How to Reduce Mental Health Stigma

Emma McGinty, PhD, MS

The 2020 American Psychiatric Association (APA) Annual Meeting was cancelled this year, with plans made to convert the world-leading psychiatry conference into a two-part virtual session and educational platform for attendees.

In lieu of regular on-site coverage, HCPLive® will be running a series of interviews, insights, and reporting on topics that frequently headline the APA meeting—featuring familiar experts.

Campaigns to reduce mental health stigma are great and varied, but some well-intentioned programs have actually been poor in execution.

It helps to know cognizant clinicians are monitoring the outcomes of public health platforms, in order to shape stronger guidance around an increasingly prevalent issue in mental healthcare.

In the second part of an interview with HCPLive, Emma McGinty, PhD, MS, of Johns Hopkins University Bloomberg School of Public Health, discussed lessons learned from the “Disease Like Any Other” campaign, clinical measures to reduce stigma, and how coronavirus 2019 (COVID-19) has affected mental healthcare.

HCPLive: You mention in your piece the pitfalls of the "Disease Like Any Other" campaign and its harm to understanding mental illness as a public health issue. Could you elaborate on that point?

McGinty: The point we raised about this in the paper is that this is a classic example of a well-intentioned messaging campaign that wasn't really evaluated before it was rolled out, in terms of the effectiveness of the messaging. It sort of makes sense conceptually, right? I can imagine myself sitting in the conference room where they're brainstorming anti-stigma messages and saying, "Oh, yeah, 'Disease Like Any Other,' that makes sense, right?"

But unfortunately, what we learned after the whole campaign had been rolled out nationwide and millions of dollars have been spent on it, was that not only did it not decrease stigma towards people with mental illnesses, in some measured it increased stigmas.

And the research suggests the reason for that is that the message increased the idea of that mental illness is permanent. It's a disease. It's something that you have forever—increased feelings of hopelessness, potentially—as opposed to a frame of this is being a temporary setback that that can be addressed. And so, this messaging has also popped off in the context of addiction—because healthcare professionals and public health professionals like myself, we think of it in this disease frame, and to us, that's very compelling.

It's very tempting to message that out to the public: it's not a moral failing, it's a disease. But unfortunately, the research on the Disease Like Any Other campaign suggests that there's potentially unintended consequences with that disease-focused messaging.

HCPLive: What are the stigma-reducing efforts that are effective and proven, that can be exercised at both the public and healthcare level?

McGinty: We highlight four of these potential solutions in a piece. The first is very low hanging fruit, which is to use person-centered language. I say that it's the simplest, but it's also really hard to do because some of the problematic language out there—like "substance abuser," or "addict" is sort of ingrained in our vocabulary. But there's very strong experimental research showing that something as simple as using a person-centered term—so "person with a substance use disorder," instead of "addict," reduces stigmatizing attitudes.

It seems too good to be true. Like I said, it can be hard to do in practice, but there's very strong research supporting that person-centered language element.

The other strategies that we talked about are emphasizing solutions to addiction, emphasizing that there is very effective, life-saving treatment to combat that idea of hopelessness, that we just talked about in the context of the disease framing.

And we've talked a bit about the other two potential ways to combat stigma already: through sympathetic narratives, people telling their own story in a way that is compelling to the other people in their lives. And then emphasizing the societal causes of addiction, rather than the individual.

HCPLive: Could fill us in on what are some of the hurdles or struggles that we see in continuing or initiating care and addiction patients during the COVID-19 pandemic?

McGinty: There's a lot of concern in the field about disruptions to medication and treatment for opioid use disorder, and other types of treatments for other types of drug addiction. But the medication treatment for opioid use disorder is particularly salient, in that if people aren't able to access their medications, that greatly increases the chance that they're going to go back to using opioids and increase the risk of overdose. So, there's a lot of concern.

Unfortunately, at this point, we don't have great empirical evidence on what's happening. It's mostly anecdotal. But I will tie those concerns back to this piece around stigma: I think stigma puts people with addiction at a huge disadvantage in a disaster context, where healthcare and public health systems are facing provider shortages and budget shortfalls, and they're having to prioritize which services to keep delivering and which populations to serve.

And by the virtue of the fact that people with addiction are so stigmatized, they're not typically at the top of that list.