Obstacles in Treatment of Older Adults
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GerontologyA Training Resource By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
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3 Obstacles to Overcome in Treating Older Adults
There are 3 major obstacles to be overcome in treating older adults. They are loneliness, Ageism and Stigma of Mental Illness.
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Dealing with Loneliness with Older Adults
Loneliness presents a profound public health threat akin to smoking and obesity, U.S. Surgeon General Vivek H. Murthy warned in an advisory issued Tuesday May 2, 2023 that aims to rally Americans to spend more time with each other in an increasingly divided and digital society.
The risk of premature death posed by social disconnection is similar to smoking up to 15 cigarettes a day and even greater than obesity and physical inactivity, according to a review of research on social connection. And socially connected people live longer.
Loneliness can lead to chronic stress, which in turn causes inflammation that damages tissues and blood vessels and is associated with chronic conditions, experts say. Isolation and frayed social connections could make it harder to maintain or develop healthy habits such as exercise and good nutrition.
Murthy said half of U.S. adults experience loneliness, which has consequences for mental and physical health, including a greater risk of depression, anxiety — and, perhaps more surprisingly, heart disease, stroke and dementia.
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The threat of Loneliness can prove deadly
The risk of premature death posed by social disconnection is similar to smoking up to 15 cigarettes a day and even greater than obesity and physical inactivity, according to a review of research on social connection. And socially connected people live longer.
Loneliness can lead to chronic stress, which in turn causes inflammation that damages tissues and blood vessels and is associated with chronic conditions, experts say. Isolation and frayed social connections could make it harder to maintain or develop healthy habits such as exercise and good nutrition.
Research shows loneliness and isolation are most prevalent in people who are in poor health, struggling financially or living alone. Strikingly, older adults have the highest rates of social isolation, but young adults are almost twice as likely to report feeling lonely as senior citizens do.
Probably the most effective way to reduce loneliness is to take more care of the people in our lives. Therapists working with Aging Seniors need to put caring for people front and center so that our fragile elderly citizens will feel less lonely but also they will be more moral, more justice-minded and healthier.
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What does the Lack of Social Relationships mean?
When it comes to social relationships, what exactly is the problem? Having too few relationships? Lacking social contact, interaction, or perceived support? Being lonely? Lacking a close intimate partner or someone in the home to rely on in times of need? Having strained or unsupportive relationships? Even from this incomplete list, it is clear that the multi-factorial conceptualization and measurement of social relationships may be a barrier to prioritization.
One way to address this barrier is to define the problem as lacking social connection. The umbrella term social connection (or social connectedness) represents a multi-factorial construct that includes structural, functional, and qualitative aspects of social relationships, all of which contribute to risk and protection.
Epidemiological research generally focuses on the structural (e.g., social network size/density, marital status, living arrangements) or functional aspects of social relationships (e.g., received and perceived social support, perceived loneliness), and some work includes multi-dimensional approaches (i.e., a combination of structural and functional aspects (Berkman, et al, 2000). Further, researchers examine the positive and negative qualities of the relationships above and beyond the functions they serve Robles,2021).
Importantly, measures in each of these domains independently predict morbidity and mortality; and, given weak correlations among them, each may influence health through different pathways (Cohen, et al., 2000). Thus, as an organizing construct, social connection encompasses the variety of ways we can connect to others socially— through physical, behavioral, social-cognitive, and emotional channels. (Holt-Lunstad, 2022).
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Health Risks of Loneliness
The lack of social connection poses a significant risk for individual health and longevity. Loneliness and social isolation increase the risk for premature death by 26% and 29% respectively.37 More broadly, lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day.4 In addition, poor or insufficient social connection is associated with increased risk of disease, including a 29% increased risk of heart disease and a 32% increased risk of stroke. Furthermore, it is associated with increased risk for anxiety, depression, and dementia. Additionally, the lack of social connection may increase susceptibility to viruses and respiratory illness.
The lack of social connection can have significant economic costs to individuals, communities, and society. Social isolation among older adults alone accounts for an estimated $6.7 billion in excess Medicare spending annually, largely due to increased hospital and nursing facility spending. Despite such high prevalence, less than 20% of individuals who often or always feel lonely or isolated recognize it as a major problem.
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Terms Related to Constructs to Aim for in Overcoming Loneliness in Older Adults
The following are Terms which relate to factors as therapists we need to watch for so as to determine if the client you are working with is indeed lonely and suffering from this situation. These terms are contained in the Publication from the Surgeon General on Loneliness.
