
Mental health disorders and the need for adequate treatments are a growing public health issue.  The term “mental illness” refers to a wide range of disorders that effect a person’s mood, thoughts, behavior, or a combination of these.  Almost half of all adults suffer a mental illness to some degree in their lifetime. In fact, “4 of the 10 leading causes of disability among people aged 5 and older are mental health disorders, with depression being the number one cause of all illnesses that cause disability…Only about 20% of people who have a mental illness receive professional help” (Arboleda-Florez).  Why, then, do these disorders which can be just as crippling as physical injuries, go so widely untreated?  Because mental illness’s symptoms often go unseen, its’ effects can be perceived from an outsider’s view as laziness or recklessness, and it can be easier to discriminate towards sufferers of a mental disorder than a physical one.  This is one of the many contributing factors of the mental illness stigma.  Public mental illness stigma is society’s negative preconceived notion of mental illness, including stereotypes, prejudices, and discrimination.  Stigma in any sense is perpetuated through lack of or miseducation, portrayals in media, or rejection of situations or people that don’t fit in with societal norms. Despite advances in the understanding and treatment of mental illness, high rates of stigma persist.  Stigma, when paired with mental illness, is extremely detrimental to communities and individuals, as it makes sufferers less likely to accept a need for help and to then seek treatment.

Stigmatizing attitudes, while by no means confined to mental illness, are far stronger when aimed at psychological illnesses than physical illness. Unlike most physical illness or disabilities, persons with a mental illness are often seen as being responsible for their condition (Piner).  This assumption, as well as all other stigmatizing attitudes, has the power to manifest into discriminatory behavior.  Discrimination towards mental illness takes three forms according to Patrick Corrigan in the second issue of Psychological Science in the Public Interest. The first type is public discrimination, where the stereotypes of mental illness sufferers as dangerous or incompetent cause exclusion from social, professional, or educational opportunities.  These unfortunate cases of discrimination can then cause self-discrimination, making a person feel that their illness is their fault, that recovery is hopeless, and that they should feel ashamed and hide their symptoms.  Feelings of inadequacy and vulnerability are common effects of many forms of mental illness, so one can see why the added feelings of self-discrimination could be potentially harmful for an individual.  The third, and arguably the most harmful form of discrimination for society as a whole, is structural discrimination. Structural discrimination is evident in the way that a person’s mental illness history can influence legal proceedings such as custody battles.  

Survey findings published by Colleen Barry, Emma E. McGinty, Bernice A. Pescosolido, and Howard H. Goldman, reported evidence of the existence of public and structural discrimination towards mental illness.  This survey of 50,000 adults from different demographics revealed that about a third of the population opposes increased government spending on mental illness treatment.  Drug addiction, a sub-category of mental illness, was found to be far more discriminated against, with 49% of the population not supporting increased funding for treatment.  While these numbers may seem positive since in each case the majority is in support of increased funding, it is important to consider how these numbers influence public policy. Those who self-identified in this survey as a Republican were “more likely to oppose equivalent insurance benefits or increased spending on treatment, housing, and job support” for both drug addiction and mental illness than their democratic counterparts (Barry).  With the current dominant party being Republican, their opposition could translate into weakened support for policies offering mental illness sufferers equity in insurance, housing, and job support options.

