Speaking of Psychology: Stamping out mental health stigma

Millions of people suffer from mental illness but stigma prevents many of them from seeking out effective treatments. In this episode, psychologist Arthur C. Evans Jr., PhD, talks about how the city of Philadelphia is using several novel approaches to help improve the mental health of its residents, fight stigma and get people on a path to recovery.

Arthur Evans is the commissioner of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services. A clinical and community psychologist, Evans focuses his work on improving treatment options for people suffering from mental illness through several initiatives, including HealthyMindsPhilly.org, an online tool and resource to support and improve the mental health and well-being of all Philadelphians.

He holds a faculty appointment at the University of Pennsylvania School Of Medicine and has held faculty appointments at the Yale University School of Medicine and Quinnipiac University. Evans was the deputy commissioner for the Connecticut Department of Mental Health & Addiction Services. In this capacity, he led several major strategic initiatives for the Connecticut behavioral health care system. He was instrumental in addressing health care disparities and increasing the use of evidence-based practices.

Audrey Hamilton: Changing how people perceive and receive mental health services is not an easy task. The stigma associated with mental illness remains a difficult barrier for many. But, we speak with a psychologist who is making mental health services, trainings and screenings more accessible to people in one city. He hopes other cities and towns will follow his lead. I'm Audrey Hamilton and this is “Speaking of Psychology.”

Arthur Evans is the commissioner of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services. A clinical and community psychologist, Dr. Evans focuses his work on improving treatment options for people suffering from addiction and other mental illnesses. Welcome, Dr. Evans.

Arthur Evans: Thank you. I'm glad to be here.

Audrey Hamilton: One of your major initiatives with the city of Philadelphia is to change how people perceive and receive community mental health services. Can you tell us about some of the ways you're doing that?

Arthur Evans: Sure. I think it's one of the most important things that we can do right now as a field. As the country is really dealing with the issue of mental health, how do people access services? How do people get what they need? One of the things that we realize and recognize is that people have very strong views about mental illness. There's stigma about that. And we feel strongly that if we're really going to help people, we're not only going to need to make sure the services are there, but people are actually going to reach out for those services. So we're using a variety of methods to do that.

Audrey Hamilton: Can you give us an example of how you are doing that?

Arthur Evans: Sure. So one of them that we recently just did, implemented, was to implement a mental health screening kiosk in a retail pharmacy. So what does that mean? That means that next to the blood pressure cuff at your local pharmacy you will be able to take a mental health screening. And it takes about five minutes at the most. It gives you information, feedback on whether or not you're likely to have a mental health condition. It's not to diagnose. It's not to give you a diagnosis or that kind of thing, but it's to say, you know, your symptoms — what you're reporting to us is consistent with depression or anxiety disorder or PTSD and here's some resources that you can reach out to for help.

Audrey Hamilton: So, for example, the blood pressure cuff that you're saying to is not going to tell you whether or not that you have heart disease?

Arthur Evans: Exactly.

Audrey Hamilton: But, it may give you an indication that it could be going that way?

Arthur Evans: Absolutely. And like a blood pressure cuff, the idea is, again, not to diagnose yourself but to find out whether or not you should seek help from your physician. And in this way, what people are doing is finding out if they should seek help from a mental health professional. We're very excited. It's the first time it's been done in the country. Our goal is to work with pharmacies around the city to get them to do this. And we think we're going to be successful with that.

Audrey Hamilton: Now, this is surprising, even to me. According to the National Alliance on Mental Illness, more than 57 million people will be diagnosed with a mental health disorder this year. That's a large number and too many of them will not seek mental health services. How can psychologists within communities help to reduce the stigma associated with treatment — especially treatment for addiction, for example?

