Psychiatric Billboards

September 18, 2015
H. Steven Moffic, MD

Maybe psychiatry should take a lesson from a fashion designer -- and promote our messages to the public via billboards.

"OVER 40M AMERICANS SUFFER FROM MENTAL ILLNESS.
SOME CAN ACCESS CARE . . . ALL CAN ACCESS GUNS."

If you haven't seen it, this quote is not taken from a speech, article, or e-mail. It wasn't from a psychiatrist, a politician, or a gun lobbyist.

No, it's from a fashion designer, the well-known Kenneth Cole. The words appear on a huge billboard that towers over Manhattan's busy West Side Highway, seen by tens of thousands daily. It is not Mr. Coles' first billboard on a social issue for which he had concern, but it is his first on mental illness.

The billboard has triggered outrage among organized psychiatry, both in the American Psychiatric Association (APA) and in the New York State Psychiatric Association. The official response on the APA's Psychiatric News Alert posted on September 3rd included this statement:

"Mr. Cole's statements on gun reform create a misleading impression that people who suffer from mental illness are violent", APA President Renee Binder, MD, wrote in her blog. "This is a disappointing misrepresentation of the facts and only serves to further stigmatize those suffering from mental illness."

APA members were urged to participate in the social media campaign against the billboard.

But I-for one-won't join this campaign. . . at least for now. Why not?

First, I would attempt to make an ally or partner out of Mr. Cole. Harsh public criticism will not likely have this effect. He has promoted other worthy social causes, and though he hasn't responded much to the criticism of this billboard, he apparently is concerned about the mentally ill. He tweeted:

"This ad not meant to further stigmatize those suffering from mental illness community in need & already under-served."

Second, while it is most admirable that the APA is concerned about stigma regarding mental illness, I don't see where Cole's facts are wrong. Can the phrases be misleading or inflammatory to some? Yes, but I don't know why the APA assumes that the billboard message would increase stigma overall. Did it conduct polls or focus groups with the public before releasing its statement? If not, who knows?... maybe highlighting the sheer number of people who suffer from mental illness might elicit more compassion than stigma.

Moreover, recent mass murders have indeed been carried out by people with obvious mental illness: in Roanoke, Virginia; in Charleston, South Carolina; and in Colorado. However, mentally ill people who commit crimes are almost always untreated or under-treated. A subset of the untreated or under-treated seems to pose a higher risk for violent acts. This risk seems irrespective of the unproven theory that taking SSRI medications may contribute to violence in some.

I would have preferred that the APA suggest alternative wording if it felt Coles’ billboard was misleading, or that it post an alternative billboard nearby that conveyed a message such as this:

Over 40 Million Americans Suffer From Mental Illness.

Getting Treatment Helps Prevent Violent Use Of Guns.

Actually, the billboard idea might be one for the APA to adopt more generally to proactively get our messages out to the public. Here are some that come to mind:

PSYCHIATRY SAVES LIVES!

FASHION DESIGNERS ARE FOR YOUR BODY;
PSYCHIATRISTS ARE FOR YOUR MIND.

MANY PROFESSIONS DO PSYCHOTHERAPY;
OTHER PROFESSIONS PRESCRIBE MEDICATION;
PSYCHIATRISTS DO IT ALL.

Perhaps billboards can be an "old school" adjunct to social media. If you agree, what slogans might you suggest psychiatry use?