BEHAVIORAL HEALTH NEWS - Understanding the Impact of Stigma
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BEHAVIORAL HEALTH NEWS
Understanding the Impact of Stigma
How the NYS Office of Mental Health is Addressing and Reducing Stigma
By Ann Sullivan, MD mental illness are no more violent than rights and the laws that protect against
Commissioner anyone else, but unfortunately are more housing and employment discrimination,
NYS Office of Mental Health (OMH) often the victims of violence. including the Fair Housing Act and
More subtle stigma permeates many of the Americans with Disabilities Act.
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the systems we live with every day, even in Partnering with the community is es-
tigma towards individuals living healthcare. For many years, health insur- sential when trying to change minds about
with mental illness still perme- ance companies have discriminated against mental health. OMH recently awarded
ates our society today. Stigma people with mental illness by not covering seven grants to organizations across the
remains a major reason individu- mental healthcare treatment or medications state that are engaged in various activities
als and families don’t seek help when in the same way they cover treatment for to educate the general public about mental
they are having emotional problems. The physical illnesses. While New York State health, including targeted audiences, such
public stigma surrounding mental illness, has strong parity laws, which, together with as landlords, corporate employers, educa-
often perpetuated by sensationalized me- federal measures, protect our rights by re- tors, the media, and healthcare workers,
dia coverage, creates stereotypes that quiring most comprehensive health insur- who are often unwittingly influenced by
lead to discrimination in employment, ance plans to cover medically necessary the stigma of mental illness.
education, housing, and other essential mental health services in the same way As a result of community advocacy, a
services. This discrimination can lead to they cover medical and surgical benefits, voluntary tax check-off program launched
self-stigma and shame for people living violations of these laws still occur. NY in NY state in 2016. This program allows
with mental illness, which in turn dis- State monitors and works to correct any NYS taxpayers to donate easily to the
courages them from addressing their is- violations, and it is important for the public “Mental Illness Anti-Stigma Fund” when
sues or seeking out the treatment and as- to let us know when this happens. filing their NYS taxes. Our latest round of
sistance they need. New York has a behavioral health om- awards emphasized activities that provide
New York State is attempting to de- budsman program called the Community innovative, culturally appropriate, and
crease stigma by implementing a robust Ann Sullivan, MD Health Access to Addiction and Mental relevant approaches to reducing stigma in
effort to educate the public about the mis- Health Care Project (CHAMP) which minority and underserved populations,
conceptions of mental illness, while at the Stigma-based discrimination against helps individual New Yorkers who are which are often most impacted by false
same time taking action to address the people living with mental illness can take facing insurance obstacles due to parity perceptions of mental illness.
impact of discrimination resulting from many forms, some overt and some more violations to get the treatment they need. In this very edition, we are partnering
stigma by holding insurance companies subtly embedded in our communities and Other systems where individuals with with Behavioral Health News as part of
responsible for parity of services and sup- our social systems impacting many differ- mental illness often face discrimination is our public awareness campaign to reduce
porting fair housing, employment, and ent aspects of a person’s life. in employment and housing - two critical stigma. OMH is teaming up with Mental
education opportunities. Additionally, A particularly harmful overt stigma is components of the recovery process. The Health News Education (MHNE) publish-
efforts being made today to educate our the media portrayal of individuals with NYS Office of Mental Health (OMH) is er of Behavioral Health News, on several
youth can really have an impact on how mental illness as violent and dangerous. partnering with community groups and stigma reduction projects. With OMH’s
future generations perceive mental health We must work hard to educate the public organizations across the state to help edu-
and wellness thus further reducing stigma. and the media that individuals living with cate individuals and families about their see NYS OMH on page 38
PAGE 2 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 3
Table of Contents Editorial Calendar
Understanding the Impact of Stigma Fall 2022 Issue
1 How the NYS Office of Mental Health is Addressing and Reducing Stigma The Behavioral Health System: Challenges Past and Present
6 Overcoming the Stigma of Mental Illness: Peers Play a Critical Role Deadline: September 16, 2022
8 Intersectionality in Behavioral Health: Multiple Stigmatized Groups
Winter 2023 Issue
10 Overcoming the Stigma of Mental Health, Chronic Illness, and Homelessness Stigma: How We Can Make a Difference
12 Stigma Is Being Used as a Political Weapon: Reject It! Deadline: December 13, 2022
16 A Real and Present Danger in the Fight Against Stigma
18 How We as Practitioners Can Foster Stigma Spring 2023 Issue
The Impact of Behavioral Health on Families
20 Increased Access to Telehealth as a Means of Reducing Stigma
Deadline: March 16, 2023
21 On Self-Stigma and Employment
22 They Are Us Summer 2023 Issue
22 From the Desk of Dr. Max: Stigma and Mental Illness Serious Mental Illness: History and Challenges Ahead
24 PROS Clients Share Their Lived Experiences of Stigma Deadline: June 14, 2023
25 Mental Health in Schools: Moving Stigma Out in the Open
26 How Mental Health Stigma Drives Suicide Risk
27 A Cruel Irony: Less Mental Health Stigma - Fewer Clinicians Contact us for information about advertising and article submissions
29 Associative Stigma: An Unseen Force
29 Two Misrecognitions About the Stigma of Mental Illness Stay Connected with BHN
31 When Internalized Ableism and Stigma Intersect
31 Stigma: The Balance Between Choice and Accountability Find over 1,200 behavioral health articles and 80 back issues at
32 CBC’s Mission to Destigmatize Workplace Mental Health
www.BehavioralHealthNews.org
32 Internalized Stigma
33 The Impact of Stigma on Mental Health Treatment for Children
33 Acknowledging the Effects of Intersectional Stigmatization Subscribe to receive the Behavioral Health News
34 There Is Hope bi-weekly Update newsletters featuring behavioral health
34 Stigma: The Often Silent Obstacle For African Americans education, webinars, upcoming events, and more!
37 Improving Help-Seeking and Reducing Stigma Through Public Messaging
Addressing the Healthcare of New Yorkers
28 Spotlight on Excellence: Joseph Wilson, Peer Specialist at S:US
35 The Transformative Power of Families Helping Families
Health and Wellness
14 Breaking Down Barriers to Using Social Determinants of Health Data
30 Drug Use Severity in Adolescence Affects Risk in Adulthood
In the News
26 COVID-19’s Affect on the Future of Behavioral Health Care
#YourTrustedSource
28 Depression Detection Has Never Been More Important Since 1999, Behavioral Health News has been providing
30 Fentanyl Seizures Increased Dramatically Between 2018-2021 a trusted source of science-based behavioral health information,
35 Jarod Stern Joins Mental Health News Education Board of Directors education and quality resources to the community.
Coming in January 2023
Mental Health Stigma: A Four-Part Roundtable Discussion Series
What is It? Panelists will Include: People with Lived Experience,
Advocates, Mental Health Providers, Researchers, and More
Who Does it Impact? Co-Sponsored By:
How Do We Reduce it?
