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Part One in an NPR Ed series on mental health in schools.
You might call it a silent epidemic.

Up to one in five kids living in the U.S. shows signs or symptoms of a mental health disorder in a given year.

So in a school classroom of 25 students, five of them may be struggling with the same issues many adults deal with: depression, anxiety, substance abuse.

And yet most children - nearly 80 percent - who need mental health services won't get them.

Whether treated or not, the children do go to school. And the problems they face can tie into major problems found in schools: chronic absence, low achievement, disruptive behavior and dropping out.

Experts say schools could play a role in identifying students with problems and helping them succeed. Yet it's a role many schools are not prepared for.

Educators face the simple fact that, often because of a lack of resources, there just aren't enough people to tackle the job. And the ones who are working on it are often drowning in huge caseloads. Kids in need can fall through the cracks.
"No one ever asked me"
Katie is one of those kids.

She's 18 now. Back when she was 8, she had to transfer to a different school in Prince George's County, Md., in the middle of the year.

"At recess, I didn't have friends to play with," she recalls. "I would make an excuse to stay inside with the teachers and finish extra work or do extra credit."

We're not using Katie's last name to protect her privacy. She's been diagnosed with bulimia and depression.

She says that in the span of a few months, she went from honor roll to failing. She put on weight; other kids called her "fat." She began cutting herself with a razor every day. And she missed a ton of school.

"I felt like every single day was a bad day," she says. "I felt like nobody wanted to help me."

Katie says teachers acted like she didn't care about her schoolwork. "I was so invisible to them."

Every year of high school, she says, was "horrible." She told her therapist she wanted to die and was admitted into the hospital.

During all this time, she says, not a single principal or teacher or counselor ever asked her one simple question: "What's wrong?"

If someone had asked, she says, she would have told them.
Who should have asked?
We talked to educators, advocates, teachers and parents across the country. Here's what they say a comprehensive approach to mental health and education would look like.
The family
The role: The first place to spot trouble is in the home, whether that trouble is substance abuse, slipping grades or a child who sleeps too much. Adults at home - parents, siblings, other relatives - are often the first to notice something going on.

The reality: Many families do not know what to look for. Sometimes a serious problem can be overlooked as "just a phase." But it's those sudden changes - angry outbursts, declining grades, changes in sleeping or eating - that can signal problems. When something unusual crops up, families can keep in close touch with the school.
The teacher
The role: During the week, many students see their teachers even more than their own families. Teachers are in a prime spot to notice changes in behavior. They read essays, see how students relate with other kids and notice when they aren't paying attention.

The reality: Teachers already have a ton on their plates. They're pressured to get test scores up, on top of preparing lessons and grading assignments. Plus, many teachers receive minimal training in mental health issues. But when they do see something concerning, they can raise a flag.
The social worker
The role: Social workers act like a bridge. If teachers come to them with a concern - maybe a child is acting withdrawn - one of the first things they'll do is call home. They see each child through the lens of their family, school and community. They might learn that a family is going through a divorce or homelessness.

The reality: There aren't enough of them. According to one model, every school should have one social worker for every 250 students. The reality is that in some schools, social workers are responsible for many more.
The counselor
The role: In some schools, counselors focus solely on academics: helping students pick classes and apply to college. But in others, they also act a lot like social workers, serving as a link to families and working with students who need support.

The reality: Like school social workers, there just aren't enough counselors. On average nationwide, each counselor is responsible for nearly 500 students. The American School Counselor Association recommends a caseload nearly half that size.
The special education teacher
The Role: Special education teachers may start working with students when a mental health problem affects the ability to do school work. They are primarily responsible for working on academic skills.

The reality: Again, there aren't enough of them. Nearly every state has reported a shortage of special education teachers. Half of all school districts say they have trouble recruiting highly qualified candidates.
The school psychologist
The Role: Here's one job that, on paper, is truly dedicated to student mental health. School psychologists are key players when it comes to crisis intervention and can refer students to outside help, such as a psychiatrist.

