Addressing stigma for health and safety

Wednesday January 9, 2013

Ralph Provenza

The recent school shootings in Newtown, Conn., the Colorado movie theater shootings, as well as a recent incident right here in Bennington involving a troubled individual and his assault rifle have prompted comments across the community about the need for stronger gun control legislation, more mental health services, and discussion about when to hospitalize someone in trouble.

No one knows what, if anything could have been done to change the course of these recent events. Yet accounts paint the picture of these individuals being unstable people who were becoming a greater and greater danger to others.

The most common questions we hear are "What would cause a person to do such horrific things" and "What could we do collectively to make our community safer?"

The President has made mental health a significant part of the conversation by saying recently that we need to make access to mental healthcare at least as easy as access to a gun.

However, Americans historically have a hard time talking about mental illness.

While much has been made about the mental state of the shooters in Newtown, and Colorado, no one yet knows what drove these young men to engage in such violent acts. Every time there is a horrific mass shooting, mental health professionals are caught in a dilemma. Clearly, shooting innocent children and strangers is not normal behavior but having a mental health issue is not a predictor of violence.

Here's what we do know:

* We know that an increased risk of violence is not significantly associated with having a mental illness.

* We know that the presence of other risk factors does make assaults more likely. Those factors include: a history of family violence; substance abuse; and lack of a support system, including homelessness, poverty and inadequate housing.

* We know that people with mental health issues are not more violent than the general population. In fact, they are more likely to be the subjects of victimization.

* Finally, we know that an unstable individual and/or their family often will not seek nor accept help because of the stigma that surrounds mental illness, and that stigma is the most common reason why people struggling with mental health issues don't get the help they need.

The consequences of stigma can be devastating. Prejudice and discrimination against these individuals can have a profound effect. It can cause embarrassment and shame, leading those with such illnesses to try to conceal their problems and avoid help.

The stigma may prevent employers from hiring people with mental illnesses. And it may cause the public to not support funding for treatment and prevention services.

Stigma may be obvious and direct, such as someone making a negative remark about another's mental health condition or treatment. Or it can be subtle, such as the assumption that someone with a mental health condition might be violent or dangerous.

These and other forms of stigma can lead to feelings of anger, frustration, shame, and isolation, as well as discrimination at work, school and in other areas of one's life.

While our views about the mentally ill have evolved over the years, we still have a long way to go to overcome the misconceptions, fears and biases people have about mental illness, and the stigma these attitudes create.

To help someone in crisis or who is developing the signs and symptoms of mental illness, we must know about the risk factors and warning signs. And we must be willing to step forward to act on our knowledge and offer help until appropriate professionals, peers, or family support can be engaged.

Mental health treatment and support does work. People can manage their conditions and lead productive lives, and a key part of their recovery includes support from their family, friends and community.

The emphasis here in Vermont is on supporting and treating people in their own communities, close to their families, friends and familiar surroundings. Hospitalization for a mental health issue is a last resort in Vermont and hospitalizing a person against their will requires a determination that they are imminently and uncontrollably a danger to themselves or others - a higher bar, for sure.

We at UCS have a system of services and knowledge and we have intervened in many community crisis situations including the recent assault rifle incident.

Can we use more funding for mental health treatment? Of course.

While we do offer immediately accessible crisis intervention services and have actively worked to dramatically reduce our waiting lists for counseling, we could certainly use more capacity. But, it's equally important that people are comfortable to seek the services that are available.

Discrimination and community misconceptions remain among the most significant barriers to people with a mental illness gaining access to the services they need and being able to actively participate in the community.

Unlike dealing with a broken leg, when someone is struggling with a mental health or substance abuse issue, no one sends a get well card. Until a trip to the mental health center is no more embarrassing than a trip to the orthopedist or the eye doctor, we will continue to have community members reluctant to seek the mental health treatment they need.

While we will never fully understand the reasons behind these episodes of violence on the part of certain individuals, increasing our understanding and acceptance of mental illness is essential if our friends and family members with a mental illness are to live in, and contribute to, our communities.

Ralph Provenza is executive director of United Counseling Service of Bennington County. UCS serves the community with counseling, early care and education, and clinical support. To reach UCS, call 442-5491, visit, or


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