What’s the most significant obstacle people face when it comes to being open about mental health?

I’ve been thinking about this question in the days since the conversation on mental health advocacy that came out of the Conquer Worry podcast. This morning I met with my therapist and we were discussing the challenges of mental health advocacy and I talked about how I think one of the best ways to make progress towards more accessible (and acceptable) mental health care is to break down the barriers people have about being open. I know I’m not the first one to use the analogy (nor is this the first time I’ve used it) but I strongly believe people with a mental health issue ought to “come out of the closet”. One of the things that fueled the success of the gay rights movement has been a willingness of people to be open about who they are, to let their relatives, friends, and coworkers understand that at our core we’re all experiencing the same desires, the same need for love and companionship, and that those values belong to everyone. Living openly had an effect on stereotypes, on stigma and on people’s priorities. I believe that could apply to the experience of mental illness as well.

If you accept the premise that being open about mental illness would help to change the conventional approach to how we deal with access to care, treatment and support then the next question is naturally, why aren’t more people being open? What are the barriers they must contend with in order to come out? Here are four areas where I think there’s a significant challenge ahead of us in terms of why people aren’t more open…

Stigma
When I’m talking about stigma for purposes of this post I’m dealing specifically with misapprehensions about mental illness that are perpetuated by the media. Stigma can take several forms, whether it’s that people with a mental illness are prone to violence (actually they’re much more likely to be the victims of violence) or even a more benign idea that mental illness is actually a benefit (think of a “tortured genius” like Van Gogh). Stigmas can define you before you even get out of bed in the morning. I think many people don’t want to be open about their mental health issues because they don’t want to be associated with terms like “crazy” or “disturbed,” and who can blame them? But in order to challenge the stigmas we need to be able to correct the misapprehensions and we do that by telling people what our experience is really like.

Stable, Accessible and Affordable Care
I find it’s much easier to talk openly about my mental health as someone who is managing it with medication, therapy, mindfulness meditation, etc. and so I have some stability in my life- I’m not facing a crisis on a daily basis.  Despite the progress of legislation like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, the ability of people to access and afford mental health treatment still lags behind what you might call traditional health care (of course mental health care IS health care). Some people struggle to to find a medication or a therapist that they feel comfortable working with even when they are able to pay for treatment. Without even access to affordable mental health care how can anyone be expected to find the stability to feel confident about being open?

Support
I am incredibly fortunate that I have a strong support network between my family, my friends and my work environment. When I needed to take a leave of absence from work during the weeks after my suicide attempt I was able to. But the reality is not everyone has a strong network of support to lean on, and that can be a huge barrier to being open about a mental illness. If you’re worried that the people around you won’t support you if you come out with your mental health challenges I can understand the pressure to stay closeted. If you are worried about job security or your living situation being open may not be an option for you. That’s one reason why I think those of us that have the luxury of a strong network MUST work to make it easier for everyone to be able to open up about their mental health.

Self-judgment and shame
Mental illness will make you feel ashamed of yourself, and that can shut you up when it comes to talking about your mental health. I know that when I was in the depths of my own depression I was incredibly suspicious of the idea that I could ever feel better or that things can turn around. I think this kind of skepticism is one of the most difficult obstacles for people to overcome when it comes to being open about mental health. Depression lies to you and tells you that you’re alone and that nobody will understand or identify with you. Unhealthy and unproductive self-judgments make you question the idea of being open enough to even ask family and friends for help, let alone be open about mental health with others. This may be the most pernicious obstacle facing people with mental illness.

Share your thoughts
This isn’t an exhaustive or all inclusive list of the obstacles people face, but four of what I see as major roadblocks when it comes to being open about mental health. I’d love to hear what others think- what were the things that either held you back or are currently holding you back? If you aren’t open about your mental health struggles what might need to change? What can mental health advocates be doing to eliminate or at least mitigate these obstacles?