Ending the Stigma on Mental Illness

The stigmatization of mental illness is an issue for many sufferers. Matters like insufficient healthcare equity, lack of appropriate working accommodations, and discrimination are all issues individuals with mental illness must face. One of the main causes of the stigmatization of any subject matter is the lack of knowledge on the subject. In the article, “Depression in the Workplace Remains a Costly Problem” by Matt Dunning, he shows how individuals who are not thoroughly educated in mental health don’t know how to “interact” with those who have it. Organizations like the National Alliance of Mental Illness (NAMI), try and reach out to the general public who lack a thorough education on mental illness to try and put an end to the stigma. However, one of biggest concerns lies within the health care department. Medicaid, health insurers, and people in the medical field such as ob-gyns all share improper treatment methods for mental illness patients in common. The medical field needs to expand their accommodations and treatment methods to supply sufficient help for these patients.

With the stigma, appropriate treatment or proper accommodations are scarce, causing the worsening of existing symptoms (NAMI). These individuals are at a high risk of stigmatizing themselves according to the peer-scholar review, “Psychometric Evaluation of the Internalized Stigma” by Chih-Chen Chang, et al. Because these individuals are constantly encountering “external and objective discrimination,” it eventually leads to discriminating and stigmatizing themselves, which is one of the worst forms of stigma (Chang, et al, 2014). The best way to address this issue is to reach out to various audiences.

Typically, when trying to end the stigma of mental illness, authors tend to reach out to those who directly affect it. David Bornstein’s article, “Treating Depression Before It’s Postpartum” is published by the New York Times. The New York Times is a newspaper publication who’s audience tends to be college-educated New Yorkers (The New York Times). However, the word “postpartum” in the title of Bornstein’s article is a dead giveaway that the audience is most likely pregnant/postpartum women. Another audience who directly affects mental health are clinicians. Findings from the academic journal are implicated for clinicians who design interventions for patients with mental illness (Chang, et al, 2014). Dunning’s audience however, is different since he’s addressing employers.

US employers may be losing profit due to insufficient working accommodations for employees with mental illness, as shown in the first sentence of the article, “[d]epression among workers is costing U.S. employers billions” (Dunning, Crain).  Despite the different audiences, the purpose is fairly coherent throughout the pieces.

One of the main purposes that authors try and persuade is health care equity. NAMI does this in many ways. Similar to Bornstein, NAMI exclaims that certain actions must be taken. According to a policy report by NAMI, “The Doctor is Out,” Medicaid must “improve coverage under federal parity law” by recruiting and contracting “with a wider range of providers,” so that patients with a mental disorder may have a fair opportunity of finding a psychiatrist within their network (Anon., NAMI). While NAMI focuses on changes that must occur within the health care system, Bornstein addresses the changes that must be made within the specialty ob-gyn care.

Research shows that postpartum depression actually starts “during the pregnancy,” but often isn’t “detected” because ob-gyns don’t provide appropriate, if not any screenings to detect such symptoms (Bornstein, The New York Times).  These issues can easily decrease through mandatory screenings for depression from an ob-gyn, according to the results of two studies published in 2014 (Bornstein, The New York Times). Like Bornstein and NAMI, the scholar review’s focus is on the healthcare industry, however, Chang, et al, are different in the sense that they’re promoting specific tools in measuring internalized stigma.

Chang, et al, believe that clinicians and researchers who want to measure and evaluate internalized stigma should use the Taiwan version of the ISMI scale without the Stigma Resistance subscale, since it’s proven to not “appropriately fit in the concept of internalized stigma” (Chang, et al, 2014). This is important for clinicians and researchers to ensure that they’re using the appropriate tools in terms of prognosing patients within the healthcare system. Unlike, Bornstein, NAMI and Chang, et al, Dunning’s proposals lie within the business industry.

Dunning stresses on the importance of providing special accommodations and opportunities to discuss mental illness for employees with a mental disorder. One method of doing this would be to enforce “protocol training for human resources” and “front-line managers” (Dunning, Crain). This way, supervisors will be able to know how to respond to their employees when one comes forward with their struggle with mental illness.

One of the best ways to reach out to the general public when trying to end the stigma on mental health are through platforms that are easily accessible to the public. NAMI demonstrates this well, since their platforms range from public policy reports to public activities, but their main ones consist of creating and analyzing scientific research/clinical trials, fact sheets, etc., such as their survey conducted in 2015, “A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care” (Anon., NAMI). Their research typically involves data collected from surveys on individuals with mental illness, much like the data collected from a studies in the academic journal.

The academic journal provides findings through detailed and concise evidence from studies approved by the Research and Ethics Review Board of the CHi Mei Medical Center, of the measurement of invariance of the ISMI scale across time (Chang, et al, 2014). While NAMI and Chang, et al,  pieces are more evidence-based, Bornstein and Dunning use a more empathetic approach.

