the silent stigma
DESCRIPTION
An analysis of the neglected epidemic of mental illness in the United States.TRANSCRIPT
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.
12 A STORY SUPPR ESSED
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.
18 A STORY SUPPR ESSED
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.
24 AN UNSPOKEN STIGM A
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
30 AN UNSPOKEN STIGM A
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.
32 AN UNSPOKEN STIGM A
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.
37
38 A NEGLECTED EPIDEMIC
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.
42 A NEGLECTED EPIDEMIC
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.
44 A NEGLECTED EPIDEMIC
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.
52 A BANDONED BY SOCIETY
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
56 A BANDONED BY SOCIETY
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?
58 A BANDONED BY SOCIETY
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
62 AN UNSPOKEN STIGM A
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.
66 BR EAKING THE SILENCE
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
68 BR EAKING THE SILENCE
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
70 BR EAKING THE SILENCE
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
72 BR EAKING THE SILENCE
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