The reality: If you sense a pattern here, you're right. In the U.S., there is just one school psychologist for every 1,400 students, according to the most recent data available from the National Association of School Psychologists.
The school nurse
The role: Most any school nurse will tell you, physical and mental health are tough to separate. That puts nurses in a prime spot to catch problems early. For example: A kid who comes into the nurse's office a lot, complaining of headaches or stomach problems? That could be a sign of anxiety, a strategy to avoid a bully, or a sign of troubles at home.

The reality: The U.S. Department of Health and Human Services recommends at least one nurse for every 750 students, but the actual ratio across the country can be much higher.
The principal
The role: As the top dogs in schools, principals make the big decisions about priorities. They can bring in social-emotional, anti-bullying and suicide-prevention programs.

The reality: Principals also have a lot on their plates: the day-to-day management of student behavior, school culture and teacher support.
Getting help, and "excited for life"
Katie says things started to turn around for her when she met a nurse at the Children's National Health System in Washington, D.C., who finally showed interest in what was wrong.

Now, she's begun college and wants to be a pediatric nurse.

"I'm doing a lot better now" she says. " Obviously, I mean, I'm a lot happier. I'm excited for school. I'm excited to graduate. I'm excited for life."

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Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students

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An estimated 20 percent of children show signs or symptoms of a mental health problem. It's a destructive force in schools, but most educators don't have the training or resources to help.

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We've all been there. On the brink of an emotional breakdown, (maybe even in the middle of one) concerned about school, extracurriculars, college, what the heck we're going to be and in the future. Every negative emotion you know bottled up and boiling, and feeling as if it's only a moment before you spontaneously combust. You lash out at friends and family, can't focus on school work, or maybe even completely disengage from it all. do

But the question we must ask ourselves is: how did we get here? And more importantly: what the hell do we do now?

Mental health is something that is rarely talked about within schools (whether that be elementary, middle, high school, or beyond) and yet it is something that is guaranteed to affect everybody's life in one way or another.

We've all gotten sick before right? Sprained an ankle, maybe even broken a bone? And we all know that if we're hurt, that we should go and see a doctor, fix what needs to be fixed, and move on with our lives. But for some odd reason, we don't view our mental health in the same light. We will all struggle with our mental health, yet will rarely -if ever- do anything about it. And as of right now, our schools do not help very much in getting the help or education we need.

Don't get me wrong, our health classes do brush up on the definitions of some things; depression, anxiety, maybe even eating disorders if you're lucky. Other than that though, mental illnesses are viewed as these scary, faraway things that will never truly affect us. A topic too taboo to discuss with the youngsters. Something that means, if we do happen to be that the one in a billion instance of being affected, that we can basically kiss the rest of our life goodbye.

Have I got some news for you, buckaroo.

The statistics surrounding mental illnesses are -to put it lightly- incredibly jarring. One in five of every youth aged 13 to 18 have, or will have, a serious mental illness. Around 8.6% of all of the youth in America have severe depression, however a staggering 76% of those affected -that's around 1.6 million kids- have received inadequate, or simply zero treatment for it at all.

Nearly 50% of adults with chronic mental illnesses developed diagnosable symptoms by the age of 14. Suicide is the third leading cause of death in youth ages 10 to 24, with 90% of those who have died due to suicide having had an underlying mental illness. I could keep going, but these facts barely even graze the tip of the iceberg in regards to mental health and it's affect on our society, especially our youth, today. Yet, the discussion around mental health is still incredibly lacking (if it's even there to begin with).

Based on my own personal experience, I think that the stigmatization of these topics has made it near impossible for students to realize the overbearing presence of mental health struggles amongst our age demographic. Our society has consistently romanticized and ridiculed the topic, to the point where the only mention of mental illnesses are when they're used as a descriptor, derogatory term, joke, or some crude combination of all three. I mean, how many of us have heard -or even said- phrases along the lines of "I'm, like, super OCD" or "ugh, she is so bipolar" or "I wish I was anorexic."

