When 261,000 people fear someone “finding out”

A new study of the use of mental health care services among adults in California has been published (with full pdf text). Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California (Tran & Ponce, 2017), examines the records of mental health consumers over four years. Findings are startling, but sadly not surprising. For example, in 2013, it was estimated that 2.2 million people in California needed mental health services. However, 77% of that 2.2 million did not receive mental health services. Nearly 8 of 10. Those at the intersection of economic security, age, learning, and language were the most impacted, including men, Latinos, older adults, and those with less education and non-English speakers (Tran & Ponce, 2017).

More specifically, stigma played a huge role in determining lack of care.

When asked why they did not see a health professional in the past year, a majority (64%; 354,000) of adults with mental health need who felt they needed help endorsed cost of treatment as a reason; 47% (261,000) indicated that they “did not feel comfortable talking with a health professional” or were concerned if “someone found out [they] had a problem;” and one of five (20%; 109,000) adults said they had difficulty getting an appointment.

When 261,000 people are afraid of someone finding out they need help for a problem, we have a problem. Imagine 261,000 people with diabetes not getting insulin because they were afraid that  someone would find out they had a problem. Imagine 261,000 people with chest pain not getting help because they were afraid someone would find out.

What would happen? A large number of them would die. We figured this out during the early days of AIDS/HIV. As the number increased, as we all began to know someone who had in one way or another been effected, we dropped fear and increased knowledge. We put research dollars to the problem. We learned what it was and was not. We embraced those infected, we supported communities devastated by the disease. We corrected each other, demanded our institutions not discriminate. We beat stigma. We saved lives.

Why not mental illness? Is the stigma of mental illness somehow different? From the research I have done over the past decade I feel comfortable saying a resounding , NO. It is the same stigma that separated lepers in Biblical times.

Stigma is not a choice, it is a rule of the road that those with mental illness know intimately. It is not merely “feeling” afraid that someone would use the information inappropriately or harmfully. It is direct knowledge that in fact they would be harmed. Stigma is not an abstract hashtag or fundraiser. Stigma is not an issue of diversity, inclusion, or fluidity on an abstract spectrum of identity. Stigma stops people who need help from getting help.

When 261,000 people who need help and can’t get it, one wonders how bad the alternative must be? Loss of family, shelter, job, relationships, food security, freedom, custody of children. As a mother, I would risk diabetes, heart attack or shark attack to avoid anything that would jeopardize my life with my children. I will follow the rules of the road; and in Los Angeles…we have freaking freeways.

Tran, L. D., & Ponce, N. A. (2017). Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California.

The Mother of all Stigma

Show me this line. Science says it exists. The law says it exists. Psychology agrees, and Lord knows all religions nod their collective heads in agreement. The consensus is a certainty of a line between good and bad mothers.

There is no such line. But there is the illusion of a line. Scary, shadowy, perhaps lurking in all of us? A marker, a definable difference between madness and badness that most silently, if not unconsciously, use to measure motherhood.

In her 2009 book, The Blind Assassin, Margaret Atwood described,

What fabrications they are, mothers. Scarecrows, wax dolls for us to stick pins into, crude diagrams. We deny them an existence of their own, we make them up to suit ourselves — our own hungers, our own wishes, our own deficiencies.

We create mothers. All of us, together, right now, create motherhood. We collage illusory concepts of good ones, bad ones, our own, ourselves. We co-create constructs of mothers that suit our own needs. And that’s okay, we do that with just about everything.

I wish we knew, the minute we peed on the stick, measuring our motherhood in such an elegant manner as urinating on plastic, that we would too easily become that which we fear–judgmental. Motherhood is the dividing line, dear ones…divas, daughters. Once we are mothers, we believe we access permission to set ourselves apart morally-to stick pins in the models of motherhood we are told are bad. And bad mothers? Are usually the sad ones, and the mad ones.

Before we have time to flush we start the long journey into patriarchy’s favorite weapon: motherhood. And that tool, motherhood itself, as old and readily accessible as breathing, drives the engine of stigma. It just does. Normal mothers, or Normals as I call them, also love to hate different mothers. The group think, GroupOn, pile on of pointing the finger of fault at the perception of deficiency is social play for Normals. Maybe Normals envy the seeming surrender of difference. Mothers who live lives of creativity, spontaneity, sadness, depravity, greatness, passion, shadow and light, have a freedom to be that Normals wish they owned.

Don’t get me wrong, I have been an expert marksman in the use of judgment against other women.  The tool of judging mothers is MAN’S tool. I am done with this weapon. Any mother is my sister.


Atwood, M. (2009). The blind assassin. Hachette UK.

What Mother’s Risk When They Disclose a Mental Illness, by Liz Coalts

3 weeks postpartum

I told the woman giving me a pedicure that I just wanted someone else to take care of my baby.  She looked at me really confused, said ‘oh’ and went back to painting my toes.  I made her uncomfortable.  I said something wrong.  Well, let’s not say something like that ever again.

