A SILENT STIGMA the epidemic of mental illness
Š 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 STIGM A the epidemic of mental illness by Kristin Riger
TABLE OF CONTENTS
6
01. A STORY SUPPRESSED
20
02. AN UNSPOKEN STIGMA
60
46
34
03. A NEGLECTED EPIDEMIC
05. BREAKING THE SILENCE
04. ABANDONED BY SOCIETY
The following story is a reflection of my own experience, but it addresses an issue that affects 1 in 4 Americans.
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.
8  A S TO RY S U PPR E S S ED
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.
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.
11
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.
12  A S TO RY S U PPR E S SED
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
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 struggled to maintain her mental health, sobriety and financial stability.
15
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
It took almost five years after Patrick left for Mom to stabilize her condition. Finding affordable treatment centers and medication, 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.
17
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.
18  A S TO RY S U PPR E S SED
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 A N U NS P O K EN S T I GM A
02
AN UNSPOKEN STIGMA In 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. 21
STIGMAS BREED FEAR AND MISUNDERSTANDING. Approximately 70 per cent of Americans think that the cause
In addition to underestimating the uncontrollable nature of
of mental illness is personal weakness, which implies that it is
mental illness, for most Americans, many mental conditions
their fault. This “weakness theory”, termed by Vijai Sharma,
are scary or viewed as dangerous. It has long been believed
Ph.D., suggests that if a person would try harder, they would
that schizophrenics are violent, dangerous and should not
overcome the mental disorder they are suffering from.
be functioning in normal society.
What they may not know is that most mental illnesses cannot
But according to the Surgeon General’s 2010 report on mental
be cured by personal strength or sheer will power alone. In
health, “in the last two decades, the number of homicides
my mother’s case, the anxiety and depression that came along
committed by mentally ill people has not increased, while the
in conjunction with bipolar disease was so debilitating that
number committed by others has more than doubled”.
she could not function without taking medication. Regular therapy was also extremely important in her case.
In reality, most schizophrenics are withdrawn, frightened individuals who are at far greater risk of suicide than of
Take another case in which untreated anxiety becomes so
violence towards others; in fact, you are probably far more
severe that a person quits working or stops going out in order
likely to be killed by lightning than by a lunatic. This lack of
to avoid all situations that make them anxious. Take another
understanding of schizophrenia and other mental disorders,
example where untreated depression kills all the joy that a
however, leads to unfounded fear in the mental ill.
person had in life, until finally that person does not want to get out of bed.
In general, society underestimates the uncontrollable and debilitating nature of mental illness, which is the catalyst
While others are waiting for the mentally afflicted to be put
for what breeds secrecy and guilt about these conditions.
into jail or to “just pull out of it,” people will suffer as a result
It therefore blocks out proper intervention until the situation
of their misguided conceptions about their disease.
gets beyond the ability to treat.
23
A HISTORY OF MISGUIDED FEAR Most of us would agree that the mentally ill are viewed as
illness until urbanization in the early 19th century. Treatment
outsiders in our society. This has been the case, however, for
assumed the form of isolated asylums where the mentally ill
a long time. The stigmatization of people with mental disor-
were administered the treatments of the era.
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.
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
Many women who were mentally ill were branded as witches
organized religion, whereas the body was seen as the concern
and ceremonially burned on the village post as an act of kind-
of physicians.
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.
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
In colonial times, people with mental illness were described
advances in the 20th century that proved the vast interrela-
as lunatics, and there was no concerted effort to treat mental
tionships between the two.
24 A N U NS P O K EN S T I GM A
You are three times as likely to be struck by lightning than be hurt by someone with a mental disorder. Source: MSNBC
In the 1960s, deinstitutionalization and the problems associ-
most negative ratings among the public, with a high propor-
ated with the implementation of community-based mental
tion of respondents saying that people with these disorders
health care brought mental illness into the public sphere.
were unpredictable and dangerous.
