Effects
Stigma surrounding mental health is widespread and may take many forms:
Public Stigma: The most pervasive mental health stigma is the reaction the general public has to people with mental health challenges. Public Stigma is the aggregate of negative beliefs and prejudicial attitudes held by members of society about those dealing with mental disorders.
Self-Stigma: This form of stigma comes about when individuals with mental health challenges internalize the negative beliefs and attitudes held by others. Self-stigmatized individuals may feel shame, guilt, or a sense of inferiority because of their condition, which often creates barriers to recovery.
Structural Stigma: This stigma refers to the societal-level conditions, cultural norms, and (reliance on) institutional practices that constrain the opportunities, resources, and well-being of individuals marked by mental health stigma. Structural stigma may also include policies that discriminate against people with mental health disorders.
Affiliated and Courtesy Stigma: Affiliated Stigma is experienced by individuals who are associated with stigmatized people, such as family members or friends of those with mental health challenges. This is closely related to Courtesy Stigma, which is stigma attached to those who help or treat stigmatized individuals, mental health professionals and peers.
Some common effects and manifestations of these stigma include:
- Stereotyping: Those with mental health challenges may be labeled as dangerous, unpredictable, or incompetent.
- Discrimination: They might face discrimination in employment, housing, or social settings due to their mental health status.
- Isolation: Due to fear of stigma, individuals might avoid social interactions, further isolating them.
- Reluctance to Seek Help: Stigma can deter people from seeking treatment or help, worsening their mental health condition.
- Misunderstanding: Many people might lack education or knowledge about mental health conditions, leading to misconceptions and biases.
Challenging Traditional Models
Dr. Vikram Patel is a Professor and the Chair of the Department of Global Health and Social Medicine at Harvard Medical School. Named one of Time magazine’s 100 Most Influential People, Patel is also regarded as a pioneer and a champion for the need to raise awareness about mental health stigma–and to change how we go about addressing it. Patel and a growing number of contemporary mental health advocates are committed to transforming what they view as an outmoded mental health care model based on traditional methods that have shown themselves to be ineffective.
“If you should speak to to anyone affected by a mental illness, the chances are that you will hear stories of hidden suffering, shame and discrimination in nearly every sector of their lives. But perhaps most heartbreaking of all are the stories of the abuse of even the most basic human rights that are played out every day, sadly, even in the very institutions that were built to care for people with mental illnesses, the mental hospitals.”
Vikram Patel, “Mental Health for All, Involving All,” Ted Talk
Patel calls for adoption of a more holistic and community-based approach to mental health. He is a strong proponent of task-shifting, a strategy that shifts less complex service tasks away from a short supply of highly trained mental health specialists to others with fewer qualifications in order improve access to mental health services. Task shifting frees up professionals to focus on more complex cases and other important roles such as mental health care capacity-building and supervision. Patel also challenges these same professionals and program administrators to abandon an antiquated mental health system that approaches mental health care in the same manner it practices clinical medicine: diagnose illnesses, assign names to conditions, then respond with prescribed interventions, often based on medication.
Wikimedia Commons: The 6th Asian Awards, Press Room
“There is growing acknowledgment that a singular, structural challenge has been the narrow dichotomous framing of mental ill health through the prism of diagnosed mental disorders,” Patel writes in a newly released paper in The Lancet.1 “This framework has dominated the field for around half a century…Disappointingly, 50 years on, we still do not have a single biological finding that can be applied to diagnose any mental illness, nor a single new therapeutic agent or target for prevention. Yet, this reductionist framework continues to prevail, privileging certain types of providers (e.g., mental health specialists), interventions (e.g., medications), delivery settings (e.g., hospitals), particular perspectives of recovery (e.g., focused on clinical symptoms), and particular perspectives on research priorities (e.g., focused on biological mechanisms).”
Not only is that prevailing, reductionist framework not helping, many would argue it’s doing the opposite. Cherene Caraco, Founder, Chief Global Strategist, and Executive Officer of Promise Resource Network (PRN) in Charlotte, NC, U.S., counts herself among those. A self-described traditional mental health disruptor, Caraco is not afraid to say she’s a survivor not only of a mental health challenge, but also of the very system designed to abate it.
