Don’t Make Mental Health Policy About the Stigma

1403216691000-Jessica-Dawson-06

Cost of not caring: Stigma set in stone by Liz Szabo, USA TODAY.

This second article of a USA Today series, Mentally Ill Suffer in Sick System, this morning began exploring, "the human and financial costs that the country pays for not caring more about the nearly 10 million Americans with serious mental illness." But the article didn’t address any of the aggregate human costs nor any of the financial costs the country pays due to serious mental illness. Maybe future articles will, and that’s what I would like to encourage with this post.

Now, admittedly, USA Today isn’t in the top 10% of resources I normally rely upon for keen insights and emerging trends and drivers in healthcare, but nonetheless I think they deserve enormous credit for using their national reach to bring greater awareness to a critically important issue.

From a public policy perspective, however, this first contribution is wide of the mark in advancing the type of dialogue that could actually lead to meaningful public policy initiatives impacting mental and behavioral health services. So though I very much doubt their editors will ever see this post, I would like to provide some input that might be useful in developing content for future articles in the series.

Today’s article focused on two themes: the latent impact that stereotypes associated with mental illness still have, often creating self-absorbed obstacles to seeking and receiving much-needed diagnosis, treatment, support services and ongoing care; and the dramatic lack of sufficient resources committed to helping those who are brave enough to seek assistance and support.

Of course, stigmatism is still very real, yet very difficult to understand: it isn’t just a case of stereotyping and ignorance. Mental illness is difficult for many of us to comprehend because the mechanism responsible for its existence is the same mechanism we use to understand it. Most of us can use our brains to understand heart disease, diabetes and lung cancer. But somehow using our brains to explore and reason through a disease process that in others (or, to be sure, often ourselves) impacts our thinking can be uncomfortably counterintuitive.

The inherent stigmatization isn’t just in the fact that someone with mental illness is, "different." It’s the added frustration of having difficulty understanding why they are different. An individual receiving chemotherapy for cancer may look different than their appearance prior to disease. Someone who has had an amputation resulting from diabetes has a noticeable difference in appearance. But mental illness very often doesn’t carry with it the externalities of these changes in appearance (the manifestation of behavioral health consequences resulting from mental illness may lead to dramatic changes in appearance, but those are usually self-chosen much the same way one would choose a different hair color or style).

So while it may be said that ignorance is a lack of understanding acted upon, I agree we should continue to concentrate efforts on building understanding and awareness through continued education, rather than trying to coach away ignorance through reprimand and humiliation that too often characterize so many public awareness campaigns.

Such efforts have had beneficial impact: as a society we are generally much more accepting today than 20 years ago that mental illness is not a self-chosen condition bearing the shame of poor choices and moral subservience. And they have concurrently raised awareness about the urgent need to develop more effective public policy to address accelerating mental and behavioral health needs.

And so, as related in the USA Today article, the most emotionally convenient and expedient approach to lobbying for additional funding in support of MH/BHS is to continue making the case that mental illness should be viewed just as any other disease of a human organ – since the brain is, after all, a human organ. This reflects the inherent strategy that fighting the stigmatization of mental illness will hold sway over those able to increase funding of MH/BHS policy initiatives. But I don’t think it will because every dollar allocated to healthcare is becoming increasingly precious.

From a policy perspective, I believe it is both folly and a wasted effort to spend valuable resources on lobbying for more funding without being able to provide realistic and achievable budgetary offsets. To do this, advocates of MH/BHS programs need to focus their time and energy on generating evidentiary support for where and how funding of existing programs that address the consequences of mental illness can be more effectively invested in programs that diagnose and treat mental illness – i.e., before that illness results in consequences which place resource strain on other areas of social health and welfare (e.g., utilization of hospital emergency departments and the criminal justice system, the economic impact on families and the cascading effect that has on the rest of society). This is, I assume, what USA Today claims the series intends to do via relaying the “human and financial costs” of mental illness. We will see.

