The Hippo


May 25, 2020








Courtesy photo.

Mental health misperceptions
The stigmas behind mental illness and how to start changing them

By Ryan Lessard

 Derek Quintey suffers from depression. A middle-aged man from Londonderry, he was losing a lot of work because of it and didn’t tell his bosses what was going on for fear of how they’d react. But when he decided to seek treatment in June, it was actually his employer who helped him, through an employee assistance program that helped him confidentially navigate the resources available. Health care workers recommended partial hospitalization and connected him with a support group in Nashua.

To get to that point, Quintey had to overcome the stigma that surrounds mental health.
“Mental health is not treated the same as if my leg was broken. There’s still a big stigma out there,” Quintey said.
A social disorder
In fact, Quintey faced several stigmas: public stigma — how people at work or in social circles might view mental illness; self-stigma — how Quintey viewed his own condition; and structural stigma — how the view of health care providers, policy makers and insurers affected his access to care.
Gretchen Grappone, a New Hampshire native, is a training consultant specializing in mental health stigma with Atlas Research based in Washington, D.C. With grant funding from the Endowment for Health, she trains frontline health care workers and health center staff on the nature of mental health stigma and ways to overcome it.
Part of that training, which she recently facilitated for the Mental Health Center of Greater Manchester, goes over the seven different types of stigma. 
In addition to public, self and structural stigma, there’s also perceived stigma (a belief in stigma held by others), label avoidance (avoiding treatment for fear of being labeled mentally ill), stigma by association (when stigma is extended to people connected to someone with a mental illness) and health professional stigma — because although it seems counterintuitive, research has shown that health care providers may share these attitudes with the general public.
Ken Norton, the executive director of the National Alliance on Mental Illness in New Hampshire, said the day before his organization’s annual NAMIWalks fundraiser earlier this month there were 32 adults and one child in emergency rooms across the state waiting for mental health treatment beds.
“We would never treat any other medical illness that way, and we need to do better,” Norton said.
Grappone said stigmas can prevent people with mental illness from seeking help, and more broadly, they can limit work and social opportunities.
“When it becomes a problem is when it leads to prejudice, which leads to a negative action, which is discrimination,” Grappone said.
And that, said MHCGM President Bill Rider, comes with real consequences — possibly even death, if mental illness suffers are afraid to get the help they need.
“Mental illness has a mortality rate to it,” Rider said.
Studies have shown that people with mental illnesses have a life expectancy 20 to 25 years shorter than those without, and mostly from preventable conditions. 
One way to tackle this issue is by targeting misconceptions and stereotypes. The Campaign to Change Direction, which kicked off in New Hampshire in May, is one such initiative. The campaign outlines five signs of mental illness in oneself and others: feeling withdrawn, personality changes, agitation, poor self-care and feelings of hopelessness.
For even severe psychoses, Rider said, cases often start out during late adolescence, and there are usually plenty of red flags like “sort of unreal thinking, maybe some disjointed thinking, magical thinking,” Rider said. “And what, I think, individuals do themselves and what people around them do is they minimize it. … They say, ‘Geez, it’s just a phase that they’re going through, they’ve been hanging out with these weird guys lately’ … and they pass it off. And often there’s this cloak of silence where it’s not even discussed with the individual.”
Catching mental illness early, and maybe having those awkward conversations, can go a long way toward treating the issues and making sure they don’t get worse, Rider said.
Still, family members, friends or colleagues may not know how to treat people with a mental illness. Grappone said that in her trainings, most people don’t believe they are discriminating against anyone. But much of the discrimination happens unconsciously. 
Potential employers might see a veteran with PTSD and believe that makes the person violent and unpredictable, for example. Hospital staff might see a person with depression and think they’re lazy. Family might believe a loved one with depression is lacking in strength or enough faith in a higher power.  
None of that helps the issue of self-stigma, which can be affected by an individual’s upbringing, culture or military training.
“There’s a lot of research that shows that self-stigma is really key,” Norton said. “When we look at veterans, for instance, the numbers of them that report having some type of psychological injury as compared to the almost half who never seek treatment, that really speaks to the self-stigma. And that’s true of the general population as well.”
Grappone said about 30 to 40 percent of people nationwide report self-stigma. And with veterans and active-duty personnel, she said the issue seems to be wrapped up in notions of strength and weakness.
Exposure therapy
Research shows education programs tend to work well only among adolescents, Grappone said. For the rest of the population, the thing that seems to work best at reducing public stigma is for more and more people to “come out” about their mental illness.
Grappone herself suffers from depression and said it was freeing when she first talked about it in a newspaper interview. This makes sense, she said, if you look at stigma as an anxiety disorder.
“We know the effective intervention for anxiety is to not avoid what you’re fearing or what you’re anxious about. We call it exposure therapy,” Grappone said. “So I see self-disclosure as exposure therapy.”
Norton also has a mental illness. He said he has suffered thoughts of suicide his entire adult life.
“I think the way out of that is realizing that you’re not alone and maybe talking to other people that are in recovery who talk openly about mental illness,” Norton said. “When we hear somebody talk about having a mental illness and being in recovery or having an addiction and being in recovery, that’s where it can really make a difference.”
 Grappone said she would like to see more people with mental health issues come out from the shadows. Only that, she said, will make a dent in normalizing mental illness.
Earlier this month, Quintey and his wife and friends walked in the NAMIWalks 5K walk through downtown Concord. He was one of more than 700 people who participated. When it first started 14 years ago, only about a tenth as many people took part in the walk.
Still, there’s a lot more work to do.
“So much money, millions and millions of dollars have been spent on these education campaigns,” Grappone said. “And that’s great and they’re well-intentioned, but ... research shows that over the last 10 years, there’s been absolutely no reduction in public stigma.”
She said recruiting mental health ambassadors from health care professions would be a good start. And Norton said that shouldn’t be hard, considering that one in five mental health professionals have a mental illness. 

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