At 13 years old, Caraco says she exhibited behavior that caused her to enter mental health services. Once inside a facility, a misdiagnosis threatened to keep her there and ultimately would threaten her life.
“Like many others, I came into a diagnosis at a very young age,” Caraco says, “and that diagnosis turned into two. Turned into three. Turned into five. Turned into eight. I eventually ceased being myself and became the labels people were looking for to describe what was going on with me. This is what happens with the diagnostic way of doing things – we’re looking at behavior and patterns over time, and then translating that behavior into pathology. Pathology means you get a diagnosis. Diagnosis means you have an illness. The diagnosis then becomes this prophecy of who you are, and that the chances of you having and living a fulfilling life starts to decline.”
Given what she does now, Caraco understands this in hindsight.
“At the age of 13, like so many young people, I blindly believed what they told me. I was young. I was told that I was sick and that I would always be sick. And when you’re told that by medical doctors–professional people–something happens with your sense of self. You lose your identity. You lose your confidence. All those things kind of go out the window and for many people, that leads straight into chronic illness.”
As it turns out, there was no pathology behind Caraco’s troubles.
“The entire time I was in services, I was actually experiencing sexual abuse,” Caraco says. “But they looked at my behavior and just translated it as an illness. They didn’t ask the right questions, like, ‘Why would a 13-year-old child be starving herself in order to disappear?’ Developmentally, that’s not typically what happens with kids. But unfortunately, with the process of medicalization and clinicalization, the answer is usually something like ‘Well, you have a biologically based brain disease called A, B, or C, and you need a psychotropic medication and not to be too stressed.’ Then you go into treatment for the rest of your life and live your life as a mental patient. That literally becomes their answer.”
“We keep doubling down on these traditional systems and blaming the person: ‘Well, if they were just medication compliant,’ or, ‘If they would just do this or that,’ or, ‘If we would go back to long-term hospitals, then we would have something.’ But the truth is that none of those things have ever worked.”
Cherene Caraco
Caraco proved that prophecy wrong by becoming an award-winning mental health advocate who operates one of the best known, peer supported organizations in the U.S. PRN is dedicated to improving, redefining, and transforming the attitudes, systems, and policies surrounding mental health. More than that, PRN has become a valuable source of help and information for the many under resourced and underrepresented individuals facing mental health challenges in the area. PRN is staffed by 125 “lived experience” experts, every single one of whom is a survivor of mental health challenges. In many cases, their peer connections and simple act of storytelling – sharing their personal experiences related to mental health with those facing similar challenges – can help to erode stereotypes, reduce stigma, and inspire others to seek further help or act.
“Our entire staff is comprised of people that live it or that have lived it. We call it “expert by experience” as opposed to expert by education,” Caraco says. “We’re not discounting the value of some of the educational things, but we’re trying to right-size a system filled with we call “people that go to school” experts, with a system that relies upon people who have lived and are living this every single day, surviving, and thriving and stumbling, and figuring it out. That gives you an earned wisdom that cannot be replicated by any degree, any licensure, any professional career, because you’ve earned that expertise by living it.”
Once in college, Caraco changed her major to psychology so she could learn more about her own mental health by studying it. In the process, as an intern, she made her way into a short-term, acute care psychiatric hospital for children in adolescence. She was shocked at what she saw.
“I was all about my illness up until that point, but when I walked in that hospital and I started working, I thought to myself, ‘this is what they thought would help me?’ The first thing my supervisor said was I want you to get to know these kids by reading their files and pay close attention to anything maladaptive. And I looked up at her and I said, ‘How am I ever going to get to know these kids by reading their files?’
Caraco said that was it.
“A jolt went through my body right then and I realized what had been done–was being done to me, systematically. It had been reinforced and reinforced and reinforced, over, and over and over again. I was not the exception; I was the rule. So, I made a commitment on that very day I was not going to be a part of that system. Instead, I was going to be a part of changing it. I worked in Group homes, inpatient settings, outpatient settings, community settings, any place that I could work to understand the way that the systems were designed. How the billing worked. I did all the traditional things for a long time. I needed to soak it all up.”
What Caraco helped to create is a far cry from any of those traditional institutions she worked in.
“Today at PRN, I have employees that were labeled with schizophrenia and various thoughts disorders and psychoses. I have employees that are suicide attempt survivors and employees that have been involuntarily hospitalized for many years. I have employees that are overdose survivors, people that were incarcerated for life, had sentences of life, and life plus 10 years. I have employees that have lived on the streets and have been or are unhoused for many years. Employees that have used harm reduction as their approach around substance use. Domestic violence survivors.
What a great opportunity if we can tap into this expertise and change these systems–change the paradigm and change the treatment. Change the policies. Change the practices. Create connectedness and some level of insight as to what is really happening with people. If we can do that, then we are in the Wellness business. I tell people that I went from being in the illness business, which is that whole clinical medical paradigm, to being in the Wellness business, because I am surrounded by Wellness every single day, all day long. And that’s a beautiful thing.”
Challenging Stigma, Battling Barriers
The impact of self-stigma is central to Caraco’s account. Mental health issues are known to have profound effects on an individual’s self-esteem and self-worth, effects that can be magnified by a clinical diagnosis that may or may not be valid. This relationship between mental health and self-perception is often bidirectional: mental health disorders and diagnoses can lead to diminished self-esteem, while low self-esteem can exacerbate or even contribute to the onset of more pronounced mental health issues. Disorders like depression, for example, often involve pervasive negative thought patterns. Affected individuals might see themselves as worthless, unlovable, or incompetent. Conditions like depression and anxiety also often involve ruminative thinking, where individuals constantly replay negative events or worries, amplifying their feelings of inadequacy or hopelessness.
Elliot Pinsly, another award-winning disruptor and mental health advocate, is a licensed clinical social worker in Nashville, TN. Pinsly founded the Behavioral Health Foundation (BHF) in 2020, a data-driven, nonprofit policy research center focused on mental health and addiction issues. While Pinsly’s road to mental health advocacy is far different than Caraco’s, the flavor of his messages is the same. Like Caraco and Dr. Patel, Pinsly is dedicated to bringing about change to what he views as a broken system.
In 2019, the World Health Organization estimated that 1 in every 8 people, or nearly 970 million around the world, were living with a mental health disorder.
“When I graduated with my masters, I got a job at the VA hospital in Nashville,” Pinsly recalls. “My first job was to take a list of no-show appointments from the day before and call to see if folks were OK–try to get them rescheduled to come back in. Soon after, I started doing the first telehealth consults that were ever done at the VA in Nashville, where I was asked to diagnose new patients.”
That experience at the VA would plant a seed that ultimately led Pinsly to change his way of thinking.
“I realized that if someone goes in to see a therapist, or a psychiatrist or whoever it may be, if there is reimbursement expected from any part of the insurance system or from the government, you had to put a diagnosis on them immediately if you want to start billing for services. Otherwise, insurance wouldn’t pay for it. This contributes to stigma, in my opinion.”
That stigma can have dire consequences. A good deal of Pinsly’s work at BHF deals with mental health issues and criminal justice.
“Let’s say someone goes to the emergency room or they’re at a clinic being evaluated and it’s determined they need to be involuntarily admitted to the psych hospital,” Pinsly says. “Do you know how those people are transported? More often than not–in almost every part of the nation, it’s in a law enforcement vehicle. In handcuffs. Every jurisdiction has different rules, of course, but generally statutory authority falls to the sheriff in terms of duty to transport people under a civil order of commitment. Remember, we’re talking about people that haven’t even been charged with a crime.”
According to researchers at the UCLA Luskin School of Public Affairs, the rate at which Americans are held against their will and forced to undergo mental health evaluations and even state-ordered confinement has risen sharply over the past decade.2 Both Caraco and Pinsly stress the profound impact that results when stigma results in inhumane treatment and discrimination–descriptors that are often used to characterize involuntary commitment, or IVC.
