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This past Wednesday, a new U.S. president was inaugurated, initiating new possibilities for national policy that can impact the lives of Americans living with mental health issues.
Although President Biden made it clear that the top four immediate priorities of his administration will be addressing the COVID-19 pandemic, the U.S. economy, climate change, and racial injustice, I believe that a national campaign addressing mental health stigma fits well within the priorities emphasized in his inauguration speech. Below, I lay out my reasoning, and make some recommendations for how such a campaign might look.
First, as my colleagues and I have previously argued, the U.S. has had a de facto national “pro-stigma” campaign for the past several years. This campaign has advanced a false (i.e., not supported by evidence) narrative that people with serious mental illness are the primary perpetrators of disturbing mass shootings, using this to deflect responsibility from lax gun regulation enabling these shootings and/or hateful ideologies that appeared to have motivated shooters in several instances. This has also been used as an argument for regressive policy changes such as the mass inpatient detention of people with mental illness, which was advanced by both the last U.S. president (“build institutions for sickos”) and some media outlets.
Supporting that this campaign has been impactful is national survey evidence indicating that the expectation that people with schizophrenia are likely to be violent (and should therefore be socially avoided) has increased, such that a roughly 70% of Americans endorsed this expectation in 2018, up from less than 60% in the late 1990s. Further, in recent national polls, 83% of Americans blamed the US mental health system for mass shootings. In his inaugural address, President Biden indicated that a priority will be addressing political extremism, so it would make sense that a part of this effort would be to combat the false narrative that mass shootings and similar disturbing actions are committed by “mentally ill monsters,” as stated by the previous administration, as these statements deflect from a genuine investment of resources in countering groups espousing hateful ideologies.
The COVID-19 pandemic has also awakened an interest in mental health issues among many in American society, so a national anti-stigma campaign would be a timely response to this. This has been primarily driven by widespread awareness that concern about infection, social disconnection related to prevention efforts, loss of loved ones who died from the virus, and the consequences of the virus itself, all impact mental health in a myriad of ways, and there is ample data supporting that the pandemic has increased psychological distress on a national level. As a result, it has been argued that longstanding mental health problems might constitute a “fourth wave” of the pandemic.
I echo these arguments, but also emphasize that such an effort should not make the mistake of too many anti-stigma initiatives by focusing solely on the most common mental health issues of “depression, anxiety, and stress.” People with serious mental health conditions, such as schizophrenia, bipolar disorder, and PTSD, have also been strongly impacted by the pandemic, which has led to the loss of in-person contact with service providers and support groups (which is not easily replaced by technological platforms such as Zoom for many, if not most, of these individuals), loss of contact with family members and friends, and increased social avoidance from community members shunning those that they see as “virus spreaders,” in some cases.
Throughout the pandemic, I have been involved in providing and supervising mental health services to people diagnosed with severe mental illnesses and I have witnessed first-hand how difficult it has been for many individuals with complex needs. Notably, while supervising trainees volunteering on a support line set up in response to the pandemic, it was evident that a high number of calls came from people with severe mental health diagnoses who had been impacted by losses related to the pandemic. Not focusing on people with severe mental health diagnoses risks leaving those in greatest need out of a national dialogue about the importance of mental health awareness, conveying the implicit message that any encouragement of dialogue about mental illness does not apply to the “truly mad” (as British human rights activist Liz Sayce suggested).
Furthermore, one of the greatest emphases of President Biden’s address was empathy (“Hear one another; see one another; show respect to one another”). People diagnosed with severe mental illnesses are too often socially rejected for acting or appearing different, and a national anti-stigma campaign encouraging acceptance of people who act or think differently would fit well with this point.
I will here note that many on the political left have labeled many of the followers of the previous president as “crazy” or “mentally ill,” and such a message might also fit with an emphasis on political understanding and reduce the use of “crazy” as a pejorative (and inappropriate) label in our national discourse, which can only increase stigma.
Although widely-held conspiracy theories such as QAnon do not meet the technical definition of delusions (since they are not idiosyncratic ideas, but culturally sanctioned), understanding how believing in something that provides an all-encompassing answer to the confusion of life might help increase national understanding, dialogue, and unity. Understanding why some endorse such beliefs on the individual level can also be clearly differentiated from the deliberate spread of misinformation initiated by hateful and extremist groups/ideologies.
In conclusion, I believe that the time is now for the federal government to follow the example of Canada, the UK, and several other countries and establish a national anti-stigma campaign. Such a campaign would need to be informed by research, such as the recommendations of the 2016 National Academy of Science report on “Ending Discrimination Against People with Mental and Substance Use Disorders.” There is a wealth of evidence on what does and does not work in this area, which can and should be drawn on. As the Biden Administration has also indicated a commitment to science, working with established experts would also be consistent with the values espoused in the inauguration address. As President Biden stated, “this is our historic moment of crisis and challenge…we must meet this moment.”