Films and other media have romanticized many of these illnesses to be seen as desirable or "quirky" personality traits. We don't even realize that it's happening, however, mental illnesses are constantly being framed in a wonky light, therefore further subconsciously perpetuating our negative association with it's presence. And unfortunately, this stigma surrounding mental health is only growing.

So what do we do now? How do we get rid of something that is so deeply ingrained within our society?

That's where schools come in.

Ah yes school, the dreaded center of knowledge and (let's be more realistic here) stress. But, there is a power schools have that we often ignore. Schools are the epicenters of education (well, ) and are one of the few places where we get to learn about issues that are prevalent, (normally) in the hopes that one day, currently may be the ones to solve them.

The first step towards solving a problem is recognizing it's a problem in the first place. And somehow, even with its heavy impact and undeniable looming presence in our day-to-day lives, the topic of mental health has been completely avoided by our education system. Now, this is not our schools fault, but I'd be lying if I said that we couldn't do completely more in emphasizing the importance of mental health education and awareness within our schools. Starting off by acknowledging theses issues from the get-go. way

One of the biggest problems I faced while struggling with my own mental health, was simply having no idea where to go or what to do about it. I felt ashamed of my actions, I felt hatred towards myself, and I felt as if all of my struggles were somehow "invalid" and didn't or need "treatment." Having discussed this with many mental health advocates, it seems as though these are recurring feelings amongst nearly everyone who has ever had to reach out for help in regards to their mental health. And every single one of those people would all tell you the same thing: that treatment is not only helpful, but absolutely, positively, matter in order to get better. necessary

Nearly 20% of youth aged 13 to 18 have a diagnosable mental illnesses, yet our schools barely educate us on what these mental illnesses are. We need to have education on these issues starting from elementary and middle school -where these issues first start arising. We need resources at the ready, with mental health information known just as well as we know the quadratic formula.

One of the hardest parts of learning about your mental health is learning to take care of it, but if that's something we learn as part of our general education, that problem can be completely erased.

In response to this lack of education, and (honestly) out of sheer curiosity, I decided to hold a poll on my Instagram. In this poll, I asked six questions in relation to mental health and mental illness education within schools, and asked people to respond to them with a yes or no answer. The results of the poll can be found at the end of this article, but there were two questions in particular whose results, I think, perfectly sum up how mental health education is handled within our schools today.

In my first question, I asked whether people thought that mental health should be discussed more in schools. Ninety-four percent of them answered yes. Next, I asked whether their schools taught about mental illnesses and/or mental health and how to deal with them. Seventy-three percent of them answered no.

Can you see the issue here? It's not the fact that kids don't want to learn about these issues. In fact, it can be seen that they'd prefer it if they did. But when more than 70% of them aren't provided with any information on these topics in the first place, how will they ever be able to acknowledge, and even further, solve the issues regarding them?

One of the main reasons that mental health and illness awareness is so stigmatized can be traced back to that fact that we aren't educated on what these things are in the first place. We aren't aware of the fact that will struggle with their mental health, regardless of whether they have a mental illness or not. We aren't aware of the fact that even if we don't have a mental illness ourselves, we are guaranteed to know someone who does, based purely off of statistics. everyone We aren't aware of the fact that our mental health is identical to our physical health, in that, if we don't take care of it, it slowly deteriorate. We aren't aware of the staggering statistics about mental illnesses and how they affect our society. We aren't given the tools to know what common mental health struggles are or how to take care of them. We aren't given the resources necessary to properly seek additional help if we need it. will

Coming from someone who struggled with bulimia from when she was 12 until I was 15, who didn't understand the extent of danger she was putting herself in everyday she didn't get help, who felt alone, who didn't know that recovery was possible -let alone even a thing , who has watched her some of her closest friends nearly lose their lives to suicide, who talked to nearly hundreds of other students before she realized just how relevant this issue is: we need proper mental health education within our schools.

Not just for that every 1 in 5 statistic, not just for all of the too-young lives lost to suicide, not just for the millions of kids who have to struggle in silence everyday, but for everybody.