PAGE 4 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Mental Health News Education Behavioral Health News
Board of Directors Honor Roll of Sponsors
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Outreach Institute for Community Living (ICL)
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General Counsel, New York State Psychiatric Association
Secretary
Silver Sponsor
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Unique People Services
New York Psychotherapy and Counseling Center
Treasurer Services for the UnderServed
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Vibrant Emotional Health
Members of The Board Behavioral Health News
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Sachs Policy Group
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PAGE 6 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Overcoming the Stigma of Mental Illness: Peers Play a Critical Role
By Edwin Rosario institutions and even with society as a
and Jose Cotto, LCSW whole. Much like how the popular Rumi
Institute for Community Living (ICL) excerpt goes, “Yesterday I was clever, so
I wanted to change the world. Today I am
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wise, so I am changing myself.” I under-
haring a lived experience may be stood that expecting change from com-
the single most important tool we plex systems is okay but aiming to be-
have to address the stigma of come the change that I wanted to see was
living with a mental illness, and even better. Upon my release, I decided
the isolation of COVID only exacerbated to look for support for my own mental
how important it can be to have someone health and was fortunate to have met
to talk with who truly understands. some amazing people that helped me in
Over the past two years, we all learned tremendous ways and guided me in de-
to keep a very close eye on mental health. constructing my own stigmas.
We came to see just how much this pan- How did I get to where I am today,
demic affected our physical, emotional, thriving as a peer specialist helping people
and spiritual response to things that were rebuild their lives? It began when I shared
once everyday occurrences. my gratitude with a mentor and asked him
Greater awareness has led to some very how I could ever pay him back for his
positive developments, including expand- support; his words forever stayed with me.
ed funding of behavioral health services He said “Eddie, the best way to pay me
offered in different ways like telehealth, Edwin Rosario Jose Cotto, LCSW back is by paying it forward” and with that
support for new, innovative programs and encouragement I would eventually be-
overall greater acceptance and under- how it looks to the outside world. This play rapper Biggie Smalls’ song called come a Peer Specialist at ICL. My experi-
standing by the world at large. While belief is one of the main reasons why I “Suicidal Thoughts,” a narration of the ences in this journey to my current life
there’s much work still to be done to have been so interested in promoting protagonist’s struggle with holding and were birthed because of stigmas and have
overcome the stigma of mental illness, it’s mental health and shedding light on the attempting to share the trauma, regret, and helped me understand that with healthy
clear no one is a stranger to the realities of prevalent stigma around it that can go self-stigma they held internally, and I support anyone can turn their “mess” into
mental health. unnoticed to many. I can still remember would bop my head in agreement without a message and bless so many others just
Another lesson of the pandemic has specific moments in my life that helped fully comprehending the gravity of his by openly sharing it. There’s privilege in
been a deeper understanding of the critical shape and evolve my views around mental words. At the time those very words being able to say that I’ve overcome so
role of Peer Specialists and just how much illness and even question the disparity that seemed normal to me because it was what many obstacles and find myself in a posi-
they can help increase engagement in ser- if we are all created equal then why aren’t I and most people were exposed to in our tion to be able to give back. I was once in
vices so that resilience, recovery, and we all treated as such. neighborhoods. The difference was that prison and now I’m working full time,
healing are more attainable. The unique While growing up in various neighbor- now someone of influence was disclosing living with a family I created; completing
relationship between a peer and a person hoods around Brooklyn, I quickly learned it. I recall having a strong connection to my Bachelor’s Degree and planning to get
receiving services allows for a healthy it was taboo to speak about mental health. the music and feeling a sense of relief my MSW. I’m living proof that anything
blurring of “professional” boundaries - the And when it did come up, it was done so knowing that I wasn’t the only one with is possible and that taking care of our
ultimate “human touch” - someone who in a negative light. My first introduction to dark thoughts and emotions. Even though mental health is vital.
has walked a similar path. the sentiment around mental illness was as there was a visceral connection that I and I compare receiving mental health ser-
At Institute for Community Living a young child playing with my peers in a many others had with Biggie’s music, it vices to what the greatest athletes in the
(ICL), Peer Specialists play a critical role park. We were all playing basketball and was not enough of a motivator for anyone world receive from their coaches and teams.
in achieving our whole health goals be- one of the kids made a simple mistake to begin having meaningful dialogue If the best of the best athletes can openly
cause they show from their own perspec- while playing which resulted in another about it. In hindsight, I believe it planted a benefit from having a team of people sup-
tive the value of addressing physical and kid telling the boy who made the mistake seed in my mind, normalizing the need to porting them to be their best, then so can we
mental health together. ICL peers are val- that he must be “crazy and from the G look for different outlets so that my strug- as humans when it comes to receiving men-
ued partners in newer programs such as Building” and continued to make fun of gles would no longer be internalized. tal health services for winning in life.
