Stigma Excerpts

One Million & Counting
cALL 800-273-8255 or
text "sos" to 741741


"I am not okay."


? "You may feel reluctant to ask a teen if they've been thinking about hurting themselves.
You may think tht asking about suicide could plant the idea. But that's not true.
Asking is alwys a good idea. Just starting the conversation helps in many ways."
Who else agrees.

Stigma Excerpts
How and Why the 5 Steps can Help
What’s the Harm in Asking About Suicidal Ideation?
What to Do When You Think Someone is Suicidal
How To Encourage Someone To See A Therapist
"13 Reasons Why" Can Be Lethal
Words Matter
Self-Stigma Regarding Mental Illness: Definition, Impact, and Relationship to Societal Stigma
APA Launches New Journal: Stigma and Health
The relationship between stigma sentiments and self-identity of individuals with schizophrenia
Retrospective accounts of self-stigma experienced by young people with attention-deficit/hyperactivity disorder (ADHD) or depression.
Prejudice and discrimination from mental health service providers
Mental Health Awareness and Stigma
Suicide: A Cry For Life
Caregivers: When To Push And When To Show Extra Compassion

Parent's Guide to Teen Depression
Teen suicide: What parents need to know
2018 Oregon Suicides (2016 CDC data)- AFSP
Southern Oregon "Out of the Darkness" walk 9/30/17 For more information contact: Ashley Cay 541-531-5124 or

For more information:


"Not My Kid!"
What Every Parent Should Know
Why Men Choose Suicide
It's Time To Talk About Male Suicide
Watch this video before you kill yourself

Stigma Excerpts

Suicide is the 8th leading cause of death in Oregon, and the second leading cause of death for 10 to 24 year olds. Still, suicide remains a taboo topic, is highly stigmatized and is surrounded by myth and mystery.

Myth: Asking someone “Are you thinking about suicide?” or “Are you thinking about killing yourself?” will put that idea into someone's head.

Breaking the Silence
"I am not okay."

"You may feel reluctant to ask a teen if they've been thinking about hurting themselves.
You may think that asking about suicide could plant the idea. But that's not true.
Asking is alwys a good idea. Just starting the conversation helps in many ways."

What the experts say...

Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide "may in fact reduce rather than increase" suicidal ideation.

Ask the Question

Ask directly about suicide. Ask the question in such a way that is natural and flows over the course of the conversation. Ask the question in a way that gives you a "yes" or "no" answer. Don't wait to ask the question when the person is halfway out the door. Asking directly and using the word "suicide" establishes that you and the at-risk person are talking about the same thing, and lets them know you are not afraid to talk about it. Ask: "Are you thinking about killing yourself?" or "Are you thinking about ending your life?"

How NOT to Ask the Question "You're not thinking about killing yourself, are you?"

Do not ask the question as though you are looking for a "no" answer. Asking the question in this manner tells the person that although you assume they are suicidal, you want and will accept a denial.

Start a conversation. Directly and gently ask the question, “Are you thinking about suicide?” or “Are you thinking about killing yourself?” This step can be particularly difficult for many people. Sometimes people worry if they ask if someone is feeling suicidal that they might “put the idea in their head”. Worry not. There is no research that supports this idea. Asking the question will not increase the risk of someone completing suicide. If anything the person will be grateful you expressed what they have been thinking about. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Department of Education

Do not be afraid to talk about suicide. Some cultures or families treat suicide as a taboo and avoid talking about it.[15]. You may also be afraid that if you talk to someone about suicide, you will prompt them to act on their suicidal thoughts. These factors or others may lead you to hesitate to speak openly about suicide. However, you should fight this instinct because the opposite is actually true; speaking openly about suicide often prompts someone in crisis to think about and reconsider their choices. Preventing Suicide: A Global Perspective by the World Health Organization (2014)

",,,the issue of suicide among young people, by inviting youth to take the lead. We recognize the need for student involvement and ideas in shaping the campaign against suicide. By engaging young adults and providing the facts, the NCPYS seeks to help those most at risk..."

When we bravely have open and honest conversations about mental illness and suicide, we potentially make life-saving connections. Without those conversations, we only have loneliness, silence and unanswered questions. We might consider overcoming our reluctance to speak of suicide to break apart the taboo that encloses it. Until we start talking, healing cannot happen.

Suicide rarely happens without warning. Don’t be afraid to talk about suicide. You might save a life by talking about it. Never agree to keep suicidal thoughts or plans a secret; most important thing you can do is get help with the person. Google "Know When to Get Help Suicide rarely happens without warning." Oregon Department of Education

Asking about suicidal thoughts or feelings won't push someone into doing something self-destructive. In fact, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings.

