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What Does Stigma have to do with Mental Health and Disasters?

Author: Sarah Alcala, Senior Management Analyst with Aveshka Inc. in support of the Division for At-Risk Individuals, Behavioral Health & Community Resilience and Rachel E. Kaul, LCSW, CTS, Senior Policy Analyst and Behavioral Health Team Lead, HHS Office of the Assistant Secretary for Preparedness and Response
Published Date: 5/30/2017 2:41:00 PM
Category: Public Health Preparedness; Response & Recovery;

According to the World Health Organization, 44-70 percent of people that needed mental health interventions do not receive treatment in any given year. Former U.S. Surgeon General David Satcher said that stigma was perhaps the biggest barrier to people seeking mental health care. Stigma is a negative and often unfair projection of shame or judgment onto people in a particular circumstance. It occurs when people socially distance a group of “others” based on perceived negative stereotypes. People with mental illness can also self-stigmatize, which can lead to denial, unwillingness to seek treatment or poorer prognosis. Disasters create conditions that may foster or exacerbate stigma for people experiencing emotional distress or symptoms of mental illness.

Although many other barriers prevent people from seeking mental health care - lack of access to mental health care professionals, cost, cultural barriers, lack of symptom recognition - stigma remains one of the most concerning and, perhaps, preventable of all the things that make it difficult for people to pursue mental health care. It is an important factor for disaster responders to be aware of.

Following a disaster, people with pre-existing mental health needs or people with newly existing needs because of the disaster might experience stigmatization. Disasters can create situations where people may not have access to their medication, routines, caregivers, or providers, exacerbating existing mental illness symptoms. Congregate settings, such as shelters, can lend themselves to points of stigmatization because people are under stress, at a heightened sense of fear or anxiety and are often surrounded by strangers. Additionally, traumatic experiences in a disaster can worsen symptoms in people with pre-existing mental health needs and lead to behavior that is disruptive or upsetting to others. This may result in prejudicial treatment by other survivors or to misconceptions on the part of responders about those in need of care or support.

Disaster survivors are not the only ones that may need mental health interventions following a disaster. First responders may also experience trauma and need some degree of mental health intervention after disasters, but are unlikely to seek it because of stigma. First responders may feel seeking emotional support is a sign of weakness or failing in their abilities. They may be concerned they will experience ridicule from peers, or be labeled mentally unfit if they talk about distressing symptoms they may be experiencing. This stigmatization of mental health issues and treatment creates barriers that must be broken down to ensure responders seek the care they need when they are struggling to cope.

So, what can we do to break the stigma? Emergency planners and responders can engage mental health professionals in disaster planning and make addressing mental health part of the health and medical response. In congregate settings, planners and responders should recognize that mental illness may play a role in some behavior and facilitate access to a mental health professional. If a mental health professional is not immediately available, ensure staff and volunteers have the training to refer people to appropriate resources.

Everyone, including you, can create a culture where mental illness is treated as manageable medical diagnosis by:

  1. Educating yourself and others about metal health. Check out these websites for more information:
  2. Seeing the person, not the illness;
  3. Talking openly about mental health to family, friends, and colleagues, and;
  4. Being empathetic and compassionate about people experiencing mental illness – don’t use words like “crazy” or “psycho”.

When we take steps to reduce stigma around mental illness, we create and encourage a supportive, respectful culture that promotes health.


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