Skip to main content

Treating Mental Health Stigma in Medical Settings*

Article image

“We have so many patients that need care, and I don’t think many of us have been trained to work with the mental health side.  I got into this field to help older people, and I don’t feel like I really get to do that right now with everything we need to get done in a shift.”

– Staff member at nursing facility

There is enormous strain on professionals in medical and senior communities to accomplish numerous tasks and be fully present for their patients during a shift. Most workers were drawn to this field to help older adults and patients live with dignity, care, and compassion. It can be disheartening for many professionals when they experience the reality of working in these settings: the amount of paperwork, logistics, and coordination required by the system take time away from direct care with patients.  Furthermore, staff see that residents’ needs are not merely physical, but mental, emotional, spiritual, and social as well.  Over time, staff can feel increased pressure to meet each of these needs, all while working under time, staffing, financial, and training constraints.  

Accumulating stressors from the pandemic on the healthcare system have compounded the problem.  A recent survey from the American Health Care Association found that 86% of nursing homes in the U.S. are experiencing moderate to severe staffing shortages, 96% of nursing homes are struggling to hire additional staff, and 78% have hired temporary agency staff to fill the gaps.  Furthermore, over the past decade many medical systems have made financial cuts to departments such as social service and chaplaincy, who offer care for patients beyond their physical needs.  While these services have been eliminated from the budget, the need for this care has certainly not reduced.  Who, then, is left to address these needs for patients?

In addition to staffing dilemmas, providers across medical settings find themselves increasingly limited to one piece of the healthcare puzzle.  Researchers have found that there is often a lack of ownership for mental health care, leading to staff not seeing it as part of their job.  It often feels like it is (or should be) someone else’s responsibility to manage mental health care symptoms.  As a result, patients with mental health issues have poorer outcomes from surgery and medical procedures, as well as worse experiences of care than those without a mental health diagnosis. 

In a fractional medical system, it makes sense that providers feel the best thing for patients is to refer out to a specialist and distance themselves from patients who appear out of their scope. The consequences of this model, however, are that patients with mental health conditions feel as though they are falling through the cracks.  Meanwhile, staff continue to feel unprepared, stuck, and out of their scope with a subset of patients in their communities.  How can we begin to approach these obstacles? 

The first suggestion is to provide staff with more training on mental health topics.  Without quality training, staff and residents are placed in difficult and potentially harmful situations.  Often conscientious staff become fearful of doing or saying the wrong thing, which in turn leads them to distance themselves from residents with mental illness.  This action alone can unintentionally foster an increased sense of mistrust, isolation, or fear in their residents (which can exacerbate symptoms like anxiety, paranoia, depression, or withdrawal) and negatively impact functioning.  WCPA offers training and consultation programs to senior communities, and NAMI offers mental health first aid training for the general public which has also been a promising tool for staff in medical settings (

Another idea is to provide staff and leadership with ongoing consultation with local mental health clinicians.  While it may seem ideal to outsource our residents’ mental health care to a psychiatrist or therapist alone, the reality is that humans are complex social beings.  Therapy and psychiatry are incredibly beneficial and should be consulted whenever necessary.  However, once residents return home from their appointments with these specialists, the staff in the senior community are their primary social contacts and caregivers.  What staff says and does matters immensely, and these helping professionals deserve the space to discuss the challenges they experience and the opportunities to learn new ways of approaching residents with complex needs.  

Healthcare professionals are the backbone of our medical and senior care systems.  They deserve more opportunities to learn and be supported as they serve patients with medical and mental health needs.  Patients and residents also deserve to be understood, addressed, and properly cared for by compassionate staff. If your community would like more information on training and consultation, please feel free to reach out to WCPA to discuss how we can collaborate and help support your staff.

* This article is the second in a three-part series, which covers the issue of mental health stigma in healthcare.  The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system.  The final article will spotlight the experiences of family and loved ones who support an individual with physical and mental health issues.

Social Media Comparisons: Our Youth’s Greatest Frenemy

Social media has connected us all in ways unimaginable to past generations.  As adults, many of us are all-too-aware how social media has proven to be both a wonderful but also a challenging and, at times, discouraging experience; our youth, however, often lack this critical awareness.  A study conducted by Sun et al., 2022, at Stanford Medicine found that about 25% of children received their first phone by 10.5 years old and over 60% of those children had smartphones.  The study indicated that most children received their first phone between the ages of 11-13 years old, which is a critical time for any child’s physical, emotional, and social development.