Myth: Talking about suicide or asking someone if they have thoughts of suicide will encourage suicide attempts. Fact: Suicide is the second leading cause of death for young people age 15–24. Talking about suicide does not increase the risk of suicide. Rather, openly talking about fears is the first step in encouraging a suicidal person to live. That conversation can simply be asking the person if they intend to end their life. The danger is in not asking when you feel there is a risk. (page 17)

If you suspect that your teen might be thinking about suicide, talk to him or her immediately. Don't be afraid to use the word "suicide." Talking about suicide won't plant ideas in your teen's head. Ask your teen to talk about his or her feelings and listen. Don't dismiss his or her problems. Instead, reassure your teen of your love. Remind your teen that he or she can work through whatever is going on — and that you're willing to help.

You may be concerned about your son or daughter, a student, or another youth. It is important to know "Are you thinking about killing yourself?" Talking about suicide does not cause suicide. If you have difficulty asking the youth about his or her thoughts, enlist another adult to help you. Or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text "SOS" to the National Crisis Text Line 741741.

Suicide Risk Assessment "Have you been having thoughts about killing yourself either now or in the past? Do you ever feel that life isn’t worth living? Have you ever wished you could just go to sleep and not wake up? Have you ever tried to hurt yourself, wishing you would die? Have you ever tried to kill yourself?

Don't shy away from the subject: Just talking about suicide isn't going to lead anybody to kill themselves. "We know that is just not the case," Karim said. "You will not put that idea into somebody’s head by talking about suicide." Said Oshel: "Just because you ask the question doesn't mean you’ve planted a seed in their head. It is far worse to ignore it than to openly address it."

Some people (both teens and adults) are reluctant to ask teens if they have been thinking about suicide or hurting themselves. That's because they're afraid that, by asking, they may plant the idea of suicide. This is not true. It is always a good thing to ask.

Suicide is difficult to talk about, there's no denying that. If you think someone close to you is having suicidal thoughts, you might feel reluctant to bring the subject of suicide up in case it gives them the idea to do it. This is not so. In fact, most people say talking directly about their experiences can be a huge relief, and helps them to discover other ways of getting through the pain they feel. Don't let this person carry their feelings around in silence - instead, give them a chance to release them.

Complex, interrelated factors contribute to suicide among AI/AN people. Risk factors include mental health disorders, substance abuse, intergenerational trauma, and community-wide issues. Be an active part of your loved ones’ support systems and check in with them often. If a they show any warning signs for suicide, be direct. Tell them it’s OK to talk about suicidal feelings. Practice active listening techniques and let them talk without judgment.

Don’t be afraid to ask whether the person is considering suicide and whether they have a particular plan in mind. These questions will not push the person toward suicide if they weren’t considering it.

Many suicide attempts go unrecognized, but if you are aware of a previous attempt, pay attention to warning signs. If your friend is expressing some thoughts about suicide, it's okay to ask, "have you ever had these thoughts before?" and if so, "have you ever done anything about them?"

Having items close to you that you could use to harm yourself can create a dangerous situation. It’s important to remove items that you may use impulsively. What items do you have nearby that you could use to harm yourself? How can you safely remove them for the time being?

"It is important to be straight forward," Foster said. "We say, 'Are you thinking about hurting yourself? Are you thinking about killing yourself?' ... Most of the time, asking them is going to be a relief for them. They don't have to say it. They didn't have to bring it up. You have opened the door for them to come to you because they know that you are paying attention and they know you care about them enough to ask."

"We know that those at risk for suicide do not necessarily want to die, but do want help in reducing the pain they are experiencing so that they can go on to lead productive, fulfilling lives. There is a lot of ambivalence surrounding the decision to take one’s own life, and by recognizing this, and discussing it, we can help the suicidal person start to recognize alternative options for managing their suffering. Often suicidal people are experiencing intolerable emotional pain, which they believe to be unrelenting. They often feel hopeless and trapped. By helping them to recognize and explore alternatives to dying, you are planting the seeds of hope that things can improve."

What’s the Harm in Asking About Suicidal Ideation?
Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide may in fact reduce rather than increase suicidal ideation.

What to Do When You Think Someone is Suicidal

What to Do When You Think Someone is Suicidal Suicide is the 11th leading cause of death in the U.S., and the third leading cause of death for 15 to 24 year olds. Still, suicide remains a taboo topic, is highly stigmatized and is surrounded by myth and mystery.

One of the biggest — and most destructive — myths is that if you discuss suicide, you’re planting the idea in someone’s head, said Scott Poland, Ed.D, the prevention division director at the American Association of Suicidology and associate professor at Nova Southeastern University. Clinical psychologist and suicide expert William Schmitz, Psy.D., likens it to talking to someone who’s recently been diagnosed with cancer. By mentioning cancer, you’re not forcing the topic front and center. “If someone is diagnosed with cancer, it’s on their mind.” Bringing it up shows support and concern. Similarly, by talking about suicide, you show the person that you truly care about them. In fact, lack of connection is a key reason why people have suicidal thoughts; isolation contributes to and escalates their pain.

