Running Head: STIGMA AND FUNDING BARRIERS

1
Stigma and Funding Barriers: The Catch-22 of Accessing Mental Health Services
Kaleigh Albright
Temple University

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Define and Describe the Problem

There is a lack of comprehensive and adequate mental health care in the United States
Describe the Basis and Creation of the Social Problem
1.

Stigma and retraumatization of the mentally ill populations

a. Lack of understanding by the media, the common man
i. Mental illness seen as rare, abnormal, and dangerous.
ii. Gun violence tie-in.
b. Inadequate education to the contrary
c. Perpetuated stigma by policy makers and government officials
i. Gun violence tie-in, discussion of what is a mental illness problem
1. Who decides what is a problem of the mentally ill?
d. Trauma and poverty present in mentally ill populations
e. Discussion of mental illness in prison
i. Programs in prison v.s. programs in community
2. Lack of funding to programs and poor access to care
Describe and Evaluate the Current Social Policy Response
3. barriers to access care
a. Insurance companies
(http://blogs.plos.org/mindthebrain/2014/02/06/understanding-lack-accessmental-healthcare-3-lessons-gus-deeds-story/)
i. Differences between community mental health and private mental
health
b. Programs are poorly funded
i. Need more information about this
c. Workers not paid enough, high burnout, high turnover, difficulty in following a
provider/therapist/worker
Potential Remedies
Basic education
Standard of care
Open healthcare

Describe the Basis and Creation of the Problem

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As discussed previously, a severe mental illness is categorized by a diagnosis of a mental

illness in at least the past year along with a severe impairment to at least one function of daily
living, whether that is an activity previously enjoyed, holding down employment, strain on
family relationships, etc. Severe impairments such as these are found commonly, but not
exclusively, in diagnoses such as schizophrenia, major depressive disorder, bipolar disorder,
among others. But whether a mental illness is considered severe or not has little bearing on how
individuals with diagnoses are treated by their families, their community, and indeed, the nation;
an individual with a diagnosis of schizophrenia is oftentimes still considered both dangerous and
someone incapable of being helped in any way. This is a carry-over of the stigma often seen in
the time of institutionalizations and even prior, when lobotomies were common among the
mentally ill populations inside of the asylums. And while we as a society are far and away in
terms of replicating such measures, the stigma is still present.
Take, for example, the shootings in Oregon or in Aurora in the past several years. Both of
these were initially considered crimes committed by the mentally ill during news coverage long
before any true investigation into the matter. These knee-jerk reactions do very little to deter the
publics poor opinion of the mentally ill. Perhaps we are not quite at the level of Katzs
undeserving poor (source?) and yet, the perpetuating stereotype of the welfare queen (coined
by a president, no less) has not quite faded from our periphery vision. With our severely mentally
ill populations barred from working in many cases due to the aforementioned stigma, the
declining job market, high demands that ill populations cannot meet and the discriminations
therein, or a myriad of combined reasons conservative politicians would have the public of
America believe that these people are merely taking advantage of welfare, social security, and
the benefits within.

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Stigma, however, does not simply keep people from applying for or maintaining jobs. It
is an ideology that we as people maintain by continually denying the mentally ill basic rights that
neurotypical individuals those without a diagnosis that impedes on their daily living take for
granted. Take, for example, Section 8 housing vouchers. Created specifically to provide low
income housing for individuals who have a limited budget, it has since become a way in which
some landlords are able to continually oppress people who are only eligible for this type of low
income housing. Examples of this can be found in housing discrimination cases in the states, but
far beyond that, Section 8 is still considered a viable option for housing, despite the fact that
some of these buildings are old, needing serious repairs, and are in dangerous or low revenue
areas.
Link and Phelan (2001) defined stigma with four components distinguishing it from
other social phenomena: (a) It is fundamentally a label of an out-group; (b) the labeled
differences are negative; (c) the differences separate us from them; and (d) label and
separation lead to status loss and discrimination. Corrigan (2005, 2013) extrapolated Link and
Phelans (2001) components into a matrix useful for understanding the stigma of disease and
disability (see Fig. 1). The matrix is defined by two dimensions: the social cognitive constructs
that underlie stigma and the types that meaningfully impact the person with illness. Link, B. G.,
Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma as a
barrier to recovery: The consequences of stigma for the self-esteem of people with
mental illnesses. Psychiatric Services, 52, 16211626

Past perspectives on end state were generally pessimistic; for example, Kraepelin (1896)
viewed schizophrenia as a progressive downhill course, with institutionalization an unavoidable
outcome. Poor prognosis has been definitive of serious mental illness, often incorporated into