Lack of planning, social services, psychotropic medicines,
A significant proportion of respondents from the same study
medical facilities, and housing for this newly deinstitutional-
felt that people with severe depression could simply ‘pull
ized, mentally ill population combined to strain the already
themselves together’, once again reflecting a very negative
reduced public and voluntary social and human services
and inaccurate view of this disorder.
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
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.
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
25
“THERE’S A
FEAR
ASSOCIATED WITH THE
MENTALLY ILL BECAUSE WE THINK THEY’RE
OUT OF CONTROL.” —SIMON MARTIN, whose mother is schizophrenic
POOR DIET AND
DEPRESSION
EXERCISE
SPATIAL DIGESTIVE
MIGRAINES
PROBLEMS
MEMORY
BACK PAIN
LACK OF MOTIVATION
ANXIETY
BLOOD CLOTS
CANCER
HEART DISEASE HIGH CHOLESTERAL
OUR INSEPARABLE MIND AND BODY People continue to see mental health and physical health
illness has many causes — from genetics t biological, envi-
as separate functions. Mental functions, however, affect the
ronmental and social/cultural factors. The unusual behaviors
physical body. Mental functions are carried out by the brain.
associated with illnesses are symptoms of the disease — not
Likewise, mental disorders are reflected in physical changes.
necessarily the cause.
For example, physical changes in the brain often trigger
Research will continue to yield effective treatments for mental
physical changes in other parts of the body. A racing heart,
disorders and could be an effective antidote. When people
dry mouth, and sweaty palms that accompany a terrifying
understand that mental disorders are not the result of moral
nightmare are orchestrated by the brain. A nightmare is a
failings, but are legitimate illnesses that are responsive to
mental state associated with alterations of brain chemistry,
specific treatments, negative stereotyping may dissipate.
which in turn provoke changes elsewhere in the body.
The following graphic illustrates how various physical and
A mental illness is a disorder of the brain, your body’s most
mental functions, symptoms and illnesses are closely related
important organ. Like most diseases of the body, mental
to each other.
CHRONIC ARTHRITIS
STRESS METABOLISM
29
yrs 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.
30  A N U NS P O K EN S T I GM A
Instead of seeing a doctor due to shame or embarrassment, the mentally 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.
31
Internalized Stigma Impact
Hope and Self-Esteem Vocational Outcomes
Coping and Engagement in Rehabilitation
Suicide Risk
Symptom Severity Social Interaction
32  A N U NS P O K EN S T I GM A
THE IMPACT OF INTERNALIZED STIGMA Using slang words that imply someone is mentally ill, such as
need time off from work or school occasionally. Others may
crazy or nuts, is common in casual conversation, but calling
be unable to work or choose not to work, but as a society we
a mentally ill patient names aggravates their condition. They
should avoid assumptions about those with mental illness.
feel marginalized and suffer from severe low esteem. Psychiatrists say it is the names that they are subjected to that make the mentally ill withdraw from society, not the illness itself.
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
There are many negative stereotypes associated with people
people remain at home or have only short hospital stays and
with mental illness, arising perhaps from unusual behavior in
many will have only one or a few episodes in a lifetime.
some people when they are unwell. We tend to feel uncomfortable when a person’s behavior does not conform to social expectations. Because those with a mental illness can experience 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
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.
33
03
A NEGLECTED EPIDEMIC One 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.
35
MY FAMILY IS NOT ALONE IN OUR STRUGGLES. Americans are in the midst of an epidemic of mental illness
mental illness. Without adequate treatment, a patient is 31%
that few are willing to admit or talk about. The total number
more likely to abuse drugs and alcohol. One in four of mental
of people who are disabled by mental disorders and qualify
illness patients suffer from addiction, causing increasing costs
for either Supplemental Security Income or Social Security
for treatment and potential violence.
