Shame, stigma still plague mental illness | The Honolulu Advertiser

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Shame, stigma still plague mental illness | The Honolulu Advertiser | Hawaii's Newspaper

Posted on: Monday, May 5, 2008

COMMENTARY
Shame, stigma still plague mental illness

By Marya Grambs

Every year, this nation celebrates May as Mental Health Month, when we take stock of how we as a nation, as a local community, and as individuals are faring in maintaining good mental health, providing excellent care for people with mental illnesses, and reducing the stigma and shame that still surround mental illnesses and prevent people from getting the help they need.

Nationwide, the United States has higher prevalence rates (26 percent) of mental illnesses than 14 developing and developed countries.

Although approximately 80 percent of all Americans who have a mental health disorder eventually receive some form of treatment, the median delay for all disorders is nearly a decade, and less than a third of people who seek help receive minimally adequate care.

People with serious mental illnesses served in the public system are dying 25 years earlier than people without mental illnesses.

Each year, roughly 30,000 Americans kill themselves, and hundreds of thousands make suicide attempts.

In Hawai'i, there is both good news and bad news. The good news is that we have low rates of depression and suicide, and both our adult and children's mental health systems have been released from many years of court-ordered oversight and show great improvement.

We have the highest proportion of Clubhouse programs — day programs for people with serious mental illnesses where they socialize, learn to hold jobs, and are treated with respect and dignity as members, not patients. We are also one of few states with certified peer specialists, people in recovery from mental-health problems who are trained to be part of treatment teams in mental-health programs.

The not-so-good news:

Even though our suicide rate in Hawai'i is relatively low compared to other states, four times as many people kill themselves here as are murdered, and more die by suicide than by car crashes. Most alarming is the fact that Hawai'i has the highest rate in the nation of teenagers who report planning, attempting or thinking seriously about killing themselves, with ninth-graders, Native Hawaiian youth and girls at highest risk of all. Mental Health America of Hawai'i is embarking on a project to reduce teen suicidal behavior in collaboration with the state Department of Health.

Up to 40 percent of inmates in our prisons and jails have serious mental health problems, and the Justice Department has found Hawai'i's mental-health services there abysmal. (Social historians have pointed out that the same number of people who used to be warehoused in huge state mental hospitals in the 1950s are now incarcerated in our criminal justice system.) The same lack of adequate mental-health care is true for our juvenile detention facilities.

Hawai'i State Hospital, our only public hospital for those with serious mental illnesses, is consistently and dangerously over capacity, most referred from the court. This overcrowding is primarily due to a lack of staffed residential facilities in the community. NIMBY — Not In My Back Yard — is alive and well in Hawai'i, preventing these facilities (on the few occasions that there is funding available) from opening. Thus, there is little if any room for individuals in the community who desperately need 24-hour medical-psychiatric care.

Transition-age youth — those vulnerable young adults who age out of foster care, children's mental-health programs, special education, juvenile detention or who drop out of school — are most at risk for a range of serious problems, including mental illness, homelessness, crime, unplanned pregnancy and substance abuse, yet there is no comprehensive system of care to help them.

"Invisible children" — children who have a mentally ill parent — are not being helped by any service system unless they also get in trouble. Mental Health America of Hawai'i has recently hired former Rep. Dennis Arakaki to spearhead an effort to help these families.

Shame, stigma, blame, and misunderstandings still plague mental illnesses. Some people continue to be under the false impression that if you just controlled yourself, you wouldn't have these problems. But mental illnesses are disorders of the brain, and just like disorders of other organs — heart, lungs, kidneys, blood — mental disorders respond to diagnosis and treatment, not judgment and rejection. People can and do recover.

What about us as individuals? Mental health is a continuum; genetics, stress and trauma can play a role in moving someone from a place of mental health to one of mental illness.

There are things we can all do to enhance and protect our mental health. We can talk to friends and families about what's bothering us. We can contribute to our community, help others. We can eat right, get exercise and get enough sleep. We mustn't hesitate to consult a professional if we feel overwhelmed. We must reach out to others whom we think may be suffering from mental distress. There's nothing for any of us to be ashamed of. We all need help sometimes.

Marya Grambs is executive director of Mental Health America of Hawai'i. She wrote this commentary for The Advertiser.

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