Belonging
A fundamental human need—the feeling of deep connection with social groups, physical places, and individual and collective experiences.
Collective Efficacy
The willingness of community members to act on behalf of the common good of the group or community.
Empathy
The capability to understand and feel the emotional states of others, resulting in compassionate behavior.
Loneliness
A subjective distressing experience that results from perceived isolation or inadequate meaningful connections, where inadequate refers to the discrepancy or unmet need between an individual’s preferred and actual experience.
Norms of Reciprocity
A sense of reciprocal obligation that is not only a transactional mutual benefit but a generalized one; by treating others well, we anticipate that we will also be treated well.
Social Capital
The resources to which individuals and groups have access through their social connections. The term social capital is often used as an umbrella for both social support and social cohesion.
Social Cohesion
The sense of solidarity within groups, marked by strong social connections and high levels of social participation, that generates trust, norms of reciprocity, and a sense of belonging.
Social Connectedness
The degree to which any individual or population might fall along the continuum of achieving social connection needs.
Social Connection
A continuum of the size and diversity of one’s social network and roles, the functions these relationships serve, and their positive or negative qualities.
Social Disconnection
Objective or subjective deficits in social connection, including deficits in relationships and roles, their functions, and/or quality.
Social Infrastructure
The programs (such as volunteer organizations, sports groups, religious groups, and member associations), policies (like public transportation, housing, and education), and physical elements of a community (such as libraries, parks, green spaces, and playgrounds) that support the development of social connection.
Social Isolation
Objectively having few social relationships, social roles, group memberships, and infrequent social interaction.
Social Negativity
The presence of harmful interactions or relationships, rather than the absence of desired social interactions or relationships
Social Networks
The individuals and groups a person is connected to and the interconnections among relationships. These “webs of social connections” provide the structure for various social connection functions to potentially operate.
Social Norms
The unwritten rules that we follow serve as a social contract to provide order and predictability in society. The social groups we belong to provide information and expectations, and constraints on what is acceptable and appropriate behavior. Social norms reinforce or discourage health-related and risky behaviors (lifestyle factors, vaccination, substance use, etc.).
Social Participation
A person’s involvement in activities in the community or society that provides interaction with others.
Social Support
The perceived or actual availability of informational, tangible, and emotional resources from others, commonly one’s social network.
Solitude
A state of aloneness by choice that does not involve feeling lonely.
Trust
An individual’s expectation of positive intent and benevolence from the actions of other people and groups
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Social Infrastructure
The programs (such as volunteer organizations, sports groups, religious groups, and member associations), policies (like public transportation, housing, and education), and physical elements of a community (such as libraries, parks, green spaces, and playgrounds) that support the development of social connection.
Social Isolation
Objectively having few social relationships, social roles, group memberships, and infrequent social interaction.
Social Negativity
The presence of harmful interactions or relationships, rather than the absence of desired social interactions or relationships
Social Networks
The individuals and groups a person is connected to and the interconnections among relationships. These “webs of social connections” provide the structure for various social connection functions to potentially operate.
Social Norms
The unwritten rules that we follow serve as a social contract to provide order and predictability in society. The social groups we belong to provide information and expectations, and constraints on what is acceptable and appropriate behavior. Social norms reinforce or discourage health-related and risky behaviors (lifestyle factors, vaccination, substance use, etc.).
Social Participation
A person’s involvement in activities in the community or society that provides interaction with others.
Social Support
The perceived or actual availability of informational, tangible, and emotional resources from others, commonly one’s social network.
Solitude
A state of aloneness by choice that does not involve feeling lonely.
Trust
An individual’s expectation of positive intent and benevolence from the actions of other people and groups.
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Recommendations for Mental Health Professionals working with Aging Seniors
Explicitly acknowledge social connection as a priority for health.
• Provide health professionals with formal training and continuing education on the health and medical relevance of social connection and risks associated with social disconnection (e.g., isolation, loneliness, low social support, social negativity), as well as advanced training on prevention and interventions.
• Insurance companies should provide adequate reimbursement for time spent ssessing and addressing concerns about social disconnection (e.g., isolation, loneliness, low social support, poor relationship quality), and incorporate these measurements into value-based payment models.
• Facilitate inclusion of assessment results in electronic health records.
