the silent stigma

A SILENT STIGMAthe epidemic of mental illness

© 2011 Kristin Riger. All rights reserved.

The Academy of Art University

San Francisco, California

A special thanks to Patrick Myers, my brother, for his strength and

courage, and to Patricia Myers, my mother, who never gave up.

A SILENT STIGMAthe epidemic of mental illness

by Kristin Riger

6 01. A STORY SUPPRESSED

02. AN UNSPOKEN STIGMA

TABLE OF CONTENTS

20

03. A NEGLECTED EPIDEMIC

04. ABANDONED BY SOCIETY

05. BREAKING THE SILENCE

34

46

60

The following story is a reflection of my own experience, but it addresses an issue that affects 1 in 4 Americans.

8 A STORY SUPPR ESSED

This is Patrick, my little brother. As a kid,

Patrick loved playing football, watching

Field of Dreams over and over again, and

eating pizza as much as possible.

He seemed like a happy kid, but beneath

the surface, Patrick held back a secret.

Patrick had lots of friends at school, but rarely brought them home to play.

He had loving family and friends surrounding him, but he often felt alone.

Divorce rates for people with bipolar disease are twice as likely than other psychiatric disorders, and three and a half times more likely than the general population.

11

When Patrick was just seven, our mother

was diagnosed with bipolar disease. With

our parents just divorced, and me about

to leave for college, he was left to help our

mom deal with her illness.

There was a lot of love in our household,

but coping with change and their newly

empty home was not always easy.


To deal with her grief, our mom began to

drink more and more heavily. With the help

of our grandparents, Patrick was taught

how to recognize when she was under the

influence and call for help.

But it remained a family secret, for fear that

Patrick would be taken away from Mom,

and there would be nothing left to keep her

from spiraling out of control.

I could never relax or tell anyone what was going on. I worried that something bad would happen to mom if anyone found out. — Patrick Myers, on dealing with his mother’s illness

15

Eventually, it was decided that Mom was

too sick to care for Patrick, and he was sent

to live with our Dad.

But he remained close to Mom as she strug-

gled to maintain her mental health, sobriety

and financial stability.

The most difficult thing that I had to overcome was convincing myself that I wasn’t a horrible person. — Patricia Myers, on stabilizing her mental illness and addiction

17

It took almost five years after Patrick left

for Mom to stabilize her condition. Finding

affordable treatment centers and medica-

tion, and health insurance that would cover

the expense, were difficult to come by.

Her struggle to maintain her mental health

continues, but with the right support and

belief in herself, she is confident that she

can win the fight.


The future is uncertain for my family. Our

mom is healthy today, but limited financial

resources and inadequate health insurance

may hinder our ability to support her in the

years to come.

As for now, Patrick is in college, hundreds

of miles away from where he grew up. But

he never stops worrying about our mother,

and hopes that one day, he won’t have to.

Mental illness has a rippling effect on families. Each family member can be influenced in different ways, which can be genetically, psychologically, socially or environmentally.

20 AN UNSPOKEN STIGM A

2121

AN UNSPOKEN STIGMA02In addition to the fear of my mother losing Patrick, one

of the reasons my family kept her condition a secret was

because we were worried about what other people would

think. Our concern stemmed from the unspoken stigma

that is associated with mental illness in our society. Nearly

two-thirds of all people with diagnosable mental disorders

do not seek treatment due to shame and embarrassment of

their illness.

A recent survey conducted by the Surgeon General indicates

that Americans are more likely to seek treatment than cope

with mental illness than ten years ago, but the perception of

people with mental illness as being dangerous and a threat

to society is stronger today than in the past. As a result,

the burden of stigma surrounding the diagnosis and receipt

of mental health treatment is amongst the many barriers

that discourages patients from seeking treatment and from

families like mine from vocalizing the issue.

23

Approximately 70 per cent of Americans think that the cause

of mental illness is personal weakness, which implies that it is

their fault. This “weakness theory”, termed by Vijai Sharma,

Ph.D., suggests that if a person would try harder, they would

overcome the mental disorder they are suffering from.

What they may not know is that most mental illnesses cannot

be cured by personal strength or sheer will power alone. In

my mother’s case, the anxiety and depression that came along

in conjunction with bipolar disease was so debilitating that

she could not function without taking medication. Regular

therapy was also extremely important in her case.

Take another case in which untreated anxiety becomes so

severe that a person quits working or stops going out in order

to avoid all situations that make them anxious. Take another

example where untreated depression kills all the joy that a

person had in life, until finally that person does not want to

get out of bed.

While others are waiting for the mentally afflicted to be put

into jail or to “just pull out of it,” people will suffer as a result

of their misguided conceptions about their disease.

In addition to underestimating the uncontrollable nature of

mental illness, for most Americans, many mental conditions

are scary or viewed as dangerous. It has long been believed

that schizophrenics are violent, dangerous and should not

be functioning in normal society.

