The War on Behavioral Health Care: Stigma Kills

Another beloved actor dies too soon, another casualty of alcohol addiction and the stigma surrounding seeking treatment. Nelsan Ellis, star of HBO’s True Blood, was only 39 years old last July when he attempted to quit drinking on his own. Abruptly quitting alcohol and certain drugs, such as tranquilizers Valium and Xanax, can cause fatal reactions in chemically-dependent persons. Such reactions include seizures, fever, delirium, cardiac arrhythmias and heart failure. Medical care, including therapy with certain medications, can reduce withdrawal symptoms and prevent tragedy.

Despite their pain, Ellis’ family decided to share the circumstances of Ellis’ death with The Hollywood Reporter via his manager, Emily Gerson Saines. In her statement, Saines said, “According to his father, during his withdrawal from alcohol he had a blood infection, his kidneys shut down, his liver was swollen, his blood pressure plummeted, and his dear sweet heart raced out of control. Nelsan was ashamed of his addiction and thus was reluctant to talk about it during his life. His family, however, believes that in death he would want his life to serve as a cautionary tale in an attempt to help others.”

Brave celebrities such as Brad Pitt and the late Carrie Fisher have spoken out about their struggles with addiction in an effort to help others. Countless public awareness campaigns, such as Mental Health Awareness Week and D.A.R.E, have launched in cities all over America. Health care institution the National Institute on Drug Abuse, long ago confirmed that addiction is a chronic, relapsing brain disease that often goes hand-in-hand with a mental illness. A disease that, similar to diabetes or asthma, needs to be diagnosed, treated and monitored throughout a person’s lifetime.

Despite these efforts, people with mental illnesses and addiction in our country are still stigmatized by society and avoid treatment at all costs, compromising their own lives and those of others around them. At a time when Americans are dying in record numbers from suicide, drug overdose and alcohol-related illnesses and accidents, stigma not only marginalizes valuable, competent people from society— it prevents them from seeking lifesaving treatment. Stigma drives behavioral health issues into the closet. Stigma multiplies the body counts.

People with behavioral health issues are justifiably concerned that they will face discrimination, social rejection or be the subject of gossip if they seek help. In certain sectors, such as law enforcement, aviation and health care, there is a risk of reputation damage or being deemed unfit to serve in their jobs when mental illnesses or addiction are on their records. Still other individuals avoid seeking treatment out of fear of losing their constitutional right to bear arms.

Is Stigma Still an Issue?

There is no doubt–stigmatization of people with mental illnesses, and especially addiction, is a real problem. According to national survey results published in the October 2014 issue of Psychiatric Services, people surveyed about addiction reported being:

  • Unwilling to have someone with addiction marry into the family
  • Unwilling to employ a person with a history of addiction
  • Willing to accept discriminatory practices against those affected by addiction
  • Skeptical of addiction treatment effectiveness
  • In opposition to policies that are helpful to individuals recovering from addiction

Furthermore, the survey revealed that only 69 percent of the respondents felt that health insurance should cover behavioral health care on par with medical and surgical treatments. Lead author Colleen L. Barry, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, commented, “While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition.”

Do Media Outlets Perpetuate Stigma?

Media professionals bear the enormous responsibility of educating the public and shaping society’s attitudes and perceptions. While people may realize that only six corporations own 90 percent of the media, many consumers may not fully understand how profoundly their own opinions and viewpoints are shaped by what they read and watch each day. Stigma surrounding mental illness, addiction and behavioral health care is a perfect example.

Recent headlines do cover the mental health and opioid crisis, and warn people of the dangers of driving under the influence of prescription painkillers and designer drugs. But despite the shift in treating behavioral health problems as illnesses rather than moral failings, mainstream news and other media outlets often seem to place the blame on the person with the illness and rarely turn the spotlight to alcohol manufacturers, pharmaceutical companies and drug trafficking networks.

Desperate parents searching the internet for help for their children are met with horror stories rather than factual information about psychiatric care and the heroes who work in addiction medicine. Headlines scream of sober living homes and fraudulent “treatment centers” involved in criminal activity, such as billing insurance for care patients did not receive, sex trafficking and money laundering. While there are irresponsible treatment centers that must be held accountable for illegal activities, the importance of supporting high-quality treatment centers should also be emphasized.

Media coverage ought to be balanced to prevent the spread of unnecessary fear and loathing of the treatment industry. Blackening the reputation of behavioral treatment as a whole perpetuates stigma and results in lost lives. Including positive stories of the lives saved at reputable institutions and things to look for when choosing a treatment center can help balance perceptions that tend to be based purely on the negative actions of a few bad actors.

Can Deaths Be Prevented?

Despite problems with regulation and insurance coverage, quality care is available for people with mental illnesses and addiction. Reputable centers offer safe and compassionate care, and advances in clinical therapy and measurement-based care are improving patient outcomes. These advances are in sharp contrast to resources available in other countries, where access to treatment is limited or nonexistent.

In Mexico, for example, powerful drug cartels run rehabilitation clinics where “patients” are beaten, killed or forced to sell drugs. Many countries treat the addicted like criminals. In Afghanistan, “patients” are kept in shackles so they don’t run away to get relief from withdrawal symptoms. In China, “patients” spend years working in factories and as forced labor. While such punitive measures do not exist in the U.S. prison system, many people simply go untreated. Those fortunate enough to receive quality care can get better and thereby avoid prison, homelessness and even death.

If America is truly concerned about the ever-worsening opioid epidemic, there are many actions the media, legislators and the general population can and must take. The press must present a balanced and truthful picture that stops painting people with behavioral health issues as volatile, violent villains. It must also educate the public about the many excellent treatment centers that are out there, and what to look for when seeking care. Congress must pass a health bill that provides ample funding for anyone who needs treatment. And the public must have respect and compassion for people with behavioral health issues before this war becomes a genocide.

Stigma, bias and ignorance are not the only problems facing behavioral health care providers and their patients. The costs of providing treatment often exceed the reimbursement received from health insurance companies, creating an unsustainable environment for treatment providers. These and other financial considerations will be explored in the next article in this series, “The War on Behavioral Health Care.”

About the Author

Dana Connolly, Ph.D. has decades of experience in health care as a clinician, medical researcher and educator. Dr. Connolly is currently a senior staff writer for Sovereign Health, where she translates current research into practical information. Sovereign Health is a health information resource and Dr. Connolly helps to ensure excellence in their model. For more information and other inquiries about this article, contact the author at