In general, it’s important to take any suicide thought or attempt seriously. But what does that mean and then where do you go from there? Because we talk so little about suicide, there’s little awareness about how to help. Dr. Poland emphasizes that people don’t have to suddenly step into a therapist’s shoes and counsel the person. But there are important ways you can help. Drs. Schmitz and Poland discuss the best ways below.

Take suicide seriously, and don’t minimize it.

When talking to a person you think might be suicidal, it’s critical not to dismiss what they’re saying. While this makes sense, we might minimize a person’s pain without even realizing it. Poland even sees this when training professionals on suicide prevention.

For instance, in a training example, if the person says, “My life is so terrible right now,” it’s usually met with reactions like “Oh, it’s not that bad” or “I know you’d never hurt yourself.” Even when the person mentions being overwhelmed, well-trained professionals dismiss the comments. For instance, they say: ‘Things were awful for me last semester, too, and I got through it. Let me help you with your studying.” Although help is being offered, this reaction still minimizes and discounts the person’s feelings and experiences. And both slam the door on communication.

Know the warning signs.

According to both experts, these are some of the warning signs to pay attention to: dramatic changes in behavior or weight; drinking more than usual; mood changes; anxiety; making hopeless statements about death and dying; and isolating or withdrawing, such as dropping out of activities. Ultimately, though, “trust your gut that something is not quite right,” Poland said.

The American Association of Suicidology also features an in-depth list of warnings signs. It’s designed to help professionals detect risk for suicide, but it may give you more information.

Approach the person.

If you notice one or several red flags, don’t hesitate to talk to the person. Again, the worst thing you can do is to ignore what’s happening. Poland suggested starting the conversation by saying something like: “’I’d like to talk to you a minute, I’m really worried, you seem like you’re a little down. Could we talk about that? I’m here to help.”

Also, during the conversation, consider your physical cues. You may be asking the person to share their feelings with you but your demeanor may indicate that you don’t really care, you’re rushing or you’re not open or fearful about hearing them.

Importantly, never agree to secrecy, Poland said. For instance, you can say, “I really care about you, I’m here to help, and I cannot promise to keep this a secret,” he said.

Be direct.

Some resources suggest asking the person if they have thoughts of hurting themselves. According to Schmitz, such questions are “rarely beneficial.” That’s because “When people walk around the topic of suicide [such as the question of hurting oneself], it can send the unintended message that it is not OK to discuss suicide.”

Also, he added that “for a lot of suicidal individuals, they have no desire to hurt themselves, they are striving to cease pain and want relief/death, and will often decide on the ‘least painful’ method of suicide in their ideations.”

Ask the person directly if they’re considering suicide, Schmitz said: “You know, John/Jane, a lot of people with (insert warning sign[s]), can have thoughts of suicide or of killing themselves, are you having any thoughts of suicide?”


“Too often we either don’t listen well or we say something that cuts off the conversation,” Poland said. But listening is one of the best ways you can help, both experts emphasized. Give the person the opportunity to tell you how they’re feeling and what they’re going through.

Be genuine.

As Schmitz said, “We can have so much fear in talking about suicide [and] we’re so scared about saying the wrong thing, that we say nothing.” Speak from the heart. Anything that’s said genuinely and directly, he said, ultimately can’t be damaging.

Schmitz recalled working with a high-risk suicidal patient whose thoughts included killing himself with a gun. During one of their sessions, when talking about treatment, Schmitz unwittingly said to the patient, “we just haven’t found a magic bullet for this yet.” “Doc, ‘I’m not sure that’s the best analogy,” the patient responded, and they were able to laugh at the situation because of the connection they had.

“It’s not about the right four words or two sentences, it’s about the connection,” Schmitz emphasized. There are no magic words. What’s important is conveying empathy, concern and a willingness to help.

Help them eliminate access.

If the person discloses to you how they’re considering committing suicide, eliminate access to those means, Schmitz said. For instance, if they’ve had thoughts of using a gun and there are guns in the house, either get the guns out or get the person away from the home, he said.

Even if the person says in passing that they’re thinking about overdosing, it’s invaluable to see what kinds of medications are in the house and to talk about getting rid of them, he said. He added that you can tell the person, “I really care about you and I don’t want you to do something impulsive that you’ll regret.” This shows them that you genuinely care.

Convey hope.

“The next critical message after connection and empathy is that [suicidal thoughts are] treatable and there is help,” Schmitz said. Numerous studies have shown that treatment can reduce the severity, duration and frequency of suicidal thoughts. Let the person know that they’re not alone, that others have experienced suicidal thoughts and go on to lead fulfilling lives after seeking treatment.

Help them get help.

When talking to the person, the key is to get them treatment right away. As Poland said, “this isn’t something we want to wait on,” even if it’s checking back with them later that day or the next day. Avoid assuming that things will be better the next day.

At their university, Poland encourages faculty members to walk students to the counseling center or call a provider together immediately after their talk. Together, the two of you also can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is free, confidential and available 24/7. (Here’s more information.)

Call 911 in case of an emergency.

