 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on reducing stigma and discrimination. And, you know, this isn't one of our typical counseling courses, because it's not necessarily direct intervention with clients, although it can be. Some clients or some people don't want to go to treatment because they stigmatize mental health issues. They stigmatize addiction. So they're like, well, I don't want to be grouped in with those people. I don't want to find out that I have that kind of disorder or diagnosis or whatever they want to label it as. So by reducing stigma and discrimination, we are able to get people into treatment who may not have otherwise gone to treatment. We are able to reduce stigma and discrimination in families of persons with mental health issues to help them see kind of, you know, the forest for the trees, so to speak. And we're also able to improve the community in general public. So if you think of it from a socio-ecological standpoint, we're really dealing with improving the system at the micro and macro system levels. So we're going to define stigma and discrimination, explore the protections under the ADA, list several ways our consumers are stigmatized or discriminated against, and identify ways we can fight discrimination. So just starting out with some basic introductory data, people experiencing mental health conditions often face rejection, bullying, and discrimination. This can make their journey to recovery longer and more difficult. So when you think rejection, you know, you might automatically think, you know, who's going to reject them? Well, they're not supposed to, and theoretically it doesn't happen, but in reality it does in workplaces. People can be rejected, and that's not okay with the ADA. I'm just saying what's reality. In schools, you know, people who are depressed or anxious or thought to be different tend to be rejected. And families can reject their loved ones who have a mental illness or a substance use disorder. All of these people are susceptible to bullying and discrimination in the workplace, in services provided, in housing, in a lot of different things. Mental health conditions are the leading cause of disability across the United States. When you start delving into the numbers, and the numbers are really pretty conservative, if you will, because for every person that is represented by those numbers, there's probably, my guess, would be two or three more who aren't represented, because they haven't sought treatment. We found that the percentage of people who need treatment, who access treatment is under 50% in the United States. So just kind of putting that out there. And the numbers are really reflected on those people who access treatment. Sorry, I've got something in my eye. Even though the most people can be successfully treated, less than half of the adults in the United States who need services get the help they need. The average delay between the onset of symptoms and intervention, brace yourself, is 8 to 10 years. Okay, so think about this. If the onset of symptoms happens at age 12, then they may not get treatment until they're 20. They go through that entire middle school and high school developmental period, struggling with mental health symptomatology without intervention. How does that impact their development? How does that impact their future when they don't receive the help they need? But okay, so that's just a huge, you know, glaring one. Take somebody who starts developing depression when they're, you know, 26, you know, midlife. They're out of, well, not midlife, but they're out of college. They're starting on their careers. They're starting families. There's a lot of stress that goes along with that. And then, so what did I say? 26, so 26 and 8 is 34. Math's not my strong suit. So they don't get help until they're 34, which means they may have five, six, seven year old kids at home or maybe even older. And when they were symptomatic before they started receiving treatment, those children were going through their critical developmental periods, their attachment, their lots of developmental milestones. And if the parent was emotionally unavailable because of mental illness, what impact did that have on the child? As well as what impact does that have on the parent who reflects back and goes, oh, I feel so guilty because I wasn't the parent that I thought I quote should have been. So, you know, this eight to 10 year delay is pretty significant for a lot of reasons, not just because somebody's struggling, but because of all of the ramifications. If you think about, you know, throwing a stone into the water, the initial ripple is the person suffering. Then the bigger ripple is the impact they have on their family and, you know, maybe their workplace or where they go to school. And then the bigger ripple is the impact that has on the community at large. So what is stigma? People who have identities that society values negatively are said to be stigmatized. And, you know, that can be, there's a whole range of things from weight to ethnicity to mental illness. There are lots of stigmas out there. So we're not saying that this is the only stigma, but we are talking exclusively about mental health and substance abuse issues in this particular course. Thanks to stigma, people living with mental health conditions are often alienated and seen as other people. You know, a lot of times when people think about mental health conditions, they don't think about Jim Bob, the neighbor who is a CPA and, you know, has three kids and is on his company baseball team. They don't think of that as somebody with mental illness. You know, maybe he has generalized anxiety or depression and is well controlled with therapy or medication or both or who knows, he has a mental illness. But they don't think of it like that. When they think about mental illness, the general public who hasn't been educated, they think of people who are severely and persistently mentally ill and unstabilized. So we want to help people see that you'd be surprised, you know, if you sit in your church congregation or if you sit at your office and there's, you know, 100 cubicles. Eight of those people may have depression, for example, 20 of those people may have anxiety. So one in five. Wow, you know, that starts driving at home and they're like, well, nobody in my office seems to be depressed or anxious. Well, they're doing a good job of covering it up or dealing with it. But it doesn't just because we don't see it doesn't mean it's not there. We want to help people see that it's really much more common, unfortunately, then, you know, people often think people who are stigmatized are perceived as dangerous, and we're going to go into a big discussion about dangerousness later And I did this actually before the last school shooting. So this does not have a bearing on that. But it's important for the general public to recognize that people with mental health issues are not usually dangerous. And