Breaking the Silence: Stigma in Mental Health Care

Teenager sitting on floor, breaking the Stigma in Mental Health

Did you know that, in a room of 25 kids, about 5 of them would have a mental health disorder? How many do you think are getting help for it? Only about 20% of children and teens receive treatment, so only one child of the five. There are a host of reasons youth may lack access to medical care: a shortage of specialized providers, increasing costs, or lack of public knowledge about the healthcare system. However, mental health care has the added barrier of societal stigma in mental health, which may discourage families from seeking services even when they are needed. You are likely familiar with some of the myths around mental health that may keep kids quiet. Let’s talk about how to help them speak up.

Myth #1: Everyone gets sad or distracted or anxious sometimes; that diagnosis isn’t real.

It is definitely true that having phases and off days and growing pains can be “normal”. However, by definition, psychological disorders are only diagnosed when symptoms have become a pattern that exceeds most children’s experiences and starts significantly interfering with their ability to function in an age-appropriate way. These diagnoses are all based on decades of ongoing research confirming people’s experiences, symptoms, and effective treatments.

Myth #2: You should be able to get over it. It’s your fault if you’re not getting better.

There is an unfortunate air of blame fueling mental health stigma. If Johnny would just play with other kids more, he would cheer up. If Paola would just sit still in class, her grades would be better. We all wish it was that easy! With physical health, if you could just “wish away” the flu, who wouldn’t?! Unfortunately, we can’t, and the same is true for mental health. If a child is struggling with impulsivity, depression, or wetting the bed, there are likely a complex web of biological, behavioral, and emotional factors contributing that make it difficult to “just snap out of it.”

Myth #3: If I go to therapy, people will think I have “problems”.

Here, there is an implication that people with mental health concerns are “crazy”, “dangerous”, or “weird”. In reality, people who go to therapy are just people. Furthermore, not everyone who goes to therapy has a diagnosable condition. Many people choose to go to therapy for personal growth, life transitions (e.g., divorce, college), managing grief, learning new skills, or even prevention of developing a mental health disorder. While some people go to therapy for longer periods or for more serious symptoms, others go for a few sessions to manage a short-term issue, just like going to the doctor for a cold.

Myth #4: Therapy is scary; I don’t want to tell my secrets to a stranger.

It can be intimidating for a kid to think about talking about feelings, memories, or symptoms that they normally would not. However, therapists are not scary; again, they are just people. They are specifically trained to get to know children and their families, develop relationships and build trust with them, and maybe not even dive into sensitive topics right away. It’s their job to make therapy both comfortable and productive. It’s also their job – by law – to protect clients’ information and not share it with others. Sometimes, the best way to fight therapy stigma is just to give it a try – see for yourself!

Myth #5: You should be able to do this without medication; it’s a matter of willpower.

Would we tell someone near-sighted not to wear glasses because they shouldn’t need that kind of help for something biologically different about their body? No. The same is true for mental health. People often try many informal strategies and changes prior to medication. If these worked, the issue would already be fixed. I would not want to downplay the seriousness of side effects or frustrations people may have finding the right medication. Nevertheless, many commonly used psychotropic medications have been used for several decades, extensively researched, and are considered safe (though it’s important to consider age ranges for kids).

Myth #6: Mental health is less important than physical health.

In reality, the two are inextricably linked and key to quality of life. Poorer mental health often leads to poorer physical health, such as poorer immunity, GI difficulties, or sleep issues. Caretakers know it’s time to take a child to the doctor if a fever creeps above 103 or to get antibiotics for an ear infection. But do they know how many tantrums from their five-year-old or how many nights of insomnia from a teen to endure? Stigma might say that a parent taking time off work or a child from school for therapy or self-care is indulgent or second place, and these things will “work themselves out”. Science says otherwise.

Myth #7: Only certain communities have mental health problems.

Context certainly influences what people see as problematic. Sally’s high energy on the soccer field might be celebrated, but in the classroom, it might result in disciplinary action. Definitions of mental health vs. illness depend on what people know and value, which varies by setting, country, and culture. However, research shows that psychological disorders are present across the world, though the way symptoms show up and the services available may differ. Similarly, different communities may have different levels of awareness. Families with access to health insurance, specialist providers, regular health screenings, front-line health news, and informal social networks may be on the lookout for issues other families might not be familiar with.

Myth #8: I can’t trust the system.

Truthfully, the mental health field has at times in its history misrepresented research and treatment, stigmatized some groups, and otherwise perpetuated inequalities. While discouraging, it’s important to acknowledge these real sources of potential distrust proactively to help people feel safe seeking care. More recently, many legal and ethical protections have been put in place to build safe, effective, and culturally responsive treatment for everyone. All providers are now required to thoroughly explain and get consent for procedures. Ethical codes require providers to work toward cultural competence, understand the specialized needs of client communities, at minimum to “do no harm,” and to refer out when appropriate. There are also efforts to build a more diverse psychological workforce to help identify the blindspots in our system and hopefully help families find providers they feel they can trust and relate to.

Myth #9: Mental health should be private. Talking about it is oversharing or attention-seeking.

It is definitely up to every individual how much personal health information to share; however, if they do decide to share about mental health, that is good and okay. It is okay to share if they go to therapy or take meds. It is okay for a student to let a teacher know they need a day off due to repeated panic attacks. It is okay to ask friends for support (although respecting others’ boundaries and mental health is important, too!). If you or your child find yourself reluctant to talk about mental health, it may be worthwhile to ask if self-stigma is one of the reasons. One way to end stigma is to put a face and voice to mental health concerns. If one kid speaks up, it may empower others.

Summary

Can you imagine if only one in five kids who had a physical illness or injury went to their physician or ER? In the same way, it is disheartening to consider whether any child avoids getting psychological help due to internalized stigma about feeling “weak,” “bad,” or “broken.” While stigma in mental health has been prevalent for a long time, there have been encouraging improvements recently. Reducing shame, secrecy, and hesitation about addressing mental health can be greatly helped by continuing to have open conversations using reliable information in the way we have today.

Further Resources

About the Author

Taylor Thompson, Ph.D., serves as a distance learning developer and literature coder on the Services and Products Development team at PracticeWise. Learn more about Dr. Thompson on the PracticeWise team page.

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