Shelter Assertive Community Treatment him until it was time to go home. I was not The role of mental health stigmas and
(ACT) Intensive Mobile Treatment (IMT) aware that the G building was the Psychi- its toll ended up revealing itself to me in Edwin (Eddie) Rosario is a Peer Spe-
teams as well as longstanding programs atric Ward of Kings County Hospital until a major way as a young adult. I still cialist on the ICL Shelter Assertive Com-
like Transitional Shelters, Community many years later but what I subconscious- found myself holding many things in and munity Treatment (ACT) Team where he
Residences for Young Adults, Supported ly learned that day was that it wasn’t okay felt like I was living a double life; in front uses his clinical skills and experience to
Housing, and Traditional ACT teams. to fall into the category as someone from of friends and family I would put on a provide high quality care to some of our
Through a new internship program, ICL the “G Building” because in my neighbor- smile, while inside I was suffering be- most vulnerable. It is through his lived
began working recently with a local col- hood that would make you a target. cause I was too afraid to share and be experience and training that he has
lege as the field placement for Peer Spe- The older I got the more I would hear judged. I would try to justify it by playing grown to believe it’s never too late for
cialists which can lead to a permanent the term being used and I would cross the hand that I was dealt which in other anyone to bloom. His mission is to share
position. Additionally, a revamped com- paths with many more people wanting to words dealing with my thoughts, feelings, seeds of encouragement that will positive-
mittee by and for Peer Specialists will ostracize and target people with mental and traumas on my own. My lack of clari- ly impact lives and inspire people to
enhance programming and provide sup- health challenges. Neighbors would even ty and fear led me to make some poor bloom wherever they plant themselves.
port to our colleagues. celebrate and welcome those coming out choices and unfortunately I wound up Eddie has completed the Peer Training
Peer specialists have become uniquely of incarceration yet have a dismissive and incarcerated. It was in prison that I no- Program at Howie the HARP Advocacy
able to address stigma, particularly during sometimes silent regard for anyone that ticed that many of the people I met there Center and earned an Associate’s Degree
the pandemic. About to celebrate his one- would be released from a mental institu- had mental diagnoses and were from from Borough of Manhattan Community
year anniversary at ICL, Eddie Rosario tion. With all these observations and ex- neighborhoods similar to mine which College with a focus on Liberal Arts. He
demonstrates just how valuable and val- periences, I still didn’t question the status didn’t sit well with me. is working on his Bachelor’s Degree at
ued Peer Specialists are today at ICL. He quo and social stigmas because in hind- Right before my eyes was the evidence Brooklyn College with the hope of pursu-
clearly has what it takes for this difficult sight, I was like the metaphoric fish who of what not having enough meaningful ing a Master’s Degree in Social Work.
but ultimately rewarding work. was the last to know that it was in water. dialogue, education, and awareness about Aside from helping others, his greatest
I have come to believe through experi- Environment played such a huge role in mental health can lead to. For some, it source of pride is being a father. Jose
ence that whatever prevailing condition shaping my world around mental health was a vicious cycle of going from jail to Cotto, LCSW is Senior VP for Residential
one is born into can be considered normal but so did entertainment. I remember as a hospital to shelter. I wanted this to Treatment at the Institute for Community
to the one who is experiencing it despite teen turning on the radio and they would change and grew very frustrated with the Living (ICL).
The Behavioral Health Community Has Many Vital Programs and Services to Help You During Times of Crisis
Visit Behavioral Health News - www.BehavioralHealthNews.org
BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 7
PAGE 8 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Intersectionality in Behavioral Health:
Serving Those With Membership in Multiple Stigmatized Groups
By Kismyth Shuler, LCSW, Master with our organizations leadership, speak-
CASAC, Director of Integrated Services ing with community members, and with
The Guidance Center of Westchester community partners about intersectionali-
ty, make it an inclusive conversation so
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that we can be thoughtful about decisions
hat are your social identities? we make, policies we create, and utilizing
How do you identify and practices that are supportive of stigma-
how does the world see you? tized populations. If we are not talking
“Intersectionality, a term about intersectionality, we are not ad-
coined by legal scholar Kimberlé Crenshaw, dressing it. If we are not addressing it,
emphasizes the “multidimensionality” of marginalized groups will continue to ex-
oppressed people’s lived experiences and perience of stigmatization. Hence, we
recognizes how various types of oppression become complicit in continuing to perpet-
frequently coexist and intensify one another uate stigmatizing oppressed and marginal-
(Karmakar, 2022).” As part of my many ized populations.
intersecting identities, I identify as a Black I will leave you with a quote from the
cisgender woman. My identities are not late great inspiring Maya Angelou: “Do
independent of each other and overlap with the best you can until you know better.
who I am and how I am seen in the world. Then when you know better, do better.”
Social stigmas can have a negative con-
notation and/or lead to discrimination influenced homogenous approach is that ingly, Collins (2019) states intersectionali- The Guidance Center of Westchester is
against an individual or group based upon we risk our efforts being out of alignment ty is about interconnections, reciprocity of part of the Access Network - a group of
their social locations such as race, gender, with the needs of stigmatized popula- engagement, and rapport building. agencies led by Access: Supports for Liv-
religion, co-occurring disorders, disabil- tions. Even further, we potentially leave a Let us consider health disparities within ing. Together, the nearly 2,200 staff of the
ity, sexuality, and other identities. When gap between the treatment needs and so- our healthcare systems. Social determi- Access Network provide support to more
we consider what intersectionality means, cial justice problems that may be contrib- nants of health have a negative impact on than 17,000 adults and children with men-
it is complex and is interconnected to so- uting factors to the individual and group marginalized and stigmatized groups. tal health and substance use needs, devel-
cial justice issues including, but not lim- issues within systems and structures that Almeida et al. (2019) suggests that use of opmental disabilities, children, and fami-
ited to, power dynamics and systemic are broken and stigmatizing, leaving op- an intersectional assessment to inform lies facing challenges, and those who
oppression inclusive of disparities of pression and marginalization to continue ways in which social determinants of need support with housing and employ-
wealth, health, education, experiences in to be perpetuated. health determine overall wellness and ment across New York’s Hudson Valley,
the legal system, employment/wages, and An intersectionality framework can health by using a decolonizing process the five boroughs of New York City, and
access to resources. These disparities have have a meaningful impact and potentially and approach. Assessment of financial or Long Island.