again, it's that availability heuristic, you know, the people that we see, and I firmly believe that not everybody who engages in school shootings or, you know, mass murders or, you know, horrific crimes. I don't believe every single one of them is mentally ill in terms of being depressed or schizophrenic or something. Sometimes they just make that choice. And you could argue that book. That's not for here nor there. What we're talking about is, when these bad things happen, they start digging around to find out if the person had a mental illness. Well, they may or may not. But when you think that one in five people is struggling with a mental illness, then the chances are pretty good that they may have it. And then when you say, All right, you know, of the people that are disgruntled enough to do this kind of act, how many of them are struggling, then it kind of narrows. But what we're talking about is not people with mental illness. We're talking about people who are dangerous, and they're not one in the same. And I'm not sure if I'm kind of making myself clear, but just because somebody has a mental illness and was involved in a horrific crime. That's just the tippy, tippy, tippy tip of the iceberg of all the people with mental illnesses. Most of the people with mental illnesses never ever have a problem with the law, have a problem with violence, you know, at least not doing violence. Sometimes they're victimized, but so we'll get back to that. They can be seen as irresponsible or unable to make their own decisions. Well, I know a lot of people who have no diagnosable mental illness who are downright irresponsible. And I know a lot of people with mental illness who are very responsible, and they can make their own decisions. Again, this is not the severely persistently mentally ill population. This is not the population who is, you know, has cognitive dysfunctions. Yes, that population is out there. But again, that is only a small portion of the people who are have a mental illness. And I hate that term mental illness, but we're going to use it for the purposes of today's class. They're less likely to be hired or promoted. And if somebody knows, you know, there are ADA protections against discriminating against people with mental illness. But, you know, if it comes to the attention of the supervisor or the employer that, you know, so-and-so is on antidepressants, then it has been shown in some organizations, and I'm not going to name names, that the people will not get promoted or will not be retained. You know, they look for a reason to get rid of them or they transfer them to other positions, you know, that are less dangerous for the organization. So we want to take that into consideration because there are a lot of people who are in safety sensitive type positions who have depression, who have anxiety, who would probably have a much higher quality of life if they sought treatment and or maybe considered medication. Medication only works in about 34% of the cases, so I'm not saying it's a panacea, works for some. But think about how much better their life would be and probably how much safer they would be in their safety sensitive position if they were happy and having a high quality of life, as opposed to going, well, if I get medication, if somebody finds out on medication, then I won't be able to do this job anymore. They're less likely to get safe housing, and you're like, what does that have to do with it? A lot of people with mental illness, because it's harder to get hired or promoted, may tend to be in areas where it is lower income housing. People with severe and persistent mental illness tend to be poorer because they don't have stable employment and not everybody who has a mental illness can be employed. There are people with severe and persistent mental illnesses, and those people tend to be in lower income brackets and unsafe neighborhoods. They're more likely to be criminalized than offered health care services. So, you know, if Jim Bob has generalized anxiety or clinical depression and he just can't deal with it, so he goes to the bar and he has, you know, a bunch of drinks to try to help himself feel better, or at least numb the pain for a while, and he gets into a bar room brawl. Jim Bob is going to end up in jail for, you know, public intoxication and, you know, the bar room brawl, whatever they would call that, assault of some sort, instead of saying, you know, what happened that led this person to this particular outcome. They're afraid of rejection to the point they don't always pursue opportunities. So a lot of people with mental health issues, especially if they were uncontrolled for a period of time, like eight to 10 years before they sought treatment, may not want to put themselves out there because they're afraid they won't get the job. They're afraid that people don't want to be their friend. So we want to help them develop their social skills, which may be somewhat stunted if they have been, you know, withdrawn for a while, and look at other ways we can help enhance their self-esteem and reduce the likelihood of rejection. And we want to look broadly. And while I continue talking, think about other ways that people with mental illnesses are stigmatized. When you go to certain self-help group meetings, if you are on medication for mental health conditions, you're rejected. They tell you, no, you can't be here because you're on, you know, a mood-altering substance. Well, yeah, but, you know, people don't generally get high off Zoloft. And it's not all self-help group meetings. You know, it's just certain, it's not even all AA or all NA or all celebrate recovery. It's just certain specific meetings in certain specific places. And you don't know until you go, but it's kind of devastating for people who encounter that they want help. And they're told, no, you can't. So anyhow, there are other times where people get rejected from, you know, from their church community where the church community says, you must have a demon inside you, you must be evil. And that's what's causing this. So they feel rejected. Certain cultures look at mental illness as very, very shameful and reject the individual with the mental illness. But that entire family may actually experience rejection in the community because if somebody has a mental illness. So we always want to, you know, look at what are the possible things that might be maintaining this mental health issue or preventing the person from seeking services. What other things do we do that might stigmatize people? Scapegoating is another one. You know, if you look for somebody that has a mental illness to blame for what happened, you know, you said, well, they were unstable. They, you know, it's their fault this happened. Instead of looking at what did we do that contributed to the situation and we're going to get to that a little bit more in a minute too. But scapegoating is definitely an issue that we want to pay attention to. So let's