Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and Social Justice
Adapted by Briana Gilmore, March 2015
“Stigma kills.”
That is how Ron Manderscheid, PhD, opened his address last month at the Together Against Stigma: Each Mind Matters conference in San Francisco. Manderscheid joined other mental health experts in a symposium to discuss how stigma can be reduced or eradicated through policies that support mental health promotion, prevention, and early intervention strategies.
Manderscheid’s opening remarks aren’t hyperbolic. People with mental health and substance abuse conditions die an average of 25 years before other citizens. Less than half of those with needs receive any care at all, and it takes an average of a decade before people access the treatment they need. Suicide rates are also at the historic high of 40,000 people a year, exacerbated by the economic insecurity and reduction in services brought on by the great recession. And as Manderscheid and this USA Today article elucidate, people often only receive care when their experiences have become severe enough that they have turned into complex, illness- and symptom-based disabilities. Advocates liken this to only admitting a cancer patient into treatment when they reach stage four of their illness.
So how can policy reduce stigmatization that prevents people from accessing care, living successfully in the community, and sustaining recovery? Ron Manderscheid advocates for a five-point reform plan that includes:
1. Parity: Leveling the insurance playing field through parity laws is a first step to affording equitable treatment for mental health and substance abuse. Many states and insurance companies are just at the beginning of implementing successful parity reforms, because they necessitate sweeping financial, regulatory, and programmatic changes that take time to adopt. They are also not fully applicable to Medicaid and Medicare recipients in most states, thus further exacerbating stigma for people and families experiencing poverty. Parity is now also only available when a person receives specific treatments. Dr. Manderscheid indicates that if we want true reform through parity, we need to extend it to equal housing, equal jobs, equal supports, and equal pay.
2. Practice: Practice is moving rapidly toward fully integrated care through team-based practice approaches and integrated funding models. True practice integration, however, must integrate behavioral health clients with all other clients in health and medical homes. Stigmatization can sustain practices of exclusion that separate people with behavioral health needs out and away from their peers and people experiencing other health-related concerns. “Separate but equal” cannot remain a valid practice strategy if our system aims to achieve parity.
3. Promotion: Achieving the benefits outlined in the Affordable Care Act includes utilizing resources toward health promotion and prevention. Activities that sustain these opportunities are also ones that can pay for resources in the community that help clients recover, experience wellness, and live full lives. Promoting recovery through policy means that states and counties need to swiftly invest in integrated practice that promotes and rewards early intervention and wellness-based strategies. These types of services have been minimally financed since psychiatric hospitals started closing decades ago. Integrating these services into mainstream financing mechanisms and incorporating them into discharge planning and whole-health treatment plans is essential to promoting community recovery.
4. Peers: Developing a peer workforce can only enhance parity reforms and promote dignity and community-based recovery. People with lived experience can actively reduce stigmatization by gaining employment, and helping consumers and family members understand that behavioral health is not something to be feared or diminished. Peers should work across the health system, not just with behavioral health clients, to offer a wide range of experiences, values, and capacity to people in recovery across the wellness spectrum.
5. Participation: Moving “out of the office” toward inclusive participation doesn’t only include outreach and engagement in services. Participative, community-based action includes public demonstrations, legislative hearings, key meetings with public leaders and executives, and coalition building among organizational leaders. Raising the visibility of a recovery-based movement is essential to reducing the stigma associated with mental health and substance abuse treatment.
If we begin with a human rights based approach to equality, and capitalize on the gains made in the Affordable Care Act, we can achieve measurable reductions in stigmatization through incorporation of the “five-P’s” outlined above. Defeating stigma demands civil rights and social justice actions at every level, including transparency of effective policy leadership in state and local governments. We are all responsible for reducing stigma, and we can all create opportunities for growth and change from policy to practice.
For more information about how policy can reduce stigma, contact Ron Manderscheid, PhD at rmanderscheid@nacbhd.org or visit the National Association of County Behavioral Health and Developmental Disabilities Directors at www.nacbhdd.org .