New report calls for effort to reduce negative attitudes toward people with disorders
The U.S. Department of Health and Human Services (HHS) should lead efforts among federal partners and stakeholders to design, implement, and evaluate a multipronged, evidence-based national strategy to reduce stigma toward people with mental and substance use disorders, says a new report from the National Academies of Sciences, Engineering, and Medicine. Many private and public organizations in the U.S.—including eight federal agencies—are already engaged in anti-stigma and mental health promotion efforts, but these efforts are largely uncoordinated and poorly evaluated.
The committee that conducted the study and wrote the report looked at the results of U.S. campaigns related to HIV/AIDS and at anti-stigma campaigns in England (Time to Change), Canada (Opening Minds), and Australia (beyondblue). It found that all successful national anti-stigma programs were supported by government at the federal level and took place over decades, relied on long-term funding, were evaluated and monitored on an ongoing basis, and had a multifaceted strategy to address the full range of relevant needs.
"Mental health and substance use disorders are prevalent and among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment," said committee chair David Wegman, professor emeritus in the department of work environment at the University of Massachusetts in Lowell. "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."
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs at some point. In a 2014 national survey, 14 percent of adults in the U.S. said they had experienced a mental health problem within the past year, and 4 percent said that they had experienced a serious mental illness—one that met standard diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders. In another U.S. survey, 24 million people aged 12 and older (9.4 percent of the population) said they had used illicit drugs in the past month, and 17 million people reported alcohol dependence or misuse.
Norms and beliefs about people with behavioral health and substance use disorders are created and reinforced at multiple levels, including day-to-day contact with affected individuals, employers and other organizational policies and practices, community norms, the media, and governmental law and policy. HHS should collaborate with all stakeholders, particularly the criminal justice system and government and state agencies, to identify and eliminate policies, practices, and procedures that directly or indirectly discriminate against people with mental and substance use disorders.
For the national strategy led by HHS, the relevant stakeholders include people in treatment for mental and substance use disorders and their families, insurance companies, employers, health care providers and administrators, law enforcement officials, and professional health education institutions. A multipronged approach should include educational programs, traditional and social media campaigns, legal and policy interventions, and contact based-programs—those efforts that facilitate social contact between people with and without behavioral disorders and that have the strongest evidence base for reducing stigma.
The report also includes recommendations for future research by the Substance Abuse and Mental Health Services Administration (SAMHSA) on the characteristics of effective peer service training programs, the relationship between attitudes and actual behavior toward people with mental and substance use disorders, and formative research on effective communication to assist in developing interventions and tailoring them for target audiences.
The committee noted that "stigma" is used in peer-reviewed literature and by the general public to refer to a range of negative attitudes, beliefs, and behaviors about mental and substance use disorders. SAMHSA is moving away from the use of this term.