Breaking the Stigma

-by Catie Middleton

Today, stigma is perhaps the greatest barrier to mental health care. Attitudes that see mental health issues as threatening or uncomfortable help to foster the social stigma and discriminating behavior that those with mental health problems experience. Those who suffer from mental health problems also internalize that stigma and discrimination, often resulting in not seeking treatment themselves.

Bev Zabler, an assistant clinical professor at the University of Wisconsin-Milwaukee’s College of Nursing, aims to dispel that stigma.

Zabler, who has been in nursing for 40 years, has worked in almost every healthcare setting that exists, but found her love in public, community and population health, something that she still actively works in today.

“We want to improve health outcomes.”

The Health Resources and Service Administration (HRSA) granted Zabler and her team $999,950 for their Behavioral Health Integration project that began last July.

The Behavioral Health Integration project stems from a model developed by the University of Washington-Seattle AIMS Center called Collaborative Care.

According to the University of Washington-Seattle’s Psychiatry and Behavioral Sciences Department, Collaborative Care “is a specific type of integrated care developed at the University of Washington that treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature.”

The idea is that a behavioral health provider would be present and prepared to help clients when they come for appointments related to primary care. The HRSA grant allows for the Collaborative Care model to be implemented.

Zabler believes that the behavioral health provider being within the same clinic setting as primary care will help to make the much-needed connection for clients.

“When you go to your primary care provider, they specifically deal with the physical problems. They check your height, weight, blood pressure, hearing, vision, all those things. They may complete a physical or address illness concerns. And they might ask a few questions about your mental and emotional health,” said Zabler.

The Collaborative Care model, and the HRSA grant, allows for mental and emotional health to come to a forefront of care, with screenings and immediate referrals available for clients.

Zabler is a part of a national cohort of 16 nurse-managed health centers that are implementing the model.

The Collaborative Care model is being implemented in the UWM Silver Spring Community Nursing Center, where primary care services are provided. In addition, behavioral health education, screenings and referrals are taking place at the UWM House of Peace Community Nursing Center.

The population that they serve at the UWM Community Nursing Centers is primarily low-income, underserved and African-Americans.

“People living in poverty have extra stressors, as well as any people experiencing the impacts of racism. So, there’s again a high risk of behavioral health needs,” said Zabler.

Zabler hopes that by educating people to see and understand the mind-body connection, mental health will become as accepted as primary care is.
“There is a body-mind connection. There are stress components to many diseases,” said Zabler.

The mind-body connection is the understanding that one’s thoughts, feelings, beliefs, and attitudes can positively or negatively affect one’s biological state.
For example, depression is something that can be treated through both the mind and the body.

“The evidence shows that in the case of depression, medication works, but the best treatment is therapy along with the medication.”

By connecting the dots between physical and mental health, Zabler and the Behavioral Health Integration Project hopes to get people the help they need and see results.

The team has hired a full-time behavioral health provider and psychiatrist consultant, whose roles include supportive care for clients, as well as outreach and education for nursing students.

Although in its early stages with the first round of patient outcomes just starting to arrive, the Behavioral Health Integration project knows that the Collaborative Care model does help people.

“The AIMS Center research on the model showed that people are getting relief from depression and other behavioral health problems in a shorter time frame,” said Zabler.

The initial response to the project from the communities they are serving has been positive, and Zabler hopes that trend continues, and that ultimately, the mental health stigma can be broken.

“It is connected,” said Zabler. “We are mind, body, and spirit.”

HRSA Disclaimer:
“This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) Nurse Education, Practice, Quality, and Retention Program Interprofessional Collaborative Practice: Behavioral Health Integration, under grant number UD7HP30930 for $999,950. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.”