We’re more accepting of mental health illness than ever, but we still have stigma-busting to do.

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It’s far easier to engage in a meaningful, compassionate conversation about mental health issues in 2021 than a few decades ago, when they were still considered hush-hush. Compared to previous generations, Millennials and Gen Z are more open about their struggles with mental health and possess a greater understanding that mental wellness and physical wellness are integrated.

“Nine out of 10 of young people in this country believe that mental health should be more of a priority for elected officials,” says Dr. Benjamin F. Miller, Chief Strategy Officer of Well Being Trust, a national foundation committed to advancing the mental, social and spiritual health of the nation. To illustrate his point, he describes the efforts of students in Oregon led an initiative to draft and pass legislation allowing them to take mental health days. Sadly, until the end of the 20th century, those with mental illnesses suffered from a stigma that made it hard to be accepted in society and seek treatment.

The dark history

Miller explains that because people didn’t understand mental illness, those who had it were often shunned socially.

In the old days, people blamed demon possession,” he says. “The term ‘stigma’ wasn’t adopted into our culture until around the 60s, when sociologists and psychologists started to recognize how people were treated differently based upon something that they had.”

“People thought those with emotional health challenges needed to be locked away in what we called insane asylums,” explains Rheeda Walker, Ph.D., clinical psychologist, researcher, professor at University of Houston and author of The Unapologetic Guide to Black Mental Health.

“They didn’t tell anybody [how they felt] because they were fearful of how other people would respond and treat them. There was a lot of misunderstanding and the mistreated people could have been helped. One of the things that we know now is the earlier that someone gets help or intervention for whatever psychological disturbance they may be experiencing, the better their prognosis.”

Miller explains that The Community Mental Health Act of 1963, signed into law by John F. Kennedy, was a turning point in how people with mental illness were treated. “It was the first attempt to remove the structural elements of stigma by making it more normal for people to be in their communities,” he says.

Scientific progress helped as well.

“In the 70s and 80s, science helped us to see the underlying neurological issues in a brain scan for someone suffering from schizophrenia, for example. These things opened our eyes to the fact that this wasn’t something that was made up, or a moral failing. This was truly something that was happening chemically inside of you,” says Miller.

As these findings were surfacing, so did the National Alliance on Mental Illness (NAMI) in 1979, the largest mental health association in America. It was started as a support group for parents of kids who had mental illnesses.

“A group of parents gathered around a kitchen table, fed up by the discrimination they faced while trying to help their children with mental illness,” says Dr. Ken Duckworth, Chief Medical Officer of NAMI. “They were turned away from care, even told that their parenting caused their child’s severe mental illness. They bonded together with people around the country to demand change, and while it was slow at times, they made progress.”

Since forming, NAMI has evolved into the country’s largest grassroots advocacy organization for mental illness. They educate and raise awareness of mental illness, supporting both patients and their families with classes and support groups, advocacy and advocacy training, research, and offer guidance in navigating the costs of medication.

The Prozac revolution

In the 90s, the adoption of Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac, in treating depression signaled a revolution of sorts that pried open a more fluent dialogue about mental illness. For example, the late Elizabeth Wurtzel’s memoir Prozac Nation vividly chronicled her battle with depression and SSRIs as a teenager and young woman.

According to an examination of trends in antidepressant use called “National Patterns of Medication Treatment for Depression, 1987 to 2001,” the estimated national number of patients with depression seeking care increased from 14.4 million doctor visits in 1987 to 24.5 million in 2001. What’s more, the rate of antidepressant medication treatment in these patients also increased from 70% in 1987 to 89% in 2001. “There were a lot of individuals in this country experiencing depression who were just so hungry for help and SSRIs became a solution for that,” says Miller.

Celebrities speaking out

Through the late 90s and into the 2000s, celebrities began to publicly admit to their own mental health challenges, ranging from postpartum depression (Brooke Shields, Chrissy Teigen) to bipolar depression (Kanye West, Catherine Zeta-Jones), to anxiety (Emma Stone, Lady Gaga) and depression (The Rock, Michael Phelps).

These admissions helped usher in an era of greater understanding about mental health. “It shouldn’t be on the back of the person facing the illness to have to educate every person around them, but the person with the lived experience sometimes has the most profound voice and story to tell to help normalize what they’re experiencing,” Miller explains.