move on to dangerousness a little bit. The major determinants of violence continue to be socio-demographic and economic factors. So where you live has, plays a big role in it. If you live in a dangerous neighborhood, then you're going to tend to get involved in more violent activities potentially. When you tend to be, people who tend to be more impoverished tend to be under a lot more stress. So that can in some individuals and the majority of individuals, no matter how stressed out they get are not violent. But if you take someone with this propensity for violence that we haven't figured out how to measure yet and you stack the deck against them, then it's more likely that that propensity may come to fruition. Substance abuse, whether it occurs in the context of a concurrent mental illness or not, tends to precipitate violence. We have violence over getting drugs. We have violence because, you know, because somebody hadn't paid their dealer. We have violence against people when they're trying to do things to get the money to procure the drugs. We have violence when people are under the influence and either in a manic episode, in a psychotic episode, in a, well, in a psychotic episode, or if they're clinically depressed, you know, and we're talking about violence here. We're not saying violence towards others necessarily. We're talking about suicide. We're talking about self-injury. We're talking about potentially homicide and other outwardly aggressive things. I remember when, in high school, we had this thing called Grad Night and we went to Disney World. And, you know, all of Disney World was closed except for the high school people for the evening. And apparently, 11 students from our school, five that were on my bus, decided to use PCP that night. And they started having a really bad trip. And the five that were on my bus ended up in the hospital because they were banging their head into the wall until it, one banged his head into the wall until it got bloody. And the other four did, you know, similarly self-injurious things. So we're talking about violence. They weren't acting out towards others, but they were having a really bad trip. Alcohol, we know, is a disinhibitor. So if somebody, you know, it takes off the filter that says, that's a bad idea. And they just can go from zero to 100. Again, think about all the people you know who drink, you know. And I know a lot of people who drink recreationally. They're not alcoholics. And I know a lot of people who are alcoholics. And the majority of them don't have a violent bone in their body. So I want to keep reiterating that, that dangerousness happens, but it's not the mental illness. It's not necessarily the substance. It's something else going on that all this other stuff sets the occasion for. If the substance abuse takes away the inhibitions or produces some psychotic episodes or hallucinations, then somebody who is prone to violence may act out. Historical, you know, if you look at the person and you see that they have a history of past violence, juvenile detention, physical abuse of others, or being abused themselves or parental arrest records, they found that those are correlated with a propensity towards dangerousness. And contextual, you want to look at, you know, we're talking about this deck that we're stacking here. And if you have somebody who has had a recent divorce, they're unemployed, they feel like they've been victimized. Anything that has taken away their power or their sense of control, they may try to lash out to get their control back to gain some sense of dominance or control again. So we want to look, you know, and think about domestic violence incidents. You know, a lot of times, you know, if there's a divorce or a breakup, you know, some people will become violent. The majority of people go through divorces and breakups and, you know, there's not any violence at all. So we want to make sure we pay attention. But these are factors. If you have someone that has a history of, you know, violence or detention or you think may have a propensity for dangerousness, then we want to look at where can we mitigate the socio-demographic or economic factors? How can we help them access the services they need so they can be rested, so they can have a job, so they can have social support, and so they can feel like they're in a safe living environment? How can we educate them? We may not be able to prevent substance use, but how can we educate them about the effects of substance use so they can make a more informed decision? And contextually, what kind of skills and tools can we provide to them that will help them mitigate their impulses? You know, that distress tolerance. So sitting there, maybe you want to put your fist through the wall, but you don't have to. And y'all know my bumblebee metaphor. Bumblebee lands on your arm. Your first instinct, your urge, is to swipe it off because you don't want to get stung. But you can use distress tolerance skills and weight, and eventually the bumblebee will fly away. If you swat it off, it's probably going to sting you and it's a bad thing. Same sort of thing with violent impulses or any kind of impulses. When you have an urge, eventually it'll just fly away. Unless, you know, you start aggressively paying attention to it or trying to do something about it. So you can wait. You don't have to swap the bee. It's far more likely that people with a serious mental illness will be the victim of violence. So are they dangerous? You know, as a whole? No. You know, as a whole, most people are not dangerous. So, you know, we're not talking about a population that's more dangerous than, you know, kind of the general population. What we are looking at is, you know, what kinds of things might trigger a person that has a propensity to violence. Research is focused on the person with mental illness rather than on the nature of the social interchange that led up to the violence. So that whole deck stacking thing I was talking about. Antisedence in inpatient units. And obviously it's harder to look at people in outpatient or just in the general community. But looking at an inpatient unit is kind of a microcosm. Antisedence of aggression, a ward atmosphere, lack of clinical leadership, overcrowding, ward restrictions, lack of activities, and poorly structured activity transitions. And so I'll share a couple of anecdotes, war stories, whatever you want to call them. When I was running the residential unit, there were times because of the way our funding went that we needed to increase census. And I remember when my administrator decided that, you know what, we're going to bring in bunk beds and we're going to put eight people in a room. So, I mean, eight people in a room, they had the square footage of their bed and enough room to walk out and it was very, very tight. Now you put eight people that have stuff in a room because each of them had clothing and, you know, they had to get ready and they all had to be in group