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Fighting Stigma

This article was prepared by Nora Underwood for Canadian Health Network. Nora Underwood is a journalist living in Toronto.

Date published: October 15, 2005

It’s incredible to think, as you look around that wedding reception or board meeting or high-school reunion, that one in five of the people there has or will have a mental illness at some point in their lives. Mood disorders, schizophrenia, eating disorders, substance abuse problems, anxiety, bipolar depression-any of these and other mental illnesses can affect people of all ages, ethnic backgrounds, and income levels.

We read frequent stories about mental illness, we see depictions of people suffering from mental illness, 20 percent of us will experience it firsthand-and yet there is still so much stigma attached to these diseases that, according to the Canadian Mental Health Association almost half of sufferers never get treatment. For some people, the stigma is so great that they cannot even tell family and friends what they are going through. And yet, none of us is immune.

Considering so many people have such difficulty opening up to people close to them, it’s no wonder that there are real fears about being stigmatized in the workplace. In fact, mental illness tends to strike people in their late teens and early twenties-often just at the earliest point of their careers, when they are least likely to ask for help or special accommodation. And the cost of mental illness in the workplace is enormous: 30 to 40 per cent of disability claims are for mental illness, and the losses amount to about $33 billion a year, not including treatment and health care-plus the unknowable costs in lost productivity by those people who suffer in silence.

The reality of mental illness in the workplace and the impact-positive or negative-employers have on those who are dealing with it was the focus of this year’s Global Business and Economic Roundtable on Addiction and Mental Health, a group of senior business leaders and former federal finance minister Michael Wilson (whose son, Cameron, committed suicide in 1995). Speakers at an April meeting spoke of the importance to the person and the financial benefit to the company of hanging on to and helping employees through mental illness. “We’re all at risk,” stated Dr John Frank, scientific director of the Institute of Population and Public Health at the Canadian Institutes of Health Research. “There’s not much room for stigma.” Dealing with mental illness is no different than coping with any other form of disability, he added. “We’re just worse at it.”

A Far-Reaching Impact

The word stigma means a mark indicating that something is not normal-a mark of disgrace. Those who are stigmatized because of mental illness, or anything else, are victims of discrimination-and the stigmatization not only intensifies their suffering by causing feelings of rejection and isolation but it also negatively affects treatment outcome. In a 2001 survey conducted by CMHA and Wyeth Pharmaceuticals, two-thirds of respondents claimed to have suffered from depression or anxiety themselves or were close to someone who had and one-third of them said they believed other people's perceptions of them would change if they found out.

Another report, "Mental Illnesses in Canada," stated that stigma and discrimination "force people to remain quiet about their mental illnesses, often causing them to delay seeking health care, avoid following through with recommended treatment, and avoid sharing their concerns with family, friends, co-workers, employers, health service providers and others in the community." It also contained the Canadian Alliance on Mental Illness and Mental Health's assertion that preventing discrimination against the mentally ill was a most important step toward improved mental health for Canadians.

Communication and flexibility are key:
According to the Canadian Psychiatric Association, people with a mental illness suffer more stigmatization in the workplace than those with other disabilities, and are more likely to come up against long-term disability and under/unemployment. "Many employers and employees have unwarranted fears and see persons with psychiatric disabilities as unskilled, unproductive, unreliable, violent or unable to handle workplace pressures," says a CPA pamphlet on "Mental Illness and Work."

But changing that environment takes time and the efforts of both employees and employers. It helps to remember that employers are better off financially-not to mention ethically-investing in a valued employee by supporting him or her through treatment. That may mean making some (likely) temporary changes to working hours or work conditions but the payoff following successful treatment is a happier, healthier, more productive employee. Employers set the tone for the workplace. If reasonable accommodations are made willingly to help an employee through a difficult time, that sends a powerful and important message to the rest of the staff. And it also goes a long way to helping the employee feel supported-a great help in the treatment process.

How employers can help?

Mental Health Works, a research project involving the voluntary sector, government and business, outlines all the rights and responsibilities of both employees suffering from mental health problems and their employers. It also offers tips for employers on how to help an employee return to work from a mental-health leave. This is when leading by example is most important. The onus is on employers to create an environment that is harassment-free and supportive for the returning employee. Often, if an employer takes the initiative and learns more about the employee’s illness it will help him or her convey to other employees the importance of not stigmatizing the returning employee. (First, however, an employer should discuss how much information the returning employee wants disclosed to colleagues.)

When, how-and whom-do you tell?

Employees should think carefully about how much and to whom they are planning to disclose information. That depends on the work environment. First of all, if an employee can perform the job perfectly well despite a mental illness, they are under no obligation to disclose their condition to an employer. In fact, the benefits and risks of disclosing should be carefully weighed before any action is taken. If an employee is at a crisis point or needs special accommodation for doctors’ appointments, they should know that an employer doesn’t need every gritty detail; the employer needs concrete information about the mental illness and how its treatment will affect the work performed, the working day or the work environment.

Sharing information with co-workers is a matter of personal choice, but if co-workers will be directly affected by changes then it helps if they understand why (and many times co-workers become a great source of support). If you have specific needs, voice them to your employer. If you cannot do your regular job in the same way as always, suggest other possibilities in the company while you undergo treatment.

Reality check

The first, best, way to combat stigma – at the workplace or otherwise – is to get educated about mental illness and then educate others.

  • No one asks for a mental illness. Some are caused by chemical imbalances in the body. Some people are genetically predisposed to certain types of the disease. Some are a result of an overload of stress, grief, pain, sadness or difficult circumstances.
  • Most mental illness will, if treated properly, be cured or at least controlled. Treatment will be profoundly more successful when the person who is suffering has the support of employer, family and friends.
  • Mental illness is not something a sufferer can simply get the better of by force of will.
  • The diseases are not signs of weakness or lack of intelligence. Mental illness can affect anyone at any time and, according to the CMHA, many studies have indicated that people who suffer a mental illness or typically of average or above-average intelligence.
  • Contrary to a common myth, people with mental illnesses aren’t any more violent than any other group. We just hear about it more.
  • Men are less likely to believe that they can suffer from mental illness but there is a growing body of evidence to dispute that. And in Canada, 80 per cent of those who commit suicide are male.
  • The costs of mental illness are enormous in every way. The economic cost in 1998 in Canada was estimated at $7.9 billion in care, disability and early death. Another $6.3 billion went to uninsured health services and time away from work for depression that was not being treated. In 1999, 1.5 million hospital days were due to mental illness.

Changing the mindset

What can we all do to help fight the stigmatization of those who are suffering from mental illness?

  • If you have first-hand experience with a mental illness, consider sharing it. There is almost no more powerful way to educate family and friends than that. Think about the positive impact someone like actress Brooke Shields, who talked about her postpartum depression, or William Styron, who wrote about his depression, has on others.
  • Know the facts and pass them on. If you hear someone talking about mental illness who has the wrong information and is perpetuating stereotypes, consider telling them what you know to be true.
  • Be sensitive about language-and help children understand what words just aren’t cool to use. Words such as “wacko,” “retard,” “loony,” “psycho,” “cuckoo” are offensive not only to those who are suffering with mental illness but also to their family and friends. Words reinforce incorrect stereotypes and they drive people who need help into hiding.
  • Have an open mind about people who have a mental illness. The disease is only one part-and often only a temporary part-of who they are.

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