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 Institute 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,
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.
a third were under treatment—up from a fifth in a similar
On the other hand, we could be simply expanding the criteria
survey ten years earlier.
for mental illness so that nearly everyone has one. What about
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
36 A NEGLEC T ED EPIDEMI C
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
Anxiety 18.1%
Post-Traumatic Stress
ADD 4.1%
3.5%
Personality Disorders (Antisocial)
9.1%
Mood Disorders (Bipolar, Depression)
9.5%
38  A NEGLEC T ED EPIDEMI C
Schizophrenia
1.1%
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. Source: National Institute of Mental Health
39
THE IMPACT AT HOME The impact of both parental and adolescent mental illness on
According to mental health experts, the families of these
family life and children’s well-being is devastating. Children
children have inadequate health insurance, which does not
whose parents have a mental illness are at risk of developing
provide coverage for the intensive counseling and therapy
social, emotional and behavioral problems.
that is often needed by these troubled youths. At last resort,
The environment in which children grow affects their develop-
many of these children are taken to emergency rooms.
ment and their emotional well-being as much as their genetic
Not treating mental illnesses in children until they reach the
makeup does. When parents are mentally ill, the chance is
crisis stage has ramifications far beyond the emergency room.
greater that their children might become mentally ill. Children
According to Susan Maney, clinical director of the Children’s
are also more likely to be sick if brought up in a household
Home Society Cobb Center, which provides mental health
with parents suffering from mental illness.
treatment for children, neglecting mental illness in young
Families, professionals, and society often pay most attention to the mentally ill parent, and ignore the children in the family.
people negatively affects schools, neighborhoods, and even leads to the break-up of families.
Providing more attention and support to the children of a
According to Maney, it is often not until after children act
psychiatrically ill parent is an important consideration when
out in a violent or dramatic way — hurting a sibling, injuring
treating the parent.
a schoolmate, or harming themselves — that they are taken
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 defiance and conduct disorder.
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.
41
50% 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.
42  A NEGLEC T ED EPIDEMI C
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.
43
THE STAGGERING COSTS The ramifications of untreated mental illness take a signifi-
the ones who will be there to help pick up the slack, either
cant economic toll, ranging from substance abuse treatment
pay their bills, loan repayments or medical expenses.
centers, violence rates and increased incarceration costs.
On a community level, serious mental illnesses (SMIs) cost
Mental health does not just affect the individual but it also
approximately $200 billion in lost earnings per year, according
affects the people and the communities around them. If we
to findings published in the American Journal of Psychiatry.
examine the costs, we can start at the individual and what
People suffering from a SMI—defined as a range of mood and
they stand to lose.
anxiety disorders, including suicidal tendencies, that signifi-
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
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.
that are seriously impaired by such mental illnesses as depres-
As violence rates increase inadequate treatment, so does the
sion, panic disorder and obsessive-compulsive disorder make
amount of arrests. It costs about $50K to incarcerate a person
about $16,603 less than those without such conditions.
each year. As a result, lack of mental illness funding raises jail
The cost of mental illness of course reflects onto the indi-
costs, which ultimately leads to increased taxes.
vidual’s family as well. The pain and heartache of supporting a
In the event of the person losing their life, the emotional cost
loved one through a mental illness is taxing not just mentally
is devastating and many people find it difficult to recover. The
but financially as well. The individual struggles at work,
overarching cost to the community for mental health sufferers
becoming financially unstable. Their loved ones are usually
is the burden it places on taxpayers and employers.
44 A NEGLEC T ED EPIDEMI C
$200
b
The estimated loss of earnings per year due to untreated mental illness. Source: American Journal of Psychiatry
45
04
ABANDONED BY SOCIETY The 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 coverage 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.
47
THE DISMAL REALITY Since the turn of this century, the lifespan of the average
Those who seek treatment typically do so after a decade,
American has nearly doubled. Our physical health—as a
during which time they are likely to develop more problems.
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.
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
Yet, despite unprecedented knowledge gained in just the
be equal to dollar limits on medical benefits if mental health
past three decades about the brain and human behavior,
coverage is offered.
mental health is often an afterthought, illnesses of the mind remain shrouded in misunderstanding, and patients do not receive the support they need.