Bornstein’s article is an opinion-editorial piece, meaning Bornstein is more persuasive in his argument. For example, he uses quotes from a mother who personally struggles with her postpartum depression developing into “severe depression” (Bornstein, The New York Times). She expresses her feelings of not “deserv[ing] to be alive,” which shows the audience her struggle (Bornstein, The New York Times).

Dunning is also empathetic in this sense, but instead of having people with a mental disorder speak up, he has employers discuss their observations. Employee benefits manager at Aerojet Rocketdyne Inc., Violet Vernon, explains how employees resist opening up about their mental illness because they “fear” it’ll “inhibit their professional development” (Dunning, Crain). Vocabulary such as “fear” and “discrimination” in the workplace, shows that the author is using an empathetic approach (Dunning, Crain).

The one thing all these authors share in common is the belief of the seriously negative affect the stigma has on these individuals. Bornstein and Dunning recognize the uncomfortability and discrimination that individuals must endure because of the general “lack of awareness” among healthcare professionals and employers (Bornstein, The New York Times; Dunning, Crain). Dunning believes that the workplace should be a safe and welcoming environment for all employees, while Bornstein feels that pregnant/postpartum women should not have their symptoms be shrugged off, due to the “misconception” that are caused by “hormonal changes.” In any case, they both believe in the fair treatment of these individuals, as does NAMI.

NAMI believes in equity in terms of health care for people with mental health conditions. That all patients deserve access to all forms of treatment such as “medication, evidence based services and supports”(NAMI). Chang, et al, however, understands that patients have a high risk of “isolation,” “delayed treatment-seeking,” and stigmatizing themselves, due to the negative stereotypes. This is why Chang, et al,believe that clinicians and researchers should have proper knowledge of the tools their using to assess their patients (Chang, et al, 2014).

The stigmatization of mental illness poses as a serious problem for individuals with the illness. They have to struggle with discrimination, insufficient health care equity, and self-stigmatization. The types of people varies, from pregnant women to employees. For women, twenty to twenty-five percent will experience depression in their lifetime and “one in seven will experience postpartum depression (Bornstein, The New York Times). However, should obgyns create proactive measures, such as mandatory screenings for depression, their risk of it manifesting into severe depression could decrease (Bornstein, The New Times). This is similar to Dunning’s view, which is that since mental illness can cost US employers “billions,” due to the “absences and lower productivity,” employers should provide said employees with opportune accommodations.

With the appropriate accommodations for employees with the illness, they’ll no longer have to fear “losing their jobs” due to the lack of understanding. Employees can feel more comfortable at work, thus making them more efficient (Dunning, Crain). Not only is it pertinent to have these individuals feel more accommodated in the workplace, but also by their healthcare providers.

NAMI insist on fair access to proper treatment. Health insurers and Medicaid need to “improve coverage under federal parity law” and provide full access to psychiatric treatment (NAMI). This way, individuals who suffer from mental illness can gain relief through accessible psychiatric treatment. However, appropriate treatment comes from a proper diagnosis, which is why Chang, et al,  evaluates data and “tests the measurement invariance of the ISMI across time” to validate the measures of the ISMI scale. According to their findings, clinicians should use the Taiwan version of the ISMI scale as it can properly examine the “effects of programs on decreasing internalized stigma” for individuals with mental illness, however they can omit the Stigma Resistance subscale (Chang, et al, 2014).

With all these efforts combined, individuals with mental illness may gain some relief through sufficient healthcare access and proper diagnosis through specific tools. Also, with overall raised awareness of mental health, the stigma may be reduced.

Works Cited

Bornstein, David. “Treating Depression Before It’s Postpartum.” New York Times, 16 Oct. 2014, p. 9(L). SPN.SP01, http://link.galegroup.com/apps/doc/A386464657/SPN.SP01?u=cuny_ccny&sid=SPN.SP01&xid=78678396. Accessed 19 Feb. 2018.

Chang, Chih-Cheng, et al. “Psychometric Evaluation of the Internalized Stigma of Mental Illness Scale for Patients with Mental Illnesses: Measurement Invariance across Time.” PLoS ONE, vol. 9, no. 6, 2014. Academic OneFile, http://link.galegroup.com/apps/doc/A416777050/AONE?u=cuny_ccny&sid=AONE&xid=50357a6b. Accessed 19 Feb. 2018. 

Dunning, Matt. “DEPRESSION IN THE WORKPLACE REMAINS COSTLY PROBLEM; Workers seldom use assistance programs offered.” Business Insurance, 8 Dec. 2014, p. 0001. Academic OneFile, http://link.galegroup.com/apps/doc/A393110725/AONE?u=cuny_ccny&sid=AONE&xid=629f6c51. Accessed 19 Feb. 2018.

“NAMI.” NAMI: National Alliance on Mental Illness, www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out.

“NAMI: National Alliance on Mental Illness.” NAMI: National Alliance on Mental Illness, www.nami.org/.