Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 2016 The oS cial Obligation to Reduce Stigma in Order to Increase Utilization of Mental Health Services Melissa Sue Berdell Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Berdell, M. (2016). The ocS ial Obligation to Reduce Stigma in Order to Increase Utilization of Mental Health Services (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/304 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. THE SOCIAL OBLIGATION TO REDUCE STIGMA IN ORDER TO INCREASE UTILIZATION OF MENTAL HEALTH SERVICES A Doctoral Project Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Healthcare Ethics By Melissa S. Berdell May 2016 Copyright by Melissa S. Berdell 2016 THE SOCIAL OBLIGATION TO REDUCE STIGMA IN ORDER TO INCREASE UTILIZATION OF MENTAL HEALTH SERVICES By Melissa S. Berdell Approved April 7, 2016 _____________________________ _______________________________ Henk ten Have, MD, PhD Gerard Magill, PhD Director, Center for Healthcare Ethics The Vernon F. Gallagher Chair Professor of Healthcare Ethics Professor of Healthcare Ethics (Dissertation Director) (Committee Member) ______________________________ ______________________________ Dr. Joris Gielen Henk ten Have, MD, PhD Assistant Professor of Healthcare Ethics Director, Center for Healthcare Ethics Center for Healthcare Ethics Professor of Healthcare Ethics (Committee Member) (Center Director) ______________________________ James Swindal, PhD Dean, McAnulty College and Graduate School of Liberal Arts iii ABSTRACT THE SOCIAL OBLIGATION TO REDUCE STIGMA IN ORDER TO INCREASE UTILIZATION OF MENTAL HEALTH SERVICES By Melissa S. Berdell May 2016 Dissertation supervised by Dr. Henk ten Have Many mental health organizations have developed campaigns that concentrate on reducing the stigma towards mental health with the intentions of increasing access and utilization for people with mental illnesses that are not receiving appropriate mental health services. The mental health campaigns predominantly focus on establishing awareness and education related to the number of people with mental illnesses and diagnoses so that people will not be ashamed or embarrassed to have mental illnesses or access mental health treatments. However, societal prejudices have caused many people diagnosed with mental illnesses to lose jobs, homes, and families; therefore, in general, people are afraid of being diagnosed as mentally ill and seeking mental health treatments. Additionally, recent national attention and media reports of tragic and senseless events caused by people diagnosed with mental illnesses intensified the societal prejudices and stigma towards people with mental illnesses, which have depicted these people as iv extremely harmful to themselves and others. Consequently, societal demands magnified the need for public changes to prevent future tragedies, which contributed to President Barack Obama proposing regulations and policy agendas aimed at reducing stigma towards mental health and increasing access and utilization of mental health services. The mental health campaign initiatives and legislative proposals are supportive to the cause by reducing prejudices and barriers for people diagnosed with mental illnesses, and hopefully, preventing future tragic events. However, the research indicated that there is another barrier to mental health services impacting the lower levels of access and utilization. v TABLE OF CONTENTS Chapter 1 – Introduction Issues Influencing Access to Mental Health Services Reducing Stigma Overview and Outline of Mental Health Services Stigma towards People Seeking Mental Health Services Chapter 2 – Overview and Outline of Mental Health Services History of Mental Health Services Importance of the Medical Model: Diagnosing and Treating Mental Health Evidence-Based Treatments Chapter 3 – Stigma towards People Seeking Mental Health Services Evidence and Demographics of Stigma Factors Magnifying Stigma towards People Seeking Mental Health Services Reduction in Utilization Chapter 4 – Reeducating and Changing Public Opinion to Reduce Stigma Methods of Change to Increase Utilization of Mental Health Services Approval of Legislation for Parity and Access to Increase Utilization Implementation of Ethical Practice and Patient Safety Standards Chapter 5 – Validation of Mental Health Awareness Campaigns and Programs Anti-Stigma Campaigns and Trainings Compounding Mental Health Campaigns to Address Stigma and Fears of Mental Health Services Mitigating Stigma and Increasing Access with Additional Mental Health Awareness Chapter 6 – Social Obligations Community Mental Health Models Prevention of Harm and Tragic Events Affordable Care Act and Justice Chapter 7 – Conclusion Summary of the Project Future Considerations Conclusion vi Chapter 1 – Introduction Issues Influencing Access to Mental Health Services Many mental health organizations have developed campaigns that concentrate on reducing the stigma towards mental health with the intentions of increasing access and utilization for people with mental illnesses that are not receiving appropriate mental health services. The mental health campaigns predominantly focus on establishing awareness and education related to the number of people with mental illnesses and diagnoses so that people will not be ashamed or embarrassed to have mental illnesses or access mental health treatments. However, societal prejudices have caused many people diagnosed with mental illnesses to lose jobs, homes, and families; therefore, in general, people are afraid of being diagnosed as mentally ill and seeking mental health treatments.1 2 Additionally, recent national attention and media reports of tragic and senseless events caused by people diagnosed with mental illnesses intensified the societal prejudices and stigma towards people with mental illnesses, which have depicted these people as extremely harmful to themselves and others3. Consequently, societal demands magnified the need for public changes to prevent future tragedies, which contributed to President Barack Obama proposing regulations and policy agendas aimed at reducing stigma towards mental health and increasing access and utilization of mental health services.4 The mental health campaign initiatives and legislative proposals are supportive to the cause by reducing prejudices and barriers for people diagnosed with mental illnesses, and hopefully, preventing future tragic events. However, the research indicated that there is another barrier to mental health services impacting the lower levels of access and utilization.5 1 Another barrier for people with mental illnesses is the stigma towards mental health professionals and treatments that is impacting utilization of services because of the people are fearful or have misconceptions of mental health services. Previously, the imperfect history of mental health services including treatments such as convulsive therapies, electro-shock therapies, lobotomies, and antipsychotic pharmaceuticals has elevated public concerns with the medical model regarding consent, safety, and confidentiality. The images of patients with mental illnesses being forced into painful and ineffective treatments at asylums have raised questions about the legitimacy of early psychiatric practices. The images of psychiatrists abusing or testing on people labeled as “mad” or “insane” became the public perception of mental health treatments and was exacerbated by the entertainment and media reproductions of these images. Diverging from the public concern and portrayals, there are movements and evidence to support that psychiatric and mental health treatments are evolving and supporting positive outcomes for the recovery6 of people with mental illnesses.7 To encourage and legitimize the mental health practices and treatments that were producing benefits and demonstrating outcomes, many of the oversight and advisory agencies, including the American Psychiatric Association, have progressed in establishing ethical practice and patient safety standards that protect people with mental illnesses.8 Even though mental health services are increasing in general, there is still a reluctance within our society for people to access mental health services. The reluctance to access mental health services has been driven by stigma and societal prejudices against people seeking treatments for mental illnesses. The prejudices and perceptions have entrenched society with stigma that people diagnosed with mental illnesses are dangerous, insane, and dependent.9 Moreover, the prejudices and perceptions have produced stigma that mental health treatments are unsafe, 2 coerced, and futile. Consequently, people with mental illnesses are avoiding the labels, such as mad or insane, and dreading the mental health treatments that are portrayed as harmful and involuntary. Therefore, the mental health campaigns must compound the awareness and education to address the stigma and fears towards both mental health illnesses and treatments in order for the culture of the society to understand the