2. “MENTAL HEALTH”
Emotional, psychological, and social well-being. How we handle stress,
relate to others, and make choices. Mental health is a spectrum.
Many factors contribute to mental health, including:
• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Lifestyle and life circumstances, such as diet and exercise,
social support availability, opportunities for relaxation
Source: U.S. Dept. of Health and Human Services,
MentalHealth.gov (2019)
3. “MENTAL HEALTH
CONDITION”
Medically referred to as “Any Mental
Illness” (AMI): Any mental,
behavioral, or emotional disorder,
ranging from mild to moderate
impact on one’s daily life
• generalized anxiety disorder
• depression
• eating disorders
• post-traumatic stress disorder (PTSD)
• obsessive-compulsive disorder
(SMI): A mental, behavioral, or
emotional disorder resulting in
serious functional impairment, which
substantially interferes with or limits
one or more major life activities
• schizophrenia
• bipolar disorder
• severe depression
• severe obsessive-compulsive disorder
“SERIOUS MENTAL
ILLNESS”
Source: National Institutes for Mental Health, 2019
4. MENTAL HEALTH CONDITIONS
ARE COMMON, YET OFTEN UNSEEN
In 2018, 47.6 million
adults aged 18 or older
reported experiencing
mental health conditions
at some point during the
previous year.
1 in 5 American adults
experience a mental
health condition every
year, and 1 in 25 lives
with a serious mental
illness.
=
Source: National Institutes for Mental Health, 2019
5. THE EFFECT OF MENTAL HEALTH
CONDITIONS
• For nearly 40 years, mental health
conditions have been the second-most
common cause of disability in the United
States.1
• 70% of those diagnosed with a mental health
condition also experience a co-morbid
illness,2 such as obesity and diabetes—and
in higher rates than in the general
population.3
Sources:
1. United States Social Security Administration (2013)
2. Kessler et al. (2004)
3. Firth et al. (2019)
6. Personal
• Increased risk of chronic disease
• 19% of people with mental health issues
also have substance misuse issues
Family
• At least 8.4 million Americans care for a loved one
with mental or emotional health issues
• Worldwide, 15-23% of children live with a parent with
a mental health condition
Community
• 20% of people experiencing homelessness also have a serious mental illness
• 1 in 8 U.S. emergency department visits are related to mental and
substance use disorders
World
• Depression and anxiety cost the global economy $1 trillion
each year in lost productivity
Source: NAMI, 2019
7.
8. Only 43% of American adults
with mental health conditions,
and 64% of adults with serious
mental illness, receive
treatment.
• No insurance or poor coverage1
• Limited access to healthcare
providers2,3
• Attitudinal factors4
“I can handle this on my own.”
“Strong people don’t need help.”
• Stigma5
Sources:
1. Graison Dangor, NPR (June 17, 2019)
2. Mental Health America (2019)
3. Andrilla et al. (2018)
4. Mojtabai et al. (2011)
5. Abbey et al. (2011); Stuart et al. (2012)
9. • Personal stigma
• Lack of mental health knowledge
and/or confidence1,2
• Unfamiliarity with cultural or
religious norms3
• Differing views of collaboration4
Sources:
1. Brunero et al., 2018
2. Reed & Fitzgerald, 2005
3. Carpenter-Song et al., 2010
4. Pals & Hempler, 2018
DISCUSSING MENTAL HEALTH ISSUES
WITH PROVIDERS CAN BE TOUGH
10. Myth: People with serious mental
illness are violent and unstable.
Truth: Only 3%–5% of violent
acts can be attributed to
individuals living with a serious
mental illness.1
People with serious mental
illnesses are over 10 times more
likely to be victims of violent crime
than the general population.2
Racism, hate, and domestic
disputes are far more reliable and
frequent indicators of violence
than mental health issues. 3
Sources:
1. Fazel & Grann, 2006
2. Choe et al., 2008
3. KVIA.com, Jan. 9, 2020
11. Myth: Once you’re diagnosed with a
mental health condition, you’ll never
recover.