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
According to Thomas Insel, Chief of the National Institute
provide health insurance. Even if they did offer insurance, my
of Mental Health, because of the government’s lack of
Mom often would not qualify, due to the cost of the medica-
support, it is estimated that about a third of people in need
tion that she was taking. This led to increased out of pocket
of mental health services rely solely on non-professional
expenses for medication, additional financial difficulties and a
sources such as internet groups and spiritual advisors.
higher chance for relapse and declining health.
Less than half of those suffering from mental illness receive
These facts leave us with few options for people that are
any treatment whatsoever, and only 11% are receiving the
struggling with mental illness. Let’s take a closer look at how
successful treatment that allows them to lead a fulfilling life.
the government is coming up short.
49
INADEQUATE REFORM Health care reform for mental health look promising twenty
Mental health is becoming more important to policy makers,
years ago. Mental health made headlines almost twenty
but a major stumbling block in policy debates has been the
years ago during the 1990s. Congress called those years
lack of reliable data about the rapidly changing health care
the Decade of the Brain, prompting research that has led
system and how it affects mental health issues.
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.
50  A BA ND O NED BY S OCI ET Y
Parity Legislation In recent years, concerns about the adequacy of health insurance benefits and quality of care for individuals with mental illness have led the majority of states and the federal government 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.
What the Parity Law Says Despite parity legislation, insurance coverage remains prob-
In addition, the law exempts a health plan if an application
lematic for persons at risk for mental health disorders. State
would increase total costs for the plan by 1 percent or more.
parity laws have had no significant effect on utilization of
It also exempts small employers. State parity laws are often
mental health services. Utilization is no higher in parity states
much stronger than the federal legislation but do not apply
than in states without such laws. One explanation is that
to self-insured employers.These initial evaluations of data
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
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 opponents 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.
health benefits completely.
51
MENTAL HEALTH SERVICES SPENDING 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
$4.6 $3.0
20 4 (PROJECTED)
52  A BA ND O NED BY S OCI ET Y
$20.2
$9.7 $6.6 $5.0
2010
2007
2004
53
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% Medicare: 14%
Other State/Local: 20%
Medicaid: 19% Private Insurance: 27%
Out of Pocket: 14% Other Private: 16%
Source: National Alliance on Mental Health
56  A BA ND O NED BY S OCI ET Y
PRIVATE: 53%
ARE FUNDS ALLOCATED PROPERLY? Public funding serves as the overwhelming source of money
most require clients to qualify for programs by demonstrating
for individuals with mental illnesses coming out of prison or
poverty or disability. In some states, the funds are funneled
jail, few of whom have any access to private insurance. Public
through federally approved managed-care frameworks while
funding for mental health services involves an exceptionally
others adhere to federal program guidelines.
complicated mix of local, state, and federal monies.
Low-income people with mental disorders are at increased risk
As of February 2011, states are reducing all services in an
of homelessness. Programs that assure access to mainstream
effort to plug a $27 billion budget gap. Mental health
and targeted community-based services for homeless people
programs, unfortunately, will lose a disproportionate share
with serious mental illness, such as the Projects for Assistance
of the budget cuts.
in Transition from Homelessness (PATH) program, should be
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
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.
2011, mental health advocates have contended that the
Supplemental Security Income (SSI) benefit levels must be
stigma attached to mental health issues often makes funding
increased so that mentally ill Americans are not forced to live
for its care an easy target for cuts.
in poverty. In most states, even if the SSI grant does cover
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
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.
services are paid for regardless of who accesses them, while
57
24
yrs
The mental health field is currently plagued by disparities in
Even though legislation says that parity laws will mandate
the availability of and access to its services. These disparities
the increased coverage for mental illnesses, these laws have
are viewed readily through the lenses of racial and cultural
proven to have holes, and many worry that employers will
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
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
10-24. However, funding for adults is still imperative, particu-
that provide treatment for people on a local scale, their
larly when considering the vast amount of parents suffering
resources are stretched far too thin to help everyone who
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.
58  A BA ND O NED BY S OCI ET Y
needs treatment on the level that someone with a more serious issue may need, such as schizophrenis.