• Providers and insurers can educate and incentivize patients to understand the risks of, and take action to address, inadequate social connection, with a particular focus on at-risk individuals, including but not limited to those with physical or mental health conditions or disabilities, financial insecurity, those who live alone, single parents, and both younger and aging populations.
Integrate social connection into patient care in primary-, secondary-, and tertiary-level care settings by:
• Actively assessing patients’ level of social connection to identify those who are at increased risk or already experiencing social disconnection and evaluate the level of necessary supports.
• Educating patients about the benefits of social connection and the risk factors for social disconnection as part of primary prevention.
• Leveraging interventions that provide psychosocial support to patients, including involving family or other caregivers in treatment, group therapies, and other evidence-based options.
Work with community organizations to create partnerships that provide support for people who are at risk for, or are struggling with, loneliness, isolation, low social support, or poor-quality relationships.
• Create opportunities for clinicians to partner with researchers to evaluate the application of evidence-based assessment tools and interventions within clinical settings, including evaluating the efficacy of applications for specific populations.
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Recommendations for What Individual Older Adults can do
Older Individuals Can:
• Understand the power of social connection and the consequences of social disconnection by learning how the vital components (structure, function, and quality) can impact their relationships, health, and well-being.
• Invest time in nurturing their relationships through consistent, frequent, and high-quality engagement with others. Take time each day to reach out to a friend or family member.
• Minimize distraction during conversation to increase the quality of the time they spend with others. For instance, don’t check their phone during meals with friends, important conversations, and family time.
• Seek out opportunities to serve and support others, either by helping their family, co-workers, friends, or strangers in their community or by participating in community service.
• Be responsive, supportive, and practice gratitude. As they practice these behaviors, others are more likely to reciprocate, strengthening their social bonds, improving relationship satisfaction, and building social capital.
• Actively engage with people of different backgrounds and experiences to expand their
understanding of and relationships with others, given the benefits associated with diverse connections.
• Participate in social and community groups such as fitness, religious, hobby, professional, and community service organizations to foster a sense of belonging, meaning, and purpose.
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A Model Program for Wellness Enhancement that Lessened Loneliness for Older Adults
What this program conducted in Independent Living Facilities accomplished:
• A team of counselors developed a wellness coaching program that was distinctive due to its use of a novel underlying wellness framework, structured curriculum, and incorporation of group coaching.
• The program resulted in positive changes to resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose.
• Benefits related to psychological QOL and loneliness were still present at 1-month follow-up.
Applications of study findings
• Wellness coaching may be an effective strategy to expand wellness offerings provided to older adults residing in independent living communities.
• Staff members of the facilities who received a standardized wellness coaching curriculum were well-received as coaches, which may provide independent living communities with a convenient and cost-effective approach to providing wellness coaching. (Fullen, et al., 2023).
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References on Loneliness
Berkman LF, Glass T, Brissette I, Seeman TE. (2000) From social integration to health: Durkheim in the new millennium. Social Science & Medicine. 51(6):843-857.
Fullen, M.C. , Smith, J.L., Clarke, P.B., Westcott, J.B., McCoy, R. & Tomlin, C.C. (2023). Holistic wellness coaching for older adults: Preliminary evidence for a novel wellness intervention in senior living communities. Journal of Applied Gerontology, 42(3), 427–437.
Holt-Lunstad J. (2022) Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health.43(1):193-213.
Office of the Surgeon General. (2023), Our Epidemic of Loneliness and Isolation, Surgeon General’s Advisory on the Healing effects of Social Connection and Community at: https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
Robles TF. (2021). Annual research review: Social relationships and the immune system during development. Journal of Child Psychol Psychiatry. 62(5):539-559.
Shankar, M. (2022). The Science of Loneliness with Surgeon General Vivek Murthy-A Slight Change of Plans Podcast, Nov 22, 2022 at: https://www.youtube.com/watch?v=qy04nm8PG5k
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Impact of Ageism
Foreword
Ageism was described as social stigma associated with old age or older people—which has deleterious effects on older adults’ physical health, psychological well-being, and self-perception (Fullen, 2018).
There is a substantial body of research indicating that age stereotypes influence older adults’ health and well-being. For instance, older adults’ perceptions of aging are associated with memory performance, hearing decline, developing Alzheimer’s symptoms, and dying from respiratory or cardiovascular illnesses. In fact, reserch has found that even after controlling for age, gender, socioeconomic status, loneliness, and functional health, older adults with more positive self-perceptions of aging lived 7.5 years longer than those with less positive self-perceptions of aging (Fullen, 2018).