In addition to calling 911, stay with the person until emergency services arrive, Poland said. It’s vital not to leave a suicidal person alone. You can show support and compassion by saying things like “‘I’m going to be there for you,’ I’m going to visit you’ or ‘Who can I call for you,’” he added.

Unfortunately, suicide is largely misunderstood in our society. But there are many things you can do to help, including: paying attention to the warning signs, approaching the person, being direct and empathetic, truly listening and helping them find help right away.

How To Encourage Someone To See A Therapist

It’s hard to watch someone you care about struggle with their mental health. It’s even worse when you know they could benefit from professional help. Approaching an individual and encouraging them to seek therapy can be a tricky situation. If done the wrong way, you could aggravate the person or turn them against the idea entirely. However, there is an effective way to have this conversation.

Here are some steps you can take to tell your loved one about the benefits of seeking therapy.

Show Support

Misconception about mental health and therapy has intensified stigma in society. Your loved one may be aware that they need help, but may be afraid to seek it if they think you will judge or treat them differently. Therefore, it is essential to use non-stigmatizing language when talking with them about their mental health. Assure them that you will support them through the therapy process.

Demi Lovato is one of the most vocal celebrities about her mental health issues. She mentioned on multiple occasions how important it was for her to have people around that really care about her wellbeing. She credits her support group for being able to go through everyday life. Demi asks for advice from her loved ones and asks them to let her know when they feel something’s off: "So whether it's with my management team or with my friends, every choice that I make, I run by people. And that's what's really helped me—vocalizing what you need."

Be Sensitive To Timing And Place

Talking to someone about mental health requires emotional sensitivity as well as physical sensitivity. The “where” and “how” the topic is presented may determine how a person reacts to your suggestions. Your loved one may not be as bold as Kesha when she shared her condition and struggles with the world while receiving an award.

Don’t start this delicate conversation in front of other people or where others can hear as this may cause discomfort. And avoid grouping up in an intervention-style conversation as people do on TV shows. Allow the person struggling to decide whether they want others to know. This way, they feel respected and in control of their own treatment.

Also: Avoid talking to someone when they are in a bad mood, tired, have tight deadlines at work or if they’re doing something important. They may dismiss you or disregard the weight of the topic. Approach the person when they’re in a good mood, relaxed and undistracted. Try as much as possible to keep the conversation private, friendly and relaxed.

Prepare For Resistance

Not all people who hear about therapy will be willing to try it out. You need to be prepared to make your case if your loved one resists your suggestion. Here are some ideas that you can use to highlight the importance of therapy:

  • Try to use your relationship as leverage, in a loving way. Whether you’re their sibling, friend, spouse or relative, tell them how important your relationship with them is to you. And how it could benefit from their seeking therapy. However, avoid giving an ultimatum as it can cause emotional distress.
  • Name their admirable qualities. It’s easier to appeal to someone by pointing out what you like about them. When you point out someone’s positive qualities, they will be motivated to take the necessary steps to better themselves even further.
  • Explain specific areas of problematic behavior. Most people who refuse therapy may claim that they don’t have a problem. By pointing out specific problems without coming off as judgmental, you can help them see the need for seeking professional help.

Offer To Help

You can try to embolden someone to go to therapy, but unless you are willing to offer meaningful support, it’s not going to encourage them. Some people do not know where to start when seeking help. Guide them in finding a suitable therapist in the area, depending on their preferences. You can contact offices on their behalf or research various professionals, their credibility and reviews.

Some people are scared of seeing a therapist alone or signing up for group therapy. Offer to go with them until they’re comfortable. You can sit in the waiting room during their first few sessions. Make sure to assure them that you won’t ask prying questions about the counseling unless they want to share.

Seeking therapy is one of the best steps that a person with a mental health condition can take. However, it’s an effort that requires great strength and courage. Share your suggestions as openly as possible and leave them to make the decision that best suits their needs. Above all things, assure them of your continued love and support throughout the process.

Suicide: A Cry For Life

From time to time during my work as a pastor, I have faced the sad task of officiating a funeral or memorial service for a person who died by suicide. Grief is complicated for those experiencing a suicide loss; loved ones face not only sadness, but also anger. Although the anger isn’t always rational, it is certainly understandable.

Many also face the stigma our cultures—and often our churches—assign to a death by suicide. For instance, I think it’s a terrible shame when families insist that the service not even mention the word “suicide.” Once, a mother whose son died by suicide reasoned that she feared his life would forever be reduced to that single act. She feared that all other aspects of his life, like the work he did and the friendships he enjoyed, would be forgotten. “If he had died of cancer, or in a car accident, that wouldn’t be all people talked about,” she argued.

Inspired by this mother’s fear of how her son’s memory might be reduced and skewed, I began to characterize suicide in my funerals and memorial services as not a desire for death, but a cry for life—more life, better life.

