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COMMENTARY: Stigma is greatest barrier to mental health

By Mark Jacobson, certified peer support specialist, Winona, MN

Stigma is the greatest barrier to helping individuals with mental illness. Many people mistakenly think that people with mental illness are dangerous or that people with substance abuse disorders have a moral failing. In fact, the majority of people with mental illness pose no threat to others. And regardless of moral beliefs, addiction is a disease that impairs a person's health, social function and ability to control substance use.

This misunderstanding causes feelings of shame and fear among people with co-occurring disorders. Many people isolate themselves to avoid embarrassment, or deny that they need mental health treatment. Stigma in our society also prevents people in need from receiving help. Cultural rejection can prevent individuals with addiction from finding work, maintaining stable housing and providing for themselves.

The vast majority of inmates in the federal prison system have been convicted of drug-related offenses, and the criminal justice system in the U.S. is one of the biggest sources of addiction treatment referrals in the country.

According to a 2017 report by the Bureau of Justice Statistics, a 2011-2012 national survey found that more than a third of prisoners and nearly half of jail inmates in the U.S. had a history of mental illness. A separate report found that 59 percent of state prisoners and 63 percent of sentenced jail inmates met the criteria for drug dependence or abuse from 2007 to 2009. Some criminal justice programs, such as drug courts, are trying to end the cycle of recidivism by providing alternatives to incarceration.

Homeless people often have co-occurring disorders and limited or no access to health care. They may not know that they have a mental illness, and they may have a history of legal issues that makes it impossible to hold a job.

More than 200,000 people who had a substance use disorder or a severe mental illness experienced homelessness in 2016, according to the Substance Abuse and Mental Health Services Administration.

Approximately 50 percent of veterans who need mental health treatment seek it, and slightly more than half of those who do receive treatment get adequate care, according to the Substance Abuse and Mental Health Services Administration. An estimated 70 percent of homeless veterans also have a substance abuse disorder.

Some veterans choose not to seek treatment because they don't want to be treated differently by peers, and many Veterans Affairs clinics have been plagued with long wait times.

Since the 1980s, the medical community has recognized that co-occurring disorders require specialized treatment. In recent years, experts have attempted to standardize the term co-occurring disorders and those with mental health disorders. The Substance Abuse and Mental Health Services Administration generally uses the term co-occurring disorders to refer to substance use disorders and mental disorders.

The physical and emotional symptoms of co-occurring disorders vary depending on your life circumstances, and the type of substances you use and the type of mental illness.

Comprehensive addiction treatment includes therapy for underlying Causes of substance abuse. Detox alone isn't sufficient. To recover from addiction, every aspect of mental illness must be addressed.

Comprehensive, integrated treatment plans are designed to fit each individual's specific health needs. The frequency and intensity of treatment is based on the severity of each mental health condition.

The most effective treatments for addiction last at least 30 days, but long-term recovery has to include aftercare. Most people in recovery from addiction attend daily or weekly support group meetings. Many people also receive outpatient counseling on a regular basis.

Recovery from mental illness is similar. Patients should continue to attend therapy for co-occurring mental disorders after they leave rehab. If doctors recommend medications, such as antidepressants or antipsychotics, patients should continue to take them for as long as their doctor advises.

Individuals with severe mental illness may require regular counseling appointments for life, but most people with co-occurring disorders are able to attain happiness and fulfillment after achieving sobriety from alcohol or other drugs.