Children in this age range typically begin puberty, which can cause a cascade of shifts in self-esteem due in part to hormonal changes, growth spurts, and peer influence.  At this time, youth develop what Elkind (1967) calls Adolescent Egocentrism, or the belief that others are preoccupied with the child’s appearance or behaviors and the inability to differentiate their personal beliefs from the perceived beliefs of others.  Because of this, the weight of their peers’ opinions increases dramatically.  They begin to believe that adults cannot relate to them or understand their problems like a friend can, so they begin to ask other youth for life advice before a parent or other adult.  This leads many young people to attempt to solve their problems using poor coping skills, such as food restriction and over-dieting, substance use, and self-harm.  

These conditions lead to the perfect storm for the harmful influences of smartphones and social media.  Children today are so easily connected with texting, video-chatting, and social media, that the expectation to stay in touch with peers has become astronomically high. It is inducing social anxiety in our youth at a greater rate than adults, according to the National Institute of Health.  Youth express fears and describe experiences of losing friends if they do not “keep up the streaks” on Snapchat or respond within a few minutes of receiving a message or text from a friend.

Moreover, many tweens and teens are terrified of missing out on social experiences with their peers.  Social experiences, with the help of smartphones, now encompass interactions that other generations may not perceive as impactful, like being included in a group chat, but these situations can have major ripple effects.  All too often, middle schoolers’ group chats include a great deal of gossiping about others.  Not being in a group chat can mean that the child is the focus of the gossip, which can evolve into isolation from the friend group in real world situations, like school and social events. With this high pressure, it’s no wonder why our youth are becoming so obsessed with their smartphones and social media.

In addition to sharing videos, pictures, and texts, Snapchat projects users’ locations and a rating system for how frequently each user responds to others.  This allows users to know where their friends are, if they are there with other mutual friends, and if that person is responding at a desired consistency.  In sum, it makes it very easy to know if someone is being excluded and, in the case of direct messages sent to the excluded person about the social event, when that exclusion is purposeful. 

Tik Tok and Instagram feature an onslaught of content that ranges from thoughtful advocacy to hateful propaganda.  These apps primarily send customers media based on previously identified preferences – the apps attempt to send users more and more content that mimics what the user already follows, which can create an unhealthy echo-chamber experience.  Users can find themselves bombarded with content from an unhealthy community, like “thinspo,” (eating disordered thinness inspiration), or an overload of misinformation based on public opinions.  

Just as would be expected, public opinions are often body-shaming, diet-glamorizing, and hateful toward anyone who disagrees with the group.  This, for many, leads to poor body image and entering the diet culture at younger and younger ages. In a study by Neumark-Sztainer and Hannan (2000), dieting was reported by 31.1% of the 5th-grade girls increasing to 62.1% among 12th-grade girls.  Disordered eating was reported by 13.4% of the girls and 7.1% of the boys.  Understanding that thinness does not equate to health and that most images and videos are edited is hard enough for someone with a fully-developed, adult brain, but when children’s limbic systems are developing faster than their prefrontal cortexes, and tweens are being persuaded by their emotions and only beginning to develop abstract thinking and deductive reasoning, it would be preposterous to believe that our youth are not developing negative self-concepts using social comparison to others online.

In addition to negative thoughts about their bodies and images, youth are experiencing existential crises about their futures, long before launching age.  Seeing “influencers” gain fame and fortune on social media formats by means of self-exploitation at younger and younger ages has led adolescents to feel like they are falling behind the curve when it comes to making a life for themselves.  They voice concerns about their comparative lack of popularity and persuasion of others [or number of followers] and how well they have planned their future careers and lifestyles.  Not to have a plan for the future by high school, for many, means to be unprepared for life and to be at risk of never accomplishing anything.  This hyperbolic outlook contributes to adolescent dependence on social media, because they have started using it as an outlet to discover potential passions to pursue through their lifespan, which can be as defeating as it is inspiring.

To believe that young people, especially in early adolescence through young adulthood, are not engaging in self-comparison on social media is to have too high of expectations for them.  No child is immune to online social comparison, unless someone in their life intervenes by stepping in and talking about how they view themselves and others.  In doing so, low self-esteem or maladaptive cognitions can be identified and interrupted through discussions about the false realities of social media, developing realistic views of the self, and, critically, reduced time spent on social media. 