“IVC is just another way of saying someone’s rights are being removed,” Caraco says. “Imagine a sexual abuse survivor with a high level of vulnerability who gets shackled, thrown in the back of a police car, then gets strip searched and cavity searched at a psychiatric hospital upon arrival. Someone watching them bathe. Watching them go to the bathroom. That’s simply abuse on top of abuse.”
There is data to support what Pinsly and Caraco contend. According to a 2017 study published in JAMA Psychiatry, the post discharge suicide rate during the first three months after discharge from psychiatric facilities was approximately 100 times higher than the global suicide rate. Patients admitted with suicidal thoughts had rates nearly 200 times the global rate.3
“We don’t exactly have the best track record in terms of folks who have mental health issues and encounters with law enforcement, who generally don’t have the specialized training needed generally to work well with these folks. And law enforcement is generally the first to admit that and say ‘we need help. We’re here for public safety. We’re not healthcare professionals.’”
Elliot pinsly
Sadly, despite these staggering numbers, Pinsly says police don’t have much of an option. But he and others have set out to change that–at least in Tennessee.
Bringing About Change
After his stint at the VA and briefly running a therapy clinic for veterans, Pinsly took a position as an intensive in-home therapist at a large nonprofit, working with children and families. As his role expanded to outreach, he started working in coalitions and developing partnerships with school districts to expand school-based mental health therapy – skills that would serve him well in the future. As part of his roles, Pinsly collaborated with a mental health court – a voluntary, specialty criminal justice system court that provides an alternative path for people with mental health issues. Only four such courts existed in the U.S. in 1997, a number that has since grown to over 300, with programs in nearly every state.4
“If you get a good judge, one who really cares about people,” Pinsly says, “mental health courts work well because it’s a lot more compassionate of an environment. Empathy is more ingrained in the process than in a traditional court, something that’s extremely important for those experiencing mental health issues. After all, empathy is a not necessarily a key tenet of our criminal justice system.”
In Nashville, that compassionate judge was Daniel B. Eisenstein, a mental health court stalwart who would one day be honored by the National Alliance on Mental Illness (NAMI) for his mental health court work. When Eisenstein retired, he reached out and invited Pinsly to participate in a new project, one that was focused on providing community-based care and would eventually become the Tennessee Diversion Coalition. Pinsly explains how important the work was in addressing stigma and that oft traveled and complicated intersection between mental health and the criminal justice system.
“The key was getting everybody at the table,” Pinsly says, law enforcement, healthcare providers, advocacy leaders, and people with lived experience. “Eventually we got money for pilots to handle those situations in a different way. Connecting people to 24/7 walk-in centers. Healthcare handling transportation. Softer. No restraints. As a team, we said, ‘let’s get someone there that can help better than a police officer alone.”
In 2018, the Tennessee General Assembly provided $15 million in funding for what was then called “pre-arrest diversion” infrastructure, with a goal of redirecting individuals with mental illness, substance use, or co-occurring disorders from the criminal justice system to community-based treatment and supports. Similar programs are now being launched in other locations around the US.
This type of innovative collaboration and diversion strategy has roots dating back to a program launched in Oregon in the late 1980s–and is still thriving today. CAHOOTS (Crisis Assistance Helping Out On The Streets) is a nonprofit, nongovernment, non-police mobile crisis intervention program formed as a partnership between the White Bird Clinic and the Eugene, Oregon Police Department (EPD). CAHOOTS teams include a medic and a crisis worker who respond to psychological crisis and mental health emergencies. Sometimes CAHOOTS responds alone, others in joint response with the PD. In other cases, CAHOOTS is called if it is determined their services are a better match for the situation. When hospitalization is necessary, CAHOOTS has the freedom to provide transport in lieu of the PD, a service that mitigates stigma for the afflicted and supports a law enforcement agency not designed to deal with mental health issues.
The Eugene Oregon Police Department Crime Analysis Unit reports the CAHOOTS program diverts anywhere from 3%-8% of EPD Calls for Service. In 2021, CAHOOTS had some level of involvement in no less than 22,055 public initiated calls.
