In recent years, as our understanding of mental illness has continued to develop, we have seen many positive changes that have impacted behavioral health care and the lives of consumers. Nevertheless, public and personal misconceptions about mental illness continue to be of concern as it creates and promotes stigma in how we perceive individuals who are diagnosed with mental illness as well as how they perceive themselves. This leads to millions of individuals with mental illness not receiving the proper support they may need. Mental health stigma is a long-standing public and human rights problem that causes a complex social process that results in labeling, separation, diminution of status and discrimination, which systemically creates disadvantage and limits life chances to people diagnosed with mental illness (Stuart et.al., 2012). As a result of the adverse impact of mental health stigma, a large number of people with mental illness do not seek critically needed care/treatment/services available to them due to feelings of shame and fear of being perceived as inadequate, incompetent, or dangerous (Corrigan & Shapiro, 2010).
From left to right: Vickie, Vanessa, John, Marisol, and Enmanuel
Peer Counselors at the ACMH Residential Crisis Support Program agree that mental health stigma may transform into self-stigma, preventing individuals from realizing their strengths, value and capabilities; thus, feeling unable to believe that they would ever be able to thrive and grow beyond their stigmatization labels. “You feel locked out, like nobody is going to want you”- John Kvarnstrom, Peer Counselor. ACMH Peer Counselors shared that overcoming feelings of entrapment, due to mental health stigma, is extremely challenging. It can take an extended period of time before considering the possibility of joining the workforce and, our peer staff agree that even once they did, they felt that at any given moment, they would be dismissed from their jobs.
There are various methods and interventions that have been implemented in mental health settings and community arenas to increase public awareness of mental health stigma and ultimately work to reduce it. One of the most valuable interventions used to reduce mental health stigma is the modeling of compassion. Research on the value of compassion has been found to be extremely effective in supporting mental health recovery for those individuals who have experienced it. Modeling compassion has been shown to reduce low self-esteem and self-denigration in those with Major Depressive Disorder (Avest et al., 2021). Furthermore, modeling compassion promotes self-compassion which is defined as the ability to treat oneself with warmth, kindness and non-judgmental understanding when suffering (Ka Shing Chan, 2018).
One tool often used to model compassion towards oneself and others is mindfulness. Research suggests that mindfulness may help individuals respond to stressful experiences with psychological flexibility, which is defined as the ability to be in the present moment with all of the thoughts and feelings it contains without the need to emotionally defend oneself; but stay focused on goals and values; thereby, alleviating psychological distress (Ka Shing Chan, 2018). The body of literature suggests that utilizing mindfulness to model compassion at a community level promotes empathy, compassion for humanity, acceptance and inclusion for individuals with mental illness. Peer Counselor, Emmanuel Pantoja-Gonzalez, shared the importance of understanding the range of emotions that an individual with mental illness can go through based on their experiences and situation at a certain moment in time. “Someone with a mental illness who may be facing homelessness and lack of support, may be showing anger and frustration, but all this comes from fear and uncertainty. As someone with lived experience, I understand this and it allows me to model compassion under challenging circumstances. It’s important to give people time and support them without judgement.”
The implementation of peer support groups, where individuals living with mental illness can show compassion to one another and share their concerns and experiences with stigma, have been known to help build positive alliances and empower them to reduce self-stigma (Ka Shing Chan, 2018). In 2012, SAMSHA produced the What a Difference a Friend Makes campaign designed to encourage individuals to step up and support friends who are living with mental health illness. Marisol Cruz, Peer Counselor, recalls the moment when a friend and fellow peer acknowledged her talent for visual arts and strongly suggested that she pursue it at the Howie The Harp peer advocacy and training center. It was here that Marisol found the inspiration to discover her sense of self. “Having someone modeling compassion to me was very helpful in learning to model it for others and for my own healing. I learned to realize that I’m not defined by a label.”
What does modeling compassion actually look like when actualized in tangible human experience? Peer Counselors working at ACMH’s Residential Crisis Support program find that the most valuable way to model compassion is by active listening. Individuals diagnosed with a mental illness often feel dismissed by others and Peer Counselors have heard the phrase “I hate to bother you” too often during their work with guests going through emotional distress. Peer Counselors provide support and model compassion by listening to the guests and showing them that their concerns are valid. They support individuals in developing Wellness Action Recovery Plans (WRAP), personalized plans for individuals to achieve their recovery goals, and engaging in socialization and community activities. Peer Counselors agreed that taking the time to do these activities with someone in crisis can go a long way. Moreover, in the same way that someone modeled compassion for them by believing in them and shining a light on their strengths and abilities, they strive to do the same with others through their work. “Letting guests know where I’ve been and how I slowly got better, instills hope in them and that’s the biggest thing. They look at what you are doing and they think maybe they can do it too.”- John Kvarnstrom, Peer Counselor. Reducing self-stigma is a work in progress for many individuals diagnosed with mental illness. ACMH Peer Counselors have experienced that modeling compassion works both ways, as they strengthened their own self-compassion while providing support to guests at the Crisis Support program.
Interventions such as modeling compassion have proven to reduce self-stigma. But so much more work needs to be done, at both the individual level and in society at large, in order to combat the debilitating effects of mental health stigma.
Vickie Mishoulam, MA, MSW, is Addictions Specialist; Vanessa Proaño, MA, is Senior Director for Residential Programs; Marisol Cruz, AA, NYCPS, is Peer Counselor; John Kvarnstrom, AA, CASAC-T, NYCPS, is Peer Counselor; and Enmanuel Gonzalez-Pantoja, CASAC-T, CRPA, NYCPS, is Peer Counselor, at ACMH, Inc.
References
Avest M.J., Schuling R., Greven C.U., Huijbers M.J., Wilderjans T.F., Spinhoven P., Speckens A.E.M. (2021). Interplay between self-compassion and affect during Mindfulness-Based Compassionate Living for recurrent depression: An Autoregressive Latent Trajectory analysis. Journal of Behavior Research and Therapy, 145.
Corrigan P.W., & Shapiro J.R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907-922.
Garfield R.L., Zuvekas S.H., Lave J.R., Donohue J.M. (2011). The impact of national health care reform on adults with severe mental disorders. American Journal of Psychiatry, 168, 486-494.
Ka Shing Chan K., Lee C.W.L., Mak W.W.S. (2018). Mindfulness Model of Stigma Resistance Among Individuals with Psychiatric Disorders. Mindfulness, 9; 1433-1442.
Stuart H. (2012) The stigmatization of mental illnesses. Canadian Journal of Psychiatry, 57(8) 455-456.
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