Truth: Just like with physical
illness such as diabetes or
asthma, mental health conditions
can be successfully treated and
managed.
“Recovery,” or the process in
which people are able to live,
work, learn, and participate in
their communities, is unique for
everyone. It can include
medication, talk therapy, lifestyle
change and/or group support.
Source: MentalHealth.gov
12. Myth: People with mental health
conditions aren’t productive
employees and can’t handle the
stress of a job.
Truth: When people with mental
health conditions receive proper
treatment and symptom
management, they can be as
effective on the job as those
without diagnosed mental health
issues.
13. COMMUNICATION COUNTS
• Reduce stigma, stereotypes, and discriminatory behavior
against people experiencing mental health conditions
• Help people recognize symptoms of mental health
conditions in themselves1 and others
• Increase the rate of treatment-seeking2
• Improve the mental health care people receive when
they do seek help
Sources:
1. Hahm et al., 2019
2. Ross & Goldner, 2009; Schulze, 2007; Schulze & Angermeyer, 2003
By communicating more thoughtfully about mental
health conditions, we can:
14. BUILD AN INSTINCT TOWARD
PERSON-FIRST LANGUAGE
Avoid Saying…
• That’s crazy/ psycho/ insane.
• She’s a schizophrenic.
• He’s bipolar.
• substance abuse or addict
• suffering from mental illness
• successful suicide or committed
suicide
Instead, say…
• That’s wild/ bizarre/ odd.
• She has been diagnosed with paranoid
schizophrenia.
• He has been diagnosed with bipolar
disorder.
• substance use disorder
• living with (or experiencing) mental
health conditions
• completed suicide/ died by suicide
15. A 2019 study of 1,300 Tweets found
that mental illnesses were more
stigmatized and trivialized than
physical illnesses.
AVOID TRIVIALIZATION
Source: Robinson, Turk, Jilka & Cella, 2019
RT@***; I have so much OCD
when it comes to the
notifications on my phone
I wish anorexia was something I could
catch, I could really use it rn
RT@***: his laugh will cure depression and
cancer
193
70 72
32
40
410
30
22 25
70
346
135
0
50
100
150
200
250
300
350
400
450
AIDS Cancer Austism Depression OCD Schizophrenia
Number
of
Tweets
Stigmatization and Trivialization on Twitter
Stigmatization Trivialization
16. • Mental Health America (mhanational.org): An
advocacy group that provides education, tools
for mental health promotion, updates on public
policy, and ways to get involved
• National Alliance on Mental Illness (NAMI;
nami.org): This well-established grassroots
organization offers video resources, online
discussion groups, resources for loved ones,
information on statistics and current research,
and more
• National Suicide Prevention Lifeline:
1-800-273-8255 (TALK)
FURTHER RESOURCES
Editor's Notes
The goals of this module are to:
Educate students about the prevalence and effects of mental health conditions.
Bust common myths about people living with mental health conditions.
Help students understand why it’s hard for patients and providers to talk about mental health issues.
Demonstrate how accurate, sensitive communication can combat stigma against mental health issues.
We achieve these goals through:
a lecture that gives basic facts and statistics about mental health conditions; and
an activity to help students understand media framing.
First, it’s important to define our terms.
Mental Health = According to the U.S. Department of Health and Human Services, mental health is the “emotional, psychological and social well-being.”
The World Health Organization defines it as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.”
People experiencing mental health conditions often have personal preferences on how to define or refer to their issues, so it’s important to remember that no one term will be comfortable for every individual. However, in the interest of creating a shared language, here are two common ways to talk about mental health challenges. These are terms as defined by the Substance Abuse and Mental Health Services Administration, and supported by the National Institute for Mental Health.
Mental Illness or Mental Health Condition = Sometimes referred to in medical settings as “mental illness,” the term “mental health condition” refers to a mental, behavioral, or emotional disorder such as generalized anxiety disorder, depression, eating disorders, post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder.
Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. Some examples include schizophrenia, bipolar disorder, severe depression, or severe OCD.
