According to research from the National Institute of Mental Health, there were an estimated 43.7 million adults aged 18 or older with a mental illness in 2012. This figure represents 18.6 percent of all adults in the United States (1). The prevalence of mental illness in America only raises the stakes for the country’s complex and long-standing problem with providing efficient mental health care for those effected. These stakes have a monetary value as well. The economic cost of untreated mental illness is over $100 billion each year, according to the National Alliance on Mental Illness (2).
Unfortunately, a major barrier to achieving the goal of widely-accessible mental health care is the social stigma of mental illness. The following seeks to examine the influences on this social stigma, compare them to reports on public perception, and consider how both of these factors have influenced, and are predicted to influence, the state of mental health care in the new landscape shaped by the Affordable Care Act.
The Media’s Influence
Research indicates that most people primarily get their information about mental illness from mass media (3). What they see, naturally, shapes the way they think about mental illness as a whole, in addition to individual disorders. Regrettably, the media’s portrayal of mental illness is largely negative and/or inaccurate, which is what makes social stigmas especially problematic.
Cheryl K. Olson, Sc. D., co-director of the Center for Mental Health and Media at Massachusetts General Hospital Department of Psychiatry, pointed out, “Studies have found that dangerousness/crime is the most common theme of stories on mental illness. [But] research suggests that mentally ill people are more likely to be victims than perpetrators of violence”(4). Research collected in 2009 further showed that mental illness alone does not predict violent behavior.
Fictional representations of people with mental illness have also played a role in perpetuating negative and inaccurate information. Professor Otto Wahl, author ofMedia Madness: Public Images of Mental Illness, argues that the television series Monk, which features a lead character with obsessive compulsive disorder (OCD), mostly portrays the character and his illness in a positive light. However, as part of the show’s storyline, Adrian Monk regularly attends therapy, but never seems to exhibit signs of improvement. Wahl argues that this portrayal (and others like it) perpetuate the myth that treatment of mental illness is ineffective.
More modern depictions of mental illness include anxiety disorders in the 2012 film Silver Linings Playbook and the 2010 film The King’s Speech; post-traumatic stress disorder in The Perks of Being a Wallflower (2012); dissociative disorder in Black Swan (2010); and narcissistic personality disorder in Blue Jasmine (2013). Although the increase in exposure of mental illnesses is a step toward the normalization of mental illness as a whole, these fictional portrayals (among the others included in the surplus of the past few decades) are often not entirely uncontroversial. However, experts have noted that fictional portrayals of mental illness are typically more accurate and humanizing when compared with more journalistic portrayals.
Public Perception of Mental Illness: Now and Then
According to a mental health report from the Substance Abuse and Mental Health Services Administration (SAMHSA), 61% of Americans believed that a person diagnosed with schizophrenia is a danger to others (5). The same report notes that there is little evidence between criminality/violence and having a mental illness.
In 2012, the Centers for Disease Control and Prevention (CDC) published a report titled “Attitudes Toward Mental Illness: Results From the Behavioral Risk Factor Surveillance System,” which included a survey of particular mental illnesses that people found threatening. The top three illnesses were schizophrenia, alcoholism, and drug dependence (6).
Tracking public perception of mental illness can help us better understand the state of mental health literacy, while also better identifying potential negative influences. A few helpful comparisons from the above CDC report include the following:
- 1996: 54% of the U.S. public attributed major depression to neurobiological causes.
- 2006: 67% of the U.S. public attributed major depression to neurobiological causes.
- 1996: 78% of people endorsed the benefits of treatment by a physician for people with major depression.
- 2006: 91% of people endorsed the benefits of treatment by a physician for people with major depression.
These statistics indicate that the public is gradually progressing in its understanding of mental illness. However, the researchers note that improvements in neurobiological understanding of mental illness appeared unrelated to negative attitudes. In a small number of cases, a more acute neurobiological understanding of mental illness actually increased the chances of a person having a negative attitude toward the illness.
In another recent study of U.S. adults, one a quarter of people agreed that the public is generally caring and sympathetic toward those with mental illness. Additionally, respondents indicated that they would be less willing to pay for mental health treatment than they were to pay for physical health treatment (6).
