In order for the United States to succeed in reducing the stigma associated with mental illness and substance use disorders, the Department of Health & Human Services should lead the way, according to a National Academies of Sciences report.
The report said U.S. campaigns tied to HIV/AIDS and antistigma campaigns in countries such as England, Canada, and Australia show that “a coordinated and sustained effort over 2 or more decades” is needed.
“Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders,” Dr. David H. Wegman, chair of the committee that issued the report, said in a statement. Dr. Wegman is professor emeritus in the department of work environment at the University of Massachusetts in Lowell.
The report’s authors said a federal policy that culls from current, evidence-based methods already in use by many organizations – including eight federal agencies – can help change misconceptions about mental and behavioral illness (National Academies of Sciences, Engineering, and Medicine, “Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change,” Washington: The National Academies Press, 2016 [doi: 10.17226/23442]).
In addition, the report said, efforts toward integrating behavioral health and primary (and other physical) care in the country’s health care system “offer possibilities for breaking down the walls that separate physical health from mental health in treatment and in the education of health care professionals.”
Dr. Patrick W. Corrigan
“This is an important document that will rival former Surgeon General David Satcher’s report on mental health,” Patrick W. Corrigan, Psy.D., part of the panel that the National Academies convened to produce the report, said in an interview.
Up to a quarter of the U.S. population will experience mental health problems, including addiction, at some point in their lives, according to the Centers for Disease Control and Prevention. Meanwhile, a survey conducted by the National Institute on Drug Abuse showed that 17 million Americans reported alcohol dependence or misuse. However, while more than half of those who responded to a nationwide survey said that people with mental illness deserved compassion, only a quarter of those in the throes of mental disease felt they were treated compassionately.
The country’s fragmented approach to treatment, prevention, and allocation of necessary resources for mental illness stems, in part, from an overall lack of agreement on how actually to define mental illness, Dr. Wegman and his coauthors suggested. An approach by the HHS-led Substance Abuse and Mental Health Services Administration (SAMHSA) could help frame the dialogue around the many aspects of mental illness diagnosis, by including the discrete categorizations of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authors said. They also said the emerging science that indicates the role of trauma, neurobiology, cultural influences, and the dimensionality emphasized in the National Institute of Mental Health’s Research Domain Criteria (RDoC) could help toward that end.
SAMHSA’s role as envisioned by the National Academies also would include coordinating national efforts for peer training, determining the need for specific research around the relationship between attitudes and behaviors toward those with mental illness, and developing targeted messaging aimed at dispelling myths about mental illness.
Dr. Corrigan said it is important for antistigma programs to be led by people who are harmed by stigma, for example, people with mental illness and or substance use disorders. These antistigma efforts also need to “combine insights of broad-scale public health/communication campaigns with grassroots strategies that promote contact. Research is essential to move this agenda forward,” said Dr. Corrigan, Distinguished Professor of Psychology at the Illinois Institute of Technology, Chicago.
The report was written by the National Academies’ Committee on the Science of Changing Behavioral Health Social Norms; board on behavioral, cognitive, and sensory sciences; and division of behavioral and social sciences and education.
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