But according to the Surgeon General’s 2010 report on mental

health, “in the last two decades, the number of homicides

committed by mentally ill people has not increased, while the

number committed by others has more than doubled”.

In reality, most schizophrenics are withdrawn, frightened

individuals who are at far greater risk of suicide than of

violence towards others; in fact, you are probably far more

likely to be killed by lightning than by a lunatic. This lack of

understanding of schizophrenia and other mental disorders,

however, leads to unfounded fear in the mental ill.

In general, society underestimates the uncontrollable and

debilitating nature of mental illness, which is the catalyst

for what breeds secrecy and guilt about these conditions.

It therefore blocks out proper intervention until the situation

gets beyond the ability to treat.

STIGMAS BREED FEAR

AND MISUNDERSTANDING.


A HISTORY OF MISGUIDED FEAR

Most of us would agree that the mentally ill are viewed as

outsiders in our society. This has been the case, however, for

a long time. The stigmatization of people with mental disor-

ders has persisted throughout history by way of stereotyping,

fear, bias, avoidance, distrust, anger, and embarrassment.

Our fear of mental illness is deeply rooted, which gained its

roots in the Middle Ages when it was seen to be the “devil’s

work.” People believed the mentally ill were possessed by

the devil and therefore the exorcists physically tortured the

mentally ill to drive the evil spirit out of their bodies.

Many women who were mentally ill were branded as witches

and ceremonially burned on the village post as an act of kind-

ness to save their souls. For at least three thousand years as

the records tell us, patients with psychotic illness were feared,

therefore tortured and chained so others could live safely.

In colonial times, people with mental illness were described

as lunatics, and there was no concerted effort to treat mental

illness until urbanization in the early 19th century. Treatment

assumed the form of isolated asylums where the mentally ill

were administered the treatments of the era.

There was also separation of the mental health treatment

system from physical healthy during this time, categorizing

mental health in a separate category from other illnesses.

The philosopher Rene Descartes initially conceptualized the

distinction between the mind and the body in the 17th century.

He deemed the mind as completely separate functions, and

based on his writings, the mind was seen as the concern of

organized religion, whereas the body was seen as the concern

of physicians.

Descartes partitioning of these functions ushered in a new

separation between our mental and physical health as being

in different realms altogether that still exists today, despite

advances in the 20th century that proved the vast interrela-

tionships between the two.

25

In the 1960s, deinstitutionalization and the problems associ-

ated with the implementation of community-based mental

health care brought mental illness into the public sphere.

Lack of planning, social services, psychotropic medicines,

medical facilities, and housing for this newly deinstitutional-

ized, mentally ill population combined to strain the already

reduced public and voluntary social and human services

delivery networks. The end result was that many of the newly

deinstitutionalized patients ended up homeless and on the

streets of America’s cities, becoming a much more visible

part of the urban landscape.

Following this period, prejudices continued to develop that

deemed a mentally ill individual as a social outcast. Some

studies have suggested that certain mental disorders attract

greater stigma and prejudice than others. A recent study

conducted by the National Institute for Mental Health (NIMH)

found that schizophrenia, alcoholism and addiction had the

most negative ratings among the public, with a high propor-

tion of respondents saying that people with these disorders

were unpredictable and dangerous.

A significant proportion of respondents from the same study

felt that people with severe depression could simply ‘pull

themselves together’, once again reflecting a very negative

and inaccurate view of this disorder.

Unless these attitudes soften, and the corresponding desire

to provide resources available for persons with mental illness

increases, the prospect of providing the mentally ill with the

opportunity to become an accepted part of a neighborhood

or community remains tenuous at best.

You are three times as likely to be struck by lightning than be hurt by someone with a mental disorder.Source: MSNBC

“THERE’S A FEAR ASSOCIATED WITH THE

MENTALLY ILL BECAUSE WE THINK THEY’RE OUT OF CONTROL.” —SIMON MARTIN, whose mother is schizophrenic

DEPRESSION

MIGRAINES

POOR DIET

AND

EXERCISE

SPATIAL

MEMORY

BLOOD

CLOTS

LACK OF

MOTIVATION

DIGESTIVE

PROBLEMS

BACK

PAIN

ANXIETY

29

CANCERHEART

DISEASE

STRESS

CHRONIC

ARTHRITIS

HIGH

CHOLESTERAL

METABOLISM

People continue to see mental health and physical health

as separate functions. Mental functions, however, affect the

physical body. Mental functions are carried out by the brain.

Likewise, mental disorders are reflected in physical changes.

For example, physical changes in the brain often trigger

physical changes in other parts of the body. A racing heart,

dry mouth, and sweaty palms that accompany a terrifying

nightmare are orchestrated by the brain. A nightmare is a

mental state associated with alterations of brain chemistry,

which in turn provoke changes elsewhere in the body.