Treating Mental Illness: Accessibility Through Healthcare and the Recent Effects of the Affordable Care Act
Researchers from Loyola University Maryland found that only 20% of adults with a diagnosable, or self-reported mental illness saw a mental health provider in the previous year (7). Lack of access to care is one root of the problem, since most people with serious and persistent mental illness are unemployed, living below the poverty line, and often face tremendous obstacles obtaining adequate, affordable housing, according to the U.S. Department of Health and Human Services (8).
However, the lack of self-management of mental disorders among those affected tends to get tangled up in the lack of resources. The stigma associated with mental disorders causes people with such illnesses to associate embarrassment with accessing mental health services. Since public health goals are focused primarily on the prevention of mental illness, its social stigmatization acts as a barrier in minimizing the onset of illness, in addition to promoting early treatment to prevent the worsening of symptoms left untreated for an extended period of time.
Since this dynamic emerges from poverty and lack of resources, the effects of the Affordable Care Act (which targets these very aspects of health care accessibility) have been dramatic in the realm of mental health care. The law includes mental and behavioral health treatment as one of 10 essential benefits required by new insurance policies sold under the federal health exchange, and to patients on Medicaid.
But due to state-by-state disparities, coverage for the following disorders is not exactly guaranteed:
However, the act prevents insurance companies from denying coverage to people with pre-existing conditions, which includes mental health disorders like schizophrenia, depression, bipolar disorder, and drug or alcohol dependence.
Although less directly related to mental health care coverage, one aspect of the ACA that dramatically improves mental illness treatment in the U.S. is its stipulation that young adults can remain on their parents’ health insurance plans until age 26 (9). The American Mental Health Counselors Association (AMHCA) reported that half of all mental health substance abuse conditions begin by age 14, with as many as three-quarters of conditions beginning by age 24 (10). This stipulation makes mental health care significantly more accessible to younger people, which helps to catalyze the public health prioritization of prevention.
Destigmatization Tactics and the Future of Mental Health Care in the U.S.
The October 2014 issue of Psychological Science in the Public Interest includes commentary from Former U.S. First Lady Rosalynn Carter, Rebecca Palpant Shimkets, and Thomas H. Bornemann of the Carter Center Mental Health Program, which says, “[This issue] makes a strong start in consolidating and disseminating what we now know—that public policy, the law, and the media remain our greatest resources to stimulate change and spur action” (11). The commentary also includes emphasis on building connections to mental health through other fields, such as education, public health, and primary care.
However, as important as these structural changes might be, the group notes, “One does not work long on mental health issues before recognizing the additional hardships caused by stigma.” Though studies, including those illustrated in this report, show clear (though gradual) progress in terms of media representation of mental illness, the commentary had a much less optimistic tone, instead observing “widespread, inaccurate, and sensational media depictions that link mental illness with violence.”
The National Alliance of Mental Illness recognizes that breaking down the tremendous barrier of stigma requires a collective effort from the public. The organization supports its own chapter called StigmaBusters, which is aimed at raising awareness and taking action to combat mental health stigma (12). More resources for combatting stigmatization on an individual level can be found on NAMI’s official website.
One of the most obvious and unfortunate responses to people with cognitive and emotional disabilities is that other people simply do not want to be around them. This often includes family and friends. By providing real life treatment experiences, we build appropriate interpersonal skills so our residents can rebuild relationships with family and friends, and even make new friends.
The Villa Orlando and Pasadena Villa’s Smoky Mountain Lodge are adult intensive psychiatric residential treatment centers for clients with serious mental illnesses. We also provide other individualized therapy programs, step-down residential programs, and less intensive mental health services, such as Community Residential Homes, Supportive Housing, Day Treatment Programs and Life Skills training. Pasadena Villa’s Outpatient Center in Raleigh, North Carolina offers partial hospitalization (PHP) and an intensive outpatient program (PHP). If you or someone you know may need mental health services, please complete our contact form or call us at 407-574-5190 for more information.