significant and long-lasting impact to better outcomes in behavioral health care. economic stability, healthcare access and
marginalized groups who are stigmatized Through conversations with our clients quality, environmental factors, food inse- References
based upon their intersectional identities and groups about how they experience the curity, housing, unemployment, cultural
and social location. stigma of having intersecting identities, and social stigma, support networks, edu- Collins, P.H. (2019). Intersectionality as
There is no one size fits all when look- socio-politically and culturally, can pro- cation, and literacy to name just a few. Critical Social Theory. Durham: Duke
ing at engagement and behavioral health vide validation, acknowledgement, inclu- There is a cycle and theme of these social University Press. https://muse.jhu.edu/
treatment approaches which can either sivity, and a deeper understanding of determinants of health that are experi- book/69118
support those we serve or harm an indi- ways in which we can understand and enced at a high rate by marginalized and
vidual’s overall well-being. Culturally support those individuals. Singh et al. oppressed populations. We tend to focus Karmakar, Goutam (2022). Feminism and
aware, sensitive, and appropriate respons- (2020) suggests that intersectionality more on what is considered deficits of an Intersectionality: Black Feminist Studies
es and approaches should be thoughtful scholars inspire behavioral health provid- individual rather than how systems in and the Perspectives of Jennifer C. Nash.
and intentional. Approaches and interven- ers to understand that using common the- which these populations are engaged with Journal of International Women's Studies,
tions for a person who identifies as a cis- ories can be harmful to clients with a continuously oppress, stigmatize and even 23(1), 388-395. https://vc.bridgew.edu/
gender, bicultural, female, can look differ- dearth of awareness of cultural compo- pathologize. Within our healthcare sys- jiws/vol23/iss1/21
ent from approaches for a person who nents around more influential and tradi- tems as a whole, we need to do better with
identifies as Black, gender nonconforming tional theories. deconstructing and eradicating the stigma Rhea V. Almeida, Lisa Marie Werkmeister
and differently abled. As we are reflective The term epistemology is about how we of those with intersecting identities and Rozas, Bronwyn Cross-Denny, Karen
and cognizant of intersecting identities in know what we know. What are our ways the experiences of being marginalized, Kyeunghae Lee & Ann-Marie Yama-
historical, social, cultural, and political of knowing? How do we know what the oppressed, dismissed, devalued and un- da (2019) Coloniality and Intersectionality in
contexts, and are inclusive of an intersec- experiences of intersectionality are of stig- heard. Social Work Education and Practice, Journal
tional framework when in dialogue with matized individuals and groups? We must There are many interventions we can of Progressive Human Services, 30:2, 148-
stigmatized groups, we gain better insight be moved to think about systemic oppres- implore. Training is a critical aspect of 164, DOI: 10.1080/10428232.2019.1574195
to the experiences of these populations sion, explore and be curious about the per- bringing awareness, knowledge, tools and
through their narratives. son and environment, recognize power resources about intersectionality and ap- Singh, A.A., Appling, B. and Trepal, H.
Behavioral health services are not imbalances, consider our own intersecting plication of the framework. While many (2020), Using the Multicultural and Social
wrapped in a box with a bow. We serve a identities, consider our own power, privi- may have heard the term intersectionality, Justice Counseling Competencies to De-
diverse population of community mem- lege, and oppression that we hold and be many may not fully understand how to colonize Counseling Practice: The Im-
bers who each have unique and complex culturally conscious. Hold courageous apply the framework and how to have portant Roles of Theory, Power, and Ac-
experiences and needs, inclusive of his- conversations inclusive of an individual’s discussions about intersecting identities tion. Journal of Counseling & Develop-
torically and presently stigmatized intersecting identities and an awareness of and the impact socially, politically, or ment, 98: 261-271. https://
groups. The expectation to conform to any biases that may negatively impact culturally it has on stigmatized groups and doi.org/10.1002/jcad.12321
society’s Western culture, values, and those with whom we work. “It requires social justice issues that inherently are
beliefs of what behavioral health ap- that social workers be vigilant, bold, and attached. I say, get comfortable with be- Sulé, V. (2020) Critical Race Theory.
proaches and interventions should look knowledgeable. It tells us that in order to ing uncomfortable. Encyclopedia of Social Work. https://
like are not in alignment with the experi- serve for justice, one has to get to the heart Inviting and holding conversations in a oxfordre.com/socialwork/view/10.1093/
ences of stigmatized populations. The of the matter” (Sulé, 2020). There is a nar- learning and teaching environment, inclu- acrefore/9780199975839.001.0001/
impact to this primarily Western- rative to be heard and explored. Accord- sive but not limited to, supervision spaces, acrefore-9780199975839-e-1329
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PAGE 10 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Consumer Perspectives: Overcoming the Stigma
Of Mental Health, Chronic Illness, and Homelessness
By Glenn, Rachelle, Robert, protective of ourselves and less trusting
and Stephanie of others.
“After I went to the hospital, people
looked at me differently, people stayed
This article is part of a quarterly series away from me, labeled me as crazy - eve-
giving voice to the perspectives of indi- ryone, including my friends and family. It
viduals with lived experiences as they made me standoffish and very private. I
share their opinions on a particular was very non-trusting of others. I didn’t
topic. The authors are served by Ser- feel like anyone did anything that made
vices for the UnderServed (S:US), a me feel safe. Everybody pushed me away.
New York City-based nonprofit that is I really wanted people to have an open
committed to giving every New Yorker mind, ask me questions, hear me out, lis-
the tools that they can use to lead a life ten to me to understand where I was com-
of purpose. ing from,” said Robert. “I was constantly
thinking ‘What did I do wrong?! Was it
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my fault?! Are people right about me?’ I
e are four New Yorkers finally came to the realization that every-
ranging in age from 39 to one goes through ups and downs and that
62. We all receive support has made me happier and more in tune
from Services for the Un- with myself.”
derServed including housing, mental Glenn said, “For me, the stigma around
health services (therapy, medication man- Stigma Causes Harm ic illness, and/or homelessness. It has my HIV was the biggest thing I faced.
agement, and psychiatric rehabilitation), been really hard for all of us when people People really didn’t understand the virus
help preparing for and finding employ- We have all experienced stigma be- treat us differently because of what we’re
ment, and/or case management. cause of mental health challenges, chron- going through. Stigma has made us more see Consumer Perspectives on page 14BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 11
PAGE 12 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Stigma Is Being Used as a Political Weapon: Reject It !