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In 2017, the American Psychological Association published: Guidelines for psychological practice with older adults. This was based on Principle E of the APA Ethics Code (APA, 2002a, 2010a) which urged psychologists to respect the rights, dignity, and welfare of all people and eliminate the effect of cultural and sociodemographic stereotypes and biases (including ageism) on their work. In addition, the APA Council of Representatives passed a resolution opposing ageism and committing the Association to its elimination as a matter of APA policy. (APA, 2002c)
Ageism, a term first coined by R. N. Butler (1969), refers to prejudice toward, stereotyping of, and/or discrimination against people simply because they are perceived or defined as “old”. Ageism has been evident among most health care provider groups, including marriage and family therapists, social workers, clinical psychology graduate students, and health care providers to adults with Alzheimer’s disease. Attitudes toward older men and women differ in a manner that reflects the convergence of sexism and ageism and differentially impact older adults based on gender. For example, cultural standards of beauty may be magnified for older women and create pressure on them to maintain a certain body and appearance consistent with a youthful image). Ageist biases can foster a higher recall of negative traits regarding older persons than of positive ones and encourage discriminatory practices.
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Ageism Stereotypes
Ageist attitudes can take multiple forms, sometimes discreet and often without intentional malice. Even persons with severe dementia respond with behavioral resistance when spoken to in an infantilizing. There are many inaccurate stereotypes of older adults that can contribute to negative biases and affect the delivery of psychological services. For example, stereotypes include the views that
(a) with age inevitably comes dementia;
(b) older adults have high rates of mental illness, particularly depression;
(c) older adults are inefficient in the workplace;
(d) most older adults are frail and ill;
(e) older adults are socially isolated;
(f) older adults have no interest in sex or intimacy; and
(g) older adults are inflexible and stubborn.
These stereotypes are not accurate, since research has found that the vast majority of older adults are cognitively intact, have lower rates of depression than younger persons, are adaptive and in good functional health, and have meaningful interpersonal and sexual relationships. In fact, many older adults adapt successfully to life transitions and continue to evidence personal and interpersonal growth. Older adults themselves can also harbor negative age stereotypes, and these negative age stereotypes have been found to predict an array of adverse outcomes such as worse physical performance, worse memory performance, and reduced survival. Subgroups of older adults may hold culturally consistent beliefs about aging processes that are different from mainstream biomedical and Western conceptions of aging. It is helpful for therapists to take into account these differences when addressing an individual’s specific needs.
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Negative stereotypes can become self-fulfilling prophecies and adversely affect health care providers’ attitudes and behaviors toward older adult clients. For example, stereotypes can lead health care providers to misdiagnose disorders, inappropriately lower their expectations for the improvement of older adult clients (so-called “therapeutic nihilism”; and delay preventive actions and treatment. Providers may also misattribute older adults’ report of treatable depressive symptoms (e.g., lethargy, decreased appetite, anhedonia) to aspects of normative aging. Some therapists unfamiliar with facts about aging may assume that older adults are too old to change or are less likely than younger adults to benefit from psychosocial therapies.
What may seem like discriminatory behavior by some health providers toward older adults may be more a function of lack of familiarity with aging issues than discrimination based solely on age. For example, many therapists still believe that with aging, those with schizophrenia do not show symptom improvement. However, research on older adults with schizophrenia reveals that positive symptoms of schizophrenia do abate with age. Therapists may also benefit from considering their own responses to working with older adults. Some health professionals may avoid serving older adults because such work evokes discomfort related to their own aging or relationships with parents or other older family members.
Additionally, working with older adults can increase professionals’ awareness of their own mortality, raise fears about their own future aging processes, and/or highlight discomfort discussing issues of death and dying. As well, it is not uncommon for therapists to take a paternalistic role with older adult patients who manifest significant functional limitations, even if the limitations are unrelated to their abilities to benefit from interventions.
