Access to Care: Mental Health and Stigma
Available data shows that roughly 26 percent of adults and 20
percent of children
experience diagnosable mental health conditions each year. Mental health disorders
do not discriminate, meaning that all cultures and racial backgrounds are at
risk to feel and/or experience the impacts. Unfortunately, there are few
individuals that make use of the needed psychological and/or therapeutic services
for treating such conditions and less than 50
percent of people with mental health issues actually receive treatment.
In fact, Broman
discussed the low help seeking behavior that occurs among minority populations.
Broman further
argued that minority populations continue to experience a higher unmet needs
when compared to the non-Hispanic White population, even after controlling for
socioeconomic status (SES) and possession of health insurance.
The fact that there is a stigma associated with mental illness
is one of the major reasons that mental health services are underutilized. The
Center for Disease Control and Prevention (CDC) defines mental illness as, “health conditions that are characterized by
alterations in thinking, mood, or behavior (or some combination thereof)
associated with distress and/or impaired functioning.” The World Health
Organization (WHO) defines mental health
as “a state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his community.”
Unfortunately, in our society a distinction is not always made between the two
and we tend to use the two terms interchangeably. This lack of clarity is one possible
explanation for why mental health services remain underutilized.
Of course,
there are other factors that may influence people’s use of mental health
services. As mentioned above, the stigma surrounding mental illness and
ethnicity are influential factors, but in addition, attitudes, SES,
affordability of services also play roles in either the promoting or preventing
people from seeking mental health
treatment. Research
has shown that untreated mental illness during childhood may be a risk factor for a host of
issues: suicide, substance abuse,
delinquency, failure to complete secondary level education, and psychopathology
in adulthood. Furthermore, mental illness is associated with increased health problems (e.g.
cardiovascular disease, obesity, diabetes, etc.) and substance use.
Given society’s view of seeking
treatment for mental illness, it is important that a distinction is made
between mental illness and mental health to help reduce negative connotations
of seeking mental health services. Therefore, it is essential that more public education occurs to stress the importance of mental
health. We should all strive for mental health as we do for physical health.
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ReplyDeleteThat is an important question Apryl and that study is certainly disconcerting although not surprising. I would assume that the National Alliance on Mental Illness (NAMI) has some kind of training for professionals: www.nami.org
ReplyDeleteSeveral of their campaign efforts are focused on stigma reduction:
http://www.nami.org/template.cfm?section=In_Our_Own_Voice
http://www.nami.org/Template_itstime.cfm?Section=Its_Time
Maybe we could suggest that the UM School of Nursing have an In Our Own Voice (IOOV) presenter speak for students in their Mental Health and Illness Across the Lifespan course. I went to a conference and saw two IOOV speakers for a previous job and it was an incredibly valuable experience.
I totally agree that the stigma is the number one reason why those suffering from mental health disorders do not seek help. The stigma is that if you have a mental health disorder you are weak and that its your own problem to resolve. How to change individuals' attitudes, especially nurses, about mental disorders is the big question. I think it takes more than a textbooks to accomplish this change. In fact, I do not think one can truly understand the severity of a mental health disorder until one has lived with it or is close to someone who has. I think it takes the expertise of those who suffer from mental disorders to educate the public and us as health professionals. A TEDtalk by Kevin Breel exemplifies this. Breel suffers from depression and discusses his life and the stigma of having a mental disorder. He demonstrates the stigma associated with depression by saying, "What would you rather have for a Facebook status? I'm having trouble getting out of bed today because I hurt my back. Or I'm having trouble getting out of bed because I'm depressed."
ReplyDeleteKevin Breel's TEDtalk can be found here: http://www.youtube.com/watch?v=C3yqXeLJ0Kg
In addition to the stigma of mental illness, I think another driving factor in the (lack of) access to mental health care is the lack of availability under many health plans to have anything other than minimal care for mental health issues. This includes access to psychotherapy, behavioral therapy, and other counseling. This has the effect of people either not seeking needed mental health care or receiving incomplete or piecemeal care by general providers, such a general practitioner or NP. This, in turn, relegates much "mental health care" to a medication issue, where patients are given a script for an antidepressant without concurrent therapy.
ReplyDeleteAs we have found out, nurses are often the "smooothers" in the medical system. We are charged with being a patient advocate, public relations representative, and stop gap. When it comes to mental health, that means nurses and social workers are tasked with providing nearly all mental health care for patients who cannot otherwise afford professional (and focused) care.