Because mental illness is what it's been portrayed as in our media. Because our mental health is something we should brush under the rug. Because 1.6 million children should not have to suffer with a diagnosable medical issue without treatment because it isn't seen as what it is: a medical issue. Because, yes, some diseases are chronic, but all of them can be made livable with proper treatment. And most importantly because we are not, and should never be, alone in these struggles.

Without a proper education on these topics, we will never be able to move forward in eliminating the stigma around them. There are so many other aspects in regards to mental health's presence in our society today, but we need to start . Without resources initially being provided to our youth, these jarring numbers will only continue to rise as we grow older.

So, let's get this conversation going. Start to talk about these issues more. Reach out to your schools about providing resources and raising awareness. Do not ignore your mental health. Try to be more aware of the people surrounding you and how they may be struggling as well, I can guarantee you'll be shocked at the sheer amount of people who are affected; whether directly or indirectly.

Because if there is one thing I can tell you with the utmost confidence, it's that you deserve to live your life to the fullest. That your struggles are valid and should be treated as such. That we can be the force to change the course of how mental health is viewed and treated within our daily lives.

We are the future. Let's make sure that we do everything in our power to ensure that we're a progressive, aware, supportive, and healthy one.

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Instagram Poll:
I asked six yes or no questions in regards to mental health & illness awareness, these are the results:

Question 1: Do you think mental health should be discussed more in school and/or daily life in general?

Question 2: Have you ever struggles with your own mental health?

Question 3: Do you know someone who has struggled with their mental health and/or has had a mental illness?

Question 4: Do you ever feel like you have to ignore your mental health struggles (whether it be due to to school, gender roles, familial, societal, or any other reasons)?

Question 5: Does your school teach you about mental illnesses and/or mental health and how to deal with one or both of them?

Question 6: If yes to the last question, does your school provide accommodations, resources, and/or help for those who may struggles with mental health issues?

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Sources for Statistics:
https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

Mental Health America- Facts, Stats, and Data
http://www.mentalhealthamerica.net/issues/state-mental-health-america http://www.mentalhealthamerica.net/issues/mental-health-america-youth-data

US Department of Health and Human Services- Mental Health Myths and Facts:
https://www.mentalhealth.gov/basics/myths-facts/index.html

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Opinion: Why we need to talk about mental health in schools

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We've all been there. On the brink of an emotional breakdown, (maybe even in the middle of one) concerned about school, extracurriculars, college, what the heck we're going to be and do in the future. Every negative emotion you know bottled up and boiling, and feeling as if it's only a moment before you spontaneously...

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A recent Duke University study involving more than 10,000 American teenagers revealed that more than half of adolescents with psychiatric disorders go untreated. For those who do receive treatment, schools are the most likely source. That's good and bad news. While schools play a vitally important role, budget cuts - and misplaced priorities - have been undermining their ability to provide these services.

"It's still the case in this country that people don't take psychiatric conditions as seriously as they should," said Jane Costello, associate director of the Duke Center for Child and Family Policy. "This, despite the fact that these conditions are linked to a whole host of other problems."

U.S. schools have by default become the mental health system for the nation's children, a role that was magnified in the wake of the December 2012 shooting at Sandy Hook Elementary in Newtown, CT. Trained and licensed counselors, however, are not the regular presence at schools they used to be. Mental health professionals are rotated among schools, if available at all.

The National Education Association supports a comprehensive approach to making schools safer that includes addressing mental-health needs. "We must dramatically expand our investment in mental health services," says NEA President Dennis Van Roekel. "Proper diagnosis can and often starts in our schools, yet we continue to cut funding for school counselors, school social workers, and school psychologists."

After Sandy Hook, national interest in improving student mental health services spiked and was a key element of the Obama administration's comprehensive plan to reduce school violence. The president's proposal included $150 million for school-based resource officers and mental-health professionals, $50 million for training new social workers, and $15 million in new funding to train teachers in "mental-health first aid." Congress has yet to approve funding for these initiatives and the issue was quickly overshadowed by the bruising legislative battle over gun control.