Paternalistic attitudes and behavior can potentially compromise the therapeutic relationship, affect cognitive and physical performance, and reinforce dependency. Seemingly positive stereotypes about older adults (e.g., that they are “cute,” “childlike,” or “grandparentlike”) are often overlooked in discussions of age-related biases. However, they can also adversely affect assessment of, therapeutic processes with, and clinical outcomes with older adults. Therapists are encouraged to develop more realistic perceptions of the capabilities and strengths as well as vulnerabilities of this segment of the population. To reduce biases that can impede their work with older adults, it is important for therapists to examine their attitudes toward aging and older adults and (since some biases may constitute “blind spots”) to seek consultation from colleagues or others, preferably those experienced in working with older adults.
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It is imperative that therapists who work with aging adults be aware of the impact of ageism and work to correct any faulty thinking that comes out in their work with this population.
References on Ageism
American Psychological Association. (2002a). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060–1073. doi:10.1037/0003-066X.57.12.1060
American Psychological Association. (2002c). Guidelines on multicultural education, training research, practice, and organizational change for psychologists. Retrieved from: http://www.apa.org/pi/oema/resources/ policy/multicultural-guidelines.aspx
American Psychological Association. (2010a). Ethical principles of psychologists and code of conduct including 2010 amendments. Retrieved from http://www.apa.org/ethics/code/index.aspx
American Psychological Association (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34–65. DOI: 10.1037/a0035063
Butler, R. N. (1969). Ageism: Another form of bigotry. The Gerontologist, 9, 243–246
Fullen, M. C. (2018). Ageism and the Counseling Profession: Causes, Consequences, and Methods for Counteraction. The Professional Counselor (8)2, 104-114 http://tpcjournal.nbcc.org doi:10.15241/mcf.8.2.104
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Impact of Mental Health Stigma
What are examples of mental illness stigma? When someone with a mental illness is called 'dangerous', 'crazy' or 'incompetent' rather than unwell, it is an example of a stigma. It's also stigma when a person with mental illness is mocked or called weak for seeking help. Stigma often involves inaccurate stereotypes.
hree out of four people with a mental illness report that they have experienced stigma. Stigma is a mark of disgrace that sets a person apart. When a person is labelled by their illness, they are seen as part of a stereotyped group. Negative attitudes create prejudice, which leads to negative actions and discrimination.
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Stigma brings experiences and feelings of:
- shame
- blame
- hopelessness
- distress
- misrepresentation in the media
- reluctance to seek and/or accept necessary help
Families are also affected by stigma, leading to a lack of support. For mental health professionals, stigma means that they themselves are seen as abnormal, corrupt or evil, and psychiatric treatments are often viewed with suspicion and horror.
Some groups are subjected to multiple types of stigma and discrimination at the same time, such as people with an intellectual disability or those from a cultural or ethnic minority.
Stigma around mental illness exists in the world because of a lack of understanding and knowledge, but many are eager and curious to learn about mental health.
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Common misconceptions about mental health problems
- Mentally ill people have a weak character.
- Mentally ill people are potentially dangerous.
- People with mental illness should just “snap out of it.”
- Mentally ill people are violent.
Some other stigmas include the following: Age, race, mental illness, physical illness, physical disabilities, developmental disabilities, sexual orientation, gender identity, education, nationality, religion, and physical appearance.
Stigma is a harsh reality for many people, beyond those that have mental health problems, because it prevents them from enjoying a ‘normal’ and productive life. In fact, many people are so uncomfortable with the self-stigma that causes feelings of shame that they would rather suffer in silence than get the help that they need.
Stigma Free Zones
Stigma exists in our world and makes certain people be perceived as ‘weird’ and makes many issues difficult to talk about and there are many who suffer in silence. Many people feel shameful and devastated and the purpose of creating Stigma-Free Zones is to create conversations free of stigma encouraging people to have hope and be inspired by the possibilities that life offers.
Stigma-Free Zones are determined to ‘stomp out stigma!’ People can learn a lot from the stories of other people who have survived mental illness, among other stigmas, and these experiences will be key in helping others to understand the challenges that so many people face.
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It is important for all of us to understand people’s differences and celebrate their diversity and individuality, which truly makes up the unique fabric of humanity.
Stigma reduction refers to the elimination of prejudice and discrimination against people with mental health and substance use disorders. When a disorder is stigmatized, people with that disorder are stigmatized. There is a misconception that these disorders only happen to people with “flawed character” or moral failure of some kind. In reality, these disorders can happen to anyone. Risk factors associated with these disorders – such as poverty, experiencing violence, or being from a marginalized group – are also heavily stigmatized.
