(Hint: One of Them Isn't Calling It "Mental Health")
Every morning, I wake up to an inbox with messages like this (identifying details changed):
"I just read your piece titled 'I am Adam Lanza's mother.' It rang true to me in every way. My son is 10 years old and he has been in 12 different schools, four behavioral centers and continues to get worse. He talks openly about how he is going to kill us all. He hides knives in his room, attacks, steals, screams profanity."
"I've been diagnosed with depression, anxiety, panic disorder, PTSD, Intermittent Explosive Disorder, Bipolar, and I'm recovering from drug/alcohol addictions. I have never been able to see a quality therapist or psychologist. One time I found one that I liked and then stopped going because my insurance changed. The mental health care system in this country is appalling."
"I have experienced aspects of what you are writing about with a sibling who has bi-polar--extreme depression and suicide attempts. In fact she's been in ICU for the past two weeks, so my other sister and I continually search for answers in how best to care for her."
"I never know how to tell people how scared I am. Right now I am well controlled with medication but I am terrified. What happens if my meds stop working and I can't control myself?"
And then, as I'm searching the Internet for real solutions to help my friends, my HuffPost mental health alert sends me this: "5 Real Ways to Combat the Stigma around Mental Health."
Apparently, a bunch of experts got together and came up with some suggestions for ending stigma. The problem is that they're the same suggestions we've been hearing for 20 years now. And the stigma needle, despite all this anti-stigma talk, is not budging.
I'm all for ending stigma, especially the self-stigma that keeps parents from asking for help or consumers from feeling okay about their medical treatment. As an example, I just had a conversation with a friend who has bipolar disorder. She admitted that she felt bad that she had to take medication to manage her condition.
"But when I don't take my meds, I don't feel like me," she said. "Plus, my life starts to fall apart. I like this me, the 'me' that is in school, working, making a better life for myself. But I feel like I should be able to manage this on my own, without meds."
My jaw dropped. I have hypothyroidism. I have never once felt guilty for taking my daily thyroid medication or thought that I ought to manage my thyroid condition "on my own, without meds."
You know what might end the stigma of mental illness? Treating it for what it is: illness.
While the experts talk about mental health, here are my suggestions for five real ways to combat mental illness:
1. Make early intervention a top priority. Pediatricians should all be trained to include mental health questions in well child visits. Shocked that a child of 5 might express suicidal thoughts? I know hundreds of families who have had that experience. The earlier we can get children and families help, the more likely they are to manage the illness and lead productive lives. And new care models developed at Yale University suggest that intervention right after first episode psychosis can improve long term outcomes for young people with schizophrenia.
2. Train more psychiatrists and increase access to care for people with mental illness. Instead of teaching community leaders to look for signs of depression, we should be focused on training a workforce that is competent and capable of delivering evidence-based care to people who need help. The shortage of psychiatrists, especially those who work with children, is a real and growing problem.
3. Stop saying "mental illness," and start saying "illness." I'm not suggesting that we should stop talking about mental health, by the way. But serious mental illness is physical illness. Mental health is important to everyone, and people with any type of chronic health condition are at greater risk of depression. But as long as we keep artificially separating serious mental illness and serious physical illness, stigma will remain, and true parity will never be achieved. People will continue to think that mental illness is a choice or a character flaw.
4. Listen to families and provide them with actual support. Maybe you saw the story about the Virginia mother who is prepared to face child abandonment charges rather than bring her 12-year old son home from jail. The comments on this story show just how pervasive this problem is. People who aren't living this experience seem to think that there's some place we parents can go to get help for our children. Some of us jokingly refer to this place as "CandyLand."
5. Enough talk; it's time for action. We are getting really good about talking about mental illness. I have no problem telling you that I was treated for depression. My son, who has bipolar disorder, has no problem telling strangers in the grocery store checkout line that lithium has completely changed his life. It seems like every day, a celebrity or athlete shares his or her struggle with mental illness. And that's a good thing. But what about those whose voices aren't being heard? What about the people in prison, or living on the streets? When will we stop talking and take action to help them? Peer support is a good start, but some of us need more. Assisted Outpatient Treatment is one community services program that has enabled people with serious mental illness to live in their communities and stop the revolving door of incarceration and homelessness.
I'm tired of hearing stories from suffering families. It's time for the experts to sit down and have a real conversation about mental illness and how we, as a society, can offer them help and hope.