Even though the White House has continued to spotlight the issue, (Last week Vice-President Joe Biden announced that the administration is promising $100 million to improve mental health services), federal action on mental health has stagnated.
"We Tend to be a Reactive Country"
Many schools responded swiftly to the Sandy Hook tragedy by bolstering school security on a number of fronts - from a greater police presence to more sophisticated surveillance technology to even bulletproof whiteboards. What has been missing in most communities has been a commitment to preventive measures that could actually address the behavior that could metastasize into violent action.

Responding to a slew of new enforcement-based policies in New York schools, Amanda Nickerson, an expert on school crisis prevention and intervention at the University at Buffalo, said school districts have an obligation to take a more expansive view of what improves school safety.

"I'm always astounded as we are cutting mental health staff and social workers and school psychologists and others, and then we're going to spend money on hard-wired security," Nickerson told The Buffalo News. "I'm not saying that those things aren't important, but at the end of the day, if we look at the thwarted school shootings, that's almost always that somebody identified that there was a threat that was made, and they got the help that was needed."

"We tend to be a reactive country," says Dr. Sharon H. Stephan, co-director of the Center for School Mental Health at the University of Maryland. "So a lot of these measures reflect that. Clearly, we need a system of supports in our schools and communities that stress prevention."

Stephan is seeing encouraging signs at the state level. "The importance of mental health is obviously a much more bipartisan issue than gun control. There's more cooperation between political parties, despite the struggle over budgets. I would say that the movement is quite promising."
Schools Can't Do it Alone
According to the 2013 State Legislation Report issued by the National Alliance on Mental Illness, an improved economy allowed state legislatures to at least begin rebuilding mental health budgets that were decimated by the recession. Several states passed laws legislation aimed at ensuring adequate access to care, and improving early intervention, school-based services and staff training.

Stephan says the most effective programs create partnerships between schools and community organizations that can facilitate connections and provide a continuum of preventative care services. Resources and expertise are pooled, making it easier to recognize when someone is troubled and requires help.

Schools are a critical part of this equation, Stephan explains, because they provide a less-threatening environment for the student and there's a level of trust between staff and families that doesn't necessarily exist with other providers.

"We've seen that teenagers will not seek out the help they need without the school playing a key role in the process. They're engaged in the school at some level, and when they're engaged they can get better."

"But, overall, helping students access treatment is a shared responsibility in every community. Schools can't do it alone."

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Is Mental Health the Next Focus of the School Safety Debate? - NEA Today

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A recent Duke University study involving more than 10,000 American teenagers revealed that more than half of adolescents with psychiatric disorders go untreated. For those who do receive treatment, schools are the most likely source. That's good and bad news.

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Providing information about mental health in schools through seminars, workshops, and guest speakers will inform not only the teachers but the students about the growing issue that affects almost 1/5 of adolescents today. Not only could this lead to the health and security of the students at said school, it will lessen the rate of drug abuse and high school drop outs.

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-1/5 students show symptoms of mental health disorders in a year
-nearly 80% of children who need mental health services won't get them
-"Around 8.6% of all of the youth in America have severe depression, however a staggering 76% of those affected –that’s around 1.6 million kids– have received inadequate, or simply zero treatment for it at all."
-"Suicide is the third leading cause of death in youth ages 10 to 24, with 90% of those who have died due to suicide having had an underlying mental illness."
-"Much work yet needs to be done to fully understand the breadth and scope of prejudice against people with mental illness."

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-whether treated or not, children still go to school and what they face there can cause low achievement and even lead to dropping out
-"Nearly 20% of youth aged 13 to 18 have a diagnosable mental illnesses, yet our schools barely educate us on what these mental illnesses are"
-nearly 94% of students said they wished mental health was discussed in their schools, but when asked if their schools taught about mental health, 73% said no.
-"Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness."