Mental health conditions are more common than you probably think. In 2018, 20% of American adults reported experiencing some mental health condition during the previous year, while 1 in 25 lives with a serious mental illness.
Mental health issues are common, and can have a big impact. For example, for 40 years running, mental health conditions have been the second-most common reason that people file for disability claims from the government, according to the U.S. Social Security Administration. (Musculoskeletal system and connective tissue disorders are the Number 1 cause of disability in the United States.)
Mental health challenges often lead to physical health issues, for various reasons. Sometimes, mental health issues have physical symptoms, sometimes prescriptions used to manage mental health issues cause other health problems, and sometimes physicians only treat a patient’s mental health condition and fail to address his or her physical conditions, so they become worse.
Though mental health issues are often very personal, the impact of mental health problems ripples through all of society.
If you do not have a mental health condition, it’s hard to understand what life is like with one. Here’s a short video in which Bentz Deyo talks about his life with bipolar disorder. He had his first manic episode at 16, and experienced several relapses after that. However, he is now thriving, and credits his mental health condition with giving him a unique sense of creativity, which he funnels into fiction writing.
There are lots of similar videos on YouTube if you’re interested in hearing more first-hand experiences with mental health issues.
Janet was able to reach out and seek treatment, and create a recovery plan that works for her. But less than half of American adults with mental health conditions seek any sort of help. Why?
No insurance or poor coverage. Despite laws requiring health care insurers to offer coverage for mental health-related therapy and treatment, there are ways to get around paying for those things. Researchers at the Congressional Budget Office reported in 2019 that private insurance companies are paying 13% to 14% less for mental health care than Medicare does. Further, a 2017 report by the actuarial firm Milliman found that an office visit with a therapist is five times as likely to be out-of-network, and thus more expensive, than a primary care appointment.
Limited access to healthcare providers. According to 2018 data from the Kaiser Family Foundation. The nation needs just over 7,000 more mental health clinicians to fill the provider shortage. A recent study showed that 31% of people facing a mental health crisis faced a wait of 1 week or more to see a trained therapist. Plus, some people live in geographic areas that simply don’t have mental health providers within them: A new study in the American Journal of Preventive Medicine finds that a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.
Attitudes: In the 2011 National Comorbidity Survey (Mojtabai et al.l, 2011 ), 72.6% of adults who in the past 12 months “felt that they might have needed to see a professional for problems with their emotions, nerves, or mental health” said they instead desired to handle the problem on their own, and thus did not seek treatment. (That was also the most common reason cited for dropping out of treatment.)
Stigma: Stigma has been identified as one of the primary barriers to access care and to receiving equitable quality of care by several studies (Abbey et al., 2011; Schulze & Angermeyer, 2003; Schulze, 2007; Stuart et al., 2012). The stigmatization of mental illness discourages open conversation about mental health, implies that mental illness is shameful, perpetuates incorrect myths about those experiencing mental illness (e.g. that they are dangerous), and enforces the idea that people with mental health issues should be avoided.
Even when folks interact with heath care providers, they often hesitate to bring up mental health concerns – further, providers might not recognize signs of mental illness. Why?
Personal stigma: Providers are human beings, and they may hold personal stigma or fear against mental health conditions. Many may not have personal experience with mental health issues, and may have only encountered mental health patients during times of crisis.
Lack of knowledge: Medical schools often don’t provide detailed interactions with patients experience mental health challenges. Studies have shown that general health practitioners feel they do not know enough about mental health challenges to screen, recognize, or identify such patient (Brunero et al., 2018), and nurses are often uncomfortable speaking with mental health patients because they do not want to use the “wrong language” and “make things worse”(Reed & Fitzgerald, 2005).
Poor cultural understanding: Different cultures have different ways to describe mental illness, and have different ideas about when/how to discuss is, as well as what type of treatments and recovery they prefer. Researchers determined that European Americans often seek care from mental health professionals and espouse beliefs about mental illness that align with the biomedical perspective on disease, while African-American and Latino individuals are more likely to embrace non-biomedical interpretations of their symptoms, such as “demons were around me” (p. 238) or “ataque de nervios” (“attack of nerves”; Carpenter-Song et al., 2010).