Arthur Evans: Sure. So I think one of the most important things is that we demystify what we do. I think it's essential. I often talk about our field working on a black box principle — meaning that we have treatment programs or private practice offices. They are sort of a mystery to the community. People see those programs. And one of the things we're doing in Philadelphia to try to address that is we as a payer of those services, say to our providers, you really have to be a part of the community, not just in the community. And what that means is we expect that people are going to do outreach — that they're going to do community screenings — that they're going to do education — that they're going to invite people in for various kinds of events. And the providers who do that have, I think, recognized that by doing that they are perceived much differently. People are much more willing to reach out to them when they need help. And I think as a general rule that's something that we need to do as a profession is to get out of what I again call our black boxes, our treatment programs, our offices. Get into communities. Let people see us in a different kind of role. And I think it goes a long way in helping to reduce the stigma.

Audrey Hamilton: Do you think the Affordable Care Act, which was implemented by the Obama administration — is it doing its part in making more mental health services available to people who need them? Do you notice this?

Arthur Evans: Yes, well, absolutely, because if you look at the number of people who have a diagnosable mental disorder. You look at the number of people who do not seek treatment, one of the big reasons is that people do not have health insurance. And I think that one of the things that many of us in the field are excited about is that the ACA for the first time is going to make sure that millions of people in this country have access to health care. That in turn allows them to then have access to mental health care. So, I think it's going to play a big role in us getting to literally millions of people who currently need our services but are not accessing them. 

Audrey Hamilton: I'm interested in hearing more about a program you support called “ Mental Health First Aid .” Can you tell us about this program? Why you think it's important to implement something like that now?

Arthur Evans: Sure. Mental Health First Aid is a one-day training course that really helps the general public understand mental illness, understand or recognize when someone might be having a mental health problem and know how to support the person and/or refer the person for other help or to seek self-help. We are tremendously excited about it.

The response that we've gotten to our efforts to train people within the city has been really overwhelming. Our goal right now is to train 10,000 people by the end of next year. And, you know, what's exciting about that is you think about even a large city like Philadelphia, to have ten thousand people in our community that are better able to recognize when a person is having a mental health challenge, know how to respond is very exciting. You know, if you're in a restaurant and someone has a heart attack, they'll probably be five or six people who can jump up and do CPR. If you're in a restaurant and someone starts to exhibit psychiatric symptoms, most people run the other way. And so what Mental Health First Aid does is it really gives the average person the ability or the skills and the confidence to help people in those instances. So, it's been very well received by a broad cross section of people in our city from people in our criminal justice system to people in our schools to people in corporate America. People regardless of where they are recognize that these are issues that affect lots of people and that they need help in addressing those issues.

Audrey Hamilton: If you know someone who you think has a mental disorder or if you're concerned about your own mental health, you know, what are the first steps a person should take to find the right diagnosis and treatment?

Arthur Evans: Sure. So I think that varies a lot depending on what community you're in. If you're in Philadelphia, for example, we have a number of hotlines and numbers that you can call. There's a suicide hotline. We have a hotline for people who are in a psychiatric crisis. We have information lines. For example, we have a website that we've created that is called healthymindsphilly.com . And we created that website because we wanted to have a place that people could go on the website that was very accessible, that was destigmatized in a lot of ways. It's, you know, that's very colorful and accessible and we put a lot of information out there — mental health screening, information about Mental Health First Aid, information about how you access services — and those kinds of resources I think help people to reach out for help. If you're in a community — most communities do have a suicide hotline. Most communities do have an information line. There's a national website called Network of Care , which is in many cities and states around the country. And so if you Googled “Network of Care” in your town or your state, in many states you will find a website that will give you information on services in your community. So, I would say, unfortunately unlike physical health care where people know where the local hospital is and often have a relationship with a primary care provider, when it comes to mental health, people typically don't have those kinds of ongoing relationships. So it takes a little bit of digging depending on what neighborhood or what community you're in.

Audrey Hamilton: Okay, Dr. Evans, thank you so much for joining us.

Arthur Evans: Well, thank you. I appreciate it and had a great time. Thank you.

Audrey Hamilton: For more information on Dr. Evans's initiatives, please go to our website . With the American Psychological Association’s “Speaking of Psychology,” I’m Audrey Hamilton.