Commentary—

No Middle Ground On Mental Health Issues

By Donna R. Campbell,

In October many of us have focused our attention on increasing awareness of mental illness and there is even a federally declared “Mental Illness Awareness Week.”

Last year at this time I wrote an opinion article that sparked a range of thoughtful and passionate reactions after it was published by several newspapers in Connecticut. Discussions about mental illness and recovery rarely spring from any middle ground opinions.

Stigma is an offensive and disturbing fact of life for those who struggle with mental illness and addictive disorders. It is largely a fear-driven phenomenon. Few popular misconceptions are as difficult to change and as harmful as the belief that those with mental illness are unpredictable and dangerous. The fact is that only a very small percentage of mental health patients commit serious crimes, and mental illness accounts for a very small portion of general violence in the community.

The custodial, institution-based model of care for those with mental illness that was in place for centuries was both the cause and effect of stigma. Moving people to state hospitals dislocated them from their communities, family, and friends until personal identities were lost. The exclusion of psychiatry from mainstream medicine resulted from the conviction that most mental health conditions were incurable. Thus both patient and caregiver were seen as hopeless and valueless.

One of my first jobs was as a social worker assigned to a group of men who had spent most of their adult lives warehoused in a state hospital. I thought I was there to help them get better. The hospital told me my job was “deinstitutionalization” — jargon for forced discharge. This was in the 70s and there were virtually no community services available. The choices were retirement homes, “flophouses,” and the street. I saw my patients leave, get robbed or beaten, verbally abused, and turned away from jobs and shelters. I saw them stop taking medications and return to the hospital sicker and further damaged. Not one of them ever hurt anyone else.

We’ve done better since then, but it isn’t close to enough. Mental Illness Awareness Week is intended to open up the issues, to provide opportunities to talk candidly about discrimination and prejudice, to have those difficult conversations most people like to avoid.

I’ve learned a lot from my work over the past 30 years and I continue to gain insight into the complexities of how we treat our mentally ill. I am now certain of one thing: knowledge by itself will not erase stigma and prejudice.

The concerns about mental illness, both real and symbolic, need to be removed. We need to continue to develop more and better public and consumer education, and consistent, accessible, quality consumer-driven treatment. We need to make real investments in community services, rehab programs, legal, housing, and basic needs supports. Those of us involved in service planning must combine our science with honesty and sensitivity.

It is an unpleasant truth that people who are discriminated against too often turn on each other, rather than recognizing that there is a shared and real challenge beyond them. Our job is to make the world a safer and fairer place for people with a mental health disorder and to help them toward mutual recovery.

(Donna R. Campbell is a licensed clinical social worker and is president and CEO of the Northwest Center for Family Service & Mental Health in Lakeville.)