Educational: COVID-19 and stigma about mental health: A pandemic silver lining?

Educational: COVID-19 and stigma about mental health: A pandemic silver lining?

Ellen Beckjord, PhD, MPH

Vice President, Population Health and Clinical Optimization and licensed clinical psychologist, UPMC Health Plan

One of the ways I’ve coped with the COVID-19 pandemic is by looking for the few-and-far-between “silver linings” that have resulted from the event. One such potential silver lining is a lessening of the stigma associated with mental health challenges. Stigma has long plagued seeking, getting access to, and receiving services to help with mental health challenges – everything from seeking short-term counseling for temporarily increased levels of stress and distress to psychiatric treatment for mental health disorders like mood disorders (including depression), anxiety disorders, and addiction.

Stigma” originates from the Greek word “stizein,” meaning “to tattoo” and then from the Latin word “stigmat,” meaning “to mark or brand.” Today, the Oxford Dictionary defines “stigma” as “a mark of

disgrace associated with a particular circumstance, quality, or person.” In short, experiencing challenges with your mental health is a mark that most people don’t want to have. While I’m aware of ways that stigma has a foothold in mental health – there’s embarrassment and shame associated with having a mental health disorder or receiving mental health treatment – I’ve always had a hard time understanding why. If you remember the remarkable television show “My So-Called Life” from the 1990’s, you may recall an episode when the main character, Angela, is fretting about whether a blemish on her face will leave a scar. Her best friend, Rayanne, tells her: “Living leaves a scar.” Whom among us gets through life without encountering challenges – mild, to moderate, to severe – that leave a scar, or mark, and for which the help of others, including trained mental health professionals, has incredible value?

I recognize that my perspective is a function of having been raised in a family that valued mental health and wellbeing, with parents who had the resources to make mental health treatment available to me during times when I needed it in adolescence and young adulthood, and that was reinforced as I completed my training to become a licensed clinical psychologist. And while this perspective may still be the exception and not the norm, the indiscriminate nature of COVID-19, the way it left its mark on EVERYONE in one way or another, may have chipped away at the stigma associated with mental health and, in that way, may be one silver lining of the COVID-19 pandemic.

You may have had COVID, and if you didn’t, you almost certainly know someone who did. In the early days of the pandemic, you were likely affected by the fear and uncertainty that pervaded our lives as we waited to fully understand how the virus was transmitted, what we could do to keep ourselves and our loved ones safe, and how to navigate the necessary parts of our lives – how to survive – while the world changed around us, sometimes at a pace that felt like minute-by-minute. A recent publication in the scientific journal The Lancet1 estimates that, globally, the excess mortality due to COVID-19 over the two-year period from 2020 to 2021 was more than 120 deaths per 100,000 people. This means that the vast majority of us know someone, or know someone who knows someone, who died from COVID.

In her book, “all about love,” bell hooks writes, “When we are taught that safety lies always with

sameness, then difference, of any kind, will appear as a threat.” While the author’s ultimate point here is that difference should not be inherently linked with a sense of danger, we can acknowledge that the universal nature of facing the uncertainties and consequences of the first fully global pandemic in our

lifetimes resulted in a sameness that makes it more difficult to stigmatize mental health challenges: if COVID-19 left its mark on your mental well-being, you are not alone.

One positive outcome is that we’re talking more about mental health. I was recently invited to speak on the topics of mental health and behavioral medicine at a national conference that was being held virtually, and when we started the session to record the presentation, one of the conference organizers commented, “This is the first year we’ve had a session focused on mental health.” While this represents progress, talking about mental health is not sufficient for truly changing the ways we care for people with mental health challenges, mental health disorders, and discussion alone will not improve the mental health and wellbeing of people and populations. It is up to policymakers, health care systems, health care providers, and each of us to meet this moment and turn this opportunity into real change by advancing mental health parity, by increasing the availability of evidence-based and culturally competent mental health treatment at all levels of intensity and in multiple modalities, and by having the courage to take our mental health as seriously as we take our physical health.

Normalizing the importance and ubiquity of behavioral health has driven innovation in how such care can be delivered – often remotely. For example, UPMC Health Plan members can access RxWell, a mobile app, that combines proven, self-guided deep breathing and other techniques with the help of

health coach. Many employers also offer access to counselors and support through UPMC Health Plan’s LifeSolutions employee assistance programs. Such support is offered over the phone, through video chat via UPMC AnywhereCare virtual counseling or in person. These virtual counseling services are available to UPMC Health Plan’s Medicare membership, too, through the Resources for Life program.

In addition to offering these important tools to our members, UPMC Health Plan is also focused on community supports to promote the importance of discussing and caring for mental health. Community Care Behavioral Health organization (Community Care) is a subsidiary of UPMC and part of the UPMC

Insurance Services Division. Community Care was created to support Pennsylvania’s mandatory managed care program for Medicaid recipients, called HealthChoices. Since 1999, they have delivered behavioral health services to Medicaid recipients and this year will celebrate their 25-year, Silver Anniversary. Beginning in May and throughout the remainder of the year, Community Care will celebrate their achievements and partnerships with a series of events. These events include a four-part, Innovations in Behavioral Health Lecture Series, a mindfulness presentation, a County Collaborations Webinar Series, and a Healing Arts art show highlighting creative works from our members. Timely information about these events will be shared on our new blog entitled, “Information.Insight.Innovation.”

The best description of how the COVID-19 pandemic has affected stigma around mental health is not

that it has lessened stigma, it’s that COVID-19 has created an opportunity to lessen the stigma associated with mental health. COVID-19 has cracked stigma’s armor; it’s put a foot in the door that has, for so long, shut people off from seeking and receiving help for of all kinds for mental health challenges. Keeping mental health in the shadows does not protect us from shame and embarrassment, it robs us of opportunities to observe – and celebrate – our resilience. Making real changes regarding how we approach mental health challenges will not expose our weaknesses – it will expose our strengths.

Embracing the need to tend to our mental health is an act of humanity and an act of love. In the words of bell hooks, “When we choose to love we choose to move against fear – against alienation and separation. The choice to love is a choice to connect – to find ourselves in the other.”

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