By Michael B. Friedman, LMSW criminal. But murder by people with psy-
Adjunct Associate Professor, Columbia chosis is so rare that it is included only as
University School of Social Work a footnote.
I
• People with mental illness are far more
and many others have said it before likely to take their own lives than the
but, as recent events make clear, we lives of other people. This became an
will have to say it again and again and increasingly serious problem in the first
again: Mental illness is not the cause two decades of the 21st century. Ac-
of mass murder in the United States. cording to the CDC, the rate of suicide
The continuing assertion by the politi- has increased 32% since the beginning
cal right that it is has become a core ele- of the century and is now roughly dou-
ment of the vituperative and dangerous ble the rate of homicide, which re-
political division that besets the United mained about the same from 2000-
States today. It is effective as political 2019, but jumped about 30% in 2020
rhetoric because of the widespread mis- and apparently is continuing to rise.
belief that people with serious mental
illness are violent and dangerous - i.e., In addition to repeatedly making the
because of continuing pervasive stigma facts clear, mental health advocates
about mental illness. In the hands of the need to resist the temptation to use re-
political right, stigma has become a po- cent increases in homicides, including
litical weapon. About 5% of homicides are committed • People who commit purposeful acts mass murders, as a rationale for calling
The mental health community, whether by people with psychotic conditions. of murder or manslaughter or who for improvements in America’s mental
liberal or conservative on other issues, commit crimes that result in unin- health system. There are numerous rea-
needs to conceptually disarm those who • People with serious mental illness are far tended deaths sons why there should be massive im-
rely on the slogan that the problem of more likely to be victims than perpetrators. provements; reducing murder is not
• Perpetrators of domestic violence
violence is mental illness, particularly one of them. Reducing suicide, yes.
those who refuse to confront guns as a • Most mass murders are committed by • People seeking revenge Increasing the capacity to provide and
major vector of death in the United States. people who are not seriously mentally to get access to treatment for mental
• And more…
We need to continue to make the facts ill including: illness, yes. Improving the quality of
clear. It is notable that in its Global Study on available services, yes. Reducing frag-
• Terrorists Homicide, the UN Office on Drugs and mentation, yes. Addressing social de-
• People with mental illness rarely commit Crime recognizes multiple motivations for terminants of mental illness, yes.
• Racists
homicide, and few homicides are com- murder and divides homicides into 3
mitted by people with mental illness. • Religious bigots types: socio-political, interpersonal, and see Weapon on page 37BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 13
PAGE 14 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
Breaking Down Barriers to Using Social Determinants of Health Data
By David Bucciferro Integrating Social Determinants
Special Advisor, Foothold Technology Data into Healthcare
Vice-Chair, Electronic Health Record
Association As an industry, how can we be even
more successful in identifying and incor-
T
porating these factors into healthcare
his is the time to use technology treatment? I believe there are three factors
to overcome the barriers in inte- that will help us integrate social determi-
grating social determinants of nants into healthcare: identification, ac-
health (SdoH) information into cess, and action.
healthcare but ensuring that infrastructure
and standardization is in place will be a 1. Identification: It starts with identifica-
joint effort. tion. Identifying social determinants is not
If one were to think about individual as simple as “just ask the person.” Often,
health, you might think of the incredible this information is not disclosed by an
advances in medicine that we have seen in individual during a healthcare visit or
the past 30 years. You could think about during urgent care treatment. Even as
the use of new technologies that were social determinants have become more
only a dream 30 years ago. You might widely recognized as critical to an indi-
also think that an annual physical is the vidual’s health, the healthcare system as
key to a person’s health. Although all of it’s currently configured is not set up to
these are important advances in medical nomic Stability, Education Access and For those in the behavioral health fully identify an individual’s comprehen-
care, they are only a very small part of the Quality, Health Care Access and Quality, world, social determinants of health have sive array of social determinants. What’s
story. Medical care accounts for only 10% Neighborhood and Built Environment, always been at the center of the work that more, clinical settings and reimbursement
-20% of modifiable contributors to health and Social and Community Context. On these providers do. They have developed systems are not designed to identify and
outcomes for populations in the US the other hand, the Public Health Agency community-based programs that address account for these factors. While there are
(Magnan, 2017). You may wonder, how is of Canada has identified 12 determinants inequities and help people work, learn, pockets of successful efforts to integrate
this possible? The answer comes in the of health as follows: Income and social and thrive in the community. For most social determinants into the healthcare
correlation between patient outcomes and status, Social support networks, Education behavioral health programs, social deter- system, the system as a whole is still
social determinants of health. and literacy, Employment/working condi- minants have been at the core of recovery struggling to address social determinants.
tions, Social environments, Physical envi- and rehabilitation for many years.
Defining Social Determinants of Health ronments, Personal health practices and In recent years, there has been a grow- 2. Access: Access to social determinant
coping skills, Healthy child development, ing recognition of the importance of so- information has been an ongoing issue.
To better understand the influence of Biology and genetic endowment, Health cial determinants. There have been some When thinking about the value of infor-
SDoH, it is important to understand what services, Gender, and Culture (2020). focused, while limited, efforts to address mation, it is important to look at standard-
they are. The World Health Organization Whatever definition we use, it is im- this critical component of the healthcare ization, accessibility, and usability. Pro-
defines social determinants as “the condi- portant to understand that there are a set system. Through COVID-19 we have jects such as the Gravity Project have
tions in which people are born, grow, or range of factors that are major influenc- gained knowledge about social determi- made great progress in creating standard-
work, live and age, and the wider set of ers on the health status of individuals and nants that has helped to highlight the dis- ized nomenclature and coding for many of
forces and systems shaping the conditions populations. Regardless of one’s age, parities in our healthcare system, which the social determinants. Including social
of daily life.” Social determinants are non there are complex interactions between come as a result of racial, gender, and determinants as part of the latest USCDI
-medical factors that impact a person’s social and economic factors, as well as economic inequalities. However, for the dataset provides an avenue for interopera-
health. between physical environment and indi- most part, social determinants have not bility and sharing of this information.
