The U.S. Department of Health and Human Services (HHS) should lead efforts among federal partners and stakeholders to design, implement, and evaluate a multipronged, evidence-based national strategy to reduce stigma toward people with mental and substance use disorders, says a new report from the National Academies of Sciences, Engineering, and Medicine. Many private and public organizations in the U.S. -- including eight federal agencies -- are already engaged in anti-stigma and mental health promotion efforts, but these efforts are largely uncoordinated and poorly evaluated.
The committee that conducted the study and wrote the report looked at the results of U.S. campaigns related to HIV/AIDS and at anti-stigma campaigns in England (Time to Change), Canada (Opening Minds), and Australia (beyondblue). It found that all successful national anti-stigma programs were supported by government at the federal level and took place over decades, relied on long-term funding, were evaluated and monitored on an ongoing basis, and had a multifaceted strategy to address the full range of relevant needs.
"Mental health and substance use disorders are prevalent and among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment," said committee chair David Wegman, professor emeritus in the department of work environment at the University of Massachusetts in Lowell. "Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders."
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs at some point. In a 2014 national survey, 14 percent of adults in the U.S. said they had experienced a mental health problem within the past year, and 4 percent said that they had experienced a serious mental illness -- one that met standard diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders. In another U.S. survey, 24 million people aged 12 and older (9.4 percent of the population) said they had used illicit drugs in the past month, and 17 million people reported alcohol dependence or misuse.
Norms and beliefs about people with behavioral health and substance use disorders are created and reinforced at multiple levels, including day-to-day contact with affected individuals, employers and other organizational policies and practices, community norms, the media, and governmental law and policy. HHS should collaborate with all stakeholders, particularly the criminal justice system and government and state agencies, to identify and eliminate policies, practices, and procedures that directly or indirectly discriminate against people with mental and substance use disorders.
For the national strategy led by HHS, the relevant stakeholders include people in treatment for mental and substance use disorders and their families, insurance companies, employers, health care providers and administrators, law enforcement officials, and professional health education institutions. A multipronged approach should include educational programs, traditional and social media campaigns, legal and policy interventions, and contact based-programs -- those efforts that facilitate social contact between people with and without behavioral disorders and that have the strongest evidence base for reducing stigma.
The report also includes recommendations for future research by the Substance Abuse and Mental Health Services Administration (SAMHSA) on the characteristics of effective peer service training programs, the relationship between attitudes and actual behavior toward people with mental and substance use disorders, and formative research on effective communication to assist in developing interventions and tailoring them for target audiences.
The committee noted that "stigma" is used in peer-reviewed literature and by the general public to refer to a range of negative attitudes, beliefs, and behaviors about mental and substance use disorders. SAMHSA is moving away from the use of this term.
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The study was sponsored by the U.S. Department of Health and Human Services. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. The Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit http://national-academies.org. A committee roster follows.
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Copies of Ending Discrimination Against People With Mental and Substance Use Disorders: The Evidence for Stigma Change are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
Division of Behavioral and Social Sciences and Education
Board on Behavioral, Cognitive, and Sensory Sciences
Committee on the Science of Changing Behavioral Health Social Norms
David H. Wegman (chair)
Professor Emeritus
Department of Work Environment
University of Massachusetts at Lowell
Cambridge
Beth Angell
Associate Professor
School of Social Work
Rutgers University
New Brunswick, N.J.
Joseph N. Capella
Gerald R. Miller Professor of Communication
Annenberg School for Communication
University of Pennsylvania
Philadelphia
Patrick W. Corrigan
Distinguished Professor of Psychology
Department of Psychology
Illinois Institute of Technology
Chicago
William L. Holzemer*
Dean and Distinguished Professor
College of Nursing
Rutgers University
New Brunswick, N.J.
Clarence E. Jordan
Vice President, Wellness and Recovery
Value Options Inc.
Boston
Annie Lang
Distinguished Professor of Telecommunications and Cognitive Science
Department of Telecommunications
Indiana University
Bloomington
Rebecca Palpant Shimkets
Associate Director
The Rosalynn Carter Fellowships for Mental Health Journalism
The Carter Center
Atlanta
Bernice A. Pescosolido
Distinguished Professor of Sociology
Department of Sociology
Indiana University
Bloomington
Ruth Shim
Vice Chair of Education and Faculty Development
Department of Psychiatry
Lenox Hill Hospital
New York City
Eric R. Wright
Professor of Sociology and Public Health
Georgia State University
Atlanta
STAFF
Lisa M. Vandemark
Staff Officer
*Member, National Academy of Medicine