The success rate for treating mental illness is rising all the time, yet only one a small proportion of those suffering from treatable mental illness actually seek help. The major reason—widespread myths about what mental illnesses are, and confusion about what causes them, and what kind of treatments are available.
David Catlett, head of the health care division of Ketchum PR, whose client Solvay is currently seeking approval for a drug that treats obsessive compulsive disorders, says that only five per cent of the approximately four million Americans who suffer from such disorders seek medical treatment, a statistic that suggests the stigma attached to mental illness. Meanwhile, an Eli Lilly survey recently indicated that 30% of people suffering from clinical depression visit the clergy rather than their physicians. In our supposedly educated, enlightened society, mental illness continues to be stigmatized and played for laughs. Yet mental illness is not, as many people still believe, the result of personal weakness or a bad childhood, but rather stems from a combination of biological, psychological and social factors, often treatable with pharmaceuticals in much the same way as any other illness.
Because the root of the problem is misunderstanding, and because the most effective solution is education, and because the problem has such a devastating impact on so many people's lives, addressing misconceptions about mental illness is one of the most important tasks health care public relations professionals can tarp their skills to.
“We think of ourselves as an enlightened society," says Catlett, "but this is one area where there is clearly a role for greater education. A lot of those people who suffer from obsessive compulsive disorder, and other anxiety disorders, never seek treatment because they think they are going to be labeled as crazy and sent to a mental hospital."
For the Alliance for the Mentally Ill of Pennsylvania, Ketchum PR conducted a statewide survey to establish just what people really thought about mental illness, tying the survey to the recently passed Americans with Disabilities Act. What the agency found, says svp Bob Butter, was "tremendous ignorance" and a widespread refusal to recognize that the mentally ill were medically disabled.
Another recent survey revealed that 71 of people thought that mental illness was due to emotional weakness; 65% felt it was due to bad parenting; and 43% believed that the mentally ill brought on their own illnesses. Only ten per cent said severe mental disorders had a biological basis and involve the brain.
"People with mental illness are looked at as second class citizens," says Joseph Landi, svp at health care PR agency GTFH. "Mental illness is looked on with everything from amusement to embarrassment to fear. That keeps people from seeking treatment, even for mainstream mental illnesses like anxiety.
"One of the things that people have to be convinced of is that although these problems are called mental ill nesses, they are in fact physical illnesses. Their causes are often physical, and they can often be treated the same way other physical illnesses can be treated."
That's the focus also of a campaign being conducted by Los Angeles agency Laufer Associates for the Mental Health Association of Los Angeles County. That campaign is designed to educate people that schizophrenia, depression, manic depression and anxiety disorders are treatable, biological brain diseases.
Landi believes that public attitudes towards mental illness have implications beyond the obvious ones for patients seeking treatment. For one thing, he says, the stigma that attaches to mental illness means that insurance companies are often reluctant to reimburse treatment costs beyond a certain level, and this in turn means that pharmaceutical companies give a lower priority to mental health treatments.
"Some of these attitudes are tied in to the way the government has failed to assign adequate funding to taking care of the mentally ill, and to the limited reimbursement patients receive from most insurers for mental health care," says Bob Butter. "One of the main challenges facing groups that represent the mentally ill is attracting a fair share of funds."
Jessica Laufer, president of Laufer Associates, agrees. The MHA/LA campaign is designed to increase public acceptance of treatment for mental illness, and as a result increase funding for treatment.
"The need for public education is clear," Laufer says. "In addition to the cost in human suffering, the financial burden of mental illness is enormous. Disability and welfare payments to Americans unable to work because of mental illness is about $10 billion annually. More than 75% of the total costs of depression are indirect costs, incurred due to lost productivity."
The program has been particularly successful in reaching out to schools. More and more teachers are incorporating campaign materials into their curriculum. These include a true/false quiz to test students' knowledge, and lessons covering schizophrenia, depression and stigma, the last lesson featuring a documentary about the Project Return Players, a group of improvisational actors themselves recovering from mental illness.
Most public education campaigns start with the facts: during the course of their lives, about 22 % of the current adult population will have a mental disorder; one in four families will have a member will mental illness; 7.5 million children under the age of 18 have mental, behavioral or developmental disorders; suicide is the third leading cause of death among young people 15 to 24 years old.
However, statistics are no substitute for personal experience. One strategy employed by Ketchum for the Alliance for the Mentally Ill of Pennsylvania was media training of members who were themselves mentally ill, or who had family members who were mentally ill. Seeing these people talk openly about their problems, and the discrimination they suffered, communicated far more effectively than physicians could have, Bob Butter says.
"At the first meeting of the Alliance we attended there was guy who suffered from mental illness, a manic depressive," says Butter. "We media trained him, and he was the most compelling, dynamic spokesman we had, because everything came from the heart. He was willing to `come out' and talk about his condition."
The Alliance is also conducting a series of one-on-one media briefings, produced an annual report and position paper for providers and administrators, set up an 800 number for people seeking further information, and launched a billboard advertising campaign with the slogan: "Mental Illness: It's Not What You Think."
MHA/LA has also added advertising to its communications mix, with a campaign on the theme: "Mental Illness. The Way We Treat It Is Insane" with public service ads produced by Foote Cone & Belding.
Working with the National Association of Mental Illness, Upjohn put together a touring exhibit that focused not on mental illness but rather on mental health, called Celebrate Mental Health. It looked at the progress that has been made in treatment on mental health issues in areas such as employment, the arts, popular culture, legislation and scientific developments. Former First Lady Rosalind Carter was a spokesperson for the exhibit.
"We have highlighted things like the TV show The Trials of Rosie O'Neill, which featured Sharon Gless talking with her therapist at the start of every episode and included sympathetic portrayals of people with mental illness," says GTFH PR's Joseph Landi. "We talked about some of the icons of art history and literature like van Gogh and Hemingway. The idea was to generate some positive stereotypes to counteract the fact that every slasher movie released these days seems to feature someone with a mental health problem."
The exhibit was launched in Washington, D.C., where it was used as a vehicle for reaching opinion leaders in the medical establishment, and then taken to Chicago and Dallas, where it served as an opportunity to talk to local media and the general public about the many positive achievements of the mentally ill.
The exhibit provided an interesting counterpoint to the work of the National Stigma Clearing House, which focuses its attention on battling negative stereotypes. Recent campaigns have targeted Time Warner, because its DC Comics subsidiary planned to have Superman die at the hands of a straight jacketed escapee from a lunatic asylum; the TV show Seinfeld, which included a character referred to as "Crazy Joe" who became violent because he was unable to get his medication; and Universal Pictures, for the Brian de Palma movie Raising Cain.
Other mental health groups, meanwhile, has attacked the news media for its sensational coverage of legal actions against the manufacturers of mental health drugs, suggesting that drugs such as Upjohn's Halcion and Lilly's Prozac can lead to suicidal or aggressive behavior. While juries have found against the drug companies, regulators say there is no medical evidence that the drugs have harmful side effects when administered properly.
"Stories such as those associated with Halcion and Prozac have not been helpful," says Joseph Landi. "There has been a focus on a few individual cases which have not been reflective of the thousands of people who have gotten help from these drugs and which tend to reinforce negative attitudes about the mentally ill because they discuss violence and suicide, and the public tends to remember these outrageous stories rather than those cases when the drugs work as they are supposed to."