A mental illness is a disorder of the brain, your body’s most

important organ. Like most diseases of the body, mental

illness has many causes — from genetics t biological, envi-

ronmental and social/cultural factors. The unusual behaviors

associated with illnesses are symptoms of the disease — not

necessarily the cause.

Research will continue to yield effective treatments for mental

disorders and could be an effective antidote. When people

understand that mental disorders are not the result of moral

failings, but are legitimate illnesses that are responsive to

specific treatments, negative stereotyping may dissipate.

The following graphic illustrates how various physical and

mental functions, symptoms and illnesses are closely related

to each other.

OUR INSEPARABLE MIND AND BODY


Eleven years is the average amount of time it takes a mentally

ill person to make first contact with a psychiatrist or other

medical professional after the onset of symptoms. This is due

to the patient’s reluctancy to admit that there is a problem,

in part because of the deeply rooted stigmas against mental

health problems across many cultures.

Many patients who do have access to treatment receive care

through their primary care physician rather than a mental

health professional, such as a psychiatrist. That is partly by

choice, due to the fact that most people prefer to talk to

someone they know and trust about medical problems, and

there is still a stigma in seeing a therapist or psychologist.

yrs

31

Instead of seeing a doctor due to shame or embarrassment, the men-tally ill often abuse drugs to cope with their symptoms. It is estimated that 31% of mentally ill patients are addicts due to lack of treatment.

Depression often curbs the desire to take care of yourself, which leads to fewer visits to the doctor and poor physical problems in addition to the mental illness.


Internalized

Stigma Impact

Hope and

Self-Esteem

Suicide Risk

Coping and

Engagement in

Rehabilitation

Social

Interaction

Vocational

Outcomes

Symptom

Severity

33

THE IMPACT OF

INTERNALIZED STIGMA

Using slang words that imply someone is mentally ill, such as

crazy or nuts, is common in casual conversation, but calling

a mentally ill patient names aggravates their condition. They

feel marginalized and suffer from severe low esteem. Psychia-

trists say it is the names that they are subjected to that make

the mentally ill withdraw from society, not the illness itself.

There are many negative stereotypes associated with people

with mental illness, arising perhaps from unusual behavior in

some people when they are unwell. We tend to feel uncom-

fortable when a person’s behavior does not conform to social

expectations. Because those with a mental illness can experi-

ence disruption of their normal thoughts and feelings, their

behavior may seem odd, annoying or unpredictable.

Like others in our community, people with mental illness may

wish to pursue study, work opportunities or personal interests.

Mental illness should not be equated with reduced intellectual

capacity or ability. People with recurrent mental illness may

need time off from work or school occasionally. Others may

be unable to work or choose not to work, but as a society we

should avoid assumptions about those with mental illness.

With increasing knowledge of mental illness in the medical

field, there are now a range of treatment and support options,

if they can afford it, and which is not often the case. Most

people remain at home or have only short hospital stays and

many will have only one or a few episodes in a lifetime.

Some people retain the idea that those with mental illness

should be separated from the rest of society in an institutional

setting. Isolating people with a mental illness may sometimes

add to their distress and certainly perpetuates social distance

and community distrust.

By learning how to treat the mentally ill with respect and

equality, our society can start to remove the stigmas exist for

so many of us and our families.

35

A NEGLECTED EPIDEMICOne of the reasons why my brother was afraid to bring friends

home to play after school during his childhood was because

he felt he was the only kid at school with problems at home.

Once both of us were more open to talking about our mom’s

illness with friends, we discovered that we were not alone in

our struggles; in fact, at times, it seems as though our issues

were part of the majority of households in America.

Research shows that our problems are more common that

we thought. The number of people diagnosed with a mental

illness is growing at a very rapid rate. In the past few years,

there has been a 20 percent increase in mental illness locally,

and Americans suffer from mental illness more than any other

country. It is a growing epidemic that not many of us are

willing to talk about or admit that exists, and it is starting to

have drastic effects on the functionality of our society.

03

36 A NEGLECTED EPIDEMIC

MY FAMILY IS NOT

ALONE IN OUR STRUGGLES.

Americans are in the midst of an epidemic of mental illness

that few are willing to admit or talk about. The total number

of people who are disabled by mental disorders and qualify

for either Supplemental Security Income or Social Security

Disability Insurance increased nearly two and a half times

between the years of 1990 and 2010 — or from one in 184

Americans to one in 76. Almost 50% of families will struggle

at some point with mental illness, showing that my family

is definitely not alone in our struggles.

A survey of selected adults conducted by the National Insti-

tute of Mental Health (NIMH) between 2008 and 2010 found

that 46 percent met the criteria established by the American

Psychiatric Association (APA) for having had at least one

mental illness within four broad categories at some time in

their lives. Of a subgroup affected within the previous year,

a third were under treatment—up from a fifth in a similar

survey ten years earlier.