Recent Study A 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 appointment to see a doctor in one month after calling.
0%
Patients who receive an appointment after 30 days
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05
BREAKING THE SILENCE Although 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.
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62 A N U NS P O K EN S T I GM A
A FUTURE VISION FOR MENTAL HEALTH We have learned that more than half of Americans are either
In order to help the mentally ill receive better treatment and
suffering from a mental illness or are affected by someone
improve the overall quality of life in the United States, we
who is suffering from a mental illness. The reason why many
must first start at the root of the problem, which is a lack of
of us feel alone in this battle, however, is because it is an
understanding about mental illness is and how it should be
epidemic that nobody is willing to talk about. This secrecy
treated. In order to address these misconceptions and stig-
has been bred by the deep-seated stigmas that society has
mas, we need to communicate to the general public about
ingrained on the mentally ill.
the realities of this epidemic.
As we have seen, the prevalence of mental illness is increas-
Of course, this will not be easy, given that our society has
ing, and assistance for the mentally ill is declining, two reverse
placed the mentally ill in a separate category for hundreds
trends that working against each other. According to the
of years, but by raising awareness of this epidemic, perhaps
National Institute for Mental Health, the percentage of the
we can address some of the central issues that plagues the
mentally ill who receive adequate care has remained stagnant
majority of our society and begin to effect change. Only then
in the past seven years, with only about 13.4% receiving the
will we be start to see a change in attitudes, and hopefully, a
care that they need, only up from 1% from 2004. This leaves a
change in the amount of funding being provided for mental
wider gap of the population who are suffering without help.
health services.
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1
ELIMINATE THE STIGMA
Address existing stigmas with a poster campaign that educates the public on mental illness. 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 widespread 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
64   BR E A K ING T HE S IL ENCE
mental illness can happen to anyone, at anytime.
A. FIGHT THE STIGM
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2
GIVE PATIENTS A VOICE
Develop a website for patients to connect with therapists and other medical professionals. PROBLEM There are a variety of charitable websites and non-profit organizations 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
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THE MENTAL HEALTH NETWORK HOME PATIENTS DOCTORS RESOURCES LOCAL COMMUNITY CONTACT
Connect. And you’ll find out that you are not alone. Join the online community >
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3
EDUCATE OUR CHILDREN
Develop a toolkit for teachers on how to talk to their students about mental health. PROBLEM Children are more likely to be sick if brought up in a household 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
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PREVENT THE PROBLEM
Decrease the prevalence of mental illness with a preventative medicine awareness campaign. 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
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4
PREVENTATIVE MEDICINE CAMPAIGN STRATEGY
PREVENTION
PREVENTION LEVEL
TREATMENT
MAINTENANCE
1. Whole Population
1. Case Identification
1. Compliance
2. Selective Groups
2. Treatment
2. Rehabilitation
Schools, community health,
Mental health services,
Mental health services, non
general practice, family
general practice, private
government organizations,
services, justice services
practice services
private practice services
3. High Risk Individuals
TARGET MARKET
PROMOTION
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ESTABLISH CREDIBILITY
Publish an online journal on mental illness and distribute to educational, medical and government resources. PROBLEM Accessibility for treatment of middle ground mental diseases, such as depression and bipolar disorder, is becoming increasingly 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 informative 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
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5
THE MENTAL HEALTH JOURNAL
Resources
News
Health
Articles
Watchlist
Saved Articles
MENTAL HEALTH FUND ALLOCATION The 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.
PUBLIC: 53%
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.
PRIVATE: 47%
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LOOKING INWARD 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 communication seems possible, and one that I believe I can tackle.
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COLOPHON Name
Kristin Riger
ID Number
02594374
Course
GR 600: Visual Communications
Professor
Phil Hamlett, Hunter Lewis Wimmer and Michele Ronsen
Semester
Fall 2011
Typefaces
Serifa Avenir
Photography
Kristin Riger Flickr.com iStockPhoto.com
Illustration
Kristin Riger
Paper
Proline
Printer
Blurb
Binding
Kristin Riger