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The dictionary suggests that stigma is a “mark of disgrace or infamy; a stain or reproach, as on one’s reputation.” Since the days when the 'mentally ill' were locked away and 'alcoholics and addicts' were considered unworthy of help, stigma against people with brain diseases has been deemed acceptable in society. Today, the treatment settings have changed, and science plays a larger role in the outcomes, but sadly, stigma continues to dictate attitudes, and attitudes dictate resources.

Stigma is not just a matter of using the wrong word or action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness or substance use disorder. Do you know that many people would rather tell employers they committed a petty crime and served time in jail, than admit to being in a psychiatric hospital?

Stigma toward people with substance use and/or mental disorders and their families is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, avoidance and/or violence.  In its most overt form, stigma results in outright discrimination and abuse.

The stigma of mental illness and addiction is real, painful, and damaging to the lives of people living with these brain disorders. Fear of stigma, and the resulting discrimination, discourages individuals and their families from getting the treatment and support they need to lead healthy, normal lives. More tragically, stigma deprives people of their dignity and interferes with their full participation in society.

Do you know that stigma?

Leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders, especially severe disorders such as schizophrenia?
Reduces patients’ access to resources and opportunities (e.g., housing, jobs) and leads to low self-esteem, isolation, and hopelessness? 
Can Result in limited or inadequate insurance coverage for mental health services? 
Prevent some pharmaceutical companies from working to develop new treatments?
Deters the public from seeking, and wanting to pay for, necessary care? 
Discourages some doctors from treating people suffering from addiction or mental illness?

Can cause families and friends to turn their backs on people with mental illness?

The impact of stigma

  • The public’s attitudes towards people with substance use disorders effect whether a person gets help; during 2004-2007, two of the top reasons people gave for not getting help were worries about possible negative effects on one’s job and concern that receiving treatment might cause one’s neighbors and the community to have a negative opinion of them (Myths About Drug Abuse & Treatment, The Partnership for a Drug-Free America).
  • Because of public confusion and uncertainty about addiction, and the enormous stigma of the disease, only 10 percent of the people in need of alcohol and drug treatment each year get help (National Alcohol & Drug Addiction Recovery Month 2009, NCADI).
  • Despite the fact that an overwhelming majority of Americans believe that people with mental illnesses are not to blame for their conditions (85%), only about one in four (26%) agree that people are generally caring and sympathetic toward individuals with mental illnesses (HealthStyles Survey 2006).
  • Only 42 percent of Americans believe that a person with mental illness can be as successful at work as others (HealthStyles Survey 2006).
  • Only a little more than one-half (54%) of young adults who know someone with a mental illness believe that treatment can help people with mental illnesses lead normal lives (HealthStyles Survey 2006).
  • Eighty percent of people with a mental illness report overhearing hurtful or offensive comments regarding mental illness (OpenMindsOpenDoors, Mental Health Association in Pennsylvania).

Stigma and Labeling

Words can be poison.

Remember the old adage “Sticks and stones may break my bones but names will never hurt me”? Not true! When mental illnesses are used as labels-depressed, schizophrenic, manic, or hyperactive-these labels hurt.

Labels lead to stigma -- a word that means branding and shame. And stigma leads to discrimination. Everyone knows why it is wrong to discriminate against people because of their race, religion, culture, or appearance. They are less aware of how people with mental illnesses are discriminated against. Although such discrimination may not always be obvious, it exists-and it hurts.

What can you do?
You can do a lot, starting with how you act and speak. 

It's important to make a distinction between the person and the illness. Transformation in services and supports for adults, children and youth with mental health problems requires a complementary transformation in the language we use to describe the people we serve. 

Change your language.
Words shape perceptions. Quite literally, seek to employ "people first" language. Describe the person first, not the illness.  The illness is only part of who that person is.  For instance, instead of saying someone is "a schizophrenic," say he or she "has schizophrenia". Avoid using disparaging language - "lunatics," "crazies," etc. -- when referring to people with mental illnesses.

The following table provides some guidance on and examples of transformational language:
Tom has a mental health problem or challenge; Tom is a person with mental illness. Tom is mentally ill/emotionally disturbed/insane/crazy.
Rick has a diagnosis of bipolar disorder.
He experiences mood swings.
Rick is (a) bipolar.
Jess experiences symptoms of psychosis.
He hears voices.
Jess is (a) psychotic.
Susie is a person who receives help/
treatment for mental health problems. She is a consumer/ recipient of mental health services.
Susie is a patient.
Susie is a person who receives help/
treatment for mental health problems. She is a consumer/ recipient of mental health services.
Jane is disabled/handicapped.
Susie is a person who receives help/
treatment for mental health problems. She is a consumer/ recipient of mental health services.
Bonnie is normal/healthy.
Rebecca has a brain injury. Rebecca is brain injured/damaged.
Ralph has asked for accessible parking/hotel room. Ralph has asked for handicapped parking/hotel room.

