Why We Don’t Notice Mental Illness Discrimination

The following is a guest post by Dan Berstein, a mediator who helps people use conflict resolution best practices to overcome mental health stigma. He is the founder of MH Mediate and the co-chair of the Diversity Committee at the American Bar Association Section of Dispute Resolution.

When I first told a colleague about my bipolar disorder, he turned to me and said, in a lilting voice, “Oh wow, you’re doing so well.” Meant as a compliment, this was actually a microaggression.

Microaggressions are comments or gestures containing subtle, denigrating messages. In the case of my friend, his remark that I was “doing so well” contained an implicit assumption that someone with bipolar disorder normally would not present as well as I appeared. Researchers have identified a variety of common mental illness microaggressions, including the implicit or explicit assumption that a person may be dangerous, inferior, helpless, burdensome, socially undesirable, or feigning symptoms, amongst other inappropriate inferences¹. It can be hard to notice microaggressions related to mental illness (as well as microaggressions in general) because they’re often expressed as part of well-intentioned, friendly statements. Therefore, people who hear or witness them may question whether something negative really happened at all.

Though microaggressions are harmful, they typically do not amount to discrimination without being linked to some other kind of inappropriate action. According to the Americans with Disabilities Act (ADA), discrimination can happen when someone believes a person has a disabling mental health problem and then asks them invasive questions, screens them out of services, denies their reasonable accommodation request, or otherwise treats them differently than other people².

Surprisingly, mental illness stigma and discrimination are often hiding in plain sight. Major institutions have inadvertently published professional guidance that disparately affects people with mental health conditions. For instance, Harvard Law School’s Program on Negotiation released a report about how to deal with “difficult people,” suggesting that displays of mental illness may be part of a hard bargaining strategy. Cardozo Law School published a set of guidelines modeling invasive questioning of people with mental health conditions. The Association for Conflict Resolution disseminated safety guidance advocating for screening people with mental health problems as being at higher risks of perpetrating violence. All of the aforementioned documents have been updated, disclaimed, or removed following outreach from the Mental Health Safe Project, which collaborates with organizations to remedy stigmatizing content.

These are just a few of many published examples. People often do not realize mental illness stigma is a problem, in part because of its prevalence in our society and the existence of structural discrimination across many institutions³. A study of mental illness microaggressions found that there was more blatant discrimination than expected, revealing that many people are not yet careful to avoid singling out individuals with mental illness for different treatment⁴.

Against a backdrop of discriminatory norms and stigma, many people are not primed to even perceive that mental illness stigma is present or that discrimination is happening. This is supported by the fact that each of the publications mentioned earlier derived their offensive material from trusted sources that had already codified or supported prejudiced beliefs or practices. The organizations seemed not to have understood that their guidance suggested disparate treatment for people with mental health problems until fielding outreach about it. In each case, it did not take much convincing for the institution to realize that their content contained problems once they looked at it more closely.

How can we get more people to take a deeper look and notice the inadvertent stigmas embedded in their actions, words, and publications?

1. Ask Questions

Whenever the topic of mental health comes up, do a gut check as to whether something inappropriate may be happening:

• Are explicit or implicit messages assuming dangerousness, inferiority, helplessness, or other negative themes being connected to people believed to have a mental illness?

• Is screening, questioning, or other different treatment being suggested based on someone having a known or suspected mental health diagnosis?

• Even if the content is well-meaning and from a spirit of helping, does it nonetheless single out people with mental health problems for special treatment they did not seek out or consent to?

2. Listen

Create opportunities for people to share feedback about the policies, practices, and published material from your organization:

• Listen to someone’s concerns when they share them.
• Try to understand why they are upset rather than avoiding communication, defending your position, or dismissing the criticism.
• Act quickly if you realize an inappropriate comment was made or problematic content was published. A best practice is taking down an offensive piece of content as soon as a concern is raised, pending a review, so that way it is not continuing to broadcast discrimination in the meantime.

3. Seek Help

Visit the Mental Health Safe Project at mhsafe.org to access tools for addressing inappropriate publications or responding to everyday microaggressions and discrimination. There are also resources to help organizations prevent these problems.

If you would like to see archived copies of the problematic documents described in this post, which have all recently been updated or removed thanks to advocacy work from the Mental Health Safe Project, you can email info@mhsafe.org.