New study: stigma not major barrier to treatment for people with mental illness

The Rand Corporation just released a major study of Mental Health Stigma in the Military that found:

"Despite popular opinion and a strong theoretical base that stigma deters treatment-seeking, we were unable to identify empirical literature to support this link ... (W)e are unable to link military mental health stigma to changes in treatment seeking behaviors ... The regression analyses revealed that stigma did not predict initiation of treatment-seeking ... We found that decreasing (or completely eliminating) stigma would not increase the number of service members seeking mental health treatment (i.e., did not significantly increase the probability that a service member would initiate treatment) ... However, a variety of other factors (e.g., availability of providers, time off of work to seek care) may affect whether intentions to seek treatment translate into actual behavior."

These findings are consistent with those of other researchers:

• A 2011 survey by the SAMHSA Center for Behavioral Health Statistics and Quality found stigma (mentioned by 7% of respondents) was low on the list of why people with mental illness do not receive care, far behind cost (50%). Stigma also came behind could handle problem without treatment, did not know where to go, lack of time, belief that treatment wouldn't help, anosognosia (did not feel need for treatment), and lack of insurance as the reason people don't get care. 
• In a survey of Californians who had difficulty getting care for mental illness, three times as many (63%) said cost was a reason, versus that they were afraid or embarrassed to ask for help (21A recent study in Psychological Medicine, "What is the impact of mental health-related stigma on help-seeking" found stigma was only the fourth highest reason people didn't seek care.
• A 2011 study, "Barriers to Mental Health Treatment" found "low perceived need for treatment" was the primary barrier to treatment with everything else--including stigma, far behind.

Another indication that stigma does not play a big role in lack of care is that the number of people who go to a doctor and get a diagnosis of mental illness has exploded. If stigma were increasing, going to a doctor for a diagnosis should be decreasing. Likewise the use of antidepressants increased 400% between 1988 and 2008. If stigma was preventing people from seeking treatment, one would expect fewer would go on medications.

Dr. Tracey Goodman Skale observed that high powered executives may worry what other executives will think if they get care, but the most seriously ill do not have such worries. She defined Skale's Rule: The role of stigma in inhibiting care is inversely related to severity of illness. Fred Martin agrees, writing in the San Francisco Chronicle:

Visiting San Francisco General Hospital's medical emergency room or walking the streets of San Francisco and seeing untreated, seriously mentally ill people would convince most observers that the biggest problem of the mentally ill is not stigma. Yet millions of tax dollars are spent on anti-stigma campaigns.

It is a shame that so many millions of dollars are spent on 'stigma' and so many advocates believe it is an important barrier to treatment.  Those dollars and time would be better off it they were spent eliminating prejudice and discrimination which do exist. For example, discrimination in Medicaid and discrimination in Medicare prevent people with serious mental illness from being admitted to hospitals when needed.

Photo by Steven Depolo via Flickr.