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ADVANCE Perspective: Nurses

Mental Health & the Stigma Question

Published February 14, 2013 11:14 AM by Rich Krisher
The horrific shootings at Sandy Hook Elementary School in Connecticut in December rekindled discussion of the link between mental health and gun violence, and violence in general.

Some in the mental health community have come out strongly against associating mass shootings like those in Newtown, Conn., and Aurora, Colo., with mental health. They are sensitive to the risk of stigmatizing mental illness, which could discourage those who experience it from seeking professional help.

It's a complex situation. One concern is where those with mental health issues can receive care. The Treatment Advocacy Center, a national group "dedicated to eliminating barriers to the timely and effective treatment of severe mental illness," has tallied a 14% decrease in the number of state psychiatric beds from 2005 to 2010, dropping from 50,509 in 2005 to 43,318 in 2010. More than 4,000 additional bed eliminations have been completed or proposed since 2010, it says.

The closures are part of a decades-old movement to shift mental healthcare from large, state-run institutions to community-based organizations, with uneven results. "Approximately half of the mentally ill individuals discharged from state mental hospitals, many of whom had family support, sought outpatient treatment and have done well. The other half, many of whom lack family support and suffer from the most severe illnesses such as schizophrenia and bipolar disorder, have done poorly," Treatment Advocacy Center founder E. Fuller Torrey, MD, writes in a Feb. 5, 2013, opinion essay in The Wall Street Journal.

While that aspect of the debate continues, the public is ready for collective action. Survey results published Jan. 28, 2013, in the New England Journal of Medicine show almost 60% of respondents support increased government spending on mental healthcare.

Concerns over stigmatizing mental health treatment are valid. But they should not be allowed to stifle an honest discussion of how to improve the mental health system at a time when the public is paying attention to the subject.

posted by Rich Krisher


As a psychiatric nurse for 20 years I have seen what happens to my patients when they do not get the care they need.Common sense would tell one that guardianship of the pt's needs is important.We are seeing less patients under guardian care.This could be because the money and manpower it involves for the states .Or that patient's families are not educated about it.But I would venture that a study on the cost to the communities for readmission 3-5+ times a year ,and police involvement would show that we are not saving money. At St. Mary's in Lewiston, Maine we have started a Behavioral Emergence Department , BED, that provides help for adults and children in crisis. We have a psychiatric nurse practitioner on 24-7.We work in conjunction with our Tricounty crisis team . The medical doctors in the regular ED medically clear our patients.the Rn 's triage and medicate as needed.Behavioral techs help with pt. care and security is there also 24-7.This has helped people get the help that they need with in hours of being admitted to our BED.

Rebecca Cote, psychiatric - RN, St.Mary's regional Hospital Lewiston Maine February 16, 2013 11:23 AM
Lewiston ME

Harold: "Stigma" is a term that's often used in the mental health community. It's not a word I chose lightly or at random. Type "mental health stigma" into a search engine and you'll see it used in scholarly articles and by government agencies and advocacy groups. The National Alliance on Mental Illness has a StigmaBusters program:

Rich Krisher, ADVANCE February 15, 2013 2:38 PM

They are sensitive to the risk of stigmatizing mental illness, which could discourage those who experience it from seeking professional help.%0d%0a%0d%0a"Stigmatizing" is among the most perjudicial terms one can choose: See stimga/Jews.%0d%0a%0d%0aIs it your intent (it is your word in this article) to impose that pattern?

Harold Maio, editor - retired, many February 14, 2013 12:41 PM
Ft Myers FL

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