Stigma Kills! Defeat Stigma!

The path is marked very clearly. Chronic stigma causes trauma and care avoidance, both of which exacerbate behavioral health conditions. These mental health and substance use conditions frequently are associated with chronic physical conditions, such as heart disease and diabetes. Left untreated, these physical illnesses cause early death. Thus, stigma kills!

Stigma occurs when some people are not valued equally. This can be seen in social exclusion. People who suffer from stigma imposed by others frequently are excluded socially, and thus are devalued in different settings ranging from the family, to the neighborhood, to the community.

Defeating stigma must be an urgent priority for all of us, as former First Lady Rosalynn Carter has stated so eloquently. A very useful approach in this effort is one rooted in social justice. Social justice has a very compelling logic:

    > Everyone has an inalienable, fundamental right to good health.
    > Everyone must be valued equally.
    >Therefore, we must address health and health care disparities, and promote equity for all.

If you agree with this logic for social justice, then several important courses of action are available to us. These actions can help to defeat stigma by reducing glaring disparities and promoting equity. For simplicity, I call these actions the “Five Ps”.

The Five Ps are:

Parity: Recent landmark federal legislation on parity of health insurance benefits and benefit management has leveled the playing field with primary care. Parity in insurance benefits means that legal tools now are available to address health and health care disparities experienced by persons with behavioral health conditions. Insurance redlining and the stigma associated with it now can become a relic of the past.

Practice: Our behavioral healthcare practices are changing rapidly from separated to integrated with primary care, prompted by the Affordable Care Act (ACA). This means that behavioral health and primary care will be provided together in a fully-integrated delivery setting—a health home or a medical home. Separation of care promotes stigma; care integration can reduce it.

Promotion: The ACA has opened vast new vistas for health promotion and disease prevention. For behavioral health clients, this means that many new avenues will open up to seek wellness and promote recovery. Both wellness and recovery are excellent antidotes for stigma.

Peers: For more than a quarter century, peers have been on the leading edge of change. Peers have brought us the concept and possibility of recovery; they have contributed essential wellness regimens; now they are on the cusp of major contributions to health literacy and activation. The effects of these wonderful contributions can be seen most clearly in the very rapid spread of peer support throughout the United States. Now, a major opportunity exists to for peers to extend this effort to integrated peer support—peer support in health homes and medical homes folr behavioral health clients and  for other clients who do not have any behavioral health conditions. Just imagine--what a marvelous way to address stigma head-on.

Participation: As we go over from the defensive to the offensive against stigma, we will need to make much more use of a tool available to all of us: direct participation in our ongoing civil dialogue. This participation can take the form of testifying at a hearing of a state legislative committee, appearing before the local county executive or county council, or even appearing before committees in the US Congress. Such actions can bring mental illness and substance use out of the shadows. We can become an integral part of the community, rather than talked about by the community.

Work on the Five Ps can change the culture of our communities and ultimately that of our Nation. We already have considerable momentum, fueled by peers, the ACA, the parity legislation, and our own reawakening to new circumstances. Let’s capitalize on these wonderful possibilities and defeat stigma.