Newly freed-up time can be channeled into real-life activities that not only engage the young person socially in a healthy way, but can also help them discover their personal passions and build their self-esteem – think team sports, art classes, playing in a band, or joining scouts.  In addition, getting a young person engaged in activities that involve self-exploration, like journaling, can inspire helpful insights that will allow a child to see their personal value without external validation.  Counseling intervention with a therapist the youth trusts can help further, when needed.

Notably, when users search for unhealthy topics, some social media apps provide responsive statements with links to healthy supports.  This is a glimmer of hope for social media as a way to get youth connected with the resources they need to support their mental health, but there is nothing else in place to prevent children from exploring a world that could severely harm them as they develop. Caring adults need to be talking to their adolescents about social media to ensure that they are using it safely and understand that most of what they see online is not a real representation of others.  Social media is never a reliable, accurate, healthy source for self-comparison.

Understanding Dementia: The Top 3 Causes

Dementia is defined as memory loss symptoms caused by a certain disease or condition, and is not part of the normal aging process. While normal aging is marked by challenges such as temporarily forgetting names or where you left your keys, forgetting why you entered a room, or occasionally struggling to find the right word, dementia is an umbrella term describing a decline in mental ability severe enough to interfere with daily life.  There are over one hundred different types of dementia.

Alzheimer’s Disease is the most common form of dementia, accounting for sixty to eighty percent of dementia-related cases. It is a progressive and irreversible disease. Alzheimer’s Disease is marked by difficulty remembering new information, disorientation, mood changes, behavior changes, increased difficulty regarding time, events, and places, as well as delusions or suspicions related to family, friends, and caregivers that are untrue or inaccurate. There are many factors that impact the chances of acquiring Alzheimer’s Disease, such as age, genetics, family history, and heart health. By eating a healthy diet, exercising regularly, maintaining good cholesterol and blood pressure, remaining socially active, avoiding smoking, limiting stress, and getting enough sleep, you are keeping your heart and brain healthy. There is currently no cure for Alzheimer’s Disease, although there are FDA-approved treatments, including hopeful new treatments only recently approved for use.

The second-most common form of dementia is Vascular Dementia, accounting for 5%-10% of cases. Vascular Dementia is marked by inadequate blood flow to the brain, which causes cell death throughout the body, but especially the brain. The effects of Vascular Dementia depend on how severe the blood vessels have been damaged and what part of the brain has been affected. There are many common symptoms of Vascular Dementia, including: confusion, disorientation, trouble speaking, trouble understanding speech, stroke symptoms such as a sudden headache, difficulty walking, poor balance, and numbness or paralysis to one side of the face or body. Many of the same risk factors and protective factors for Alzheimer’s Disease apply to Vascular Dementia as well, including cardiovascular health.  There are currently no FDA-approved treatments for Vascular Dementia, however preventing and treating underlying cardiovascular conditions can increase an individual’s protection. 

The third most common form of dementia is Dementia with Lewy Bodies (also referred to as “Lewy Body Dementia”). Dementia with Lewy Bodies causes a decline in thinking, reasoning, and independent function, as well as changes in attention and alertness, visual hallucinations which recur, disruption to REM sleep, which may cause reenactments of dreams physically and vocally, slow movements, tremors, and muscle rigidity. Additionally, individuals who have been diagnosed with Dementia with Lewy Bodies may have difficulty interpreting visual information, and issues within the autonomic system within the body, which controls sweating, blood pressure, heart rate, digestion, and sexual response. Currently, the only way to diagnose Dementia with Lewy Bodies conclusively is by autopsy, however Dementia with Lewy Bodies can be diagnosed by a physician using their professional judgment. There are also no known cures or treatments to slow or stop the disease process, however there are beneficial medications that can help to treat the symptoms of Dementia with Lewy Bodies.

A diagnosis of dementia can seem overwhelming and heart breaking. You might feel like you have no one to turn to. After receiving a dementia diagnosis, finding a mental health clinician who is knowledgeable about dementia, its various types, its progression, and what to expect can help you feel less overwhelmed and help you to focus on your own mental health and being present for your loved one during this journey. It is also beneficial for a person with dementia to see a mental health clinician themselves; benefits can include improved quality of life, improved mood, and improved symptoms of dementia at times. 

Feel free to contact a therapist at WCPA who specializes in serving older individuals, including those with dementia, and their loved ones.  You can also contact your local chapter of the Alzheimer’s Association, which provides support and resources for many types of dementia, and utilize their twenty-four hour helpline or attend one of their many support groups.  Taking these steps can help prepare you for the journey ahead and give you more time to enjoy with your loved one.