In healthcare, we are now living in an era where the expectation that research and evidence support clinical decision-making has steadfastly made its way into organizational administrative and financial decision-making. Quite obviously, we cannot hope that will ever be the same in Congress, but through the Affordable Care Act and various programmatic changes impacting state Medicaid budgets legislators are by default forcing healthcare providers to much more carefully analyze alternative investments – and to use return on investment as a tool for that analysis. Mental health advocates need to recognize this reality if they want their efforts to ultimately result in constructive public policy consistent with their overarching goals and objectives.

I really hope this understanding is reflected in future articles in the USA Today series. I understand anecdotal human-interest stories that tug at the heartstrings help sell newspapers, but they contribute very little to the knowledgebase of understanding needed to assess where and how limited resources can best be reallocated to address this tremendously difficult challenge that we all face as a society.

Cheers,
  Sparky

Picture Credit ~ Jim C. Jeong for USA Today

Comments

  1. Stacie Larson says:

    There was a bill proposed in the last legislative session in Washington State that would have required any fiscal examination of proposed policies to aid those who have serious mental illness to examine both the cost of implementing the bill and the cost of not implementing the bill. (Sorry for the convoluted sentence, but that’s the best I could do.) So far, most proposals for treatment have been called “too costly.” People who care about the people who have these worst-of-all-illnesses have long been frustrated, knowing that the illnesses can be treated, and that withholding treatment results in increased emotional, financial and societal problems.

  2. Jessica Dawson says:

    I have just finished two semesters of sociology, and governmental policies do reflect discrimination and stigma! My local hospital has rejected many people who were suicidal from receiving help! One person was even homicidal and was rejected for treatment, and that day stabbed his co-worker many times. My diagnosis is “Organic Schizophrenia Due to Childhood Head-injuries,” and I can attest that policies do reflect stigma against persons with mental illness and result in discrimination on all societal levels including governmental policies. I myself have struggled with the temptation to commit suicide, and during such a time was rejected myself from mental health services. My being alive, I consider to be the grace of God with such a broken mental health system. The USA Today article is correct, persons with mental illness often do not get the treatment they need for physical infirmities — I know this from both experience and seeing this in the lives of people I care about. Having worked closely with Liz Szabo to share a little bit of my story about working with “Stand Up For Mental Health” concerning the aforementioned article, I do believe she cares more than just selling newspapers, I believe she cares about people. Just as policies prevented me from having a wheel-chair ramp (mentioned in the article), persons with mental illness are faced with policies which hinder “life liberty and the pursuit of happiness.” I shared my story with USA Today with the hopes of fighting stigma, and spent time with Jimmy Jeong for a photo session. Now I am discontented that my photo is being used on your website to discredit the impact which stigma has on government policies. Stigma is what I have been having to deal with for almost 20 years, please don’t use my image to take us two steps back. Thank you.

    • Dear Jessica:

      First and foremost, thank you for taking time to read my post and sharing your comments. I have been writing on this blog for over two years now, and I have generated very few comments. So to receive one that is as thoughtful and caring as yours, it really does mean a lot – even if you disagree with me.

      If after reading my response here you are still discontented with the use of your image via the USA Today article, I will most certainly remove it. Before that, I hope you might take a moment or two to check out some other posts I have written on mental illness: I think you will find that I have advocated rather passionately that much more needs to be done to promote awareness, resources – and access to MH/BHS resources on behalf of those in need.

      My point was not to deprecate or trivialize in any way that stigmatism is a core reality of mental illness, presenting tremendous challenges that must be overcome – both by those suffering from mental illness, as well as those fighting to change perceptions. As I wrote, it is an important effort that has been successful and must be supported. But the reality – in my observational opinion – is that in our current political and economic environment, meaningful public policy that can secure desired goals such as earlier intervention, broader access, more social and clinical resources, etc. stands a much better chance of being achieved by focusing on how those policies can achieve a net overall economic benefit.

      I view the education and awareness of mental illness stigmatism as something that should continue to be an important social priority – but not necessarily a political priority because I don’t think it is going to help achieve the goals most advocates for mental and behavioral health advocates share. So what I would say is that if we disagree, we disagree on the best means to achieve shared goals – not the goals themselves. But I could be wrong, it happens a lot.

      Thanks again,
      ~ Sparky

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