The stigma of mental illness is a persistent and
pernicious force against which people with mental illness, their families, and
those who provide services to them must continually struggle. As noted in the
Surgeon General's report on mental health, stigma manifests itself in distrust,
bias, fear, stereotyping, embarrassment, anger, and/or avoidance. Stigma
derives in part from poor or incomplete understanding of causes and treatment
for mental disorders.
Stigma translates into problems that must be addressed by
the public mental health system if it is to provide needed services to people
with mental illness. Among the most major problems is the reluctance of nearly
two-thirds of all people with diagnosable mental illness to seek treatment.
Stigma is not the only issue that discourages people in need from seeking
treatment, but among many populations, including rural populations and members
of many distinct cultural groups, it clearly keeps many away from needed
services and supports.
Stigma also manifests itself in negative public attitudes
towards payment for mental health services. Even with passage of mental health
insurance "parity" laws in nearly two-thirds of the states, private
insurance coverage for mental illness often remains inequitable in terms of
co-payments and dollar or durational limits on coverage. At the same time,
support for public funding of mental health programs remains soft relative to
public willingness to pay for highways, prisons, or even other health services.
In recent years, a common approach by the mental heath
community to the problem of stigma has been to point out that mental illnesses
are illnesses like any other. Much faith has been placed in the promise of
research to clarify the etiology of mental illness and to further improve
treatments that already can demonstrate effectiveness comparable to treatments
for "accepted" diagnoses such as heart disease, cancer, and diabetes.
While this approach to stigma and discrimination can be shown to have had some
effect, it is clear that public support for greater expenditure on mental
health services has simply not materialized.
Recent years have also seen a rise in greater awareness of
other problems associated with mental illness, particularly within the law
enforcement, judicial, and corrections fields. Low public investment in mental
health services has resulted in a system that often cannot adequately meet the
complex needs of the people it is meant to serve. A stark symptom of this
undervalued and underfunded system is the increase in criminal justice contact
for people with mental illness. Without adequate services, many commit the
petty crimes that bring them to the attention of law enforcement and the courts
and that may result in stays in jail or prison.
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Recommendations for Implementation
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a.
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Create
public support for the investment necessary to make high-quality, comprehensive
mental health services available to those who need them.
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A significant effect of stigma is that it allows many in
society to distance themselves from people with mental illness and the real, if
complicated, social issues associated with their condition. People with mental
illness, especially those in trouble with the law, are easy to dismiss as
unworthy of public notice. At a minimum, they may be seen as inconsequential in
the broad political calculus by which limited resources are allocated. Even
harsher attitudes prevail when offenders with mental illness are seen
exclusively as authors of their own problems or when they become involved in
high-profile, often tragic, encounters with the law.
The challenge to public mental health policymakers,
providers, consumers, and family members is to find ways to make the public
aware of the experience and costs of untreated mental illness. Having found
that their own voices alone are ineffective in changing public attitudes, these
advocates must search for new allies who can help to carry the message, making
support for effective services a public priority.
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b.
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Present a common front to advocate for greater investment in improved mental health
services.
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In the face of stigmatizing attitudes, increased efforts
by law enforcement officials, judges, prosecutors, and corrections
administrators to understand and address the causes for their increased contact
with individuals with mental illness hold the potential to increase awareness
of the costs borne by society when appropriate mental health services are not
delivered. By highlighting the burdens placed on their systems by people
overlooked or underserved by the public mental health system, members of the
criminal justice system have an unprecedented opportunity to help shape public
opinion and public policy. Increased public awareness of the inefficiency
stemming from the current allocation of resources will help to create the
political will necessary to direct resources toward development and maintenance
of comprehensive, high-quality public mental health programs. Improvement in public mental health programs
will result not only in fewer criminal justice contacts by people with mental
illness but, more basically, in more opportunities for people with mental
illness to participate fully in society. (See Policy Statement 32: Educating the Community and Building Community Awareness.)
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