The effects of the growing mentally ill population is serious.

As more adults suffer from mental health problems, so does

their family, leading to deteriorating issues at home. Similar

to my family’s case, substance abuse is very heavily tied to

mental illness. Without adequate treatment, a patient is 31%

more likely to abuse drugs and alcohol. One in four of mental

illness patients suffer from addiction, causing increasing costs

for treatment and potential violence.

For adolescents, the increase in mental illness is even more

startling—a 35-fold increase in the same two decades. Mental

illness is now the leading cause of disability in children, well

ahead of physical disabilities like cerebral palsy or Down

syndrome, both of which are funded by federal programs.

Is the prevalence of mental illness that high and climbing?

Particularly if these disorders are biologically determined

and not a result of environmental influences? Maybe we are

learning to recognize and diagnose mental disorders that

were always there.

On the other hand, we could be simply expanding the criteria

for mental illness so that nearly everyone has one. What about

the drugs that are now the mainstay of treatment? Do they

work? If they do, we should expect the prevalence of mental

illness to be declining, not rising.


PersonalityDisorders(Antisocial)

9.1%

Anxiety18.1%

ADD4.1%

Mood Disorders(Bipolar, Depression)

9.5%

Post-TraumaticStress

3.5%

39

Approximately 1 in 4 Americans will suffer from a form of mental illness in their lifetime. Many illnesses will go unreported, indicating the percentage is drastically underestimated.

Schizophrenia

1.1%

Source: National Institute of Mental Health

41

THE IMPACT AT HOME

The impact of both parental and adolescent mental illness on

family life and children’s well-being is devastating. Children

whose parents have a mental illness are at risk of developing

social, emotional and behavioral problems.

The environment in which children grow affects their develop-

ment and their emotional well-being as much as their genetic

makeup does. When parents are mentally ill, the chance is

greater that their children might become mentally ill. Children

are also more likely to be sick if brought up in a household

with parents suffering from mental illness.

Families, professionals, and society often pay most attention

to the mentally ill parent, and ignore the children in the family.

Providing more attention and support to the children of a

psychiatrically ill parent is an important consideration when

treating the parent.

Over the past decade, there has been dramatic growth in

hospitalizations that have occurred among the population of

younger-aged children. They suffer mostly from depression

and disruptive behavioral problems, such as oppositional defi-

ance and conduct disorder.

According to mental health experts, the families of these

children have inadequate health insurance, which does not

provide coverage for the intensive counseling and therapy

that is often needed by these troubled youths. At last resort,

many of these children are taken to emergency rooms.

Not treating mental illnesses in children until they reach the

crisis stage has ramifications far beyond the emergency room.

According to Susan Maney, clinical director of the Children’s

Home Society Cobb Center, which provides mental health

treatment for children, neglecting mental illness in young

people negatively affects schools, neighborhoods, and even

leads to the break-up of families.

According to Maney, it is often not until after children act

out in a violent or dramatic way — hurting a sibling, injuring

a schoolmate, or harming themselves — that they are taken

to the hospital to receive the treatment that they require.

To further worsen the problem, the mental health resources

in our local health care system have gotten more scarce, and

children have had to have a pretty severe diagnosis to get

any type of service.


The National Alliance on Mental Illness says that as much as

50 percent of the mentally ill population also has a substance

abuse problem. The drug most commonly used is alcohol,

followed by marijuana and cocaine.

Those who struggle with serious mental illness and substance

abuse face problems of enormous proportions. Mental health

services are often not well prepared to deal with patients

having both afflictions. Often only one of the two problems is

identified. If both are recognized, the individual may bounce

back and forth between services for mental illness and those

for substance abuse, or they may be refused treatment

Substance abuse complicates every aspect of care for the

person with mental illness. Diagnosis is difficult, because

it takes time to unravel the interacting effects of substance

abuse and the mental illness. They may have difficulty at

home and may not be tolerated in community residences

of rehabilitation programs. Violence is also more prevalent

among the dually diagnosed population. Both domestic

violence and suicide attempts are more common, and of

the mentally ill who wind up in jails and prisons, there is a

high percentage of drug abusers.

50%

43

People suffering from severe bipolar disorder are most likely to have dual diagnosis, with 61% of cases also having a substance abuse problem.

Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.


THE STAGGERING COSTS

The ramifications of untreated mental illness take a signifi-

cant economic toll, ranging from substance abuse treatment

centers, violence rates and increased incarceration costs.

Mental health does not just affect the individual but it also

affects the people and the communities around them. If we

examine the costs, we can start at the individual and what

they stand to lose.

Financial and emotional costs are at the top, as mental health

hinders the ability to function properly at work, which usually

leads to high levels of absenteeism or unemployment. People

that are seriously impaired by such mental illnesses as depres-

sion, panic disorder and obsessive-compulsive disorder make

about $16,603 less than those without such conditions.