According to Dr. Patel, “The moment you build community-based care systems that don’t label people with fearsome diagnoses, respect their dignity and autonomy, do not incarcerate and sedate them against their will, and offer care which they value and is evidence-based, you will find the stigma will go away.”5 In his new publication, Transforming mental health systems globally, Patel lays out five principles that can be used to transform current practices;
Principle 1: target harmful social environments across the life course
The first principle requires a shift in focus, away from the treatment of diagnosed mental health conditions, to an equal, or even higher, priority for the prevention of mental health problems and the promotion of mental health. This shift is important for several reasons. First, even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental ill health.
Principle 2: care is determined by a person’s needs, not their diagnosis
Current care models are dominated by the need to establish a diagnosis to offer treatment. The use of contemporary classification systems, in which a person is classified as either having a specific mental health condition (e.g., depressive disorder, schizophrenia, or bipolar disorder) or not, is problematic for many reasons, in particular perpetuating the conflation of mental health conditions with the criteria used to diagnose and classify them.
Principle 3: empower front-line workers to deliver evidence-based psychosocial interventions
The third principle addresses where, how, and by whom care is delivered. The current model has been dominated by specialty care, siloed from other components of the health-care system. Inpatient care is often provided in hospitals or wards that are separate from general health services, and mental health outpatient care is disconnected from primary care and social welfare services. Most care is focused on acute psychiatric episodes, with a historical neglect of early interventions.
Principle 4: embrace a rights-based perspective for mental health care
For too long, people with lived experience of mental health conditions and their families have been discriminated against in employment, education, and judicial systems. Within the health-care system, there is a history of neglecting individuals with mental health conditions and ignoring their physical health needs, contributing to premature mortality. This neglect is especially true for women, who are more likely to have physical diseases associated with mental ill health.
Principle 5: place people with lived experience at the centre of the care system
The prevailing diagnosis-focused model of care is primarily driven by provider perspectives. These perspectives are limited for a variety of reasons noted earlier, not least their poor validity. Despite these reasons, insurance companies, hospital corporations, pharmaceutical companies, mental health specialists, and policy makers continue to use this approach to determine how people living with mental health conditions seek and receive care.6
These principles align well with what Caraco, Pinsly and others are working hard to achieve. Yet despite expenditures of more than $200 billion on mental health service, a 2017 WHO report places the US at 29th in the world in terms of prevalence of depressive disorders.7 Caraco says it isn’t hard to explain why.
“Why is the U.S. so far behind? Why are the issues still so prevalent?” she asks. “It’s because we are entrenched in westernized medicine that has stock in pharmaceuticals and a medical belief system that is unrivaled anywhere else in the world. It’s really very simple.”
In many ways, Pinsly agrees.
“It is clear that we have an over diagnosing problem,” he says. “We’re getting more people diagnosed, and with diagnosis comes stigma and medication. The system is perpetuating the system. I don’t want to demonize the inpatient treatment system. I don’t want to demonize all medication. Everything in moderation, everything with good information, is best. But in my experience, patients are not given good, informed consent. I think of medication as a band aid. It’s like fixing a pipe that has burst in your home with duct tape. It might be pretty strong at first. It may hold, but it’s not going to last long term. Eventually you’re going to wind up with a major issue that is worse than before. You’re going to be managing the crisis over and over again because you didn’t do anything to address the actual issue.”
“Help isn’t help if it’s not helpful. Help that is not helpful can actually do harm.”
Pat Deegan, American disability-rights advocate, psychologist, and researcher
Mental Health Success Stories
All countries and regions face unique challenges in the ways they approach stigma reduction and mental health. Here are some noteworthy and successful mental health programs from around the world:
Open Dialogue (Finland): Originating in the 1980s, this approach to treating psychosis emphasizes immediate intervention, community and family involvement, and avoiding hospitalization. It prioritizes understanding the individual’s experience and dialogue over medication.
Beyond Blue (Australia): A national initiative launched in 2000 focusing on raising awareness about depression, anxiety, and suicide prevention. It provides resources, campaigns, and support to address these issues.
The Whare Tapa Whā (New Zealand) This Māori model of health is embraced by the New Zealand Ministry of Health and is holistic, considering four dimensions: taha wairua (spiritual well-being), taha hinengaro (mental well-being), taha tinana (physical well-being), and taha whānau (family well-being).
