STIGMA: Keeping Mental Health Problems on the QT

When I used to practice therapy in an outpatient psychiatric unit of an inner city hospital I co-managed patients with a psychiatrist who would further evaluate and medicate clients as needed. Most of my clients were very distressed when the physician side of the team recommended an antidepressant, anti-anxiolytic, or other medication in conjunction with talk therapy. I would have the same conversation with different patients every time:

ME: If you had diabetes would you feel embarrassed about taking insulin?
CLIENT: No.
ME: Well think of (fill in disorder here) as if it were diabetes. Both conditions have biologic origins that can be helped by medication.

Despite my best attempts, this conversation made very few patients feel better about their diagnosis or its treatment.

It's been over 10 years since I first entered the mental health field, and I'm amazed that little has changed when it comes to the stigma associated with mental health problems, despite the educational campaigns of the federal government and NAMI. This is especially true in rural areas and smaller communities where mental health professionals are scarce and residents so tight knit that folks are afraid if someone sees their car parked in front of the mental health clinic, everyone will know they have a mental health problem before day's end. Unfortunately, this means that rather than seek proper treatment for mental health problems, people self-medicate through the use of alcohol and drugs.

My colleague and I recently published a paper in the Journal of Affective Disorders looking at the percentage of folks who have both a mental (e.g., depression, anxiety, bipolar) and substance use (drug and alcohol abuse and dependence) disorder. While we found no differences between rural and urban folks in terms of the prevalence rates of these disorders, we did find that rural residents were less likely to seek treatment for their disorders than urban folks. We wondered: Is anonymity the key to seeking mental health treatment?

This may be why there is a burgeoning of online communities for folks with mental health problems. This is great in the sense that folks can readily access information and "talk" to people with similar disorders. However, I wonder how stigma is perpetuated by communities who don't share experiences face-to-face. Are we encouraging people with mental health problems to seek support behind a screen name?

Overweight = Undereducated

A researcher at the University of Texas has discovered that obese girls in America are half as likely to attend college as non-obese girls. This finding is particularly disturbing when you live and work in a state with the fifth highest adult obesity rate in the nation (25.6%) and the third highest rate of overweight high school students (14.6%) that ranks 45th in the percent of adults over age 25 with a bachelor's degree or higher (21.3% compared to 27.2% nationwide). As a health researcher, a citizen of the Commonwealth, and a woman, I worry and wonder - what are we going to do to promote the health and well-being of Kentucky's young women?

Obviously, there isn't a simple solution to the problems of obesity or low educational attainment. However, it is becoming increasingly obvious that schools are one venue for addressing these two critical issues facing the Commonwealth - perhaps even in an integrated fashion. If you saw the movie Akeelah and the Bee, you'll recall her jump rope spelling practice. Innovation such as integrated curriculum is key when working to tackle important issues.

Some of Kentucky's state senators and representatives agree. In the most recent general session, these lawmakers proposed legislation that would bring back physical education into the school day for grades pre-K through 8, including making physical activity a component of the three R's, a la' Akeelah. That sounds a lot better to me than how I received my physical education - running through the hills behind my elementary school with my 40-something fifth grade teacher cattle-prodding me (and the two other students bringing up the rear) to hurry along. Although this bill never made it to the Governor's desk in 2007, the good news is that Kentucky's legislature meets annually. So I'm holding out hope for 2008, especially in light of this recent research. Kentucky's girls deserve better, and I'm confident we can provide it for them.