May 7, 2010

Dr. Katherine C. Nordal on Mental Health Awareness and Stigma

Questions for psychologist Katherine C. Nordal, PhD.

Reporters/editors/producers Note: The following feature was produced by the American Psychological Association. Feel free to use it in its entirety or in part; we only request that you credit APA as the source. We also have a photograph of Dr. Nordal available to reprint.

Dr. Katherine C. NordalIn recognition of May as Mental Health Month, we spoke with Dr. Katherine Nordal, APA’s executive director for professional practice. This article on mental health awareness and stigma is the first of four weekly features released during Mental Health Month.

Dr. Nordal is a licensed psychologist experienced in treating adults, children and adolescents and has clinical expertise in the treatment of stress-related disorders. As executive director for the APA’s Practice Directorate, Dr. Nordal manages a variety of activities involving legislative advocacy, legal initiatives, efforts to shape the evolving health care market, and a nationwide public education campaign, including the Mind/Body Health Campaign, to enhance the value of psychology. Dr. Nordal is a recipient of the APA’s Karl F. Heiser Presidential Award for advocacy on behalf of Psychology. She was an APA/AAAS Congressional Science Fellow (1990-91) and served as a legislative assistant in the U.S. House of Representatives and with the House Select Committee on Hunger. Her clinical interests included: learning, behavioral and emotional disorders in children and adolescents; neuropsychological assessment; brain injury in children and adults; and civil forensic psychology.

Do you think there is still a stigma associated with mental illness?

Awareness of mental health issues has definitely improved in recent decades. When I entered practice more than 30 years ago, individuals in my semi-rural community would often travel 40-50 miles to get treatment because they did not want anyone to know that they were seeing a therapist. Many people were concerned about what others may think if they were open about their mental health. In many ways, we have taken great strides since then as more people talk about mental health publicly and as we see more positive depictions of mental health in popular culture. Yet, for many, stigma remains. A 2008 APA survey found that more than half of Americans saw stigma--and concerns about what other people might think--as barriers that could prevent them from seeking mental health treatment. And while an estimated 50 million Americans experience a mental health disorder in any year, only one in four will receive treatment.

It is important to remember the impact that stigma can have. Because of stigma, people who need treatment may fail to seek it and they may face discrimination and problems at work or school or even encounter harassment or violence. Furthermore, untreated mental health disorders cost businesses millions of dollars in lost productivity, absenteeism and health care costs.

Why does the public often have a different view of mental illness than physical illness?

Traditionally, the medical model has separated mental and physical health. But this fails to take account of the strong links between the mind and body. Research shows that physical health is directly connected to emotional health, and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder. Poor mental health has implications for physical health – for example, research has shown that people with depression are at greater risk for developing heart disease, and conversely, that people with heart disease are more likely to suffer from depression than others.

Integrated health care – care that treats both the mind and body – is the key to breaking down stigma and providing the best care. Many psychologists already work in primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking the lead when a patient has a primary mental health or substance abuse diagnosis.

What can be done to combat stigma and stereotypes about mental illness?

Congress took a huge step in tackling stigma when the Wellstone-Domenici Mental Health Parity and Addiction Equity Act was passed last year. This new law means that insurance policies can no longer discriminate against those with mental health or substance use disorders. We’ve long known that mental health disorders can be as serious as those impacting physical health. The new parity law recognizes this by mandating that coverage must be the same for mental health as for physical health including co-payments, deductibles and in-patient treatment limits.

Events like Mental Health Month also serve to raise awareness and decrease stigma. Mental health disorders impact everyone – by talking about mental health we can dispel stereotypes and raise awareness.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 152,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.