All of this talk can lead to turning things around; Duckworth feels the normalization of conversation around mental health is what could eventually lead to better mental health care.

There’s still work to do

Even with all this progress, the stigma surrounding mental health and illness still lives and breathes in our society on a cellular level. “People are still afraid to seek treatment due to the fear that it might affect how others see them or even affect their employment status,” says Duckworth.

Miller expressed concern for the traumatized front-line doctors during the pandemic who won’t admit to needing help, fearing there will be a professional price to pay. “You hear stories of people [doctors] not wanting to put down on paper they are depressed, feeling anxious, or seeing a therapist because they don’t want it to be held against them when they go up for recertifying for their boards to be licensed,” Miller says.

“I’m a university professor and students talk to me about their own psychological distress,” says Walker. “They want to get help but their barriers are two-fold; one, the people around them, older aunties and uncles and moms, say, ‘Oh, you’ll be fine.’ The other barrier is finding the care they can trust and that they actually believe will help them.”

According to NAMI, 50% of those seeking treatment for a mental health condition identify as women, while only 37% identify as men. Walker says stigma associated with traditional gender roles can stand between men and treatment, observing that women “don’t have the kind of messaging where your identity is tied to your emotional and psychological strength.”

How to destigmatize moving forward

To destigmatize mental illness, Miller says it’s important to make the distinction between a mental health challenge and an actual clinical diagnosis of mental illness.

Feeling depressed or anxious is not the same thing as having a mental health professional diagnose you with major clinical depression or generalized anxiety disorder. The former can be transient and circumstantial, the latter points to a pervasive and ongoing condition, one that people might feel uncomfortable disclosing to a boss, colleague, friend, or even a family member, for fear of judgment or professional repercussion.

“Mental illness is when the sadness reaches a level of severity that leads to impairment. You stop doing the things you’re doing, you stop working, you don’t enjoy the things that you used to. Certain mental health conditions, like depression or anxiety, have some similarities but are markedly different.” Also important is considering mental illness on a continuum of severity. “Severe depression can be just as stigmatizing as someone who is taking medication for schizophrenia because they present in a way that looks like things are under control.”

Miller also feels it would help for organizations to continue to chip away at the structural stigma. For example, primary care physicians often screen their patients for depression with a simple form, and they’re required by law to call 911 if you admit to having any suicidal thoughts. But this black-and-white diagnostic approach falls short.

“That’s a structural stigma because it places the person in a position where they are being treated the same as if they broke their ankle. Mental health should be dealt with differently,” he explains.

Walker mentions she’d also like to see improved confidentiality protocols about mental health or illness issues in the workplace — and a better work-life balance. “We’re in Covid-19 social restriction and people are working 30% more than they were pre-Covid,” Walker says. “We have to be thoughtful, not just for people who may be vulnerable to depression or anxiety, but for all of our society so that we can manage and maintain a sustainable work-life balance.”

She’d also like to see more resources for the mentally ill in Black and POC communities. Her book was written to sound an alarm when suicide death rates were increasing for 5-to-11-year-old Black children but going down for white children the same age.

Walker says the understandable mistrust of treatment in Black and POC communities is largely due to a glaring lack of culturally informed care.

“Those in long-term care (for mental illness) are overwhelmingly African-American and people of color,” Walker explains. “Part of that is waiting a long time to get help. I see folks and I hear conversations where racism is minimized. The last thing someone who is struggling emotionally wants to do is encounter a provider who says, ‘Well, what’s the big deal about race and racism,’ which happens more than you might imagine. That can’t happen.”

If you know someone with mental illness, Miller says the most powerful way to support them is to ask how they are and be willing to listen to whatever comes your way — no matter how uncomfortable it might make you.

“What stigma boils down to is fear,” says Walker. “Stigma has been systemic, meaning that it has impacted whether or not people feel comfortable getting help. The more we can educate people and expose them to what real mental and emotional health challenges look like, that will speed overcoming our fear about what it means to have a mental illness.”

Written by:

Vivian Manning-Schaffel is a multifaceted storyteller whose work has been featured in The Cut, NBC News Better, Time Out New York, Medium and The Week. Follow her on Twitter @soapboxdirty.

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