at the same time. You know, they were stepping on each other, they were getting in each other's way and they were all in early recovery. You know, they were all, they've all detoxed, they weren't under the influence, but they were all in early recovery. So their neurotransmitters were still out of whack. I'm not going to say they had a mental illness because a lot of them didn't. You know, they may have, you know, situational depression, they may have substance-induced anxiety or something. But, you know, for the most part, these people were functioning pretty well, but they were really, really crowded. And there were a lot of demand. If you didn't get to group on time, there were consequences. So there was that ward atmosphere. The lack of clinical leadership. If there's not clinicians, we had not mentors, but milieu monitors that were in the day room that would help people kind of get ready and get through things in order to prevent some of the tempers from flaring. I don't know about you, but in the morning, before I've had first cup of coffee, I'm just like, don't talk. My dog always, as soon as I get my first cup of coffee and sit down, he's like, it's time to go out. No, Duke. It's not time to go out. And he will just be incessant. Really? First cup of coffee? Not even finished yet. You need to learn to read. But, you know, maybe he'll learn to read one of these days. So providing clinical leadership in terms of making sure that the milieu of the inpatient unit or the family unit or the office area is relatively relaxed. It's not hostile and conflictual at least. And, you know, I'm kind of jumping ahead to how we create this in schoolwork or community. Making sure, you know, in terms of an inpatient unit, making sure that people with certain diagnoses are given enough space that they need potentially if they have certain anxiety issues. We don't want to trigger whatever their conditions are and make it worse if they have a trauma history, you know, trauma can make people feel like they need to protect themselves. So we want to look at how can we create a trauma informed environment so we don't trigger people. And that's where the clinical leadership comes in looking at what might make people irritable. I remember one time they didn't the house didn't get to all of their groups on time. So they lost smoking privileges. Oh, my gosh, you would have thought that we told them that they would never see their families again. It was utter rebellion and anarchy. So, you know, obviously we looked back at that and said, you know, what could we do differently? And it wasn't like they lost them forever. They lost it for four hours, but it was still something that, you know, they felt like they had the right to and we took it away. Overcrowding, you know, when when they're eight to a room, they're overcrowded when, you know, I have a friend right now who has a very large family and lives in a very small apartment. And there are some tensions that flare. Think about overcrowding. If you live, if you work in an office in a clinic where you share offices, I've been there. And, you know, you're again, constantly, not literally, but kind of stepping on each other, you know, somebody needs the office to do an intervention or to do a private session and other people need to be in the office to do paperwork. So it creates conflict and time issues and, you know, lots of animosity. Lack of activities, you know, this is on inpatient, obviously, because people get bored, they need something to do. They start getting restless and can start thinking, you know, going into those places mentally that tend to be more negative. So we want to help them have activities, not only to distract, but also to give them an opportunity to experience fun recreation and learn what they like. And also, these fun activities help release endorphins and serotonin and help them feel happier, which can help relax and activity transitions. Another thing that used to, you know, really get my units upset is if we had a counselor call in sick and a group was canceled. And, oh my gosh, you know, if you had to combine groups because one therapist couldn't be there, people would get really upset. So we started working around that. And, you know, when I took over as, as supervisor, I would step in and I would do group. The only time we would cancel group is if there were no administrators even to fill in. But, you know, occasionally we would have the nurse fill in. We would have, you know, other people so we could hold the group. And these were psychoed groups. These weren't intensive therapy groups. So it wasn't unethical or, you know, counterproductive to have somebody else sit in. So thinking about, you know, the dangerousness that we're thinking about and the stigmas that we're thinking about are generally with people who are in the community, not in an inpatient unit. So in schools, how do we create that ward atmosphere where people are just kind of milling about where they don't feel like they have any direction where they don't feel like anybody cares about them. They're just a number, you know, they're patient 25643. And in schools, a lot of times students may just kind of feel like a faceless number. Not always, you know, schools are better than other places about making people feel a little more individualized. Overcrowding. I remember my, my son's first grade class, there were 21st graders in that room and one teacher. I love first graders, I love little kids, but I would not want to be in a room with 20 of them and try to get them to stay focused for six hours a day. So that tended to cause frustration, lack of clinical leadership. And when we're talking about schools or workplaces, we're talking about administrative leadership, looking at improving morale, improving team building, doing things that can help people. Have a healthier environment. So the person with mental illness because they're there is able to, you know, function just fine. You know, we want to make sure that we're paying attention to that and we're not creating mental illness. How did those, those with schizophrenia had the lowest occurrence of violence over the course of a year in a study and I have it cited down here. Of 14.8%. Now 14.8% of the people with schizophrenia and only like one or 2% of the population has schizophrenia. So that's a very, very, very small number compared to those with bipolar disorder, which was 22%. Remember when we're talking about violent behavior, we're not necessarily talking about violence towards others. This can also be self injurious behavior in some shape or form. And major depression had a 28% risk of dangerousness and there's a lot of people with major depression. So we want to look at, you know, that, you know, increases our pool. Where's that dangerousness going? Are they drinking and driving? Are they self injuring suicide attempts? What's going on that's making them dangerous? Because we don't want to say that 30% of all the depressed population is dangerous because that's not true. When we think of dangerousness towards others. Now, you know, they could be self dangerous delusions. And this is important. Delusions were not associated with violence, even the threat control override delusions, which are the ones that where there's a voice inside your head telling you to do something. I had a client who had threat control override delusions and when he would get stressed out, the voice would tell him to burn himself. And, you know, a lot of times he recognized that it was ego dystonic. He was able to recognize that it was the voice in his head and he didn't want to act on it. And he was able to develop skills and we worked with his medication to help quiet the voices, but he was able to develop skills and tools to use. So we didn't have to respond to those. So people may have these delusions, they may have voices inside them, their head telling them to do things, doesn't mean they have to. Okay, stigmas associated with mental illness. You know, if you walk up to the average person who doesn't have a mental illness and say, you know, what characteristics do you think of when you think of somebody with a mental illness? They may say lazy, dirty, diseased, weak willed. What other adjectives might people assign? I'll let you contribute those while we talk about lazy for a second. It's really important for me as a voc rehab counselor to put out there that 60% of the 7.1 million people receiving public mental health services nationwide want to work. And that's just public mental health services. Okay, so that's not everybody receiving services. 60% of those people want to work. However, you know, there's this caveat that we have because they may not be able to work full time employment. I've, you know, worked with a lot of people with severe and persistent mental illness and they would love to work. They would love to work like four hours a day or something, but they can't do a 40 hour a week job. Well, so here's the scenario that happens way too often. Somebody is receiving social security disability and SSI with a mental health services covered by Medicare and Medicaid. As recovery from whatever problem it is, in this case bipolar progressed, the person goes back to work part time. Despite the fact that they enjoy their job and their employers pleased with their performance, they resign after seven months because they don't want to lose the medical benefits that paid for the care they needed. So they no longer seek work. And this happened to my cousin actually. My cousin's not Susan, but same sort of thing happened to him. When he started working part time, he started making quote too much money to qualify for SSDI and SSI. So they started cutting his benefits and in order to afford the treatment he needed and the medicine he needed, you know, it, it wasn't on par. So they cut his benefits more than he was making. So he ended up quitting his job and now he does volunteer work and stuff. But so our system kind of stigmatizes people. It's not that they're not motivated. And one of you said not motivated and some people with like major depressive disorder when they are in a major depressive episode. They're not motivated. They're apathetic. Nothing brings them pleasure. But that's when they're in an acute episode and that's treatable and we can work with that for the most part. And we're hoping their remission periods are like a year, 18 months, two years or more. And their symptomatic episodes are only, you know, a week or two ideally. But we want to look at what's their motivation and as clinicians we can help enhance their motivation. We can help others see how motivated people are, you know, when they're not in an acute episode, you know, and when they're in an acute episode. I mean, it's kind of like having the flu 90% of the year you may be motivated and going gangbusters. And then you get the flu and it knocks you on your butt and you are not doing anything. I know my yard looks like it right now because we're all just finishing up, you know, recovering from the flu. And wow, you know, the stuff that I would normally do, like even inside dusting and that kind of stuff really got let go. And it wasn't because as a person, you know, globally, I'm unmotivated. It was during that episode of the flu and recovering from it. I was unmotivated. So we want to look at what are the factors that led up to that lack of motivation. People with mental illness are not dirty. There are a lot of people who are dirty. And there are people with mental illness who are dirty, but people with mental illness as a group are not dirty people. You know, dirtiness is something that some people choose people who are homeless who don't have access to places where they can regularly bathe maybe dirty people who are in acute episodes of depression, for example, may just not have the get up and go to get up and shower. Are they dirty during that period? Well, yeah, they can be. But that is one of the signs that they are in a really, really dark place. Most of the time they're very people with mental illness are just as clean or dirty as anybody else out there. They're diseased. No, they're not diseased. I don't like that term. And yes, I don't have any scientific, whatever. A disease is a progressive, fatal, incurable problem. And mental illness can be cured. It can be put into remission. And it's not contagious in any sort of way. I mean, yes, we can fail to commute to teach children coping skills. Yes, there are certain biological markers for depression where, you know, in some families, the brain doesn't make enough serotonin. There are certain things there, but disease makes me think of, you know, communicable things. So we want to get rid of that term too. Weak willed. If they just, you know, had a stiff upper lift, pulled them up, pulled themselves up by their bootstraps. What other, you know, trite sayings can you think of? No, you know, most people with mental illness, depression, anxiety, they don't want to be there. Imagine living in their skin. Imagine living in their head. Would you want to stay there? No. So it's not that they're weak willed. They may not have the skills and tools to help themselves do better right now, which is what counseling can help with. They may not have the ability, you know, biologically, they may need medicine or something, but it's not a matter of willlessness. Unintelligent was another one that somebody put out there. Oh my gosh. And I have to share with you one client I worked with. Brilliant man. He was a nuclear physicist. Brilliant man and had schizophrenia. When he was lucid, he was just amazing to talk to and he talked way over my head most of the time. And but when he was, you know, symptomatic, you know, he was having trouble, but he was brilliant. And many people with mental illnesses are very, very brilliant. And sometimes it's that brilliance that actually contributes to their frustration and their sense of hopelessness and