06/22/2011 07:12 pm ET Updated Aug 22, 2011

Mental Illness Stigma and How to Eliminate It

The June issue of Schizophrenia Bulletin contains an action plan by Dr. E. Fuller Torrey on how to reduce the stigma of mental illness. As I've previously written, I do not believe there is "stigma" to having mental illness; in other words, mental illness is not a "mark of shame." I think when people talk about "stigma" they really mean discrimination and prejudice. Dr. Torrey believes otherwise:

Stigma against mentally ill persons is a major problem and has increased in incidence. Multiple studies have suggested that the perception of violent behavior by seriously mentally ill individuals is an important cause of stigma. It is also known that treating seriously mentally ill people decreases violent behavior. Therefore, the most effective way to decrease stigma is to make sure that patients receive adequate treatment.

He goes on:

Everybody wants to fight stigma, and for good reason -- it is probably the heaviest burden borne by mentally ill persons. It affects opportunities for housing, employment, and socialization and becomes for many a scarlet letter.

Despite efforts to combat stigma, there has been a reluctance by the mental health community to objectively assess its causes. It is as if putting up enough posters saying ''mentally ill persons make good neighbors'' will make stigma go away.

He argues that in order to eliminate the stigma of mental illness, advocates and professionals have to connect six dots:

  1. Stigma against individuals with mental illnesses has increased over the past half-century
  2. Violent acts committed by mentally ill persons have increased over the past half-century
  3. The perception of violent behavior by mentally ill persons is an important cause of stigma
  4. Most episodes of violence committed by mentally ill persons are associated with a failure to treat them
  5. Treating people with serious mental illnesses significantly decreases episodes of violence
  6. Reducing violent behavior among individuals with mental illnesses will reduce stigma

He discusses each of these dots in detail and cites peer-reviewed research supporting each one. His article goes on to cite ways to reduce violence by people with mental illness, including reforming civil commitment procedures and standards, using conditional discharge and implementing assisted outpatient treatment.

Dr. Torrey's prescription jibes entirely with the Surgeon General's report on mental health. While that report was wrong about violence and mental illness, it was right about stigma:

Why is stigma so strong despite better public understanding of mental illness? The answer appears to be fear of violence: people with mental illness, especially those with psychosis, are perceived to be more violent than in the past.

Unfortunately many advocates for improved mental health believe that it is wrong to discuss violence and even try to deny that violence exists. They may have worked in a counseling center but probably never a prison, jail or police department.

To learn more, read "There's No Stigma to Mental Illness."