There are numerous ways to categorize vidual behaviors. These factors and inter- been as deeply integrated into medical Beyond having this information
social determinants. The CDC identifies 5 actions come together to influence one’s care when compared to the behavioral
categories of social determinants: Eco- health. health sector. see Data on page 36
Consumer Perspectives from page 10 housing and supports. Because of that I was going through. S:US therapists lis- about and so focused on the two people
tend to not share much about myself,” tened with an open mind and gave good I’d lost (my two sons) that I didn’t realize
and how you could transfer it and I was Stephanie said. “I think the biggest source advice, especially at times I needed it the my relationships with my other kids were
very stigmatized. My mom would give me of stigma came from me. I would beat most. I was able to talk about anything deteriorating. With therapy, I learned how
plastic forks and knives to eat with while myself up, saying I didn’t want to take and they didn’t judge me. The advice and to get through things, started looking for a
everyone had silverware. They would meds, I didn’t want to go to treatment. I experience from them helped a lot. Thera- job and practiced strategies to control my
scrub the toilet bowl after I used the bath- stigmatized myself a lot in that aspect. py was a place to speak my mind and it anger, like journaling, calling a counselor,
room. There was a real lack of education The way I looked at myself six years ago helped me open up. Everyone was very and counting backwards. Whenever I
and disconnect, and it didn’t work well was I didn’t need the help. I thought it receptive to listening to me and gave me called my counselor they would call me
for me. The reactions I got from my loved was okay, I was really trying to be strong genuine advice from a non-judgmental back quickly and I felt like I had so much
ones made me feel more rejected and I and was stubborn in telling people I didn’t point of view, which was something I support. It really helped that they had my
ended up just turning more to the streets need help even though I knew I might. really needed.” back when I needed it,” Rachelle said.
and did more drugs as a way of dealing But the mind is an organ. It’s like any “I appreciate having someone to go talk “Mental health is an important issue. Peo-
with things.” other organ in the body, and if there is to when I’m having a hard time or need ple don’t want to be in my community
“I hate the fact that when people know something wrong you need to treat it, and help. If people who live here start using because they don’t want to be crazy. But
you have mental health issues that they it needs to be taken care of and medicat- (substances) again, they are able to talk to S:US can make you feel comfortable
call you ‘crazy.’ I hate the stigma of ed; if there are symptoms, you need to the counselor and say, ‘Hey I can’t stop enough to talk to them. I didn’t think I
‘crazy.’ People don’t understand your treat it to be healthy. All of the same using’ and get the help they need by being wanted to talk at first, just wanted to get
mental health and you feel like they don’t things that apply to other body parts apply able to go to detox or rehab - it’s life- something off my chest, but afterwards it
understand you. I get into arguments with to the mind because it is the powerhouse saving. When people are on their own, made me understand that someone could
a lot of people because I know I’m trig- of the body. I finally realized that and I nobody is checking up on them and peo- understand me without bias and that will
gered by the things they say, especially if took the stigma off of myself.” ple are using and can be found dead, but help you come back.”
someone calls me crazy, a liar, or an unfit here I feel safe because the staff checks
mom. That triggers me and my reaction is Therapy Helped Us in Different Ways up on me,” said Glenn. A Support System and Stability
to hit when I hear things like that. I hate “Four years ago, I became a grandmoth- Are Essential for Mental Health
being called those things but there’s a Most of us have been aided by therapy; er and things became clear. I didn’t want
stigma with bipolar depression and people we’ve become more stable and made pro- my grandson to have the same problems I Experiences with mental health, chronic
think that you can’t tell what is real,” said gress in our lives. went through. And that was when I started illness, and homelessness can make peo-
Rachelle. Robert said, “When I took therapy seri- really going to therapy because I didn’t ple feel alone. We all felt that way at
“There is stigma when it comes to peo- ously it really helped me. I became more want that generational cycle to continue. I
ple with mental health having to acquire understanding of who I was and what I was staying away from people I care see Consumer Perspectives on page 36BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 15
PAGE 16 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
A Real and Present Danger in the Fight Against Stigma
By Ashley Brody, MPA, CPRP dictive of violent behavior, and as re- _Cyrus-Huncharek.pdf (ndrn.org)
Chief Executive Officer searchers catalogue the commonalities
Search for Change, Inc. among perpetrators of mass violence they Gun Violence Archive, 2002. Mass
converge on central findings. Perpetra- Shootings in 2022 | Gun Violence Archive
B
tors generally harbor extreme feelings of
y many measures we have anger, often fueled by experiences of Knoll, J. L. IV, & Annas, G. D. (2016).
achieved considerable pro- rejection and humiliation (Coalition for Mass shootings and mental illness. In L.
gress in combatting stigma Smart Safety, 2022). A desire for re- H. Gold & R. I. Simon (Eds.), Gun vio-
and its insidious effects. Per- venge in response to actual or perceived lence and mental illness (pp. 81–104).
sons who experience behavioral health maltreatment coupled with access to le-
challenges are now more inclined to pur- thal means perfects this deadly recipe Olafsdottir S. Medicalization and mental
sue treatment without incurring the repu- (Peterson & Densley, 2021). Simply put, health: The critique of medical expan-
tational risks they might have borne in if there were a bona fide correlation be- sion, and a consideration of how markets,
prior years. We regularly encourage tween the incidence of mental illness and national states, and citizens matter. In:
those in need of treatment to seek it, and mass violence, other nations would expe- Pilgrim D, Rogers A, Pescosolido BA,
we laud public figures who disclose their rience comparable trends. Mental illness editors. The SAGE Handbook of Mental
struggles with mental health or substance is not unique to the United States. Mass Health and Illness. London: Sage Publi-
use issues. Public service announce- violence committed with high-capacity cations; 2011. pp. 239–260.
ments concerning the potential benefits assault rifles is.