The cost of mental illness of course reflects onto the indi-

vidual’s family as well. The pain and heartache of supporting a

loved one through a mental illness is taxing not just mentally

but financially as well. The individual struggles at work,

becoming financially unstable. Their loved ones are usually

the ones who will be there to help pick up the slack, either

pay their bills, loan repayments or medical expenses.

On a community level, serious mental illnesses (SMIs) cost

approximately $200 billion in lost earnings per year, according

to findings published in the American Journal of Psychiatry.

People suffering from a SMI—defined as a range of mood and

anxiety disorders, including suicidal tendencies, that signifi-

cantly impaired a person’s ability to function for at least 30

days over the past year—earn at least 40% less than people in

good mental health.

As violence rates increase inadequate treatment, so does the

amount of arrests. It costs about $50K to incarcerate a person

each year. As a result, lack of mental illness funding raises jail

costs, which ultimately leads to increased taxes.

In the event of the person losing their life, the emotional cost

is devastating and many people find it difficult to recover. The

overarching cost to the community for mental health sufferers

is the burden it places on taxpayers and employers.

45

The estimated loss of earnings per year due to untreated mental illness.Source: American Journal of Psychiatry

$200b

47

ABANDONED BY SOCIETYThe stigma that exists towards mental illness in society has

contributed to the lack of sufficient federal and state funding

for mental health services. This is preventing the successful

treatment of mentally ill patients, who have experienced a

drastic deterioration in their health insurance status over the

past two decades.

Concerns about the adequacy of insurance benefits and the

available treatment led to the Mental Health Parity Act, which

required equal coverage for both mental health and physical

conditions. The Act is limited in scope, however, and has done

little to improve the quality of mental health services.

Many factors, including public policy and market trends at the

national, state, and local levels, affect health insurance cover-

age and the availability and use of health care services. These

factors must be immediately addressed to reduce or eliminate

the disparity in health care experienced by the mentally ill.

04

49

Since the turn of this century, the lifespan of the average

American has nearly doubled. Our physical health—as a

whole—has never been better. Illnesses of the body, once

shrouded in fear—such as cancer, epilepsy, and HIV/AIDS

to name just a few—increasingly are seen as treatable,

survivable, even curable ailments.

Yet, despite unprecedented knowledge gained in just the

past three decades about the brain and human behavior,

mental health is often an afterthought, illnesses of the mind

remain shrouded in misunderstanding, and patients do

not receive the support they need.

According to Thomas Insel, Chief of the National Institute

of Mental Health, because of the government’s lack of

support, it is estimated that about a third of people in need

of mental health services rely solely on non-professional

sources such as internet groups and spiritual advisors.

Less than half of those suffering from mental illness receive

any treatment whatsoever, and only 11% are receiving the

successful treatment that allows them to lead a fulfilling life.

Those who seek treatment typically do so after a decade,

during which time they are likely to develop more problems.

Efforts to increase quality of care for mental health services,

including the Mental Health Parity Act, are limited in scope.

This legislation has not encouraged employers to offer mental

health coverage; it only requires that the limits on coverage

be equal to dollar limits on medical benefits if mental health

coverage is offered.

Thus, it gives employers and insurers many options, including

dropping mental health benefits completely. This was a reality

for my Mom, who struggled to find work that was willing to

provide health insurance. Even if they did offer insurance, my

Mom often would not qualify, due to the cost of the medica-

tion that she was taking. This led to increased out of pocket

expenses for medication, additional financial difficulties and a

higher chance for relapse and declining health.

These facts leave us with few options for people that are

struggling with mental illness. Let’s take a closer look at how

the government is coming up short.

THE DISMAL REALITY

50 A BANDONED BY SOCIETY

INADEQUATE REFORM

Health care reform for mental health look promising twenty

years ago. Mental health made headlines almost twenty

years ago during the 1990s. Congress called those years

the Decade of the Brain, prompting research that has led

to a better understanding of how the brain works as well as

improved drug treatments and therapies for mental illness.

The decade closed with the White House Conference on

Mental Health and the Surgeon General’s first-ever Report

on Mental Health in America.

Since then, aggressive efforts to contain the growth of health

care costs have resulted in major changes in the delivery of

both general health care and mental health services. Several

studies have reported reductions of as much as 30 percent

in both mental health service use and costs in recent years.

Managed care approaches have shown they can effectively

reduce service use and costs for employers, but reliable data

on clinical outcomes have been unavailable in most cases.

Mental health is becoming more important to policy makers,

but a major stumbling block in policy debates has been the

lack of reliable data about the rapidly changing health care

system and how it affects mental health issues.

Parity Legislation

In recent years, concerns about the adequacy of health insur-

ance benefits and quality of care for individuals with mental

illness have led the majority of states and the federal govern-

ment to require equal coverage for both mental health and

medical conditions.

