There is a time when a mentally ill person may realize that they need help. Symptoms worry them or others enough that they consider getting treatment. But the White House Conference on Mental Health identified stigma as the most important barrier to treatment for the mentally ill. (1) More than any other reason, stigma, or fear of the consequences of being labeled “mentally ill”, prevents a person–who realizes he or she may need help–from reaching out for that help. Powerful and pervasive, the stigma of mental illness makes it hard enough for a person to personally admit that he or she has a mental illness, much less talk about it to others. (2)

Half of the severely mentally ill do not deny the reality of their illness, but because of the stigma and discrimination involved will not seek treatment for some of these stigma-related reasons:

• Fearing loss of self-esteem;
• Not wanting anyone to find out they are on psychiatric medication;
• Thinking they will spontaneously get better if they just hide the illness from others;
• Believing that doctors might look down on them;
• Fearing rejections and exclusions in the community;
• Fearing losing the love or respect of their family or other loved ones;
• If employed, being afraid of their employer finding out;
• Fear that they might be declared incompetent;
• Fearing losing custody of their children; or
• Fearing that someone they know could see them at the psychiatrist’s office.

Medical studies have found that early intervention and quality treatment reduces the costs and improves the likelihood of recovery from mental illness. “Delaying treatment results in permanent harm, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms.” (3) So it is important that the mentally ill person who resists treatment be educated on the value of treatment despite stigma. Others can help do this. It is invaluable if the ill person can get the support and involvement of a friend or family member who knows of the individual’s mental symptoms, and is aware of their reluctance to seek treatment.

The ill person needs assurance that the first step just needs to be taken, which is to get a correct diagnosis from a psychiatrist. (A referral might be needed from the family physician). The friend or family member can offer to go with them to their appointment. The friend or family member can suggest that together they can write down questions for the doctor in advance, so they go prepared.

The ill person can be counseled that it would be a bad choice to miss a treatable cause of the mental illness or medication that would alleviate symptoms. They should reassure the ill person that there are ways to deal with what others might think or say. The friend or family member can further advise that if found to have a mental illness, the mentally ill person can take suggested treatment stage-by-stage. After a diagnosis is made, he or she will decide what comes next, and so on.

With support of others, the ill person is more likely to seek treatment. Psychologist Xavier Amador counsels friends and family to “externalize the illness by Listening, Emphasizing, Agreeing and finding Partnership (the LEAP approach). LEAP is a way of connecting and getting out of the battle… to find a common ground to allow an ill person to find his own reasons for being compliant.” (4) Further information on this can be found in the book “I am Not Sick, I Don’t Need Help” (Vida Press).

If the person is not willing to listen, then a non-confrontational, non-judgmental intervention is suggested, with emphasis on the fact that friends and family inform the individual that he or she is still loved and respected despite a mental illness.

Whatever the reason the mentally ill person does finally seek treatment, he or she should be congratulated for heroism in seeking it. The ill person can be shown that improvement benefits not only themselves, but their loved ones. Once the mentally ill person has found effective treatment, it is a matter of dealing with the stigma issues one at a time, and supportive family, friends, clergy and mental health professionals can assist. “Appropriate medication and family and caregiver involvement coupled with assertive treatment targeted on patient rehabilitation are essential to effective treatment”. (5)

References

(1) Torrey, E. Fuller, M.D. and Zdandowicz, Mary T., J.D., Deinstitutionalization hasn’t worked. The Washington Post (July 1999)

(2) Mental Health: A Report of the Surgeon General (1999) Chapt. 8

(3) See Torrey.

(4) Navigating the Mental Health Maze NAMI-NYC Metro.

(5) Institute of Governmental Studies. Public Affairs Report. Mental Health Care Quality Is in the Eye of the Beholder. University of Berkeley. (Vol 43 No. 1 Spring, 2002)