Changing Public Perception about Mental Health Conditions: B4Stage4 Approach

No matter the national origin of a manuscript I am reviewing, the authors sooner or later mention that laypersons in their country still attach stigma to mental health conditions. Because of the stigma, symptomatic individuals are often reluctant to seek treatment and perhaps even reluctant to reveal their symptoms to family members and friends. In the 21st century, with its global interconnectedness and technological wizardry, this widespread stigmatization of psychiatric disorders seems a strange remnant of primitive eras. No one today should feel ashamed of depression or anxiety or forced to hide their residual distress from traumatic life events in childhood.

When attending a recent meeting of a local affiliate of Mental Health America, I learned of a great initiative to change public perception about mental health conditions. I want to share it with you. It is called B4Stage4. Launched nationwide in the USA via the internet (www.mentalhealthamerica.net/b4stage4) and through colorful posters, flyers, and other printed materials, the campaign de-stigmatizes mental illness and places heavy emphasis on screening to catch problems early (before Stage 4). Research shows that delays in seeking psychiatric treatment are longer than for seeking medical treatment (i.e., 9–23 years for anxiety disorders, 6–8 years for mood disorders, 1–2 years for psychosis) (Mental Health Association of East Tennessee, 2016a). Thus, one of the campaign flyers captures reader attention as follows:

When we think about cancer, heart disease, or diabetes, we don't wait years to treat them…When people are in the first stage of those diseases and are beginning to show symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to reverse these symptoms. We don't ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease. So why don't we do the same for individuals who are dealing with potentially serious mental illness? (Mental Health Association of East Tennessee, 2016b)

The stages of mental health conditions are described as follows in the aforementioned flyer:

 

Stage 1:	Mild symptoms and warning signs. At Stage 1, a person begins to show symptoms of a mental health condition, but is still able to maintain the ability to function at home, work or school—although perhaps not as easily as before they started to show symptoms. Often there is a sense that something is “not right.”
Stage 2:	Symptoms increase in frequency and severity and interfere with life activities and roles. At Stage two, it usually becomes obvious that something is wrong. A person's symptoms may become stronger and last longer or new symptoms may start appearing on top of existing ones, creating something of a snowball effect. Performance at work or school will become more difficult, and a person may have trouble keeping up with family duties, social obligations or personal responsibilities.
Stage 3:	Symptoms worsen with relapsing and recurring episodes accompanied by serious disruption in life activities and roles. At Stage 3, symptoms have continued to increase in severity, and many symptoms are often taking place at the same time. A person may feel as though they are losing control of their life and the ability to fill their roles at home, work or school.
Stage 4:	Symptoms are persistent and severe and have jeopardized one's life. By Stage 4, the combination of extreme, prolonged and persistent symptoms and impairment often results in development of other health conditions and has the potential to turn into a crisis event like unemployment, hospitalization, homelessness or even incarceration. In the worst cases, untreated mental illnesses can lead to loss of life an average of 25 years early. (Mental Health Association of East Tennessee, 2016b)

I believe the concept of “stages of disease” will be familiar to the general public, along with the notion of early intervention. The public is regularly bombarded with the early signs of cancer, prompting all of us to check our lumps and moles and participate in screening tests. Not so common is the anonymous, free and private screening for early signs of mental health conditions that is being offered during the B4Stage4 campaign (Mental Health Association of East Tennessee, 2016a). Participants are provided with information about community services, psychotherapy, peer support, medication, complementary and alternative medicine, and self-care activities like exercise. In my local chapter of Mental Health America, 71% of individuals who received the free screenings did seek treatment (Mental Health Association of East Tennessee, 2015).

While cognizant that the B4Stage4 initiative may not be suitable for adoption in other countries without culturally sensitive modifications, I believe its success in the United States is impressive and its basic principles are sound. I encourage readers to consider ways to emulate these principles in producing educational materials and conducting screening activities. The length of time before psychiatric diagnosis is disgraceful and the amount of human suffering appalling. The stigma of mental illness must be eliminated, and all of us can play a part.

Declaration of interest: The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper.