Stigma and discrimination in behavioral health, while improving, remain obstacles to people seeking care. And any obstacles need to be addressed, because those struggling with behavioral health and mental illness are simply not getting the help they need. According to the National Institute of Mental Health, “The percentage of young adults aged 18-25 years with Any Mental Illness (AMI) who received mental health treatment (35.1%) was lower than adults with AMI aged 26-49 years (43.1%) and aged 50 and older (46.8%).”
When I was the Chief of Behavioral Health Informatics at the San Bernardino County Department of Behavioral health, my colleague and I presented at Analytics Experience on the impact of stigma and discrimination. As people around the country raise awareness of behavioral health and, specifically mental health, during May’s Mental Health Month activities, we must make decreasing behavioral health stigma and discrimination a priority.
Ironically, it is our well-intentioned focus on value-based care and outcomes that could be exacerbating stigma and discrimination. My home state of California has engaged in a multi-year statewide stigma and discrimination reduction effort called Each Mind Matters, which has shown to be helpful. The Mental Health Services Act (MHSA), passed in California over a decade ago, emphasizes a Recovery Vision that includes “hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.” Senate Bill 82, even framed as the Investment in Mental Wellness Act of 2013, is framed positively. These are all in alignment with the Eight Dimension of Wellness promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Yet when we get into the outcomes that must be measured and reported, they’re almost always negative. MHSA states that Prevention and Early Intervention programs “shall emphasize strategies to reduce the following negative outcomes that may result from untreated mental illness” and include things like incarcerations, school failure, and homelessness. SB82’s outcomes focus on reducing unnecessary hospitalizations, criminal recidivism, and unnecessary law enforcement expenditures.
These are important outcomes that can and should be tracked and reported. However, if we only focus on negative outcomes, how does that affect our narratives around behavioral health? If we only talk about people with behavioral health conditions in terms of incarcerations, school failure, homelessness, hospital use, etc., and especially put “unnecessary” with it, could we unintentionally be creating a negative, stigmatizing culture?
What would happen if we started reporting on some of SAMHSA’s Eight Dimensions of Wellness to shape our dialogues? Rather than just trying to ensure people with behavioral health conditions don’t fill up our emergency departments, what if we also focused on seeing if we’re helping them get social support? Or arrange for them to volunteer in a community garden? World happiness expert Baron Richard Layard even suggests that well-being and happiness should be a focus of public policy.
How different would treatment and public dialogue be if we evaluated more than negative outcomes?
I previously shared about how whole person analytics can encourage person-centered care. This approach of integrating multiple data sources, including non-health data, can empower this kind of evaluation and reporting. Data about how someone accesses care may reveal dimensions of wellness not normally captured in health care outcomes, and expand our picture of impact. Text analytics can uncover insights normally hidden away in notes, focus groups or stakeholder comments that may have been missed.
Gaining a more holistic understanding of needs, barriers, and successes can help us see people as more than just burdens on our health systems and society. People with behavioral health conditions are valued and loved members of our families and society, and we need to represent them as such. Let’s take advantage of technological advances to help reduce stigma and discrimination and increase access to needed care!
If you want to explore additional ways to combat stigma and discrimination in your daily life, the National Alliance on Mental Illness (NAMI) has some good resources.