Kennedy M. Erickson is a third-year PharmD candidate at the Washington State University College of Pharmacy and Pharmaceutical Sciences, and the 2021–22 APhA–ASP National President-elect. The author would like to thank Jennifer Robinson, PharmD, for her expertise and assistance.
Admitting you need help with your mental health can be incredibly difficult, and the stigmas associated with mental health can make that even harder. Consequently, people experiencing mental health challenges delay or avoid treatment. As future health care providers, what can we do to decrease the impact of mental health stigma?
Recognizing stigma: Toward yourself, toward others
As a multifaceted phenomenon, stigma can be challenging to recognize at first glance. However, the National Alliance on Mental Illness simply defines stigma as “when someone, or even you yourself, views a person in a negative way because they have a mental health condition.”1
Per the American Psychiatric Association (APA), there are three main types of stigmas: self, public, and institutional.2 To better recognize your own stigmas, it’s important to have an understanding on each type. Each type of stigma can have devastating impacts on people living with mental health–related challenges, including exclusion from social situations, housing and employment discrimination, and negative attitudes toward treatment.3
Self-stigma is negative attitudes that people with mental illness(es) have about their own condition(s). This includes internalized shame. Public stigma involves negative or discriminatory attitudes that others have about mental illness. Institutional stigma is more systemic, involving policies of governments and/or private organizations that intentionally or unintentionally limit opportunities for people with mental illnesses. Examples include lower funding for mental illness research or fewer mental health services relative to other care.
How stigma stopped me
Despite the fact that I'm an advocate for reducing mental health related stigma, I learned in the last year that I was not immune to the impacts it had on me. It took me over a year to seek treatment for my depression. I was ashamed to ask for help. I felt I had this dark secret, and if anyone found out they would see me as incapable, inauthentically happy, and, ultimately, an impostor. In hindsight, I regret not asking for help earlier. Since I asked for help, I have been able to work with my psychiatrist to get on an effective treatment and to identify wellness strategies that work well for me. Now, I have a much brighter outlook on how I view myself and the world.
Recognizing your own stigmas—whether they are turned inward or facing outwards—can help reduce the negative impact they can have on both your thoughts and behaviors. One method I learned to recognize my own mental health stigmas involves comparing thoughts about mental health to thoughts about physical health. For example, if I had bronchitis last year, I would’ve felt validated in seeking help from a provider to treat it as soon as possible. However, when I think about how I approached my depression with hesitancy, the self-stigma I had around asking for help is apparent. If I had reached out for help sooner, I could have also reached recovery sooner! Early medical intervention for both physical and mental health conditions support better health care outcomes, and recovery is possible for both types of conditions. Through this method, we can approach both types of conditions with equality, urgency, and compassion.
In addition to this strategy, using person-first language can also help to reduce stigma by verbally putting a person before their condition or diagnosis. Person-first language articulates the idea of a condition as a secondary attribute, not a characteristic of a person’s identity. For example, stating “a person who has schizophrenia” emphasizes the person first, whereas stating “a schizophrenic person” places emphasis on schizophrenia. Putting the person first and condition second can help to eliminate stereotypes and prioritizes the individuality, dignity, and humanity of an individual with any type of condition, whether it is mental health–related or not.
Stigma recognition is important
Recognizing your own stigmas is an important first step in cultivating compassion for yourself and others. However, I’d argue the next step is even more important: challenge those thoughts.
For me, challenging my own stigmas throughout recovery has been a journey, one that originated in isolation but has blossomed into a mission toward empowerment. While working with my psychiatrist, I have learned about setting boundaries as well as prioritizing goals and actions so that they are aligned with my values and bring me wellness. Investing the time needed to develop new tools and strategies has completely changed how I view my life, my future, and—most importantly—my mental health. Through this process, I’ve realized it’s okay to ask for help, and that I can be both a person with depression and a person who is authentically happy.
Challenging my stigma has empowered me to give each day meaning and pursue activities I believe will make the world better, even if it's by only a small amount. I challenge you all to do the same for yourself, and for others.
Stand up to stigma
As the need for mental health care continues to rise throughout the nation, student pharmacists have an active role to play by building a culture of active listening, understanding, and compassion. In every possible way, it is critical to advocate and stand up to stigma.
So, be an advocate for yourself. Set boundaries and make time for wellness. Even if the leap is scary, have the courage to accept help from others, to change your life for the better, and do things that give you purpose. I use the word “purpose” with intention, as seeking happiness outright can often make individuals more unhappy.4
A tool which may help you identify meaningful aspects and purpose in your life is the PERMA well-being framework, which details 5 aspects of well-being.5
- Psychological flexibility: finding acceptance and comfort with all emotional experiences
- Engagement: being aware of the values that drive your decisions and being present in your activities
- Relationships: relating to ourselves and our communities
- Meaning: creating a life that is meaningful to you
- Achievement: setting and meeting goals for improvement
Although no model of wellness is perfect, achieving wellness through these domains may inspire you to discover other meaningful domains of wellness. By seeking purpose and holding on to optimism, happiness, and positive emotions can be achieved. In addition, you can be an advocate by sharing your story with trusted family and friends, if you feel comfortable doing so. The most important thing is to be brave and reach out for help if you need it—you can’t give from an empty cup.
Your voice can make a difference
Seek out education on mental health so you can better understand the needs of your patients and community. If available, take a Mental Health First Aid course. You can also help your patients by staying up-to-date on the current literature pertaining to mental health as well as being conscientious and compassionate with the language you use. Understanding the many root causes of mental health conditions—such as structural racism, trauma, and bullying, among other causes—is also vital to being an understanding advocate in the community. Lastly, show your patients you are there for them by spreading awareness around mental health conditions and advocating for equitable mental health care legislatively.
Your voice can make the world of difference. Raise it loudly!
Resources
These resources have been incredibly helpful to me in assessing my wellness and dismantling my stigmas. They could serve as resources for yourself and for your community. I would highly recommend checking them out.
References
1. National Alliance on Mental Illness. Stigma Free. www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree
2. American Psychiatric Association. Stigma, prejudice, and discrimination against people with mental illness. www.psychiatry.org/patients-families/stigma-and-discrimination
3. Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: A systematic literature review. Adm Policy Ment Health. 2012;40:384–99. https://doi.org/10.1007/s10488-012-0430-z.
4. Mauss IB, Tamir M, Anderson CL, et al. Can seeking happiness make people unhappy? Paradoxical effects of valuing happiness. Emotion. 2011;11(4):807–15. https://doi.org/10.1037/a0022010.
5. Kern ML, Waters LE, Adler A, et al. A multidimensional approach to measuring well-being in students: Application of the PERMA framework. J Posit Psychol. 2015;10(3):262–71. https://doi.org/10.1080/17439760.2014.936962.