According to the CDC, 1 in 7 Americans report experiencing SUD (Substance Use Disorder) and 1 in 5 Americans experience a mental health disorder in a given year. Co-occuring mental health and substance use disorders are also common. These disorders are not rare, but neither is recovery. With proper support, all mental health disorders can be managed and anyone with mental illness and SUD can recover.
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Risk Factors for Mental Health Disorders and Substance Use Disorder
Risk factors for substance use disorder and mental health disorders overlap.
These include experiences of:
- discrimination
- marginalization
- exposure to trauma
- lack of access to treatment services
- poverty
- social determinants of health
Promoting recovery should include addressing these underlying social determinants of health and promoting culturally responsive and trauma-informed treatment. Stigma reduction is an essential part of this.
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Types of Stigma
Public stigma can refer to stereotypes of people with behavioral health conditions. Belief in those stereotypes and actions taken in response can affect job prospects, housing decisions, even the quality of healthcare that they receive.
Systemic Stigma exists in the policies, laws and practices that are based on negative stereotypes about people with mental health conditions or substance use disorders.
Self Stigma refers to the negative attitudes, including internalized shame, that people have about their own condition.
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Stigma and Mental Health
Stigma causes people to feel ashamed for something that is out of their control. Worst of all, stigma prevents people from seeking the help they need. For a group of people who already carry such a heavy burden, stigma is an unacceptable addition to their pain. According to a recent report, over 50% of those with clinical level mental health risks do not seek help. In the U.S., 25% of those not seeking treatment report it is due to not wanting others to know.
Research shows that knowing or having contact with someone with a mental health disorder is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with a mental health challenge, it becomes less scary and more real and relatable.
The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:
- Talk openly about mental health. Share on social media and speak to friends.
- Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences.
- Be conscious of language – remind people that words matter.
- Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.
- Show compassion for those with mental illness.
- Be honest about treatment – normalize mental health treatment, just like other health care treatment.
- Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.
- Choose empowerment over shame – “I fight stigma by choosing to …”
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Effective Strategies For Stigma Reduction
Language: The way we talk about substance use disorders and mental illness can perpetuate stigma. It’s important to use person-first language, such as “a person with a substance use disorder” instead of “an addict.” Avoid using derogatory or stigmatizing language and instead use respectful and accurate language
Education: Education and awareness campaigns can help to increase knowledge and understanding about substance use disorders and mental illness, and to challenge stereotypes and prejudices. This can include providing information about the causes of these conditions, as well as the available treatment options.
Systemic Change: Stigma reduction requires systemic change. This can include changing policies and practices that perpetuate discrimination and marginalization. For example, reducing barriers to substance use disorder and mental health treatment by increasing access to healthcare, and implementing policies that prevent discrimination in employment and housing.
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Mayo Clinic Staff Recommendation to Overcome Mental Health Stigma
Here are some ways you can deal with stigma:
Get treatment. You may be reluctant to admit you need treatment. Don't let the fear of being labeled with a mental illness prevent you from seeking help. Treatment can provide relief by identifying what's wrong and reducing symptoms that interfere with your personal life.
Don't let stigma create self-doubt and shame. Stigma doesn't just come from others. You may mistakenly believe that your condition is a sign of personal weakness or that you should be able to control it without help. Seeking counseling, educating yourself about your condition and connecting with others who have mental illness can help you gain self-esteem and overcome destructive self-judgment.
Don't isolate yourself. If you have a mental illness, you may be reluctant to tell anyone about it. Your family, friends, clergy or members of your community can offer you support if they know about your mental illness. Reach out to people you trust for the compassion, support and understanding you need.
Don't equate yourself with your illness. You are not an illness. So instead of saying "I'm bipolar," say "I have bipolar disorder." Instead of calling yourself "a schizophrenic," say "I have schizophrenia."
Join a support group. Some local and national groups, such as the National Alliance on Mental Illness (NAMI), offer local programs and internet resources that help reduce stigma by educating people who have mental illness, their families and the general public. Some state and federal agencies and programs, such as those that focus on vocational rehabilitation and the Department of Veterans Affairs (VA), offer support for people with mental illness.
Speak out against stigma. Consider expressing your opinions at events, in letters to the editor or on the internet. It can help instill courage in others facing similar challenges and educate the public about mental illness.
