Initiative aims to ease stigma of mental illness

Jen graduated with honors from Boston University. Her accomplishment was especially noteworthy because several years earlier she almost didn't graduate from high school because of a battle with major depression.

Hers is just one of many stories incorporated into a new campaign of the Substance Abuse and Mental Health Services Administration, designed to undercut the stigma of mental illness.

There are other stories: Dawn, a social worker with a history of drug and alcohol abuse who has been sober for five years; and Jeffery, a Vietnam veteran who started hearing voices when he was 13 and has tried to kill himself nine times.

"Recovery is possible, and there is no shame in having a brain disease," Jeffrey wrote.

His statement sums up SAMHSA's message, and the agency plans to communicate it through its Elimination of Barriers Initiative. This initiative follows on the heels of the National Institute of Mental Health's Real Men, Real Depression campaign.

SAMHSA officials hope the project will make mental illness seem more like something that afflicts a neighbor rather than the unwashed stranger walking down the street.

The central points are that mental illness is common; treatment is available; and recovery is expected. The agency has committed $1.7 million annually for the next three years to underwrite paid advertising, health fairs and music festivals as well as the establishment of speakers' bureaus in eight states. After the pilot testing, what works will be taken nationally.

"We're focusing on using first-person experiences, but this is not just a media campaign," said Paolo Delvechio, SAMHSA's associate director for consumer affairs. "We're also focusing this effort on increasing contact with those who have mental illness. We do know the most effective way of countering stigma and discrimination is interpersonal contact."

Mental health advocates widely praised the efforts for addressing what most consider to be a key obstacle to care.

"This is right on target for what our field needs," said Kathy Hogan Bruen, PhD, senior director of prevention for the National Mental Health Assn. "Stigma probably is the biggest barrier that really needs to be overcome for people to get the treatment that they need."

Experts point out, though, that stigma is not the only barrier and expressed concern that this campaign may mean more people asking for help but many still unable to get it.

"Public service announcements are great, but they don't connect a person to care," said Michael S. Klinkman, MD, director of primary care programs for the University of Michigan Depression Center in Ann Arbor. "And if people do come into a practice to talk about this issue, they might be running into the barriers of not enough time; clinicians who don't have the skills to deal with this; and clinicians who don't see this as part of their basket of services."

SAMHSA hopes that the result of reducing stigma among the general population will not only lead to more people coming forward for care but also policies that will improve access.

"That's a secondary goal," said Delvechio. "By increasing awareness and understanding, that will increase attention to mental health issues that are too often overlooked."

Campaigns like this and the increasing attention to mental health may be starting to have a policy impact, at least in the area of addiction. In February, Rep. Jim Ramstad (R, Minn.) created a caucus in Congress to address addiction issues.

"There's specific stigma around addiction that's possibly even harsher," said Michael M. Miller, MD, medical director of the NewStart Alcohol/Treatment Program at Meriter Hospital, Madison, Wis.