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editions of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric
Association, 1980, 1987, 1994, 2000). Long-term follow-up research, however, paints a different
picture. Many studies have followed people diagnosed with schizophrenia for 20 to 30 years and
found that between one and two thirds met criteria for improvement or recovery (Bellack, 2006;
Ciompi, Harding, & Lehtinen, 2010; Lysaker & Buck, 2008). Recovery as outcome has multiple
definitions but generally rests on overcoming disabilities to meet goals despite ones symptoms
(Davidson, Rakfeldt, & Strauss, 2010; Liberman, 2008). This frames recovery as an end state
demonstrated by decreased symptoms and disabilities as well as attainment of age- and cultureappropriate goals for most Western adults, including independent living and a satisfying work
and family life. Alternatively, recovery has been described as a process (Ralph & Corrigan,
2005). Regardless of whether personal goals have been attained, recovery as process is achieved
when the person has replaced despair with hope, with the idea that achievement is possible even
in the face of distress, dysfunction, and disability. Viewing recovery as process does not mean
people need to demonstrate certain benchmarks such as symptom remission or expected goal
attainment. Instead, this view asserts that people can live with disabilities and achieve personally
meaningful goals that still lead to a life with personal dignity
(http://psi.sagepub.com.libproxy.temple.edu/content/15/2/37.full.pdf+html)
It is important to note that choosing not to seek treatment or dropping out prematurely is not a
phenomenon specific to mental illness or indicative of the disabilities that arise from these
illnesses. Poor adherence is the rule rather than the exception across medical care as well as in
the pursuit of wellness (ODonohue & Levensky, 2006).
(http://psi.sagepub.com.libproxy.temple.edu/content/15/2/37.full.pdf+html)

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Potential Remedies
The Helping Families in Mental Health Crisis Act of 2015, introduced by Congressman
Tim Murphy of Pennsylvania, is one such piece of legislature brought to Congress. In it, it
describes a myriad of ways in which mental health services could improve, from appointing an
Assistant Secretary of Mental Health within the Department of Health and Human Services,
serving as a position that would [ position details ], to ensuring that there is adequate funding to
encourage medical students to work in the field of psychiatry, and additional educational
programs for students in the medical field. While these particular benefits in the proposed bill
would encourage further understanding of the mental health field and the challenges faced by
those with a mental health diagnosis, there are a few pieces within the aforementioned plans that
are rather discouraging. The first is that there is a push for medical students to enter the field of
psychiatry which, while undoubtedly a noble calling, can lead to an upswing in diagnoses and
prescriptions which do not guarantee that actual physical and emotional support will be given to
these individuals. This is a concern when factoring in the cost of prescriptions and psychiatric
services, which this bill does very little to openly address.
The second concern I have when examining the bill is that while there will be more
opportunities for education within the graduate medical program, this does very little to address
the lack of education or materials available to the everyday populace, the common man, or those
in bachelors programs. The opinions of few graduate students, doctorate students, and
professionals can do little to sway the opinion of many if there are no proper channels for
education and awareness. Fundraisers, flyers, and organizational resources have provided
teaching opportunities but, still, this does not seem to be enough. This perhaps could culminate
in a separate topic altogether regarding what is and what is not acceptable education on the

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subject of the mentally ill, and how our society chooses and shapes the education in its public
and private schools, but for the sake of brevity, I will keep the discussion brief. More to the
point, I believe there should be a stronger standard of education on the subject of mental health,
to provide both a basic foundation and a stepping stone into the subject at large. In a time of the
internet, in a time of the most interconnectivity this world has ever known, to be discriminatory
towards individuals working and living alongside us due to ignorance is outrageous.
But education for the general populace is not and cannot be the only solution.
Systemic discrimination occurs more often in a healthcare setting than anywhere else. While a
lack of comprehensive education might be a reasonable excuse for discrimination in the general
populace, it is by no means an acceptable excuse for professionals.
(http://www.healio.com.libproxy.temple.edu/psychiatry/journals/jpn/2011-9-499/%7B59e1cda1-b414-477f-a5de-3c4591a7475d%7D/another-face-of-health-care-disparitystigma-of-mental-illness#) Still, we see media professionals, reporters, and politicians spouting

biased, discriminatory, and stigmatizing rhetoric across the board. It is made even worse by
healthcare professionals that perpetuate the stigma without regard to people diagnosed with a
mental illness. Even as recent as the 2012 shooting in Newtown, in the Sandy Hook Elementary
school, there were professionals making claims that shootings particularly those on a massive
scale, such as at a school or public place were committed by individuals with severe mental
illness. About half of ... mass killings are being done by people with severe mental illness,
mostly schizophrenia, and if they were being treated they would have been preventable, ,
psychiatrist E. Fuller Torrey announced to CBS News, a damning perception to give over public
and national news ( CBS News. Preview: Imminent Danger. 60 Minutes, September 27, 2013.
http://www.cbsnews. com/videos/preview-imminent-danger. Accessed July 23, 2014.). Is there

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any wonder why the general populace would have such a skewed and derogatory view of the
mentally ill if these are the perceptions professionals maintain?
The National Association of State Mental Health Program Directors has recommended
strategies to improve morbidity and mortality rates in people with serious mental illness
(Parks & Vreeland, 2007). These recommendations are to (a) designate individuals with
mental illness as an at-risk population for health disparities; (b) establish and implement
standards of care; and (c) improve access. Implementation of these recommendations is
necessary, yet this is only one step in addressing many of the disparities faced by those
with mental illness. It will not automatically create equity in health care for all with severe
mental health challenges, but it will immediately offer a layer of protection for this vulnerable
population. It will ensure appropriate treatment in primary and emergency care.

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References
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The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health
Care http://psi.sagepub.com.libproxy.temple.edu/content/15/2/37.full.pdf+html two charts
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com/videos/preview-imminent-danger. Accessed October 12, 2015.