These parity mandates were designed to stop the erosion

of insurance coverage for mental health care at a time when

scientific research is yielding significant advances in treating

mental illness, and to make it easier for the country’s mentally

ill population to get help. However, data suggests that these

goals are not being met.

51

What the Parity Law Says

Despite parity legislation, insurance coverage remains prob-

lematic for persons at risk for mental health disorders. State

parity laws have had no significant effect on utilization of

mental health services. Utilization is no higher in parity states

than in states without such laws. One explanation is that

despite numerous laws there have been virtually no changes

in employer-sponsored benefits.

Another explanation is that parity laws lead health plans

to use managed care more intensively, leaving those most

in need concerned about adequate coverage and about

the quality of their care. The Parity Act does not impose

any conditions on deductibles, copayments, limits on days

of hospitalization or office visits, or require coverage for

substance abuse. It gives employers and insurers options

for responding to the law, including dropping mental

health benefits completely.

In addition, the law exempts a health plan if an application

would increase total costs for the plan by 1 percent or more.

It also exempts small employers. State parity laws are often

much stronger than the federal legislation but do not apply

to self-insured employers.These initial evaluations of data

reinforce concerns about health care quality expressed in the

Surgeon General’s report on mental health.

Parity mandates have not resulted in either increased use of

mental health services or higher insurance costs, as oppo-

nents had feared. Many factors, including public policy and

market trends at the national, state, and local levels, affect

health insurance coverage and the availability and use of

health care services. Such factors must be addressed in any

effort to reduce or eliminate the disparity in health care

experienced by the mentally ill.


As funding for mental health services declines, medical

professionals have fewer and few resources to refer their

patients to for rehabilitation. As the graph shows below,

resources for mental heatlh services have declined on a

state and federal level consistently since 2004.

STATE SPENDING (in billions)

FEDERAL SPENDING (in billions)

Source: National Institute of Mental Health

20 4(PROJECTED)

MENTAL HEALTH SERVICES SPENDING

$4.6

$3.0

53

200420072010

$20.2

$6.6

$5.0

$9.7

EMERGENCY ROOMS ARE EXCLUSIVE FOR PEOPLE

WITH HEART ATTACKS AND GUNSHOT WOUNDS. IT’S A

DISGRACE THAT MENTALLY ILL PEOPLE ARE

HELD FOR DAYS EATING HAM SANDWICHES WITH

TOTAL CHAOS IN THEIR HEAD.

— Reed Cosper, Mental Health Advocate


MENTAL HEALTHCARE FUNDING

PUBLIC: 53%

Medicaid: 19%

Medicare: 14%

Private Insurance: 27%

Other State/Local: 20%

Out of Pocket: 14%

Other Private: 16% PRIVATE: 53%

Source: National Alliance on Mental Health

57

Public funding serves as the overwhelming source of money

for individuals with mental illnesses coming out of prison or

jail, few of whom have any access to private insurance. Public

funding for mental health services involves an exceptionally

complicated mix of local, state, and federal monies.

As of February 2011, states are reducing all services in an

effort to plug a $27 billion budget gap. Mental health

programs, unfortunately, will lose a disproportionate share

of the budget cuts.

Despite nationwide attention on mental health issues due

to the tragic shooting of Congresswoman Gabrielle Giffords

and 19 others by an allegedly mentally ill gunman in January

2011, mental health advocates have contended that the

stigma attached to mental health issues often makes funding

for its care an easy target for cuts.

To provide the full spectrum of services to meet the needs of

individuals with mental illnesses, a local provider agency must

weave together funds derived from sources that may have

different guidelines, fiscal years, and stated purposes. Some

services are paid for regardless of who accesses them, while

most require clients to qualify for programs by demonstrating

poverty or disability. In some states, the funds are funneled

through federally approved managed-care frameworks while

others adhere to federal program guidelines.

Low-income people with mental disorders are at increased risk

of homelessness. Programs that assure access to mainstream

and targeted community-based services for homeless people

with serious mental illness, such as the Projects for Assistance

in Transition from Homelessness (PATH) program, should be

expanded. At the current funding level, the program is unable

to meet the needs of people with serious mental illness who

are homeless or at risk of becoming homeless.

Supplemental Security Income (SSI) benefit levels must be

increased so that mentally ill Americans are not forced to live

in poverty. In most states, even if the SSI grant does cover

the rent, only a few dollars remain for other expenses. Benefit

levels have not kept up with increases in the cost of rent and

therefore do not provide disabled individuals with adequate

allowances for housing.

ARE FUNDS ALLOCATED PROPERLY?


The mental health field is currently plagued by disparities in

the availability of and access to its services. These disparities

are viewed readily through the lenses of racial and cultural

diversity, age, and gender.