Source: http://www.promoteacceptance.samhsa.gov/publications/TransformationalLanguage.aspx

Steps to end stigma

Substance use and mental disorders are very common. They are also widely misunderstood. Alcoholism, drug dependence and mental illness can happen to anybody. Arm yourself with the facts, and then use your knowledge to educate others and break down the barriers of ignorance, prejudice, or unfair discrimination.

Create an environment that builds on people's strengths and promotes respect. Reach out to those around you with mental illness and substance use disorders. Understanding and support are powerful, and they can make a real difference in the life of a person who needs them.

Here are some more steps can you take to help end the stigma which surrounds mental illness and addiction.

Do learn the facts about mental illness and substance use disorders and share them with others, especially if you hear something that isn't true.

Do insist on media accountability. Sometimes the media portray people who have brain disorders inaccurately, and this makes stereotypes harder to change.

Do speak out against outdated, outrageous, offensive portrayals or language about persons with mental illness.

Do respond to people who have a mental illness as individuals. Learn about the person and deal with him/her on the basis of your knowledge, not your assumptions.

Do recognize and appreciate the contributions to society made by people who have mental illnesses and substance use disorders.

Do treat people with the dignity and respect we all deserve. People with mental illnesses and substance use disorders may include your friends, your neighbors, and your family.

Do emphasize abilities, not limitations. Give people recovering from a mental illness what they need most: a chance.

Do use respectful and “people-first” language.

Do tell someone if they express a stigmatizing attitude.

Do bring together people in your community that are leaders - local business, faith leaders, police officers, and media - and educate them on how mental health affects them and the community.

Don't label people or define people by their diagnosis.

Don't be afraid to let others know of your mental illness or the mental illness of a loved one. As long as mental illness remains hidden, many people will believe it to be a shameful thing that needs to be concealed.

Don't use generic labels such as retarded, or the mentally ill.

Don't use words like “crazy," "wacko," or "loony".

Don't discriminate against persons with brain disorders like mental illness when it comes to housing, employment, or education. The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in all areas of public life.

Don't portray successful persons with disabilities as super human or “extra-ordinary”.

Don't make or laugh at jokes, watch movies, listen to songs or support other forms of media that inaccurately portray persons with mental illness or substance use disorders.

Don't support policies that perpetuate stigma and discrimination such as poorer health insurance coverage of mental and substance use disorders than physical illness; limited funding for research into the causes and treatments of mental illness; and inadequate budgets for mental health and substance abuse services.

Improved public awareness of the scientific realities of mental illness, addiction and recovery will erase myths and stereotypes, reduce social and legal discrimination and save lives—by encouraging people with mental health and alcohol and other drug problems to seek help early in the progression of their illness, when it is most treatable.

For this information on stigma and other general information, visit the Substance Abuse and Mental Health Services Administration at http://www.samhsa.gov/ and click on “publications” to find information and data on a variety of mental health and substance abuse topics.
The majority of the information on stigma presented here can be found in publications OEL99-0004 and SMA96-3118 under “mental health publications”.

Additional sources of information/resources on stigma:

National Alliance on Mental Illness (NAMI) StigmaBusters: NAMI StigmaBusters is a network of dedicated advocates across the country and around the world who seek to fight inaccurate and hurtful representations of mental illness. Whether these images are found in TV, film, print, or other media, StigmaBusters speak out and challenge stereotypes. They seek to educate society about the reality of mental illness and the courageous struggles faced by consumers and families every day. StigmaBusters' goal is to break Down the barriers of ignorance, prejudice, or unfair discrimination by promoting education, understanding, and respect. Visit NAMI at http://www.nami.org/ and click on “Fight Stigma”.

SAMHSA's Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center): The SAMHSA ADS Center enhances acceptance and social inclusion by ensuring that people with mental health problems can live full, productive lives within communities without fear of prejudice and discrimination. The ADS Center gathers information and research and provides technical assistance and support to counteract prejudice and discrimination associated with mental illness. Information, resources and publications on a variety of topics for a variety of audiences is available through their website at http://www.stopstigma.samhsa.gov/default.aspx

Minds on the Edge: Facing Mental Illness is a multi-platform media project that explores severe mental illness in America. The centerpiece of the project is a television program airing on PBS stations in October 2009. This video component is part of a national initiative that includes extensive web content with tools for civic engagement, active social media on Facebook and Twitter, and an ambitious strategy to engage citizens, professionals in many fields, and policy makers at all levels of government. The goal is to advance consensus about how to improve the kinds of support and treatment available for people with mental illness. Information on mental illness and science/research; mental illness and criminal justice; mental illness and the law; and new approaches to support treatment and recovery is also available through their website at http://www.mindsontheedge.org.
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