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-school funds= counselors and other workshops that counsel and teach students and teachers about mental health are costly
-participation= depending on the school, students and teachers might not be willing to participate in the workshops or might not have open minds when guest speakers talk about mental health

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Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people. Although research has gone far to understand the impact of the disease, it has only recently begun to explain stigma in mental illness. Much work yet needs to be done to fully understand the breadth and scope of prejudice against people with mental illness. Fortunately, social psychologists and sociologists have been studying phenomena related to stigma in other minority groups for several decades. In this paper, we integrate research specific to mental illness stigma with the more general body of research on stereotypes and prejudice to provide a brief overview of issues in the area.

The impact of stigma is twofold, as outlined in Table ​Table1. 1 . Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. Both public and self-stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination. Social psychologists view stereotypes as especially efficient, social knowledge structures that are learned by most members of a social group ( 1- 3). Stereotypes are considered "social" because they represent collectively agreed upon notions of groups of persons. They are "efficient" because people can quickly generate impressions and expectations of individuals who belong to a stereotyped group ( 4).

PUBLIC STIGMA

Stigmas about mental illness seem to be widely endorsed by the general public in the Western world. Studies suggest that the majority of citizens in the United States ( 13, 15- 17) and many Western European nations ( 18- 21) have stigmatizing attitudes about mental illness. Furthermore, stigmatizing views about mental illness are not limited to uninformed members of the general public; even well-trained professionals from most mental health disciplines subscribe to stereotypes about mental illness ( 22- 25).

Several themes describe misconceptions about mental illness and corresponding stigmatizing attitudes. Media analyses of film and print have identified three: people with mental illness are homicidal maniacs who need to be feared; they have childlike perceptions of the world that should be marveled; or they are responsible for their illness because they have weak character ( 29- 32). Results of two independent factor analyses of the survey responses of more than 2000 English and American citizens parallel these findings ( 19, 33):

1. fear and exclusion: persons with severe mental illness should be feared and, therefore, be kept out of most communities;

2. authoritarianism: persons with severe mental illness are irresponsible, so life decisions should be made by others;

3. benevolence: persons with severe mental illness are childlike and need to be cared for.

Although stigmatizing attitudes are not limited to mental illness, the public seems to disapprove persons with psychiatric disabilities significantly more than persons with related conditions such as physical illness ( 34- 36). Severe mental illness has been likened to drug addiction, prostitution, and criminality ( 37, 38). Unlike physical disabilities, persons with mental illness are perceived by the public to be in control of their disabilities and responsible for causing them ( 34, 36). Furthermore, research respondents are less likely to pity persons with mental illness, instead reacting to psychiatric disability with anger and believing that help is not deserved ( 35, 36, 39).

The behavioral impact (or discrimination) that results from public stigma may take four forms: withholding help, avoidance, coercive treatment, and segregated institutions. Previous studies have shown that the public will withhold help to some minority groups because of corresponding stigma ( 36, 40). A more extreme form of this behavior is social avoidance, where the public strives to not interact with people with mental illness altogether. The 1996 General Social Survey (GSS), in which the Mac Arthur Mental Health Module was administered to a probability sample of 1444 adults in the United States, found that more than a half of respondents are unwilling to: spend an evening socializing, work next to, or have a family member marry a person with mental illness ( 41). Social avoidance is not just self-report; it is also a reality. Research has shown that stigma has a deleterious impact on obtaining good jobs ( 13, 42- 44) and leasing safe housing ( 45- 47).

Discrimination can also appear in public opinion about how to treat people with mental illness. For example, though recent studies have been unable to demonstrate the effectiveness of mandatory treatment ( 48, 49), more than 40% of the 1996 GSS sample agreed that people with schizophrenia should be forced into treatment ( 50). Additionally, the public endorses segregation in institutions as the best service for people with serious psychiatric disorders ( 19, 51).

