Especially as emergency room visits for mental health increased during the pandemic, it is crucial to address barriers to treatment to ensure that programs and services can be easily accessed by all when needed. Even when treatment is available for mental illness and substance use, it can still be challenging to seek help due to stigma. With the use of more appropriate language, healthcare providers can facilitate better access.
Perspective
Leaders from the National Institutes of Health reviewed multiple studies on how language can contribute to stigma and impact the rates by which treatment for mental illness and substance use are accessed. These authors refer to stigma as “negative attitudes toward people based on distinguishing characteristics” and explain how language has the potential to increase or reduce stigma, which can impact access to treatment. Problematic language poses a barrier to access to services for mental illness and substance use so avoidance of stigmatizing language (such as “addict”) and use of person-centered language (like “a person with schizophrenia”) was recommended. The authors acknowledge that language evolves so the preferences of those with lived experience should take precedence.
Stigma Remains a Barrier to Treatment
A faculty member for Walden University’s Master of Science in Nursing program, Dawn Straiton, DNP, MSN, APRN, says, “The takeaway message is that we, as a society, should be working to decrease stigma because it will help people feel more comfortable seeking care.” Due to the COVID-19 pandemic, Straiton explains that mental illness and suicide risks are on the rise as global economic downturns can increase stress for many individuals. “We need to be sure people know that COVID-19 itself carries a risk of neuropsychiatric illness, but all the psychosocial challenges of the past year and a half also put us at risk,” she says. Straiton says, “In addition to my faculty role with Walden University, I work at the United Nations (UN) as a mental health staff counselor and see how stigma presents itself worldwide, not only hindering services but marginalizing people who suffer from mental illness.” In 2018, the UN’s Secretary-General committed to “creating a world where, by 2030, everyone, everywhere has someone to turn to in support of their mental health, in a world free of stigma and discrimination.” This is what we should strive for every day, but it takes effort and education. Mental illness and substance abuse disorders affect one in five people and do not discriminate based on gender or socioeconomic status, and while it can happen at any point in life, Straiton highlights that it is treatable. “Medication and therapeutic treatment have come very far in the recent decade, but the stigma often makes people believe this is the end of their life. This thinking can lead to avoiding treatment and even suicide. Nonadherence to psychiatric medication also worsens outcomes for people who suffer serious mental illness,” she says. “Think about the words you use and be mindful of how they may affect people around you who may be suffering from mental health problems. This goes beyond the negative terminology such as using the word ‘crazy,’ but even overusing or misusing clinical terms,” Straiton says. “I recently heard someone used the term ‘schizophrenic’ to describe something that was complicated and disorganized. This is a prime example of someone misusing a clinical term in a way that is stigmatizing. As a clinician, I try to talk to clients as a partner to identify the barriers that would lead to treatment nonadherence, including stigma and how to manage it.”
Person-Centered Language Helps
Meghan Marcum, PsyD, chief psychologist at A Mission for Michael, says, “The takeaway message from this article is to provide readers with an understanding of how significant language and specific labels can impact a person struggling with mental health symptoms. The stigma can prevent people from seeking care and with thoughtful language that doesn’t label people with derogatory terms, like an addict or borderline person.” These labels come from the general public too, so Marcum explains that it takes more than just a shift in healthcare providers to help reduce the effects of the stigma associated with mental health. “This article supports what research has already shown in terms of the damaging effects of stigma and how it can prevent people from accessing the care they need,” she says. Marcum says, “The public should understand how prevalent mental [illness] is across the United States and the globe. Depression is the leading cause of disability worldwide. Anxiety disorders are extremely prevalent affecting 40 million Americans every year. With the increases in mental health problems due to the pandemic, it is now more important than ever to understand the power of language and how we can all do our part to reduce the stigma.” In her work, Marcus highlights how patients respond better when clinicians use person-centered language, as a client labeled by their mental health disorder may tend to feel defensive because they do not understand the diagnosis or because the implication is that they are defined by their diagnosis. “Person-centered language allows the diagnosis to be identified but provides space between the individual and the concern, such as addict vs. person struggling with substance use,” she says.
