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Stigma and Discrimination and Mental Illness
1. Reducing Stigma and
Discrimination
Dr. Dawn-Elise Snipes Ph.D., LMHC, LPC-MHSP
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
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2. Objectives
Define stigma and discrimination
Explore the protections under the ADA
List several ways our consumers are stigmatized or
discriminated against
Identify ways to fight discrimination
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3. Data
People experiencing mental health conditions often face
rejection, bullying and discrimination. This can make their
journey to recovery longer and more difficult.
Mental health conditions are the leading cause of disability
across the United States.
Even though most people can be successfully treated, less
than half of the adults in the U.S. who need services and
treatment get the help they need.
The average delay between the onset of symptoms and
intervention is 8-10 years.
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4. What is Stigma
People who have identities that society values negatively
are said to be stigmatized
Thanks to stigma, people living with mental health
conditions are:
Alienated and seen as "others."
Perceived as dangerous.
Seen as irresponsible or unable to make their own decisions.
Less likely to be hired.
Less likely to get safe housing.
More likely to be criminalized than offered health care services.
Afraid of rejection to the point that they don’t always pursue
opportunities.
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5. Common Stigma Associated with Mental Illness
Dangerous
The major determinants of violence continue to be
Socio-demographic and economic factors
Substance abuse, whether it occurs in the context of a concurrent mental
illness or not
historical (past violence, juvenile detention, physical abuse, parental
arrest record)clinical
contextual (recent divorce, unemployment, victimization) factors.
It is far more likely that people with a serious mental illness will be
the victim of violence
Research has focused on the person with the mental illness, rather
than the nature of the social interchange that led up to the violence
STUART, H. (2003). Violence and mental illness: an overview. World
Psychiatry, 2(2), 121–124.
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6. Common Stigma Associated with Mental Illness
Lazy
60 percent of the 7.1 million people receiving public mental
health services nationwide want to work NAMI
Susan (not her real name) received SSDI and SSI with mental
health services covered by Medicare and Medicaid. As her
recovery from bipolar disorder progressed, she went back to
work part-time. Despite the fact that she enjoyed her job and
her employer was pleased with her performance, she resigned
after seven months because she did not want to lose the medical
benefits that paid for the care she needed. She is no longer
seeking paid work.
Dirty
Diseased
Weak willed
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7. Mental Illness Myths
There's no hope for people with mental illnesses.
I can't do anything for a person with mental illness.
People with mental illnesses are violent and
unpredictable.
Mental illnesses don't affect me.
People with mental illnesses cannot tolerate the stress
of holding down a job.
Therapy and self-help are a waste of time. Why bother
when you can just take a pill?
Children don't experience mental illnesses. Their actions
are just products of bad parenting.
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8. Addiction Myths
Addicts are bad, crazy, or stupid.
Addiction is a willpower problem.
Addicts should be punished, not treated, for using drugs.
People addicted to one drug are addicted to all drugs.
Addicts cannot be treated with medications.
Addiction is treated behaviorally, so it must be a
behavioral problem.
Alcoholics can stop drinking simply by attending AA
meetings, so they can't have a brain disease.
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9. What Perpetuates Stigma
Television
News/Availability Heuristic
Lack of awareness/public education
Lack of insurance coverage for long-term treatment
Widespread belief: the stereotype is argued to be true
because it is widely held to be true
Prejudicial language: negative value
or moral judgement is attached to the stereotype
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10. Perpetuation cont…
Intentional exclusion: evidence that would or could
disprove the stereotype is hidden or concealed
Misleading generalization: the evidence is
unrepresentative of the population cited as a whole
Emotional appeal: the audience is persuaded to agree
through emotion, not through logic or facts
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11. Effects of Stigma
Refusal to seek help
Worsening of symptoms
Development of depression
Withdrawal/Isolation
1/4 of adults believe that a person with mental illness
can eventually recover.
Only 42 percent of Americans believe that a person with
mental illness can be as successful at work as others.
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12. Effects cont…
Only a little more than one-half (54%) of young adults who
know someone with a mental illness believe that
treatment can help.
74% of people agree that people are not sympathetic
toward individuals with mental illnesses.
Current federal law has banned more than 150,000
mothers with past drug convictions from participation in
the food stamp program and WIC, the women and infant's
nutrition program.
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13. Fighting Stigma
Become A StigmaBuster!
Speak out and challenge stereotypes
Educate society about the reality of mental illness
Demystify the counseling process
Identify the multiplicity of causes of anxiety and
depression
Learn more about mental illness
Listen to people who have experienced mental illness.
Stigma is diminished just by talking with someone who has
a mental illness.
