Carl Evans, HFTD Sr Operations Director, Multiple Suicide Attempts Survivor, Educator & Advocate, leading HFTD’s pioneering PEERVENTION Mental Health Education Workshop.

When it comes to effective suicide prevention and mental health care, Stigma Rules Everything.

It cannot be overstated: We at HFTD believe that the first, and perhaps greatest barrier, to reducing suicide rates is removing the stigma to change the course on mental health care.

We are not alone in that assertion. In the very first national report on mental health in America issued by the office of the Surgeon General published in 1999, stigma is recognized as “the most formidable obstacle to future progress in the arena of mental illness and health.” (1)

Stigma can sound like a buzzword and it is imperative we gain an understanding of how stigma impacts our lives by shaping our communal, individual, and institutional approaches to mental health and suicide.

HFTD will be exploring stigma much deeper over the next few weeks through our podcasts and digital content. To support our assertion we highlight areas that stigma’s impact can be tangibly observed. Stigma can manifest at three main levels of our lives: individual, communal, and institutional.

Individual: At its root, stigmas on mental health originate from a presumption of how and what we control about our mental health. Mental health challenges simplified, stem from something happening within us, or a result of something that happened to us. Our genetics, or issues that come from a disruption of the development of our brains and bodies, can result in a diagnosis. We can have experiences that leave an intensive emotional impact that results in a trauma, what we call ‘psychological injury’ at HFTD.

Stigmas on mental health can be distilled to a presumption that we are 100% in control of the impact mental health challenges have on ourselves; that any inability or difficulty to function is of our own volition and not a symptom or result of a diagnosable illness or trauma.

We have the power to manage our emotions and feelings to a certain level, but thoughts, feelings, and emotions are also how we communicate things that ultimately are connected to a diagnosable illness, or psychological injury.

We have so little formal education on mental health in general, and less than a century of academic consensus that mental health has genetic and biological roots that are beyond ‘personal will power’.

HFTD Partner in Prevention, Big Brothers Big Sisters Chicago joined us on our January Conversations Cafe podcast episode to raise the visibility of mental health resources and talk about the services they provide youth in the community.

In absence of that understanding, we have centuries of social and cultural conditioning that reinforces the notion that any difficulty with thoughts, feelings, and emotions that might ultimately be linked to a diagnosable illness or trauma is probably “our fault” for not being able to handle. It doesn’t matter whether it’s very visible like psychosis or something far less visible— any difficulty with managing day-to-day life is a reflection of our basic competency as a human being.

In all facets of our lives, it is our competency as an employee or employer, student, parent, child, friend, intimate partner, leader etc. that equates to our own sense of worth. It becomes a natural feature of our survival to maintain that we are in fact competent. Connecting words like ‘shame’ and ‘weakness’ to mental health come from this stigma of competency, and a principal misunderstanding of our mental health. Consistently throughout cultures, the taboos are so intense that the very discussion of mental health is put in a shameful hidden corner of our societies.

Communal: Stigma goes beyond silencing an individual to also silencing an entire community. This takes the form of a lack of public education on signs and symptoms of mental health challenges. Moreover, it manifests as an absence of visibility of resources for mental health care. This stark absence of information and dialogue in the public forum leads to a compounding factor of personal silence, and often is a confirmation for an individual to feel alone and isolated with their challenges due to an absence of visibility.

Institutional: The single quickest way to recognize stigma at an institutional level is to observe that this is often a bifurcation between suicide and general mental health. They are not two separate discussions but one conversation about a vast spectrum. Stigma shapes prioritization of resources and validation of experiences. Even from an academic standpoint on suicide prevention, being educated on the highest risk factors can have the completely unintentional effect of creating a sort of hierarchy of mental health challenges.

Mental health challenges are often described in hierarchy, by professionals rating more outwardly visible experiences as ‘higher’ or ‘more serious’ than less visible experiences. This perceived ‘hierarchy of pain’ can further increase feelings of shame or humiliation if someone registers their experience as ‘less important’ or ‘lower’ on the monolith. Mental health challenges exist on a wide spectrum of visibility, being more or less visible, but NEVER more or less important.

If we want to pierce the veil of stigma surrounding our mental health, we must ALWAYS respect the dignity of the individual. Even though an experience might not seem harmful to YOU, that doesn’t mean it wasn’t experienced in this way by someone else. We must not minimize or criticize what someone is going through. Traditionally, the term stigma refers to any trait or attribute that causes a person to be labeled as unacceptably different from what is considered “normal”. It is a mark of disgrace associated with a particular circumstance, quality, or person. As it stands today, our understanding of mental health is dominated by stigmatizing socio-cultural beliefs.

The greatest obstacle to preventing suicide is the silence of stigma. Together we can break the silence and break the stigma that prevents individuals from seeking support before crisis.

We like to say that “normal” is just a setting on a washing machine— it does not have any purpose in reality because everyone and every experience is individually unique. Consider this quote from a twenty year old study as we are currently reside in a 30+ year spike in suicide completions in America. In regards to suicide prevention, the Surgeon General reports:

“Within many communities, silence, prejudice, and misunderstanding about the subject of suicide create barriers to open discussion. This culture of “don’t ask, don’t tell” can foster rejection, social isolation, and even discrimination . . . ” (pp.110-111) (2)

Stigma impacts the efficacy of our professional services and institutions. It compels communities not to prioritize accessibility and visibility of mental health resources. Hence, when it comes to individuals, the silence of stigma is killing us. At Hope For The Day we state that we are ‘Pioneers of Proactive Suicide Prevention’, a movement seeded in the theory that suicide is a mental health crisis. As suicide and/or ideation are a mental health crisis, it is true that individuals arrive at this state from untreated or under treated mental health challenges. And if that is true, then it is possible to create strategies to disrupt an escalation to crisis.

Prevention starts with a conversation that we are not having because of stigma, and Hope For The Day strives to connect with individuals and communities to confront and dispel this stigma through outreach to raise the visibility of resources and break the silence, and we deliver mental health education to foster proactive mindsets. We can disrupt the highest risk factors of suicide by starting the conversation at the earliest signs and symptoms of mental health challenges. That conversation can begin when each of us understands why IT’S OK NOT TO BE OK.

(1) Mental health: a report of the Surgeon General. [Rockville, Md.: Dept. of Health and Human Services, U.S. Public Health Service ; Pittsburgh, PA: For sale by the Supt. of Docs, 1999] Web.. Retrieved from the Library of Congress, <lccn.loc.gov/2002495357>

(2) Mental health: a report of the Surgeon General. [Rockville, Md.: Dept. of Health and Human Services, U.S. Public Health Service ; Pittsburgh, PA: For sale by the Supt. of Docs, 1999] Web.. Retrieved from the Library of Congress, <lccn.loc.gov/2002495357>

STIGMA RULES EVERYTHING