Erasing Stigma is Essential to Reform

By Assemblywoman Helen Thomson

Mental illness is the most prevalent health problem in America. Cases of mental illness outnumber illnesses related to cancer, lung disease and heart disease combined. Millions of Californians are affected by this disease. It is estimated that 1.3 million adults in California have a serious mental illness and 75 million children and adolescents have a serious emotional disturbance or mental illness. Sadly, despite the prevalence of mental illness, it is a disease that no one wants to discuss or acknowledge because of stigma and stereotypes.

The diagnosis of mental illness overwhelms individuals, their families, friends, and colleagues because the instinctive response is often denial, and the advice is often illusive or inaccurate. Denial, misinformation, and stigma tend to reinforce one another in the dynamic that keeps mental illness a taboo subject in our society.

The dictionary defines "stigma" as a mark of infamy, disgrace, or reproach. While common knowledge tells us that mental illness is none of these things, many mental health clients and their family members state that this definition certainly describes their experiences.

Mental illness is surrounded by fear, secrecy and mystery. People fear telling anyone about symptoms they can't even describe. People fear telling family members or friends when they have a diagnosis that no one understands. And people fear seeking treatment because they could lose their jobs, their friends, their families or even their children. Many people have such fears because they are well founded. In our society, people still experience punishment for having a mental illness.

Sometimes, people punish themselves. People take their lives rather than suffer the consequences of stigma—the suicide rate in California is 150 percent of the homicide rate. People avoid treatment and medication and therapy at their own peril—in order to avoid the label that society places upon them. They are driven to deny the reality of their illness for years—while the illness and suffering become more severe—because they too believe that there is a stigma, or disgrace, attached to mental illness.

The power of stigma is such that less than half the people diagnosed with a mental illness are actually treating their condition. The power of stigma is such that it keeps mental health low on the list of public priorities for spending. The power of stigma is such that the state and nation have avoided making good on the promise of community mental health care for more than thirty years after "deinstitutionalization" closed state mental hospitals across the country.

Only recently are policymakers recognizing the seriousness of mental illness, and finally, the code of silence is being broken by the advocacy efforts of mental health consumers and their families.

The U.S. Surgeon General identified stigma as a major barrier to progress in mental health policy. Mary Jane England, President of the Washington Business Group on Health and former president of the American Psychiatric Association, stated in an interview on psychiatric problems in the workplace that stigma is the most pressing issue facing psychiatry today. The National Association of County Behavioral Health Directors cited the need to improve understanding of serious and persistent mental illness as the highest priority for the nation’s mental health agenda. The California Little Hoover Commission identified education and advocacy as an essential first step toward mental health reform. These national and state leaders have made a good case for action on stigma as a high priority and I have acted on their recommendations by introducing AB 1422 – an omnibus mental health bill.

AB 1422 implements the key findings of the Little Hoover Commission report, which was released last November. The Commission summed up their investigation of California's mental health system by reporting that we spend billions on the consequences of untreated mental illness instead of investing in adequate mental health treatment.

An important provision of AB 1422 creates a California Mental Health Advocacy Commission to open up the public dialogue that is necessary to identify problems and solutions. The Mental Health Advocacy Commission will recruit participation of business, labor, law enforcement and civic organizations to make the case for open access in public and private mental health systems, and build broad-based, communitywide support for needed reforms.

We cannot build an effective mental health system unless we erase the decades of shame, misinformation, myths, unfounded fears, and fallacies surrounding mental illness. The California Mental Health Advocacy Commission will take on the challenge of eliminating stigma, creating greater awareness and understanding of mental illness, and generating the political will to make a major investment in mental health care.

Everything we know about mental illness tells us that early intervention and quality treatment reduces the costs and improves the likelihood of recovery. Everything we know about the current mental health system tells us that it is a costly failure for mentally ill people and for our communities. We cannot afford to maintain the status-quo. For the quality of life and well-being of all Californians, we must leave stigma behind and bring mental health into the mainstream of health care.