of behavioral healthcare abound, and Pescosolido BA. The Public Stigma of
legislation has been enacted by the fed- Ashley Brody, MPA, CPRP, is Chief Mental Illness: What Do We Think; What
eral and state governments that requires Ashley Brody, MPA, CPRP Executive Officer at Search for Change, Do We Know; What Can We Prove?
insurers to offer comparable coverage Inc. For more information, email abro- Journal of Health and Social Behavior.
for behavioral and physical health condi- findings might suggest enlightened atti- dy@searchforchange.org or (914) 428- 2013;54(1):1-21.
tions (notwithstanding insurers’ repeated tudes toward individuals living with 5600 (x9228).
failure to abide by such legislation and mental illness, but they obscure a coun- Peterson, J., & Densley, J. (2021). The
regulators’ reluctance to enforce it). New tervailing trend that has persisted, if not References violence project: How to stop a mass
York State recently distinguished itself worsened, over time. Survey respond- shooting epidemic. Abrams Press.
as a leading combatant in the fight ents’ belief that individuals with mental American Psychiatric Association, 2002.
against stigma. It now permits its resi- illness possess a propensity toward vio- Psychiatry.org - Stigma, Prejudice and Scarf D, Zimmerman H, Winter T, et
dents to allocate a portion of their in- lence increased throughout the period of Discrimination Against People with Men- al. Association of Viewing the Films
come tax refunds to finance anti-stigma analysis (Pescosolido, 2013). A full ac- tal Illness Joker or Terminator: Dark Fate With
initiatives and requires primary and sec- counting of potential reasons for such Prejudice Toward Individuals With
ondary schools to include mental health persistent bias was beyond the scope of Coalition for Smart Safety, 2022. Coali- Mental Illness. JAMA Network Open.
education in their curricula. As promis- the author’s investigation, but one cause tion-for-Smart-Safety-Letter-in-Response 2020; 3(4).
ing as these developments may be, they was posited for which abundant evidence
belie an enduring undercurrent whose exists. The U.S. media reliably depicts
momentum is poised to dismantle dec- individuals with mental illness as violent,
ades of progress. and significantly more so than their
The United States enjoys a dubious counterparts in other developed nations
distinction among developed nations for (Olafsdottir, 2011).
its epidemic of violence. As of this writ- Depictions of individuals with mental
ing, there have been 260 mass shootings illness in our news media and popular
in 2022, an average of 1.59 per day (Gun culture might reinforce longstanding ste-
Violence Archive, 2022). Clarion calls to reotypes and impede stigma mitigation
action echo across our landscape and a efforts. For instance, an examination of
diverse array of potential correctives are viewers’ responses to the depiction of a
proffered, although few find support violent mentally ill character in a popular
among both sides of the proverbial aisle. movie supports this hypothesis (Scarf et
There is one proposed “solution,” how- al., 2020). This study assessed partici-
ever, that has garnered support from pro- pants’ responses to a viewing of Joker, a
ponents of diverse political stripes. The film whose eponymous central character
identification of individuals at risk of commits a killing spree after he is forced
violence, presumably as a result of undi- to discontinue treatment for a serious psy-
agnosed and untreated mental illness, chiatric condition. Study participants ex-
has unified a polarized body politic hibited more negative attitudes toward
much as it has throughout our history. In individuals with mental illness after view-
invoking the specter of the “violent men- ing this film as assessed by the Prejudice
tally ill,” our policymakers have once Toward People With Mental Illness
again seized upon a politically expedient (PPMI) survey instrument. The study au-
distraction from actual causes of mass thors concluded such depictions might
violence and propagated a myth the re- deepen prejudice and discourage those
covery movement has labored for so who experience mental health conditions
long to debunk. from seeking treatment. This is consistent
In a comprehensive survey of research with other findings concerning “self-
on public sentiments toward individuals stigma” that includes negative attitudes
with mental illness, Pescosolido (2013) and internalized shame that persons with
found evidence of decreasing stigma be- mental illness harbor about their own con-
tween 1950 and 1996 along select dimen- ditions (American Psychiatric Associa-
sions. The author’s findings revealed tion, 2022).
increasingly nuanced and sophisticated Those who conflate egregious acts of
views concerning the nature and etiology violence with mental illness commit a
of mental illness among individuals sur- grave error that perpetuates stigma and
veyed along with a greater willingness to diverts attention from the actual causes
acknowledge their own mental health of this scourge. Only 3-5% of violent
conditions. Survey respondents also evi- acts are committed by individuals with
denced a fourfold increase in their will- mental health conditions (Knoll IV,
ingness to utilize mental health treatment James L., & Annas, George D., 2016).
throughout the period of analysis. These Other factors are significantly more pre-BEHAVIORAL HEALTH NEWS ~ SUMMER 2022 PAGE 17
PAGE 18 BEHAVIORAL HEALTH NEWS ~ SUMMER 2022
How We as Practitioners Can Foster Stigma
By Sa'uda K. Dunlap, LCSW, the group or community to which they
Lisa Furst, LMSW, MPH, belong. If we maintain a continuous and
and John Orr, MA, LMHC genuine curiosity about just who the per-
Vibrant Emotional Health son in front of is, today, we can consist-
ently find ways to deepen connection.
P
ractitioners, despite our best Check Your Messaging refers to the re-
intentions, may unconsciously ality that we live in a world where anti-
foster stigma by downplaying or quated terms that were born from bias are
not recognizing the ways in still being spoken. This technique is a
which power dynamics, implicit bias, remedy as it guides professionals to use
stereotypes, and lack of cultural humility evidence to not only inform their work,
can all build barriers to care. but also their words. A helpful practice is
To illustrate the stigmatizing potential to have an ongoing inquiry such as “How
of a practitioner’s implicit bias, let’s con- do I know this is true?” to analyze the
sider the following scenario: meaning and origin of the things we say,
especially the phrases that have been with
Leila, a 16-year old Black youth, has us for a while.