So often, our culture concludes that suicide is a rejection of life, a willful refusal to live any longer, but I believe suicide is a statement that life can and should be so much more than pain or despair. If a suicidal person only sees a future with days on end of pain, then that vision looks nothing like the sort of life we all long to enjoy.

I remember in my own times of depression and thoughts of suicide, I often thought, “If this is all there is, if loneliness and meaninglessness and failure are going to be the sum of my experience, then forget it. This is not life. I am breathing, going through the motions, but I am not truly living.” I desperately wanted to live, but I couldn’t find a way to do so. Yet without realizing it, saying that I no longer wanted to live actually became a way to live.

Having the courage to say how I was feeling and what I was experiencing—not pretending, but being honest even when what I was saying was difficult—was how I took my first steps away from a life that seemed no life at all towards a “real life” worth living. It’s a strange paradox: The more willing we are to be vulnerable and less-than-perfect, to ask for support when can no longer support ourselves, the stronger we become and the richer our lives become. Connections with others make the difference.

Opening The Conversation

When we bravely have open and honest conversations about mental illness and suicide, we potentially make life-saving connections—like what happened to me. Without those conversations, we only have loneliness, silence and unanswered questions.

When I speak to those who attend the services of a person who died by suicide, I often discover that it’s not their first experience of grieving such a death. They reference family members, friends, colleagues or neighbors who died by suicide, and how the present death brought back those earlier losses. They talk about how they continue to struggle with their memories and questions.

The shadow of suicide is long. Those who just experienced a suicide loss need comfort, and a religious service might provide it. However, that cannot happen if the manner of death is never mentioned. So, as we approach International Survivors of Suicide Loss Day, we might consider overcoming our reluctance to speak of suicide, to break apart the taboo that encloses it. Until we start talking, healing cannot happen.

And as we speak more openly and honestly, we open the possibility that the cry for life suicide represents might be heard in time.

International Survivors of Suicide Loss Day is Nov. 18

The American Foundation for Suicide Prevention will be hosting gatherings in local communities for those affected by suicide to come together and share stories of healing.

Caregivers: When To Push And When To Show Extra Compassion - Nov. 13, 2017

Marriage is difficult for anyone, but it’s even more challenging when you add in the complications of mental illness. My husband, Andrew, has schizophrenia. We’ve lived together for nearly 15 years and we’ve found success as a married couple, but our journey has been filled with many obstacles.

Beyond my relationship with Andrew, I am also a mental health practitioner. Whether I’m caring for someone with schizophrenia or depression, I often walk the narrow, unforgiving line of when to push and when to administer a large helping of mercy. Though challenging people to improve their quality of life is risky, if we don't, those who are struggling may continue to struggle.

People have asked me so many times when and how to encourage, or push, someone struggling with a mental illness. Here is what has worked for me:

Practice Compassion And Mercy First

An act of mercy starts with an open mind and a sensitive, understanding voice while communicating. I constantly challenge myself to see the bigger picture and put aside my own frustrations, so I don’t come across as judgmental or abrasive. As this type of personality can prevent an empathetic viewpoint. If I am open about my own problems around my husband, he might be more willing to talk about his own struggles.

Assess Symptoms

To push someone successfully, knowing when symptoms are flaring is helpful. Phone calls, text messaging or other forms of digital communication can make it difficult to assess symptoms. Body language and word choice, comparatively, offer a wealth of information. For example, anxiety can cause a person’s body to twitch and tighten.

Show Love During Confrontation

Unfortunately, caregivers often have to challenge struggling individuals during difficult times. Waiting for peaceful moments or willing ears is not always an option. That's where the art of confrontation and mercy merge into one cohesive act of love. However, yelling or speaking from a platform of self-assumed intelligence, pride, anger or bitterness typically results in a negative outcome. People tend to respond well to a loving presentation of information that reinforces equality.

Build Relationships That Foster Equality

Healthy relationships start with the understanding that mental health conditions have labels, but those labels don’t represent the person. Treat your loved one as a person who is equal to you, not as a lesser person because they have mental illness. If their relationship with you isn’t built on mutual respect and admiration, it will be very difficult for them to grow or be challenged by you.

With all this said, keep in mind that no one has absolute control over another human beings’ actions. Caregivers must let go at times to remain healthy themselves . Holding on to bitterness or regret can cause a caregiver emotional turmoil.

Expect to make mistakes as you grow into your role as caretaker. Though I have often felt guilty for making his life harder with my pushing, Andrew often tells me he may have been lost to a permanent state of delusion without our relationship. I know that my presence in his life has challenged him to be the best he knows how to be. Never give up on the person you love, and try to remember the immense challenges that a person with a mental health condition faces each day.

Retrospective accounts of self-stigma experienced by young people with attention-deficit/hyperactivity disorder (ADHD) or depression.