Others' judgments almost always stem from a lack of understanding rather than information based on facts. Learning to accept your condition and recognize what you need to do to treat it, seeking support, and helping educate others can make a big difference.
So what is stigma anyway?
The dictionary describes stigma as; “a mark of disgrace associated with a particular circumstance, quality, or person.” Doesn’t that just sound just plain wrong when we’re talking about people who are genuinely suffering inside their own minds? I certainly think so! However, as I said above, this generally comes from people being scared of the unknown. I mean think about it, isn’t that where most fear comes from? The stigma associated with mental health is only fueled by what we see on TV and in the news.
When we hear that a gunman who had mental health problems shot and killed a group of innocent people, suddenly the rest of us who battle mental health as seen as ‘not quite right too’. That’s not to say that everyone thinks people with mental illness are dangerous, but situations like this do not help lower stigma. The issue with the stigma associated with mental health is, people, think you must be a little ‘unhinged’ if you are suffering from any degree of mental illness.
The truth is, 1 in 4 of us will experience a mental illness at some point in our lives, so it’s not just exclusive to those who go off the rails and commit horrible acts. There are various degrees of anxiety, depression and bipolar disorder. From the person who is simply struggling to get through their day, to the person who has been hospitalized for their own, and others safety.
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Some of the most common stigmas associated with mental health, that need Io stop
1. You Must Be Crazy
Probably the most common stigma and belief about those with mental illness are ‘they’re crazy’. When someone with depression explodes into tears over what someone else would deem ‘not a big deal’, it easy for them to say ‘they’re crazy!’ The problem with others calling the mentally ill crazy is, ‘crazy’ is a very broad term. It’s also not directly related to any one mental illness. This then makes it highly offensive to those experiencing mental illness. What we hear and see on TV and in history books does not help the matter either. In popular culture, those with a mental illness are seen as folks who find themselves locked up in asylums, wearing nothing but straight jackets in padded cells. The word ‘crazy’ is so loose and broad, that it needs to stop being used to describe a wide variety of people suffering from mental illness.
2. You Must Be Dangerous
Mental illness is usually only presented in the news when it’s used to describe someone who has committed a terrible crime, before there has been any evidence to suggest the offender even had a mental illness. A common stigma associated with mental illness is that you must be dangerous to have a mental illness. For some reason, it’s widely seen that if you have a mental illness, you somehow are more dangerous. You are seen as not being able to control your thoughts and actions, and that you could suddenly lash out or hurt yourself. For example, if you are experiencing schizophrenia, or you have bipolar disorder, the wider society has an image that you are likely unstable, and possibly hostile.
3. One of the most shocking and naive stigmas associated with mental illness is that it’s self-inflicted.
For example, those who have eating disorders can find that they get a particularly rough time. To the uneducated, it is thought that if you are dangerously starving yourself, then surely you just need to eat more. Some believe that mental illness is only skin deep and that if those who suffer with it want to change, they just need to stop what they’re doing and act properly.
Those who abuse alcohol also suffer from mental illness stigma. Surely if you drink that much alcohol then you must just like getting drunk? Again, we need to educate the wider population that those who abuse substances do so due to internal pain, not because they simply ‘enjoy’ the substance they use. Mental Illness Is NOT Self-Inflicted
4. People With Mental Illness Are Different
Society simply feels as if those with mental illness are ‘different’ from ‘normal’ people. With all the research and medications being developed, this only inflames the notion that these sufferers are ‘different’ and need to be ‘fixed’. While many feel as if mental illness sufferers are both dangerous and unpredictable, they also feel as if they need to be kept separate from the wider population.
As we see in society through a variety of settings, those who are seen as ‘different from the rest’ tend to have a harder time than those who are seen as part of the ‘herd’. With a large part of the population who still feel uneasy about those with mental illness, only more exposure can crush the stigma associated with mental health.
Why Does Stigma Matter?
Removing stigma associated with mental illness is important for a wide array of reasons. Stigma brings with it discrimination. Those with mental illness experience low self-esteem, further depression, and poor quality of life when they are continuously discriminated against. The only way to disrupt the stigma is to change the negative beliefs about those with mental illness. Of course, the way in which the media portrays those with mental health needs to change, and the general public need to immerse themselves amongst those with mental illness to realize that actually, the mentally ill are not all ‘dangerous’ or ‘different’, and really they just need the love and care that everyone else on the face of this planet does.
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Reference on Mental Health Stigma
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