been referred to your community mental
health clinic by school personnel. She is Institutionalizing Fairness is the willing-
one of four siblings, two of whom have the ness to question the familiar and see if it
same father. Leila and her second oldest still has a place in an equitable and inclu-
sibling have different fathers. Leila’s sive future. Organizations have an oppor-
mother married the father of her youngest Sa'uda K. Dunlap, LCSW Lisa Furst, LMSW, MPH tunity - and an obligation - to modernize
two children. Over the past six months, their policies and practices to be consider-
Leila’s mother and stepfather have in- the stress of witnessing the constant argu- towards dismantling them. One model ate of diversity, equity, inclusion, and
creasingly argued about finances and oth- ing between her mother and stepfather led proposed by Jennifer Edgoose, MD, justice.
er matters, and there has been a tense her to leave the house during the eve- Michelle Quiogue, MD, and Kartik Si-
atmosphere in the home. Recently, Leila’s nings, when the arguments were most dhar, MD, aims to mitigate implicit bias Take Two is a recognition that we are
mother filed for divorce from her husband. frequent. Leila frequently sought comfort through eight evidence-based tactics that continuous learners about an individual’s
Leila has been nodding off in her classes from one of her oldest friends, a young is implicit. These tactics spell out the culture and that humility, in this regard,
and has been more irritable than is typical man she has known since elementary mnemonic IMPLICIT: Introspective, can be healing, and can support the break-
for her. She has been spending her lunch school. She began spending time with him Mindfulness, Perspective-Taking, Learn- down of potentially oppressive power
periods by herself and has snapped at her in his room, talking about what was going ing to Slow Down, Individuation, Check dynamics. Power dynamics are always at
teachers several times, receiving detention on at home and her feelings about it. He Your Messaging, Institutionalize Fairness, play within any helping relationship, but
on two occasions. After the first few meet- listened to her without judgment. They and Take Two.1 adopting a stance of cultural humility and
ings with Leila, she reports that her men- grew close over the past six months. Their assuming that we are in a space of learn-
strual cycle was delayed by two weeks, parents didn’t question the amount of time Introspection is the deliberate quest to ing, rather than always knowing, helps to
and she thinks she is pregnant. A week they were spending together because they identify your own biases. An accessible lessen barriers to connection between
later, during your next meeting with Leila, were longtime friends. They eventually means of doing so is through implicit bias practitioners and the people they serve.
she reports that she had a false alarm and had sex without using protection. tests such as those provided (without cost) As mental health practitioners, we
is not pregnant after all. by Project Implicit. aren’t perfect, and we are going to make
As you learn this new information, mistakes in our practice. Ideally, we learn
As you read about Leila’s presenting what are your immediate thoughts? What Mindfulness, a present-moment oriented from them in order to deepen our ability
concerns and history, what are your im- assumptions are you making about these approach to living and form of meditation to engage and support the people we
mediate thoughts? What assumptions are two young people and their parents? Are with an abundance of online resources, is serve. Recognizing our implicit biases and
you making about this young person? you identifying any strengths and re- complimentary to this process as it in- internalized stereotypes is a lifelong jour-
What assumptions and judgments are you sources available to your client even as creases self-awareness and can potentially ney, and we have an obligation to contin-
making about her family? Are any of the the challenges become clearer? What con- reduce stress, shame and other challeng- ue on that journey as we strive to provide
assumptions or judgments stemming from clusions are you making based on this ing emotions that may arise through such the highest quality services. The IMPLIC-
any bias or stereotypes associated with additional information? inquiries. IT tool, among others, can be one frame-
race, gender, or sexuality? Practitioners, despite their best inten- work to guide our practice working with
Practitioners are trained, ideally, to tions, may unconsciously foster stigma Perspective-Taking, in this model, is the diverse communities in New York
enter into the therapeutic relationship due to implicit bias. We are shaped by our more than hearing from your clients - it is State and beyond.
without bias. We are often taught that our upbringing and lived experiences. It pre- the intentional and ongoing actions to
knowledge of theories and conceptual sents itself in our journeys in therapeutic expose and educate oneself to the Sa'uda K. Dunlap, LCSW, is Assistant
models about human behavior supersede relationships with the people we serve. thoughts and insights of people who have Vice President of Equity and Belonging,
the lived experiences of people we are These biases also influence our experi- been marginalized or stereotyped. An Lisa Furst, LMSW, MPH, is Chief Pro-
charged with providing care and mitigate ence of countertransference when work- easy access point is through the regular gram Officer, and John Orr, MA, LMHC,
the potential of practitioner bias when ing with our clients. While countertrans- consumption of media that is generated is Vice President of Programs at Vibrant
providing services. While this is taught ference can be used to further our under- from individuals and groups from differ- Emotional Health.
to us as the ideal of practice, the reality is standing of a client’s internal struggles ent communities.
that we all have our own personal histo- and interpersonal dynamics, we may find Footnotes
ries and social values that dictate how we it harder to make therapeutic use of coun- Learning to Slow Down is another inten-
perceive and process information. These tertransference if we don’t identify when tional step that recognizes that part of 1. Hepworth, D. H., Vang, P. D., Blakey,
internalized ideas and values contribute our biases are affecting our clinical case caring for people means conscious consid- J. M., Schwalbe, C., R., E. C. B., Rooney,
to implicit bias, defined as when we have formulations and interventions. eration of the factors that may be affecting R. H., Rooney, G. D., & Strom-Gottfried,
attitudes towards people or associate ste- The scenarios likely brought up a num- them - prior to meeting. By adding a K. (2022). Chapter 9. In Direct social
reotypes with them without our con- ber of emotions as you read and stopped short, reflective pause - no more than a work practice: Theory and skills (p. 168).
scious knowledge (https://perception.org/ to think about the questions that were minute or two - before your appointment, essay, Cengage Learning.
research/implicit-bias). posed. Implicit bias and negative attitudes you can slow down and enter the space
toward certain groups of people impacts from a more informed perspective. Research: Science & perception. Percep-
As you continue to build a relationship health care. Research shows that these tion Institute. (2016, September 14). Re-
with Leila, you learn more about her re- unspoken biases can be changed, but first, Individuation is the opportunity to see a trieved June 15, 2022, from https://
cent life circumstances. Leila reports that one must recognize and actively work person based upon who they are, not just perception.org/research/You can also read
