People often avoid seeking treatment for mental health conditions because they fear repercussions should their conditions become known. You can call those repercussions “stigma,” as most do, or “discrimination,” as I prefer — either way, people who need help avoid it because they are afraid of losing things important to them.
Who is Most Afraid of Mental Health Discrimination?
The April 30 issue of Hope and Harmony Headlines from bp.com reported that Psychological Medicine published a review of 144 studies on mental health “stigma” (discrimination) in January 2015. The review found five specific people groups most likely to avoid treatment for fear of disclosure:
- young people
- members of ethnic minorities
- those in the military
- those in health professions
Real Grounds for Fear: High Risk of Job Discrimination
What do all of these groups of people have in common? All of these people face real job and career risks over a mental illness disclosure.
Young people have yet to become professionally established. Their peers are doing Adderall and other stimulants to be able to work crazy hours (I use the word “crazy” intentionally) to win professional advancement. “You can’t be the sluggish one,” explained “Elizabeth” to the New York Times. Her sleep tracker shows an average nightly resting time from 4:17 a.m. to 7:42. Just maintaining the sleep hours necessary to stay balanced with bipolar disorder (7 or 8 hours at pretty consistent times each night) would leave someone in Elizabeth’s position at professional risk. [Aside: 8-10 hours a night was considered normal for all adults until less than a century ago.]
Men: When you know that there is employment discrimination against people with mental health diagnoses, anyone who has or wants a job is less likely to seek treatment. Men, who still are ostracized as inadequately masculine if they express a range of emotions, have a further reason to avoid treatment. The few who do seek treatment are likely to pay out of pocket, instead of taking a chance that their employer will guess who is elevating the cost of the office insurance “risk pool” (which can increase the cost of insurance for the company). Another dodge is to accept appointments only very late in the evening or early in the morning, when one is presumably less likely to be seen. Except, of course, by other members of the late night fellowship of patients.
Ethnic minorities: How likely would you be to seek treatment if you knew you were likely to be diagnosed as schizophrenic just because you lower your eyes respectfully in the presence of your elders? As psychotic because, like all Pentecostal Christians, you acknowledge that you hear God’s voice and sometimes the voices of other spirits? Would you seek pharmaceutical-based treatments if you knew that people who look like you had been the subject of pharmaceutical experimentation for decades? People from African-American heritage in particular have a multitude of reasons to feel uncomfortable with the medical model of mental health treatment that predominates in this country.
Military personnel belong to a tight-knit culture with a long collective memory. That long memory includes career damage to nearly 4 in 10 of those referred by their commanding officers for mental health counseling. It also includes the “infamous Question 21” on security clearance screenings (“Have you ever consulted with a health care professional regarding an emotional or mental health condition?”). Today’s soldier can answer the modified question “No” if the consultation was related to PTSD or marriage problems. That doesn’t mean a soldier who wants a security clearance will feel secure seeking psychological assistance.
Health care professionals, ironically, face some of the most entrenched barriers to obtaining mental health care. Medical licensing boards in 40 states ask directly whether a candidate for licensure has been diagnosed or treated for mental illness. Of 35 state boards responding to a followup survey, 13 indicated that there would be consequences for any report of a mental illness, with options ranging from a required treatment program to revocation of the license. The same number, 13, acknowledged handling physical and mental illnesses differently.
Discrimination is unfair, un-American, and has no place in the way we treat one another. Nor is it appropriate to create a system of demands such as many of our young adults face, where job success depends on the needless use of dangerous pharmaceuticals. It’s time we started to behave as the one Body we are, embracing and supporting our hurting members, so we can all advance as God calls us toward the purpose God has given us together.