Differing views of collaboration: Providers sometimes promote a “one size fits all” treatment plan, and assume that all patients have the same recovery goals, which discourages joint decision-making. Patients may be nervous to mention mental health issues for fear of being immediately offered medications, and providers might hesitate to ask, thereby missing a chance to build a trusting relationship. (Pals & Hempler, 2018)
Beyond seeking helping from providers, it can be difficult for people with mental health challenges to talk about it with ANYONE. Lots of negative stigma and stereotypes exist. It’s time to address some of those. The first way to fight stigma is to educate yourself on what’s real and what’s a myth about people with mental health conditions. CLICK TO BRING IN FIRST MYTH, THEN CLICK TO BRING IN THE REALITY.
The first way to fight stigma is to educate yourself on what’s real and what’s a myth about people with mental health conditions.
The first way to fight stigma is to educate yourself on what’s real and what’s a myth about people with mental health conditions.
So, what can we do to help fight stigma against people with mental health issues? Educating yourself and disproving common myths is a great start. Also, the way you communicate about mental health can have a big impact. For example, accurate and sensitive communication can:
The stigmatization of mental illness discourages open conversation about mental health, implies that mental illness is shameful, perpetuates incorrect myths about those experiencing mental illness (e.g. that they are dangerous), and enforces the idea that people with mental health issues should be avoided. De-stigmatizing mental health and mental illness can change these attitudes
When we communicate clearly and accurately about mental health issues – without trivializing them (“I’m so OCD!”)and without believing that mental illness is something you can “snap out of” – we can help people recognize symptoms in themselves and others, helping people get appropriate treatment faster. A recent study (Hahm et al., 2019) explored the connection between stigma against mental illness and admission of cognition problems (which are an initial sign of mental illness). In people who had no prior contact with a person who had mental illness, the more strongly they held specific stigmatizing attitudes (i.e., the mentally ill are different, they are not treatable), the less attuned they were to their own poor performance on a concentration test.
When doctors, journalists, and ALL OF US communicate well about mental health conditions, we can improve the way individuals are treated when they seek support. For example, of people who die by suicide, only 22% discussed suicidal ideation with a healthcare provider in the month prior to their suicide (Isometsa et al., 1995), perhaps because of stigma or because they didn’t have the communicative tools to seek help.
So, how can we harness the power of communication? One way you can personally and publicly fight stigma and become an advocate for mental health issues is by using more accurate, sensitive language when talking about it.
Using person-first language emphasizes the human, not their race, gender, disability, or mental health status. It is a respectful way to acknowledge someone’s situation without making it the MOST important thing about them.
Practice using these person-first terms all the time.
It’s also important to avoid trivilalization. Though stigmatization is obviously bad, we have to be careful with how we attempt to de-stigmatize something. Trivialization can also be harmful, because it can marginalize the experience of people who have the disease, as well as make it harder to properly identify actual symptoms of mental illness.
For example, there was a 2019 study of 1,300 Tweets. When researchers reviewed these Tweets, they found that mental illness were more stigmatized—but also more trivialized—than physical illnesses. Obsessive-Compulsive Disorder was the most trivialized condition, while Schizophrenia was the most stigmatized—much more than illnesses like AIDS, cancer, or autism.
Notice that the more an issue was stigmatized, the less it was trivialized: This may indicate that the less stigmatized a condition becomes, the more comfortable we feel discussing it, but the more it feels OK to make fun of.
So, what to do about this? Use the person-first language on the previous slide, and don’t make light of someone’s serious mental condition. Educate yourself about what it means to live with a mental health issue, and treat mental health as seriously as you do physical or emotional health. You wouldn’t make fun of someone with lung cancer, would you?
There are all kinds of free, extensive resources for people who want to learn more about mental health issues, become stronger allies and advocates for people living with mental health conditions, or get involved with making the world a safer place for people who have mental health challenges. Check out these resources and more.