6 weeks postpartum

I brought my baby in to visit my coworkers.  “OMG what a beautiful baby!!!  Don’t you just LOVE being a mom?”  Telling anyone the truth makes them uncomfortable and they don’t know how to act around me.  I’ve gotten good at this lie after 6 weeks:  big big smile, ‘yes!! It’s great’.

10 weeks postpartum

I’m alone at night changing the baby.  She’s crying and squirming.  I scream at her and hit the side of the changing table.  The rage scares me.  I’m not an angry person. A mom shouldn’t have this type of aggression. I never told anyone that until just now, over 7 years later.

6 months postpartum

I’m commiserating about the not-so-glamorous parts of motherhood with a coworker who has recently returned from maternity leave.  I tell her how I sometimes have scary thoughts about hurting my baby.  She looks worried and says how that’s not ok.

16 months postpartum and 2 months pregnant

I wish every day that I lose the baby.  I hope I see blood every time I go to the bathroom.  Then I hate myself even more for not being overjoyed at the fact that I’m pregnant.  I am a smart, educated, professional woman and I am unexpectedly pregnant.  It’s wonderful how close in age the kids will be.  It will be hard for a little while, but then we will get all the bottles, diapers and daycare will be over with.  Lies I tell other people.  I can’t risk anyone finding out how irresponsible I am.  I can’t risk them finding out the monster I really am.

18 months postpartum and 4 months pregnant

I’m giving my daughter a bath.  My husband is upstairs.  She’s sitting and splashing. I can’t stop thinking about holding her head under the water.  I take her out of the tub and put her to bed.  I stand in the hallway sobbing, mustering up the courage to tell my husband what almost happened.  He will hate me.  He will leave me.  This time things were too scary.  I find the courage and tell him.  I cry some more.  He hugs me.  He doesn’t let me go.

22 months postpartum and 8 months pregnant

After a few months of therapy and a referral to a psychiatric nurse practitioner, I am diagnosed with postpartum depression and generalized anxiety disorder.  I start taking Prozac. I tell myself that the medication is just a temporary thing.  I’ll stay on it for the rest of my pregnancy and the first 6 months postpartum.  Then I’ll be fine and won’t need this anymore.

23 months postpartum and 9 months pregnant

I have my baby 5 weeks early.  I’m in love.  Everything is wonderful.

3 months postpartum

I’m hiding my intrusive thoughts.  I don’t tell my PNP about the thoughts this time because I don’t want her to increase my medications again.  I find myself being envious of an athlete who killed himself.  My therapist has me call my husband and he takes me to the emergency room.  I’m admitted to the psychiatric ward and I stay there for 5 days.

6 months postpartum

I tell my supervisor I can’t handle managing my project anymore.  It is high profile and high risk but I’ve overseen it for years so me handing it off to someone else will be complicated.  The managers in my chain of command are notified of my postpartum depression so that the proper decision is made.  I ultimately decide to keep the project and my managers let me.

85 months postpartum

I still take Prozac every day.  My doctor and I have tried to wean me from it but it causes me to slip into a depression.  So, I just keep it at a steady 40 milligrams.  My kids are healthy.  My husband and I are happy (right honey??)  I continue to be successful in my career.  I have spoken publicly about my struggles with mental illness.  I know I’ve touched the lives of people I will never meet.

Remaining silent about my mental illness, I thought I was risking:  my reputation, my career, how people perceived me, my ability to be a mom, my ability to be a wife…but I was risking my health and the health of my children.  There is so much about the first few years of my children’s lives that I don’t really remember.  I was either hiding, obsessing, sleeping or just numb.

Disclosing my mental illness wasn’t easy.  I didn’t just suddenly start posting on my Facebook wall about my struggles.  It took time.  I wish I had spoken up sooner.  There was no need for me to struggle like I did.


Liz writes @ www.theanxiousadult.com. You can find Elizabeth @ecoalts on Twitter;  and Facebook https://www.facebook.com/LizCoalts

Happy Mother’s Day, Liz. xoxo, STIGMAMA


I was put on this earth,
to put you on this earth.

I was put here to pry open the ribs of ancient love and let out the light of Beauty aching for acknowledgement, too long bent to its own brilliance by those fearing its Truth.

I was put here
to pull myself apart to do that.
To break wide open and let you out.

Nothing more in this life is necessary; nothing more important; nothing more vital; nothing next, nothing to come–it is this. This is the heart of it. This is the art of it. Living and loving my children more than myself.

My God!

My Lord!

This mother-love shows no mercy on the ego.

Mother-love sleighs all of the dragons…the delusions of what “I” could be, should be, would be.

And I do not make a natural martyr. My marriage to entitlement was a fantasy of grand things, big language, big letters, big books. I ignored what I knew–I believed what I wanted was real. I laid everything down and stood there. Down to the bones. I stood there. Stood there. I stayed there. Stayed here.

Now? I simply put down my self to lift yours up.

Simply put?
I was put on this earth to put you on this earth.