Twenty-four is the age that Americans can no longer receive

federal funding for mental rehabilitation programs. Mental

illness is the leading disability amongst children of the ages

10-24. However, funding for adults is still imperative, particu-

larly when considering the vast amount of parents suffering

a mental illness.

A key disparity often hinges on a person’s financial status;

formidable financial barriers block off needed mental health

care from too many people regardless of whether one has

health insurance with inadequate mental health benefits, or

is one of the 44 million Americans who lack any insurance.

Even though legislation says that parity laws will mandate

the increased coverage for mental illnesses, these laws have

proven to have holes, and many worry that employers will

drop their health coverage altogether. The cost of therapy

and medication for underinsured people are common barriers

keeping people from receiving treatment.

Although there are a variety of small mental health centers

that provide treatment for people on a local scale, their

resources are stretched far too thin to help everyone who

needs treatment on the level that someone with a more

serious issue may need, such as schizophrenis.

24yrs

59

Recent StudyA recent study by the Department of Global

and Social Medicine asked ten Harvard medical

students to pose as mentally ill patients seeking

treatment. Each were referred to a specialized

service, but only one was able to get an appoint-

ment to see a doctor in one month after calling.

0% Patients who receive an

appointment after 30 days

61

BREAKING THE SILENCEAlthough the future of improved funding for mental health

services on the federal and state levels is uncertain, it is clear

that the prevalence of mental illness is not going away, and

neither seems to be the stigma that goes along with it either.

Most of us do not have the power to change legislation or

available funding for mental illness overnight, but we have to

start somewhere.

Better treatment programs and funding for the mentally ill

starts when Americans overcome the burden of keeping their

illness a secret, when society as a whole understands these

illnesses better, and when mental illness is viewed with the

same gravity and seriousness as a physical illness.

05

63

We have learned that more than half of Americans are either

suffering from a mental illness or are affected by someone

who is suffering from a mental illness. The reason why many

of us feel alone in this battle, however, is because it is an

epidemic that nobody is willing to talk about. This secrecy

has been bred by the deep-seated stigmas that society has

ingrained on the mentally ill.

As we have seen, the prevalence of mental illness is increas-

ing, and assistance for the mentally ill is declining, two reverse

trends that working against each other. According to the

National Institute for Mental Health, the percentage of the

mentally ill who receive adequate care has remained stagnant

in the past seven years, with only about 13.4% receiving the

care that they need, only up from 1% from 2004. This leaves a

wider gap of the population who are suffering without help.

In order to help the mentally ill receive better treatment and

improve the overall quality of life in the United States, we

must first start at the root of the problem, which is a lack of

understanding about mental illness is and how it should be

treated. In order to address these misconceptions and stig-

mas, we need to communicate to the general public about

the realities of this epidemic.

Of course, this will not be easy, given that our society has

placed the mentally ill in a separate category for hundreds

of years, but by raising awareness of this epidemic, perhaps

we can address some of the central issues that plagues the

majority of our society and begin to effect change. Only then

will we be start to see a change in attitudes, and hopefully, a

change in the amount of funding being provided for mental

health services.

A FUTURE VISION

FOR MENTAL HEALTH

64 BR EAKING THE SILENCE

Address existing stigmas with a poster campaign that educates the public on mental illness.

ELIMINATE THE STIGMA

1

PROBLEM

Mental illness is an epidemic that nobody is talking about,

yet so many are affected by. A large part of the stigma that

exists today is because of our lack of understanding of

what mental illness is and how much it affects our society.

SOLUTION Creating a poster campaign will bring more awareness and

understanding to the epidemic of mental illness, how wide-

spread it is in the United States and to let Americans who are

suffering from these diseases know that they are not alone.

AUDIENCE Young adults, parents, adolescents, students, health care

professionals and the overall general public

6565

mental illness can happen

to anyone, at anytime.

FIGHT THE STIGMA.


2

Develop a website for patients to connect with therapists and other medical professionals.

GIVE PATIENTS A VOICE

PROBLEM

There are a variety of charitable websites and non-profit orga-

nizations that are targeted towards assisting the mentally ill.

Their mission statement to connect the community with useful

medical resources, however, remains vague without offering a

way to do this off of their website.

SOLUTION This resource website would serve as an all encompassing

vehicle for medical professionals to become educated on

where to direct their mentally ill patients for additional help,

and where mentally ill patients can easily contact experts

on the best solution for their condition.

AUDIENCE Mentally ill patients, medical professionals, activists, and

family members of the mentally ill

6767

Connect. And you’ll find out

that you are not alone.Join the online community >

HOME PATIENTS DOCTORS RESOURCES LOCAL COMMUNITY CONTACT

THE MENTAL HEALTH NETWORK


3

Develop a toolkit for teachers on how to talk to their students about mental health.