hopelessness. Let's see any of these others. One of you did share that sometimes clients will sit out in the waiting room and stigmatize each other looking at somebody else and going, at least I'm not as bad as that person. Yeah, it's true. Unfortunately, it happens and I encourage clients to focus on what they do have, but not so much focus on how bad every everybody else is doing at least not, you know, vocalize it. But there is, there is a comparison, you know, at least I'm not whatever. So mental illness myths, let's start knocking these back. There's no hope for people with mental illness. There is hope. There are millions of people every year who recover from go into remission from however you want to say it, depression, anxiety, bipolar, PTSD, you know, the whole DSM, you know, it's over there somewhere. I can't do anything for a person with mental illness. That is not true. Now people with mental illnesses need to do things for themselves. Obviously they need to be motivated to make changes, but we can help people with mental illnesses by ensuring we reduce stigma by ensuring that we accept them for who they are and we don't have any preconceived notions that are, you know, stigmatizing. And we treat them like any other person. I mean, that's what they are as any other person. So if you would do it for your friend Jane, why not do it for your friend Tom, who happens to have clinical depression? You know, we want to look at people, not diagnoses. People with mental illnesses are violent and unpredictable. We already covered that one. They are not. People can be violent and unpredictable. Mental illness or not. So we want to look at the factors that led up to that. It's mental illnesses don't affect me and they do. If it doesn't, if you don't have a mental illness or are in recovery from a mental illness, wonderful. That's awesome for you. Chances are somebody in your family or somebody's have a diagnosable mental illness or have had. Chances are people that you work with have or have had and that impacts, you know, when they're having an acute episode, it's going to impact their work product. It's going to impact their socialization. It may impact their mood and their willingness to, you know, engage in teamwork and those sorts of things. So mental illness does affect us as business owners. You know, if you've got an employee who has a mental illness, you know, great. That's awesome that you're employing somebody with a mental illness, but you need to recognize that if they're having an acute episode or if their meds are changed or something, they may need some reduced duties for a short period of time. You know, and it's when you look at the amount of time people with stabilized mental illness take off from work compared to, you know, the rest, it's the same. You know, the key is getting that mental illness stabilized through counseling or medication and psychosocial services. People with mental illnesses cannot tolerate the stress of holding down a job. Certainly they can, you know, jobs actually give them social support. It actually gives them an outlet. Now a dysfunctional work environment is going to, you know, push anybody's buttons. Again, mental illness or not. So we want to look at what are the benefits of work? It allows them to have financial independence, social support, distractions, you know, a sense of meaning and purpose, a reason to get out of bed in the morning. There's a lot of things that work can do. Therapy and self-help are a waste of time. Why bother when you can just take a pill? Well, because the pills only work for about a third of the people. And the pills are just kind of plugging a leak, but we don't know what caused the leak in the first place. So in order to address, you know, what's causing those negative thoughts or the depression or whatever, we need to look at, you know, either self-help or therapy. Children don't experience mental illnesses. Their actions are just products of bad parenting. Now, we know that children experience bipolar, depression, anxiety, PTSD, the range. And they even have some that are unique to children. So we want, there are times when children's poor behavior is because of bad parenting, no doubt. But there are also times when children's behavior and emotional outbursts and sleep difficulties and wetting the bed and, you know, anything else that's problematic can be because of mental illness. And it's important that we educate the community that children don't necessarily display symptoms of depression or anxiety or PTSD the same way adults do. So if you have a child, it's important to be aware of what are the warning signs of depression, anxiety, bipolar, those are the big ones. Maybe PTSD, especially if you've been in some sort of a traumatic incident like a hurricane or a tornado, you know, those would be the big four. But autism, that's another one that you might want to be aware of. And early onset schizophrenia, but addiction myths, addicts are bad, crazy, or stupid. No, addiction crosses socioeconomic boundaries, you know, very, very wealthy people are addicts, very, very poor people are addicts. Very, very good people are addicts. I've met some really amazing people who have been addicted. And very, very smart people. So I know the majority of clients that I've worked with over 20 some odd years are good. They're not crazy. And they're smart. I mean, they may not be brilliant, but they're at least average or above. So it's a matter of looking at some of these things and some of my clients, you know, they weren't great at book learning. And not everybody is my brother-in-law hated school and, you know, struggled through school, but then he got into a trade and became an electrician and he is a phenomenal electrician. Some of my clients, you know, they come they're like, you know, I dropped out of high school. I'm stupid. You know, sounds like the school system may not have met your needs. Most of the clients, if you talk to them about this life skills they have and the common sense skills they have and, you know, the things they've done in order to get their drugs or whatever, they're actually quite wily and smart and creative. So, you know, I try to help them see that you're smart, you're just, you may not like book learning. So, you know, let's figure out what your niche is. This is not a willpower problem. You know, when people start using even recreationally, it can disrupt the neurotransmitters, which can cause depression. It can cause which or anxiety, which may cause more use. Then you start developing tolerance. Then you start having withdrawal. There's a lot of stuff in there. And then the withdrawal, you want to feel a little bit better because you feel awful. You use again. There's a certain amount of choices in there. True, but it's not solely willpower. Again, we need to look at what caused the person to start using in the first place or what caused and, you know, if they started using recreationally and then it just kind