Resistance to Seeking Treatment for Mental Illness – How Others Can Help




Anti_Stigmatization2.jpgThere 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)

  • http://www.blogger.com/profile/25068322 Harold A.

    Hogwash! The reason most people fear the mental health system is its long, and very well documented, history of abuse.

  • http://www.blogger.com/profile/25068322 Harold A.

    Hogwash! The reason most people fear the mental health system is its long, and very well documented, history of abuse.

  • Elise Stobbe

    Yes, there is a long history of abuse in the mental health system, as a whole, and that is one of the biggest reasons for deinstitutionalization. Fear of being committed is usually among the reasons people don’t seek treatment. But most research agrees that fear of stigma is number one.

  • http://www.blogger.com/profile/25081025 Harold A

    Whose research? Those same abusers? yes. Of course they woud point the finger elsewhere.

  • the blogger

    I’m afraid I’m with the Hogwash caller….

    Research suggests that professionals can never admit to problems themselves.

    Research suggests that “personality disorder” is given to those who don’t “look the part”

    And the brain scanner I look after (yep) is rarely understood by neurologists and always throws up more questions. So how on earth psychiatrists think they know is beyond me.

    So, one could say mental health is a world for professionals who want status at the expense of people who can’t argue. If you look ok, you’ll get “personality disorder” diagnosis, or whatever matches malingering in your country, and if you look bad, you’ll get ineffective and abrupt treatment from people who don’t really want to think and just want to go home to their salary with the tick-boxes filled…

    The few who aren’t like that have waiting lists for their services twice the length of my arm…

  • Francesca Allan

    Way, way too much credence given to the opinions of E. Fuller Torrey (Treatment Advocacy Center). Torrey is an extremist who promotes increased coerced (outpatient) and forced (inpatient) drugging and has referred to being around a random mentally ill person as being as dangerous as sitting next to someone with active tuberculosis in a movie theatre. A case could be made that Torrey engages in hate speech. This article also totally disregards the evidence that outcomes are actually much worse (in terms of chronic disability) with conventional treatment. It also doesn’t mention the very real possibility of misdiagnosis. Nor does it discuss the many people who have rejected their diagnosis and lived happy, fulfilling non-medicated lives.

  • Paul

    Mental Illness is a tragedy. I have all my faculties now, excellent insight , emotionally expressive , yet it could all change and I could regress and I know that. You make alot of good points here but you can add , somewhere at the top of the list , regarding reasons for not seeking the proper help ; and that is , The state of psychiatric medication. The side effects are distressing and they encourage co-morbid illnesses. Of course they do have benefits , they are certainly better than nothing at all.

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