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14. Fighting Stigma
Talk openly about it. The more mental illness remains
hidden the more people continue to believe that it is a
shameful thing to be concealed.
Watch your language.
Don’t use terms and expressions related to mental illness that
perpetuate stigma, such as “crazy,” “loony,” or “nuts”.
Put the person before the mental illness: instead of saying “the
borderline,” say, “the person who has borderline personality
disorder”.
Support mental health treatment. If you need help, seek
it. If someone you know needs help, encourage them to do
so.
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15. Fighting Stigma
Speak up about stigma. When someone you know misuses a psychiatric
term, tell them what it really means. When someone tells a joke that
ridicules mental illness, tell them that you find such comments
offensive and unacceptable.
Respond to stigmatizing material. If a commercial, a show, or a movie
is portraying someone with mental illness in a stigmatizing fashion.
There are organizations that want to know such as StigmaBusters at
NAMI.
Demand change from your elected representatives.
Provide support for organizations that fight stigma by volunteering.
Contribute to research related to mental illness and stigma.
Share your experience with mental illness.
Help people with mental illness reenter society. Support their efforts
to obtain housing and jobs.
Respond to false statements about mental illness or people with
mental illnesses with accurate facts and information.
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16. Discrimination
Americans with Disabilities Act prohibits discrimination
against individuals with disabilities
Defined as a physical or mental impairment that substantially
limits one or more major life activities.
Who may not currently have a disabling impairment but have a
record of such an impairment
ADA statutory definition of disability
The extent of the limitation resulting from the person’s physical
or mental impairment must be assessed in light of any mitigating
measures, including medication.
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17. Addiction and the ADA
Drug addiction is considered a disability under the ADA,
if it poses a substantial limitation on one or more major
life activities
Individuals who currently use illegal drugs, even users
who are addicted, may be denied employment because
of their current use.
A person who currently abuses alcohol or prescribed
drugs is not automatically denied protection
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18. Fair Housing Act
The Federal Fair Housing Act, passed in 1968 to prevent
housing discrimination based on race, color, religion, sex,
handicap, familial status, and national origin, does
nothing to stop landlords from discriminating against
people with criminal records, such as past drug
convictions or domestic violence
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19. Education and Student Loans
Students convicted of drug crimes may be prohibited from
receiving federal student loans
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20. Summary
Don't label people with words like "crazy," "wacko," or
"loony" or define them by their diagnosis.
Learn the facts about mental health and share them with
others, especially if you hear something that isn't true.
Treat people with mental illnesses with respect and
dignity, just as you would anybody else.
Respect the rights of people with mental illnesses and
don't discriminate against them when it comes to housing,
employment, or education.
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Notas do Editor
Myths About Addiction*
* Adapted from Myths of Addiction. Carlton K. Erickson, Ph.D., University of Texas Addiction Science
1. Addicts are bad, crazy, or stupid.
Evolving research is demonstrating that addicts are not bad people who need to get good, crazy people who need to get sane, or stupid people who need education. Addicts have a brain disease that goes beyond their use of drugs.
2. Addiction is a willpower problem.
This is an old belief, probably based upon wanting to blame addicts for using drugs to excess. This myth is reinforced by the observation that most treatments for alcoholism and addiction are behavioral (talk) therapies, which are perceived to build self-control. But addiction occurs in an area of the brain called the mesolimbic dopamine system that is not under conscious control.
3. Addicts should be punished, not treated, for using drugs.
Science is demonstrating that addicts have a brain disease that causes them to have impaired control over their use of drugs. Addicts need treatment for their neurochemically driven brain pathology.
4. People addicted to one drug are addicted to all drugs.
While this sometimes occurs, most people who are dependent on a drug may be dependent on one or two drugs, but not all. This is probably due to how each drug "matches up" with the person's brain chemistry.
5. Addicts cannot be treated with medications.
Actually, addicts are medically detoxified in hospitals, when appropriate, all the time. But can they be treated with medications after detox? New pharmacotherapies (medicines) are being developed to help patients who have already become abstinent to further curb their craving for addicting drugs. These medications reduce the chances of relapse and enhance the effectiveness of existing behavioral (talk) therapies.
6. Addiction is treated behaviorally, so it must be a behavioral problem.
New brain scan studies are showing that behavioral treatments (i.e., psychotherapy) and medications work similarly in changing brain function. So addiction is a brain disease that can be treated by changing brain function, through several types of treatments.
7. Alcoholics can stop drinking simply by attending AA meetings, so they can't have a brain disease.
The key word here is "simply." For most people, AA is a tough, lifelong working of the Twelve Steps. On the basis of research, we know that this support system of people with a common experience is one of the active ingredients of recovery in AA. AA doesn't work for everyone, even for many people who truly want to stop drinking.