of spiraled out of control. We want to look at that, you know, what got the person to start down this path of addiction as opposed to recreational use. Addicts should not be punished, not treated for using drugs. Punishment doesn't do any good. You know, they have already punished themselves. And most of the things that we think of as punishments aren't necessarily punishing addicts. Jail for a lot of my clients was old home week. You know, I was from a small county. So when they went to jail, they were always seeing people that they knew from their neighborhood or, you know, other neighborhoods. And you put people in jail. All it does is stop their use briefly or you punish them. It may stop their use briefly, but it doesn't address what caused the use. So they're going to relapse. We need to provide treatment. People addicted to one drug are addicted to all drugs. That's not true. If you have somebody who's addicted to stimulants, you know, look at what function that drug provides. It gives them a sense of awakeness, alertness, happiness, you know, those sorts of things. You mean they probably would be less likely to be addicted to a benzo type drug, which calms them down because they're probably trying to self medicate some depression. Not always, but, you know, generally there's a class of drugs that people are more addicted to. Can you develop substitute addictions? Certainly. But it's a gross overstatement to say if you're addicted to one, you're addicted to all addicts cannot be treated with medications wrong. If depression or anxiety or bipolar were some of the things that the person was self medicating, then as we treat that, then it will help the addiction. It's not going to solve it, but it may help. And there are also certain medications that can help reduce cravings and reduce the likelihood of relapse for nicotine, alcohol, and opiates. Addiction is treated behaviorally, so it must be a behavioral problem. Well, you know, mental health issues, depression and anxiety are also treated behaviorally. And, you know, they're not just a behavioral problem. We know that stress, cognitions and behaviors all contribute to the balance or imbalance of neurotransmitters in the brain. Alcoholics can stop drinking simply by attending AA so they can't have a brain disease. They can put it into remission. They can learn how to deal with it a little bit better by attending AA. But we have a term that's called being on a dry drunk. And that's when somebody's not drinking because AA says you have to be abstinent, but they're holding on with white knuckles because they're not dealing with life on life's terms. And they're really struggling and they're really suffering. So when we look at people who are alcoholic, we want to look at what neurotransmitters are out of whack and what thoughts, behaviors, and physical conditions might be contributing to that. What perpetuates stigma? Television, you know, look at what television tells us about people who are mentally ill, about people who are taking medications. The availability heuristic, like I said before, the things that we hear about tend to stick with us and we go, oh, well, all people who are mentally ill must be dangerous. No, that's not true. Just because you heard about one person on the news who happened to have a mental illness and act out doesn't mean that all people with mental illness are. It's really very safe to fly in an airplane, but we hear about those one or two crashes every year. We don't hear about the 40,000 flights a day that go off without a hitch. Lack of awareness in public education. You know, we want to help people understand how common mental illness is and for celebrities to stand up and go, I have ADHD, I have depression, I have this or I've struggled with that or I've had bulimia or whatever. It's huge because then it normalizes and people go, oh, I couldn't tell by looking at you. You got it. That's it. You can't tell by looking at somebody whether or not they have a mental illness because most people are just, you run into, you think they're just every average person. You don't recognize that they're maybe struggling with something. Lack of insurance coverage for longer term treatment. So even the insurance company says, you know what? No, not so much. You know, we'll look at 10 sessions and then we're done. So that perpetuates stigma, that perpetuates the notion that mental illness may not be treatable. If you're not better in 10 sessions, you're hopeless. We don't want people to feel that way. The widespread belief that the stereotype is argued to be true because it's widely held to be true or nobody questions it and nobody stands up and says, we need to look at the facts here. And prejudicial language making a negative value or moral judgment attached to a stereotype. So those crazy people, you know, that's very prejudicial and negative. Intentional exclusion includes evidence that would or could disprove the stereotype is hidden or concealed because somebody has an agenda. They want to prove that mental illness is associated with this. So they're going to ignore any studies that might contradict it. Misleading generalizations occur when the evidence is unrepresentative of the population cited as a whole. So we don't want to say that all people with mental illness, blah, because it's just not true. And that's even true when we talk about symptoms like DSM symptoms. Emotional appeal, the audience is persuaded to agree through emotion, not through logic or facts. So the effects of stigma, and we're going to run through these real quick refusal to seek help already talked about that worsening of symptoms because of the refusal to seek help. Development of depression because of the worsening of symptoms because of the refusal to seek help you see a pattern here. A quarter of adults believe that a person with mental illness can eventually recover. One fourth, 25% of adults think that there's hope for people with mental illness. Wow, that's staggering and painful. So we need to increase the awareness that recovery is possible. Only 42% of Americans believe that a person with mental illness can be as successful at work as others. So we want to say, you know, let's look at some people who are very popular and you can Google, you know, celebrities with depression, celebrities with ADHD and find some celebrities at least who have been very successful, wildly successful. Robin Williams was stunningly successful and he struggled with mental illness his whole life. Only a little more than half of young adults who know someone with a mental illness believe that treatment can help. Well, so that's better than the adults where it's 25%. Half of the young adults believe that treatment can help, but we need to be better than that. 74% of people agree that people are not sympathetic towards individuals with mental illness. And current federal law has banned more than 150,000 mothers with past drug convictions from participation in the food stamp