STRATEGIES FOR CHANGING PUBLIC STIGMA

Change strategies for public stigma have been grouped into three approaches: protest, education, and contact ( 12). Groups protest inaccurate and hostile representations of mental illness as a way to challenge the stigmas they represent. These efforts send two messages. To the media: STOP reporting inaccurate representations of mental illness. To the public: STOP believing negative views about mental illness. Wahl ( 32) believes citizens are encountering far fewer sanctioned examples of stigma and stereotypes because of protest efforts. Anecdotal evidence suggests that protest campaigns have been effective in getting stigmatizing images of mental illness withdrawn. There is, however, little empirical research on the psychological impact of protest campaigns on stigma and discrimination, suggesting an important direction for future research.

Stigma is further diminished when members of the general public meet persons with mental illness who are able to hold down jobs or live as good neighbors in the community. Research has shown an inverse relationship between having contact with a person with mental illness and endorsing psychiatric stigma ( 54, 57). Hence, opportunities for the public to meet persons with severe mental illness may discount stigma. Interpersonal contact is further enhanced when the general public is able to regularly interact with people with mental illness as peers.

SELF-STIGMA

Low self-esteem versus righteous anger describes a fundamental paradox in self-stigma ( 64). Models that explain the experience of self-stigma need to account for some persons whose sense of self is harmed by social stigma versus others who are energized by, and forcefully react to, the injustice. And there is yet a third group that needs to be considered in describing the impact of stigma on the self. The sense of self for many persons with mental illness is neither hurt, nor energized, by social stigma, instead showing a seeming indifference to it altogether.

We propose a situational model that explains this paradox, arguing that an individual with mental illness may experience diminished self-esteem/self-efficacy, righteous anger, or relative indifference depending on the parameters of the situation ( 64). Important factors that affect a situational response to stigma include collective representations that are primed in that situation, the person's perception of the legitimacy of stigma in the situation, and the person's identification with the larger group of individuals with mental illness. This model has eventual implications for ways in which persons with mental illness might cope with self-stigma as well as identification of policies that promote environments in which stigma festers.

CONCLUSIONS

Researchers are beginning to apply what social psychologists have learned about prejudice and stereotypes in general to the stigma related to mental illness. We have made progress in understanding the dimensions of mental illness stigma, and the processes by which public stereotypes are translated into discriminatory behavior. At the same time, we are beginning to develop models of self-stigma, which is a more complex phenomenon than originally assumed. The models developed thus far need to be tested on various sub-populations, including different ethnic groups and power-holders (legislators, judges, police officers, health care providers, employers, landlords). We are also learning about stigma change strategies. Contact in particular seems to be effective for changing individual attitudes. Researchers need to examine whether changes resulting from anti-stigma interventions are maintained over time.

All of the research discussed in this paper examines stigma at the individual psychological level. For the most part, these studies have ignored the fact that stigma is inherent in the social structures that make up society. Stigma is evident in the way laws, social services, and the justice system are structured as well as ways in which resources are allocated. Research that focuses on the social structures that maintain stigma and strategies for changing them is sorely needed.

References

39. Corrigan PW. Rowan D. Green A, et al. Challenging two mental illness stigmas: personal responsibility and dangerousness. Submitted for publication. [[ PubMed] Google Scholar]

47. Segal S. Baumohl J. Moyles E. Neighborhood types and community reaction to the mentally ill: a paradox of intensity. J Health Soc Behav. 1980;21:345-359. [[ PMC free article] [ PubMed] Google Scholar]

50. Pescosolido B. Monahan J. Link B, et al. The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. Am J Public Health. 1999;89:1339-1345. [[ PMC free article] [ PubMed] Google Scholar]

63. Corrigan PW. Empowerment and serious mental illness: treatment partnerships and community opportunities. Psychiatr Q. 1984 in press. [[ PubMed] Google Scholar]

64. Corrigan PW. Watson AC. The paradox of self-stigma and mental illness. Clin Psychol Sci Pract. 1984 in press. [ Google Scholar]

Articles from World Psychiatry are provided here courtesy of The World Psychiatric Association

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Understanding the impact of stigma on people with mental illness

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Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness.