A major refrain in the mental health world is that stigma prevents people from seeking mental health care, and that’s why we need all these anti-stigma campaigns and programs. Well, the actual facts beg to differ. While stigma may prevent mental health care in a minority of cases, there are far bigger reasons why people who need care don’t get it. This begs the following questions: Why are advocates always harping on about stigma? Why are there so many anti-stigma campaigns? What would really help people with mental illness get mental health care?

Stigma Prevents Mental Health Care, Really?

According to the Cambridge Dictionary, stigma is:

“a strong feeling of disapproval that most people in a society have about something, especially when this is unfair”

So, when we talk about mental illness stigma, it’s about societal disapproval of those with a mental illness. It’s about being looked down upon because of your illness. This is a real thing that people with mental illness feel coming from others.

There are two major studies that say mental illness stigma isn’t what’s preventing mental health care, though. In one study, social stigma against mental illness does come up as a reason for not accessing health care, but overall, it’s clear that other reasons are of much greater import.

What Prevents Mental Health Care If Not Stigma? Mental Health America

Mental Health America, the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and promoting the overall mental health of all, conducts a major study on why people with mental illness don’t access mental health care every year. (They go so far as to rank States from best to worst on various factors.)

According to the latest data (from 2021) by Mental Health America, individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment at all. They are the following:

  1. No insurance or limited coverage of services
  2. A shortfall in psychiatrists, and an overall undersized mental health workforce
  3. Lack of available treatment types (inpatient treatment, individual therapy, intensive community services)
  4. Disconnect between primary care systems and behavioral health systems
  5. Insufficient finances to cover costs ñ including copays, uncovered treatment types, or when providers do not take insurance

Anyone who has sought mental health treatment can attest to the difficulty the above put on everyone with a mental illness, whether they end up successfully accessing care or not.

What Prevents Mental Health Care According to the National Council for Mental Wellbeing?

The Cohen Veterans Network, a national not-for-profit philanthropic organization, and the National Council for Mental Wellbeing (The National Council), the unifying voice of America’s healthcare organizations that deliver mental health and addiction treatment and services, released a comprehensive study of access to mental health care in October 2018. it found:

American mental health services are insufficient, and despite high demand, the root of the problem is lack of access – or the ability to find care.”

The report specifically details the following reasons why people aren’t accessing mental health care:

  • High cost and insufficient insurance coverage: Forty-two percent of the population saw cost and poor insurance coverage as the top barriers to accessing mental health care. One in four (25%) Americans reported having to choose between getting mental health treatment and paying for daily necessities.
  • Limited options and long waits: Access to face-to-face services is a higher priority for Americans seeking mental health treatment than access to medication. Ninety-six million Americans, or 38%, have had to wait longer than one week for mental health treatments. And nearly half of Americans, or 46%, have had to or know someone who has had to drive more than an hour roundtrip to seek treatment.
  • Lack of awareness: While most Americans do try to seek out treatment, there also is a large portion of the population who have wanted to but did not seek treatment for themselves or loved ones (29%) – in part due to not knowing where to go if they needed this service. What’s more, 53 million American adults (21%) have wanted to see a professional but were unable to for reasons outside of their control.
  • Social stigma: Nearly one-third of Americans, or 31%, have worried about others judging them when they told them they have sought mental health services, and over a fifth of the population or 21%, have even lied to avoid telling people they were seeking mental health services. This stigma is particularly true for younger Americans, who are more likely to have worried about others judging them when they say they have sought mental health services (i.e., 49% Gen Z vs. 40% Millennials vs. 30% Gen X vs. 20% Boomers).

So while societal stigma against mental illness was identified as being a concern for people, other barriers like high cost and insufficient insurance coverage were considered bigger reasons as to why people didn’t seek or didn’t receive mental health care.

Why Does the Myth that Stigma Prevents Mental Health Care Persist?

I think there are several reasons why the idea that stigma prevents mental health care keeps rearing its inaccurate head.

  1. It’s easy. It’s an easy thing to point to as a defeatable boogyman. It’s much harder to fight things like a lack of mental health care insurance, so people pick something they feel they can tackle.
  2. People don’t know the facts. People (including other advocates) assume that if advocates are talking about the importance of anti-stigma campaigns, then they must be right.
  3. Fighting stigma is feel-good. This is tied into the above. It’s all too easy to say you’re anti-stigma and maybe throw up a banner somewhere. that makes you feel all squishy inside, even though it does nothing.
  4. Everyone has experienced some form of stigma. Everyone can identify with experiencing societal stigma about something, so it’s easy to get people on-side for this message. It has a common-sense feeling behind it.
  5. The more anti-stigma campaigns there are, the more funding there seems to be for them. Companies don’t want to be seen as doing nothing about mental health, so they keep funding useless anti-stigma campaigns.
  6. The status quo ruffles no feathers. Anti-stigma campaigns blame the lack of mental health care on individuals and not organizations such as insurance companies or governments. People make money and succeed off the status quo; that’s why it exists. Not threatening that is the easy path.
  7. Anti-stigma campaigns don’t require systemic change. This is part of it being easy. Trying to cause a system change is very, very difficult and is something most of us (quite rightly) feel we can’t tackle.

I have a few more thoughts about anti-stigma campaigns here.

What Can We Really Do to Encourage Mental Health Care If Not Fight Stigma?

This is a much more complicated question than a simple article can articulate.

The National Council offers this advice:

“Specifically, younger Americans need more information on how and where to access care. There must also be a better understanding of the real cost of delivering mental health care and related reimbursement rates, which typically cover only a small portion of care. This is critical to help attract new providers into the field and more must be done to train and retain providers to help ensure people can get help when they need it. Finally, we must ensure standards of care are consistent through continued adoption of evidence-based practices.”

These are good suggestions if not particularly tackleable by an individual.

But that’s the point. This problem needs to be taken on by major campaigns, major organizations, and governments. Advocates can do their best to shout about the issues, but it’s much bigger than any one person.

One thing advocates must do, though, is to shout about the right problems. We need to shout data-driven, accurate information for people. If anything is going to change for the millions who need mental health care, we’re not going to do it by misrepresenting the problem.

(Here is an amazing site that will smack you with a little accuracy.)