Headspace (Australia): A youth-focused program offering early intervention services for 12-25-year-olds across a broad spectrum of mental health needs. Headspace is a one-stop-shop for young people who need help with mental health, physical health, alcohol and other drugs, or work and study support.
Bell Let’s Talk (Canada): An awareness and acceptance campaign launched by Bell Canada in 2012 with four key pillars: stigma reduction, mental health care and access, research, and workplace leadership. The most prominent part of the initiative is “Bell Let’s Talk Day,” an annual one-day advertising campaign where money is donated to mental health funds based on the number of social media and communication interactions.
Time to Change (UK): A campaign aiming to end discrimination by changing the way people think and act about mental health, reduce stigma, and encourage open conversations.
Crisis Intervention Team (CIT) Programs (International): Innovative police training in mental health topics and crisis resolution skills, reducing the need for force and ensuring individuals get the medical help they need. CIT programs are active in over 2,700 communities worldwide.
Therapeutic Communities (Italy and International): These community-based residences emphasize social therapy, self-help, and communal living to support those who are suffering from addiction. In order to facilitate long-standing lifestyle changes, the average length of stay (LOS) is three to four years, with one year dedicated to reintegration into society.
What You Can Do to Bring About Change
Individuals play a vital role in creating change in society, especially in areas like mental health. Consider ways you can take action and be part of the transformation.
Self-Education is a good first step. Familiarize yourself with the issues, challenges, and best practices related to mental health, taking care to understand the nuances. Becoming educated allows you to advocate more effectively and reduces the spread of misinformation. If you’re comfortable, you might also consider sharing personal experiences related to mental health to help challenge stereotypes, reduce stigma, and inspire others. You might join or support peer support networks, either in-person or through philanthropy.
For those who are highly motivated, many organizations are dedicated to mental health awareness, research, and policy change. Most of these organizations encourage volunteering, donating, or becoming an active member. Awareness campaigns are another avenue that can bring about change. Look into joining local or global campaigns that raise awareness about mental health. Perhaps most importantly, take every opportunity to encourage open dialogue: Do your best to foster an environment among friends, family, and colleagues where discussions about mental health are normalized.
In addition to these methods to control your own depth of awareness and empathy, Pinsly offers practical advice for anyone who wants to make a difference in reducing mental health stigma.
“It may sound simple, but we should really be thoughtful of the language we use,” he says. “The term ‘mental illness,’ for example, carries some stigma. It’s not the ideal phrase to use anymore. Try not to say, ‘that crazy person,’ or ‘that psycho.’ Use of these terms only serves to perpetuate the stigma we’re trying to eliminate. ‘Insane’ is another one. We use the word insane to talk about insane asylums and institutions. Personally, I sometimes use the word insane to talk about the way current systems handle mental health issues. Substance abuse? Research is clear we should avoid using that phrase. Substance use is more proper and less stigmatizing.”
Pinsly also cautions about subscribing to the kind of sensationalism that the media routinely dishes out.
“The media plays a huge role not only in perpetuating stigma with language, but also magnifies the problem in search of clicks and eyeballs. Please, stop immediately labeling things as ‘mental health’ related after gun violence happens. It is not helping anyone. Blaming mental health for mass violence and shootings absolutely misses the point. We all have mental health issues to some degree. When you think of it that way–that these kinds of incidents are the result of underlying environmental and social factors that have been largely unaddressed, it changes the perspective. The reality is the vast majority of violent acts are not committed by those with mental health issues. Most people with mental health issues are not violent. Data shows that only between 3% and 5% of people with serious mental health issues commit violent acts.
And finally, Pinsly also encourages us to educate our children about these language considerations.
“We really need to focus on early education. I’m assuming that most every private and public school does vocabulary where the kids learn words and the definitions, right? What a great opportunity if we could build in vocabulary that is vibrant with feeling words. Why not teach our kids to build a vocabulary that speaks to a wider range of emotions? Not just sad, mad, angry, happy. We’re way more complicated than that. If we learn to communicate better, we can really begin the shift from promoting stigma to promoting empathy. We need to change ways.”
By Rick Melnick
*References can be found here.