Objective: Little is known about self-stigma experienced by young people with mental health problems, despite the fact that research has demonstrated its existence. In the present study, we sought to investigate the experiences of self-stigma in childhood and adolescence, and particularly the nature of change in self-stigma across this developmental period. Young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) or depression before their 18th birthdays were interviewed about their experiences within their peer groups during childhood and adolescence. Methods: This qualitative study involved open-ended interviews with 16 young adults aged 18–30 years. Interviews focused on the experience of stigmatization, responses to stigma, and how these changed over time. Results: Three main themes pertaining to self-stigma emerged: (a) being different, (b) peer stigmatization and associated experiences of self-stigma, and (c) selective disclosure and a move toward greater openness. The findings also suggested that the passing of time and changes in young people’s social networks and/or degrees of recovery were associated with changes in their experiences of self-stigma. Conclusions and Implications for Practice: During childhood and adolescence, self-stigma is characterized by a sense of being different from peers and negative self-evaluation as a consequence of that difference. However, our findings also demonstrated that some young people were prepared to challenge the stigma they experienced. Further research is needed to understand the factors that contribute to these differing responses and to develop antistigma interventions that facilitate the inclusion of young people with mental health problems in their peer groups. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Prejudice and discrimination from mental health service providers

Topic: This column describes the experience of prejudice and discrimination that some mental health service users encounter in their interactions with service providers and organizations. Purpose: The intent of this column is to highlight potential action steps to address the negative beliefs and attitudes of service providers that contribute to prejudice and discrimination. Sources Used: This description draws from published material and the authors’ experience. Conclusions and Implications for Practice: If the most effective approaches to reduce public prejudice and discrimination toward people diagnosed with a mental illness are education and contact, then those methods may be useful methods to help mental health service providers view and engage persons served from a strengths-based recovery and wellness orientation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Mental Health Awareness and Stigma

Dr. Katherine C. NordalIn recognition of May as Mental Health Month, we spoke with Dr. Katherine Nordal, APA’s executive director for professional practice. This article on mental health awareness and stigma is the first of four weekly features released during Mental Health Month.

Dr. Nordal is a licensed psychologist experienced in treating adults, children and adolescents and has clinical expertise in the treatment of stress-related disorders. As executive director for the APA’s Practice Directorate, Dr. Nordal manages a variety of activities involving legislative advocacy, legal initiatives, efforts to shape the evolving health care market, and a nationwide public education campaign, including the Mind/Body Health Campaign, to enhance the value of psychology. Dr. Nordal is a recipient of the APA’s Karl F. Heiser Presidential Award for advocacy on behalf of Psychology. She was an APA/AAAS Congressional Science Fellow (1990-91) and served as a legislative assistant in the U.S. House of Representatives and with the House Select Committee on Hunger. Her clinical interests included: learning, behavioral and emotional disorders in children and adolescents; neuropsychological assessment; brain injury in children and adults; and civil forensic psychology.

Do you think there is still a stigma associated with mental illness?

Awareness of mental health issues has definitely improved in recent decades. When I entered practice more than 30 years ago, individuals in my semi-rural community would often travel 40-50 miles to get treatment because they did not want anyone to know that they were seeing a therapist. Many people were concerned about what others may think if they were open about their mental health. In many ways, we have taken great strides since then as more people talk about mental health publicly and as we see more positive depictions of mental health in popular culture. Yet, for many, stigma remains. A 2008 APA survey found that more than half of Americans saw stigma--and concerns about what other people might think--as barriers that could prevent them from seeking mental health treatment. And while an estimated 50 million Americans experience a mental health disorder in any year, only one in four will receive treatment.

It is important to remember the impact that stigma can have. Because of stigma, people who need treatment may fail to seek it and they may face discrimination and problems at work or school or even encounter harassment or violence. Furthermore, untreated mental health disorders cost businesses millions of dollars in lost productivity, absenteeism and health care costs.

Why does the public often have a different view of mental illness than physical illness?

Traditionally, the medical model has separated mental and physical health. But this fails to take account of the strong links between the mind and body. Research shows that physical health is directly connected to emotional health, and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder. Poor mental health has implications for physical health – for example, research has shown that people with depression are at greater risk for developing heart disease, and conversely, that people with heart disease are more likely to suffer from depression than others.

Integrated health care – care that treats both the mind and body – is the key to breaking down stigma and providing the best care. Many psychologists already work in primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking the lead when a patient has a primary mental health or substance abuse diagnosis.

What can be done to combat stigma and stereotypes about mental illness?

Congress took a huge step in tackling stigma when the Wellstone-Domenici Mental Health Parity and Addiction Equity Act was passed last year. This new law means that insurance policies can no longer discriminate against those with mental health or substance use disorders. We’ve long known that mental health disorders can be as serious as those impacting physical health. The new parity law recognizes this by mandating that coverage must be the same for mental health as for physical health including co-payments, deductibles and in-patient treatment limits.

Events like Mental Health Month also serve to raise awareness and decrease stigma. Mental health disorders impact everyone – by talking about mental health we can dispel stereotypes and raise awareness.

