In a training session last month at Hood College, staff members from a wide range of service agencies in Frederick County were asked to spell out the word “spot” five times in a row.
“S-P-O-T. S-P-O-T. S-P-O-T. S-P-O-T. S-P-O-T,” the participants dutifully chanted.
“Now, what do you do at a green light?” asked Kristen Myers, a training coordinator for the mental health advocacy group On Our Own of Maryland.
“Stop,” most responded. There was a pause, then a ripple of laughter as the group realized their mistake.
The simple verbal exercise, Myers explained, was a way of showing how quickly and easily perceptions can be swayed, even when the right answer seems obvious. The experiment also demonstrated how easy it can be to form misconceptions, she added, one of the major contributors to societal stigma against mental health issues and substance abuse.
Combating and highlighting stigma in Frederick County is a major goal of the behavioral health work group of the local health improvement process — an initiative to improve outcomes, treatment and services for county residents.
While the group’s overarching focus remains mental health and substance abuse, stigma can play a large role in whether a person seeks treatment for those conditions, said Peter Brehm, a work group member and vice chair of The Frederick Center, a local service provider for LGBTQ residents.
According to the 2015 National Survey on Drug Use and Health, more than 35 percent of respondents cited “social concerns” as a reason for not receiving mental health services. Those included the fear that others might find out about their condition, worries that it could adversely affect their job, and concern that neighbors or the community could form a negative opinion of them.
“Even for those of us who are aware of [stigma] ended the day saying, ‘Oh, my God, we have work to do,’” said Cynthia Terl, the leader of the behavioral health work group and the director of Community Outreach for Wells House @ Gale Recovery. “We can’t assume that anyone has a full understanding of the implications of stigma.”
For work group members, the issue is especially concerning given the prevalence of substance abuse and poor mental health in Frederick County. According to data collected by the Maryland Department of Health in 2015, 12.9 percent of adults reported having a diagnosed anxiety disorder in 2015 and 18 percent reported a diagnosed depressive disorder. More than 10 percent of residents reported that their mental health was not good in 15 or more of the past 30 days before the survey was taken.
The figures on substance abuse were equally worrisome. In 2015, 19 percent of respondents reported binge drinking in the past 30 days. And according to the most recent data from the Department of Health, 41 residents died of drug or alcohol intoxication from January 2017 to June 2017.
“This is a problem that is not going to just go away,” Terl said at the September training session. “And the stigma we are really battling is [the idea] that substance abuse is a moral choice, and not a disease that we’re trying to treat.”
Although the training last month spanned three hours and included several groups on stigma, Terl and Brehm have since taken that framework and adapted it into 20-, 40- and 60-minute modules. The one-hour training session was presented Thursday to board members for the Frederick County Health Care Coalition, who also offered suggestions and potential modifications.
The hope now, Terl said, is to introduce those modules to several prominent community groups, including local Rotary clubs and the Frederick County Chamber of Commerce. Those groups, in turn, could encourage small businesses and agencies to request the training for their own staff members.
“We want to be in front of people in the community who serve residents with behavioral health issues, who have them as neighbors,” Terl said. “Because even those of us who are service providers were awed by what we do not know.”
The training also includes suggestions for those unfamiliar with the concept of stigma. One of the most important components, Brehm said, is the use of language. An entire slide is dedicated to stigmatizing terms — “addict,” “drunk,” “psycho” — and their euphemisms.
Instead of “crazy,” for example, participants might learn to call someone “a person with mental health challenges.” Instead of saying that friends are “staying clean,” it’s better to describe them as “maintaining recovery.”
“Because if I say that a person is an alcoholic, that’s a personal statement,” Terl said. “It’s saying that alcoholism is that person, rather than the disease that person is suffering. But if I say, ‘that person is struggling with alcohol addiction,’ it gives a completely different perspective. We don’t want to take somebody who is already vulnerable and pick them up and put them in a box.”