EDUCATE OUR CHILDREN

PROBLEM

Children are more likely to be sick if brought up in a house-

hold with parents suffering from mental illness. An infant,

for example, is almost 25% more likely to regularly visit the

emergency room in the first year of life if his or her parents

are mentally unstable. Children, however, are not likely to

voice these conditions at home, and the emotional effects

can take a toll later in life.

SOLUTION By talking to children about understanding mental illness

and its effects, we will be encouraging them to feel more

comfortable to reach out to their teachers if conditions at

home are making them uncomfortable. This would increase

understanding of mental illness and assist in decreasing

its prevalence in the future.

AUDIENCE Teachers and educators


Decrease the prevalence of mental illness with a preventative medicine awareness campaign.

PREVENT THE PROBLEM

PROBLEM

Because of the stigma that is associated with mental illness,

preventative treatment strategies are minimal in our health

care system and could curb the prevalence of mental illness.

SOLUTION A preventative medicine campaign would raise awareness

on mental illness, potentially decrease its prevalence, and

ultimately, put less of a strain on government funding.

The campaign would focus on communicating prevention

strategies, as well as developing tools for early intervention

and case identification. Intervention would aim to promote

optimism and social and emotional well-being, as well as

reduce the impact of risk factors for children.

AUDIENCE Adolescents, children, teachers, parents, high school and college students and medical professionals

7171

4

PREVENTION TREATMENT MAINTENANCE

PREVENTATIVE MEDICINE CAMPAIGN STRATEGY

Schools, community health,

general practice, family

services, justice services

PREVENTION LEVEL

TARGET MARKET

Mental health services,

general practice, private

practice services

Mental health services, non

government organizations,

private practice services

PROMOTION

1. Whole Population

2. Selective Groups

3. High Risk Individuals

1. Case Identification

2. Treatment

1. Compliance

2. Rehabilitation


Publish an online journal on mental illness and distribute to educational, medical and government resources.

ESTABLISH CREDIBILITY

PROBLEM

Accessibility for treatment of middle ground mental diseases,

such as depression and bipolar disorder, is becoming increas-

ingly difficult due to the continuing budget cuts for mental

health services on both the federal and state level.

SOLUTION There is no existing online resource that provides that reliable

educational information in a format that consistently is being

distributed to medical and governmental professionals on the

state of mental health care.

By regularly showing decision-makers the immediate need

for support for the mentally ill, as well as providing informa-

tive resources to help influence their decision, we will start to

expose the need for continuing support to the people that

can make a difference.

AUDIENCE Educators, health care professionals, government officials,

medical professionals and activists

73

5

THE MENTAL HEALTH JOURNAL

Resources News Health Articles

SavedArticles

Watchlist

MENTAL HEALTH FUND ALLOCATIONThe majority of funding for mental health care is public. Public funding serves as the overwhelming source of care dollars for individuals with mental illnesses coming out of prison or jail, few of whom have any access to private insurance. And public funding for mental health services involves an exceptionally complicated mix of local, state, an d federal monies.

As of February 2011, states are reducing all services in an effort to plug a $27 billion budget gap. Mental health programs will lose a disproportionate share of the budget cuts.

Despite nationwide attention focused on mental health issues following the tragic shooting of Arizona Congresswoman Gabrielle Giffords (D) and 19 others by an allegedly mentally ill gunman, mental health advocates contend that the stigma attached to mental health issues often makes funding for its care an easy target for cuts.

PUBLIC: 53%

PRIVATE: 47%

7575

The inspiration for this project, as you probably have already

guessed, originated from what I have learned growing up with

a family trying to cope with the complicated intricacies that

arise when one of your loved ones is mentally ill.

As a MFA graphic design candidate at the Academy of Art

University, I have learned that my profession as a designer

extends far beyond moving around pixels on a page. I am a

communicator, with the ability to express ideas that invoke

emotion, persuasion and action. Herein lies the very reason

that as a designer, I can bring about change.

Reluctant at first to tackle this subject, for the uncertainty

of what I would find, I discovered that my past experiences

dealing with mental illness are much more common that I

ever imagined. It was amazing to discover that at the very

heart of why the mentally ill are so neglected is our lack of

communication about the problem.

My skills as a designer are meant to communicate and express

ideas with the intention of changing perspectives, striking at

the central issue of why the mentally ill are being neglected in

society. Knowing this, the idea of changing stigmas towards

mental illness through awareness, prevention and communica-

tion seems possible, and one that I believe I can tackle.

LOOKING INWARD

Kristin Riger

02594374

GR 600: Visual Communications

Phil Hamlett, Hunter Lewis Wimmer and Michele Ronsen

Fall 2011

Serifa Avenir

Kristin Riger Flickr.com iStockPhoto.com

Kristin Riger

Proline

Blurb

Kristin Riger

COLOPHON

Name

ID Number

Course

Professor

Semester

Typefaces

Photography

Illustration

Paper

Printer

Binding

the silent stigma

Documents

patrick myers

mental health

mom deal

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