The relationship between stigma sentiments and self-identity of individuals with schizophrenia

Objective: Stigma sentiments are the attitudes held toward a culturally devalued label or group. The present study measures schizophrenia stigma sentiments and self-identity to assess self-stigma experienced by people with schizophrenia. Method: Ninety individuals with schizophrenia and 23 controls with no history of psychosis rated the evaluation, potency, and activity of “A person with schizophrenia or schizoaffective disorder,” (stigma sentiments) and of “Myself as I really am” (self-identity). t tests, correlations, and regression analysis were used to (a) test relationships among stigma sentiments and self-identity in the groups separately; (b) test a model for predicting self-identity in the schizophrenia group, using stigma sentiments, current symptoms, and current functioning; and (c) compare the participant groups’ stigma sentiments and self-identities. Results: The evaluation category of self-identity and of stigma sentiment were correlated in the schizophrenia group, r(88) = .44, p < .001, but not in the control group. Current symptoms and the evaluation category of stigma sentiments were significant predictors of the evaluation category of self-identity in the schizophrenia group. The evaluation and potency stigma sentiments reported by the 2 groups did not differ; the control group rated itself more favorably on evaluation and potency than did the schizophrenia group. Conclusions and Implications for Practice: Self-evaluation of individuals with schizophrenia was less favorable than self-evaluation of individuals with no psychosis history, and evaluation attitudes held by individuals with schizophrenia regarding the schizophrenia label were associated with their self-identity. Results suggest preliminary utility of this simple measure in identifying self-stigma experienced by individuals with schizophrenia. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

APA Launches New Journal: Stigma and Health

The lives of people living with disease and disability are worsened by stigma, thus leading to public prejudice and loss of self-worth, and causing negative implications for health and well-being. Erasing stigma has become a major health priority due to its egregious effects. Research on the stigma of disease and disability has skyrocketed over the past several decades, and such research is essential to fully understanding stigma and the mechanisms that might remedy it.

To be published on a quarterly basis, Stigma and Health (ISSN 2376-6972) serves as a venue for articles examining research representing stigma in its various guises (e.g., public stigma, self-stigma, label avoidance and structural stigma) as it impacts people living with mental and physical illness.

Stigma and Health publishes peer-reviewed, original research articles that may include tests of hypotheses about the form and impact of stigma, examination of strategies to decrease stigma's effects and survey research capturing stigma in populations. Stigma and Health especially welcomes research studies on methods meant to erase the stigma of mental and physical illnesses. Theoretical reviews and pioneering reports on innovations are also welcome. The journal publishes regular articles as well as brief reports.

As stated in the journal’s inaugural editorial, the true value of the research published in the journal lies in helping to replace stigma with affirming attitudes and behaviors that recognize the worth of personhood not diminished by illness or wellness and that acknowledge communal responsibilities for opportunities and accommodations that help people realize their goals.

More information about the journal as well as guidelines regarding submissions can be found on the journal’s homepage. Prospective contributors and subscribers are encouraged to visit the site.

The inaugural editor of Stigma and Health is Patrick W. Corrigan, PsyD, distinguished professor of psychology at the Illinois Institute of Technology. Previously, he was professor of psychiatry at the University of Chicago, where he directed the Center for Psychiatric Rehabilitation. His research examines psychiatric disability and the impact of stigma on recovery and rehabilitation. Currently, he is principal investigator of the National Consortium on Stigma and Empowerment (NCSE). Funded by the National Institute of Mental Health, NCSE is a collaboration of investigators from more than a dozen research institutions. He is also principal investigator of current grants from the National Institute on Minority Health and Health Disparities and the Patient-Centered Outcomes Research Institute, and he is conducting stigma research with support from the Department of Defense, the Veterans Administration and the Canadian Institutes of Health Research. Corrigan has authored or edited more than a dozen books, has published more than 300 peer-reviewed articles and is editor emeritus of the American Journal of Psychiatric Rehabilitation.

Articles published in Stigma and Health will also be available through PsycARTICLES®, the most used full-text database in psychology and one of the most popular databases in all scholarly disciplines and fields. PsycARTICLES is available to a global audience of nearly 3,700 institutions and 80 million potential users.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes more than 122,500 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

How The 5 Steps Can Help Someone Who is Suicidal

The five action steps for communicating with someone who may be suicidal are supported by evidence in the field of suicide prevention.


How – Asking the question “Are you thinking about suicide?” communicates that you’re open to speaking about suicide in a non-judgmental and supportive way. Asking in this direct, unbiased manner, can open the door for effective dialogue about their emotional pain and can allow everyone involved to see what next steps need to be taken. Other questions you can ask include, “How do you hurt?” and “How can I help?” Do not ever promise to keep their thoughts of suicide a secret.

The flip side of the “Ask” step is to “Listen.” Make sure you take their answers seriously and not to ignore them, especially if they indicate they are experiencing thoughts of suicide. Listening to their reasons for being in such emotional pain, as well as listening for any potential reasons they want to continue to stay alive, are both incredibly important when they are telling you what’s going on. Help them focus on their reasons for living and avoid trying to impose your reasons for them to stay alive.

