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It's No Wonder Untreated Mental Illness Has a Stigma

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Spending money on programs to fight the stigma of mental illness is a waste and ineffective. It would be far more appropriate to use that money to provide proper treatment. If that were done, what stigma there is would be reduced.

Many argue that a major impact of stigma is that people will be afraid to admit they have a problem and not seek treatment. But the data on prescribed drugs shows that anti-depressants were the second most commonly prescribed class of drugs in 2010 (Appendix 2, P 31). Tranquilizing agents were at number 11. In 2008, the Center For Disease Control found that the fourth leading reason for doctor visits was mental disorders (Table 12).

There would seem to be little stigma associated with depression and anxiety based on these data.

Where there is still a stigma with the serious mental illnesses of schizophrenia and bipolar disorder -- and the worst offenders are health care providers as I mentioned in an earlier blog. I even commended the Mental Health Commission of Canada for developing programs to help medical students be less stigmatizing.

The consequence of that stigma was pointed out by Thomas Insel, the Director of the National Institute of Mental Illness in the U.S. He wrote in a recent blog that "the average life expectancy for people with major mental illness ranged from 49 to 60 years of age." That is a life span on par with many sub-Saharan African countries, including Sudan (58.6 years) and Ethiopia (52.9 years) and not consistent with the U.S. average of 77.9 years.

Another major cause of stigma towards those with serious mental illnesses occurs whenever an untreated person commits a horrendous act of violence and the media publicity that results. The impact of those actions by a small minority reflects on all. As pointed out in an earlier post, the commission's response to this cause of stigma is to try to convince the media not to report them.

A better solution to this, however, was put forth by Dr. Julio Arboleda-Florez. In an editorial in the November 2003 issue of the Canadian Journal of Psychiatry, he said: "Helping persons with mental illness to limit the possibilities that they become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness." He is an emeritus professor of psychiatry at Queen's University in Kingston, Ontario and headed up the anti-stigma Open the Doors program sponsored by the World Psychiatric Association.

For the anti-stigma programs that have been done, little research exists on their efficacy. In a recent issue of the American Psychiatric Association's Journal, Patrick W. Corrigan found there is no meaningful evidence on the impact of public service announcements, such as real-world change in prejudicial attitudes and discriminatory behaviours.

Dr. Heather Stuart of Queen's University in Kingston, Ontario is the mental health and anti-stigma research chair just established by Bell Canada. She consults on stigma for the Mental Health Commission of Canada and, she said, very few anti-stigma programs have even been evaluated thus their impact on the quality of life of those with mental illness is unknown.

But, in looking at the types of anti-stigma programs that are used for a previous article, I stated that there appear to be two strategies. One I called "Telling it Like it Is," (serious mental illness is a disease that can be managed) and the other, "Let's Ignore the Illness," about how we deny the existence of an illness and simply get to know the mentally-ill person as a person.

This latter approach is outlined in a paper done for the Queensland, Australia Government by Canadian consultant Neasa Martin who also consults with the Mental Health Commission of Canada. The paper states that "mental health problems are best framed as part of our shared humanity. These are an understandable response to a unique set of circumstances and not purely as genetically based illnesses or a diseased state of the brain."

The way to decrease stigma, her paper says, is through direct personal contact with the ill. I first learned this when I presented a paper on stigma by medical professionals at a conference where Martin and Chris Summerville, the executive director of the Schizophrenia Society of Canada and a member of the Mental Health Commission of Canada, presented in the same workshop with me. They both chastised me for increasing stigma. I should have been promoting friendship with the ill and not demeaning them by suggesting they have a disease.

I was stunned but will admit it's true that we are less discriminating towards those we come to know. That approach does work in race relations. But who wants to be friends with and get to know someone who is totally psychotic? If they are properly treated, fine, but otherwise, no. Most of us cringe when we see a street person sleeping on the sidewalk as we often do. I see many on Toronto's Bay Street -- the financial epicentre of one of the wealthiest countries in the world. And we cringe and hurry away when we see a dishevelled person pushing their worldly belongings in a shopping cart mumbling to themselves or shouting aloud about God or the end of the world.

In cringing and shunning them, we are stigmatizing them. Shame on us. We should get to know them which of course assumes they have the mental capacity to carry on a conversation. Maybe what we should do instead is to spend that anti-stigma money to ensure that they are treated and restored to sanity. Then most of us would want to befriend them and they would live longer with more fulfilling lives.

That would help to reduce stigma.