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Taking Issue | June 01, 1999

Combating Stigma by Providing Treatment

H. Richard Lamb, M.D.

Psychiatric Services 1999; doi:

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No problem has been of greater concern to mental health professionals, families, and people with mental illness than the stigma of mental illness in our society. Much effort has been expended in demonstrating that mental illnesses are comparable to physical illnesses, in showing that mentally ill persons can take their place in society like any other citizens, and in trying to influence the media to portray mentally ill persons sympathetically rather than as dangerous, frightening persons who can strike with irrational and unpredictable violence. All these efforts are important and need to be pursued.

However, there is another area where we might accomplish still more. Probably nothing contributes more to the stigmatization of mental illness than the commission of violent crimes by persons who are clearly severely mentally ill. Such events evoke an extremely strong reaction from the public. Unfortunately, mental health professionals often respond by blaming the media who report the violence and by explaining that it is mentally ill patients who are untreated or are substance abusers or both who commit these crimes. Besides, they say, this violence constitutes only a small proportion of the violence in our very violent society. They blame society for not providing enough funding for community treatment. All those explanations are true, but they do little to lessen the public's fears and reduce the resulting stigmatization.

Most severely mentally ill persons who refuse treatment, especially medications, are known to us. Why do we not act to place them in some form of mandatory outpatient treatment, such as outpatient commitment? Many of them have also demonstrated what any good clinician recognizes as a need for 24-hour, highly structured inpatient care, perhaps for a brief period of stabilization, perhaps for an intermediate or long-term period. Increasingly, mentally ill persons are receiving mandatory outpatient treatment and 24-hour structured care through the criminal justice system. But they should not have to commit a crime to receive the care they need. To be labeled both mentally ill and criminal is to be doubly stigmatized.

I have been told that many people, especially those without clinical responsibilities for severely mentally ill persons, so highly value liberty for mentally ill persons, and so strongly oppose involuntary treatment, that they would sacrifice their lives to maintain these liberties. As I see it, they might be sacrificing not their own lives, but ours instead.

We can reduce stigma by doing what needs to be done to ensure that persons with severe mental illness who resist treatment receive the treatment they so clearly need.

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H. Richard Lamb; Combating Stigma by Providing Treatment. Psychiatric Services. 1999 Jun;50(6):729-729.

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