program and WIC, the Women, Infant and Children's Nutrition Program. So, you know, these are the effects of stigma where they say, you know, you did a bad thing once, you need to be punished henceforth and forevermore. And as you know, I'm not going to test you on specific statistics, but they are painfully shocking and they speak to the need for us to educate our consumers as well as their families and our communities. Get to those wellness rallies, get to those town halls, become a stigma buster, speak out and challenge stereotypes, educate society about the reality of mental illness. You know, don't just say, you know, it happens a lot, give them the statistics and use, you know, use graphs. A lot of this stuff you can download from the National Institute of Mental Health and SAMHSA. You can get some really pretty brochures. Demystify the counseling process so people aren't thinking one flew over a cuckoo's nest. They're understanding that counseling is an egalitarian process to help you build on your strengths. Identify the multiplicity of causes of anxiety and depression, lack of sleep, poor diet, lack of sufficient sunlight and disrupted circadian rhythms, social stresses, lack of coping skills. It's not just, you know, some weird brain disorder, you know, there are a lot of things that can cause it. Learn more about mental illness yourself and listen to people who've experienced mental illness. Stigma is diminished by just talking with someone who has it. Talk openly about it. The more mental illness remains hidden, the more people continue to believe that it's shameful and should be concealed. Watch your language. Don't use the word crazy, loony or nuts. Put the person before the mental illness instead of saying the borderline, say the person who has borderline personality, instead of saying the addict, say the person with an addiction. And support mental health treatment, you know, advocate for it. Speak up about stigma, respond to stigmatizing material. If it's a commercial or a show, there are often organizations that want to know about this. Stigma Free at NAMI is one of them where you can actually report certain shows or commercials that you find offensive, and they will take it up with the organization that is perpetuating it. Demand change from your elected representatives. They can't change attitudes, but they can change insurance funding. They can change the availability of funding from mental health and substance abuse services. Provide support for organizations that fight stigma by volunteering. Contribute to research related to mental illness and stigma. So there are some research projects out there. Start a research project. They're not the easiest. You know, you have to have a little bit of know how. But you can also go to the National Institute of Mental Health and find out about current research topics and projects that are going on. Help people with mental illness reenter society by supporting their efforts to obtain housing and jobs. So sometimes you need to be a job coach. Sometimes you need to be an advocate for people. And you're not going to go in and say, this is Jane. She's got clinical depression. I want you to hire her. You're going to go into the store without Jane and you're going to say, you know, I just wanted to educate you about, you know, people with mental illness and, you know, the options that are there for employing someone who has mental illness and how they really make good employees. You want to have good statistics and good data to show people. Respond to false statements about mental illness or people with mental illness with accurate facts and information. The Americans with Disabilities Act prohibits discrimination against individuals with disabilities, defined as physical or mental impairment that substantially limits one or more major life activities. So that's pretty broad. Who may currently have a disabling impairment, but have or have a record of him who may not currently have a disabling impairment, but who have a record of such impairment. So if somebody was clinically depressed at one point, you know, but it's in remission right now, they still can't be discriminated against because they have a record of such an impairment. The extent of the limitation resulting from the person's physical or mental impairment must be assessed in light of any mitigating measures, including medication. So if the person can be stabilized on medication or with talk therapy or certain interventions or like with our vision, you know, I have to wear readers now. You know, that mitigates my disability. So I'm functioning pretty well. Drug addiction is considered a disability under the ADA if it poses a substantial limitation to one or more major life activities, but and there's a caveat here. Individuals who currently use illegal drugs, even users who are addicted may be denied employment because of their current use. So if they're currently using, well, that's illegal anyway, so they can be denied employment. If they have a history of using, but they're currently clean, they cannot be discriminated against. A person who currently abuses alcohol or prescribed drugs is not automatically denied protection because alcohol is legal. So the Fair Housing Act passed in 1968 to prevent housing discrimination based on race, color, religion, sex, handicap, familial status, national origin does nothing to stop landlords from discriminating against people with criminal records such as past drug convictions or domestic violence. And again, we want to look at what caused them to use drugs, what caused the domestic violence episode. You know, sometimes it's a problem. But other times it is a symptom of an underlying mental health issue that has since been treated. Students convicted of drug crimes may be prohibited from receiving federal student loans. So, you know, that's one of those icky things where they're still being discriminated against. And I'm not sure how they get away with this with the ADA, but evidently they do. So it's important to be aware of, and that might be something that you encourage clients to advocate for themselves with. So don't label people with words like crazy, wacko or loony or define them by their diagnosis. They are not the depressive. They are not the bulimic or the anorexic. They are a person who has whatever. Learn the facts about mental health and share them with others, especially if you hear something that isn't true. Treat people with mental illness with respect and dignity just as you would anybody else. And respect the rights of people with mental illnesses and don't discriminate them against them when it comes to housing, employment or education. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceuse.com slash counselor toolbox. This episode has been brought to you in part by allceuse.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists and nurses since 2006. Use coupon code, counselor toolbox, to get a 20% discount off your order this month.