Why – Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide? may in fact reduce rather than increase? suicidal ideation.

Keep Them Safe

How – First of all, it’s good for everyone to be on the same page. After the “Ask” step, and you’ve determined suicide is indeed being talked about, it’s important to find out a few things to establish immediate safety. Have they already done anything to try to kill themselves before talking with you? Does the person experiencing thoughts of suicide know how they would kill themselves? Do they have a specific, detailed plan? What’s the timing for their plan? What sort of access to do they have to their planned method?

Why – Knowing the answers to each of these questions can tell us a lot about the imminence and severity of danger the person is in. For instance, the more steps and pieces of a plan that are in place, the higher their severity of risk and their capability to enact their plan might be. Or if they have immediate access to a firearm and are very serious about attempting suicide, then extra steps (like calling the authorities or driving them to an emergency department) might be necessary. The Lifeline can always act as a resource during these moments as well if you aren’t entirely sure what to do next.

The Harvard T.H. Chan School of Public Health notes that reducing a suicidal person’s access to highly lethal means (or chosen method for a suicide attempt) is an important part of suicide prevention. A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. Research also shows that “method substitution” or choosing an alternate method when the original method is restricted, frequently does not happen. The myth “If someone really wants to kill themselves, they’ll find a way to do it” often does not hold true if appropriate safety measures are put into place. The Keep Them Safe step is really about showing support for someone during the times when they have thoughts of suicide by putting time and distance between the person and their chosen method, especially methods that have shown higher lethality (like firearms and medications).

Be There

How – This could mean being physically present for someone, speaking with them on the phone when you can, or any other way that shows support for the person at risk. An important aspect of this step is to make sure you follow through with the ways in which you say you’ll be able to support the person – do not commit to anything you are not willing or able to accomplish. If you are unable to be physically present with someone with thoughts of suicide, talk with them to develop some ideas for others who might be able to help as well (again, only others who are willing, able, and appropriate to be there). Listening is again very important during this step – find out what and who they believe will be the most effective sources of help.

Why – Being there for someone with thoughts of suicide is life-saving. Increasing someone’s connectedness to others and limiting their isolation (both in the short and long-term) has shown to be a protective factor against suicide. Thomas Joiner’s Interpersonal-Psychological Theory of Suicide highlights connectedness as one of its main components – specifically, a low sense of belonging. When someone experiences this state, paired with perceived burdonsomeness (arguably tied to “connectedness” through isolating behaviors and lack of a sense of purpose) and acquired capability (a lowered fear of death and habituated experiences of violence), their risk can become severely elevated.

In the Three-Step Theory (or more commonly known as the Ideation-to-Action Framework), David Klonsky and Alexis May also theorize that “connectedness” is a key protective factor, not only against suicide as a whole, but in terms of the escalation of thoughts of suicide to action. Their research has also shown connectedness acts as a buffer against hopelessness and psychological pain.

By “being there,” we have a chance to alleviate or eliminate some of these significant factors.

Help Them Connect

How – Helping someone with thoughts of suicide connect with ongoing supports (like the Lifeline, call 800-273-8255 or text "SOS" to 741741.) can help them establish a safety net for those moments they find themselves in a crisis. Additional components of a safety net might be connecting them with supports and resources in their communities. Explore some of these possible supports with them – are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can effectively help?

One way to start helping them find ways to connect is to work with them to develop a safety plan. This can include ways for them identify if they start to experience significant, severe thoughts of suicide along with what to do in those crisis moments. A safety plan can also include a list of individuals to contact when a crisis occurs. The My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access.

Why – Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline found that individuals that called the National Suicide Prevention Lifeline were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by Applied Suicide Intervention Skills Training-trained counselors. These improvements were linked to ASIST-related counselor interventions, including listening without judgment, exploring reasons for living and creating a network of support.

Follow Up

How – After your initial contact with a person experiencing thoughts of suicide, and after you’ve connected them with the immediate support systems they need, make sure to follow-up with them to see how they’re doing. Leave a message, send a text, or give them a call. The follow-up step is a great time to check in with them to see if there is more you are capable of helping with or if there are things you’ve said you would do and haven’t yet had the chance to get done for the person.

Why – This type of contact can continue to increase their feelings of connectedness and share your ongoing support. There is evidence that even a simple form of reaching out, like sending a caring postcard, can potentially reduce their risk for suicide.

Studies have shown a reduction in the number of deaths by suicide when following up was involved with high risk populations after they were discharge from acute care services. Studies have also shown that brief, low cost intervention and supportive, ongoing contact may be an important part of suicide prevention. Please visit our Follow-Up Matters page for more.

For more information, press/media inquiries, or partnership opportunities, please contact Frances Gonzalez at


It's ok to say, "I'm not ok.'

A conversation could change a life

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