To begin to attempt to eradicate stigma, one must examine where it originates from.  The most obvious answer is mass media.  Many examples of popular media portray the mentally ill as violent, dangerous, unpredictable—a group of people to be feared.  Perhaps painting the mentally ill in this extreme way helps people reassure themselves of their own sanity.  Even sufferers themselves may see the stereotypical portrayals of the mentally ill in media and be able to distance themselves, thinking, “at least I’m not like THAT”.  The media becomes harmful, though, when the exaggerated images we see of mental disorders become how we generalize all those affected.  TIME magazine provides a great example of the inclination to generalize the mentally ill in the article Most Violent Crimes Are Wrongly Linked to Mental Illness.  As the title implies, news sources greatly inflate the number of violent crimes that are a result of the offender’s “mental illness”.  “Only about 4% of interpersonal violence in the United States can be attributed to mental illness…yet close to 40% of news stories about mental illness connect it to violent behavior that harms other people” (Sifferlin).  In fact, according to the U.S. Department of Health and Human Services, those who suffer from a severe mental illness are actually ten times more likely to be victimized in a violent crime than the general population.  From 2005 to 2014, 22% of all news reports covering mass shootings attributed the crime to the shooter’s mental illness (Sifferlin).  News coverage such as this can be misleading to the public, because while anyone who commits a heinous crime is likely not entirely mentally healthy and may have anger issues, they often do not have a diagnosed mental illness.  For the cases where the offender had an undiagnosed mental illness, it is highly likely that they had been exhibiting symptoms long before the violent act that went untreated because they were ignored by the individual and those around them.  That being said, it is almost never a spontaneous bout of violence resulting from a mental illness that causes mass shootings and other violent crimes as the media often suggests.  Focusing on mental illness as the cause of heinous acts can shift much needed attention away from more pressing issues such as gun violence. 

While news media contains many problematic portrayals of the mentally ill, popular media is also to blame. “Much research suggests that the general public relies on the popular media as its main source of information about mental illness” including newspapers, television, radio, movies, and online content (Stout).  A recent and arguably problematic depiction of mental illness in popular media is from the Netflix series Orange is the New Black.  Sue, nicknamed “Crazy Eyes”, the character in the show with an obvious severe mental illness, is not only the show’s most frequent source of comedic relief but is also one of the most dangerous characters in the show, with a volatile and unstable personality.  Even with most of the characters in the show being convicted felons, Sue is the most ostracized and feared. According to the cultivation theory of mass media, these media forms have the power to shape our views and values.  Social learning, another mass media theory, explains how a person learns social conventions and how to behave “normally” through television and other media forms.  In regards to mental illness, this theory suggests that the mentally ill, in not fitting media’s idea of “the norm”, will largely be treated as “other” by consumers of media.   It would seem that as long as inaccurate portrayals of the mentally ill persist in the media, progress towards erasing the stigma will be difficult. 

Stigma does not only cultivate in the general public a desire for social distance from the mentally ill; it has concrete and direct effects on the quality and availability of treatment.  The stigma surrounding mental illness can help explain why a such a small section of sufferers ever receive any treatment and why those that do typically delay treatment for years past the onset of the illness (Kohn).  The main reasons for the absence of treatment according to Robert Kohn in The Treatment Gap in Mental Health Care are “failure to seek help because the problem is not acknowledged, perceiving that treatment is not effective, believing that the problem will go away by itself, and desiring to deal with the problem without outside help”, all of which can be explained by stigma and the resulting lack of knowledge the average person has about mental illness.  The “treatment gap” mentioned in the title of this study refers to the actual prevalence of brain disorders compared with the population that receives treatment for their disorder (Kohn).  The study revealed large gaps in treatment among all forms of mental illness, even for Schizophrenia which is considered the most debilitating form, where only a third of sufferers receive any treatment, successful or unsuccessful (Kohn).  From a more personal viewpoint, many sufferers share the feeling of a need for help but do not know how to get it and express hopelessness regarding the effectiveness of possible treatments (Gullslett).  If action was taken to reduce the mental illness stigma, greater education on available treatments would surely follow, and it would become easier for individuals to accept that treatment may be necessary. Hopefully, then, the treatment gap would narrow. 

