Which Would Help More: Fighting Mental Health Stigma or Political Advocacy?

Lately, I’ve noticed a trend in mental health circles. It’s a question of philosophy on some levels. What should we, as people concerned about mental health, mental illness and society, be doing with our time and energy?

The two choices boil down to fighting stigma and political advocacy. They each have their motivation and their adherents.

The stigma fighters (including the organization Stigma Fighters) maintain that the way to make things better for the mentally ill is to erase the stigma that surrounds mental illness (particularly “serious mental illness,” or SMI). And there’s no doubt that there is stigma. The mentally ill are feared and blamed for violence in society. They do not get jobs — or they lose jobs — because of their conditions. They hesitate to enter treatment for fear that friends or family will find out.

While mental illness is often no longer the “secret family shame” that led to family members being “put away quietly,” kept locked in the attic and never mentioned, many families do still find that mental illness — in themselves or their loved ones – is something to hide. Something not to discuss in polite company. Something to ignore the existence of.

People who fight stigma usually do so with information and education. Celebrities — even the British royal family — speak openly about conditions such as bipolar disorder, depression, anxiety, eating disorders, obsessive-compulsive disorder (OCD) and other of the more common diagnoses. You undoubtedly have heard the PSAs on television that explain that mental health is important and that seeking treatment is not something to be ashamed of.

Are the stigma fighters making a dent in the stigma? It’s hard to say. At least they seem to have opened a conversation about mental health, mental illness, treatments including medications, mental illness among men, suicide and other problems we face.

Still, the political advocates say, all that stigma fighting has done nothing to increase the number of psychiatric beds available or the number of psychologists caring for rural populations, the homeless, or people with schizophrenia and other illnesses including psychoses that are foreign to most people’s experience. What we need are people who will bring up these and other issues with legislators and influencers at the local, state and national levels; who will present proposals that may do some good in increasing access and funding; and who will advocate for improvements such as training for first responders in how to address mental health concerns.

And it’s true. All these things — and more — are needed. We may debate the wisdom of involuntary commitment or compulsory medication, but they are certainly topics that need to be explored if a consensus is ever to be reached. Most people in the mental health community admit that the system is broken and needs to be fixed – or possibly rethought from the ground up.

Where do I stand on this debate? I feel that one or the other is not enough. It’s not an either/or situation. It seems to me that unless there is some real progress made in fighting stigma, the voting public and the legislators will not understand the realities of mental illness, the need for change and what needs to be done to fix the system. Unless we engage in spreading information and changing people’s minds about what being mentally ill means, support for policy changes will be thin on the ground. And unless we come up with some solutions that people understand and support, nothing will change.

I work mostly in the stigma-fighting camp. I don’t have the political acumen, contacts and energy that real activism takes. I know it is vitally important, but it is not something I can do very much or very well.

What I can do, through my blogs and my books, is help with the information and education, spreading the word about mental health and mental illness, and helping alleviate the stigma that accompanies them. I also intend to start looking for opportunities in my writing to comment on the larger societal issues and proposed solutions and help with education about them as well.

To solve the problems surrounding mental illness, we must all do what we can, and what we do best.