There are those who do not see stigma as having a serious impact on the quality of life of the mentally ill.  In an article titled Labeling Mental Illness: The Effects of Received Services and Perceived Stigma on Life Satisfaction, those who believe stereotypes and labels are able to negatively shape the fate of a mentally ill person are known as “labeling therorists” (Rosenfield).  The article’s author, Sarah Rosenfield, makes an argument in opposition of the labeling theory.  Critics of the labeling theory believe that the fate of a sufferer of a mental illness depends on more individualized factors such as the severity and type of illness they have and the kind of treatment they receive, if any (Rosenfield).  Stigma is the biggest discrepancy between the two approaches.  Labeling theory critics claim that the impact of stigma cannot be measured, as “perceptions of stigma among mental patients are seen as subjective and untrustworthy” or may be paranoid thoughts caused by the illness itself (Rosenfield).  This perspective also argues that being labeled may even help a person identify a need for help.  While this criticism of the labeling theory could accurately describe the experience of some sufferers, there is more evidence supporting the argument that stigma it detrimental to mental illness.  Stigma’s ill effects are evident when examining how it has impacted the reputation of other diseases such as AIDS.  As explained in a Ted Talk by Jeffrey Lieberman, in the early days of the AIDS outbreak, the fact that it was occurring predominately in discriminated groups led to stigmatization and underfunded research, and ultimately, nearly certain death for the infected.  Eventually, groups arose who advocated against the stigma and pressured the government to increase funding for research.  As a result of this push for acceptance and support of AIDS sufferers, today it is considered a manageable disease with a far greater life expectancy than was to be expected in the early 80's.  Considering this example disproves the majority of criticism of the labeling theory as it shows how dismantling stigma through advocacy has the ability to drastically change the course of a disease.

Experts have a wide variety of suggestions of actions that can be taken to break down the mental illness stigma and narrow the treatment gap.  Many agree that the public needs to reframe their idea of mental illness to view it the same way one would view a physical affliction.  A reframing could include acknowledging that a suffer is not at fault for their mental illness, realizing that a mental disability can be just as debilitating as a physical one, and considering treatment as necessary and available for any form or degree of mental illness rather than just the most severe cases.  Focusing on these ideas when advocating for a reframing of mental illness would address some of the most common misconceptions that the mental illness stigma creates.  In Thomas Incel’s Ted Talk, he expands on the idea of treating mental and physical illnesses in an equal manner.  Early detection, for example, is important in successfully treating many diseases but is rarely proposed in regards to diseases of the brain.  With suicide being the third most common cause of death amongst people between the ages of 15 and 25, it is crucial that we find ways to detect and intervene early in mental illness just as we have learned to do with other fatal illnesses like heart disease, stroke, and diabetes. “While we don't have an in-depth understanding of [all mental illnesses], we have been able to already identify some of the connectional differences…there are some predictable patterns, and those patterns are risk factors for developing one of these disorders” (Incel).  Here, Incel describes how advancements in science are making it possible to detect mental illness risk factors through brain scans. Considering that in a brain disorder behavior is the last thing to change, brain scans would create the ability to intervene before symptoms emerge, increasing the likelihood of a full recovery (Incel).  Scientists have not perfected the brain scan method of detecting mental illness so it is not currently being used.  However, it is something to work towards that could become a reality in the near future through increased funding and advocacy. 

Reframing and early detection are long-term goals that could make great strides towards increasing the percentage of people that receive treatment for their mental illness.  More specific, short term ideas have been suggested by professionals in the mental health field as well.  The 2001 World Health Report compiled a list recommendations to address the treatment gap.  Some items included on the list are: mental health treatment should be available in primary care, the public should be educated about mental health, citizens should be involved in advocacy, policy-making, and forming self-help groups, and more financial support should be provided for research. The report proceeds to elaborate on each list item, describing ways each idea could be enacted in communities and across the world.  Jeffrey Lieberman’s Ted Talk includes a long list of practical programs that, if there were no stigma, would likely already be in place.  These initiatives include mental health screenings in primary care settings and community-based care such as rehabilitation services and residential facilities (Lieberman).  If all or even some of the programs proposed by the World Health Report and Jeffrey Lieberman were implemented with the aforementioned general, long-term goals in mind, it could have a groundbreaking effect on the state of mental health in our society.

In a world where the impact of mental illness is felt by such a large part of the population and a wide gap in treatment can have such grave implications, why does the topic seem so largely swept under the rug?  As we’ve learned from history, working to remove stigma is the first step towards progress—better research, education, and a far better chance for recovery will soon follow.  We are all individually responsible for being advocates for mental illness and making sure the future a more accepting place for the mentally ill.  This can be as simple as paying mind to not distance oneself from an acquaintance who may be exhibiting symptoms, not treating mental illness as something to be ashamed of or feared, and generally reframing the concept of mental illness in one’s mind to exclude stereotypes and stigma.  In a larger sense, the absence of a mental illness stigma would cultivate a far more empathic, self-expressive, and unified society.
