Summer 2021
Chatting with a Stigma Change Agent: Cynthia Petion
by Jennifer Brown
What was the landscape around behavioral health stigma and discrimination in Maryland when you first started in the field?
I started working in the mental health arena in 1984 at a psychiatric rehabilitation program as part of the first wave of deinstitutionalization, of moving folks from hospitals into community programs. I worked with a diverse population, one of which was Black males on conditional release – and almost all of them had a diagnosis of schizophrenia. It made me question how accurately they were being assessed. What prejudgments might be part of this?
In 1994, when I came to work for the state, I saw an opportunity to shape policy and to address stigma and discrimination and ended up addressing it even in myself! I wanted to look at strategies to help people have better access to services and to make sure assessments were accurate. I had worked in the mental health side of things, but at that point, I didn’t fully understand substance use. I thought that “addicts were addicts.” But I learned – I grew to understand more about substance use disorders, and that folks are often using the substances to mask or to cope with mental health issues.
Did anything surprise you when you first started looking at stigma and discrimination in the behavioral health field?
I was really surprised by the interdisciplinary stigma among providers – nurses stigmatizing therapists, psychiatrists stigmatizing psychologists, etc. I recall a time we were at Crownsville Hospital to do a training and we wanted of course to make the environment safe and conducive to dialogue but as the staff came into the training, all the nurses sat together, all the social workers sat together – every discipline was separated. That was surprising but also an interesting example of stigma applying clearly to providers as well. We addressed it with the CEO, who hadn’t really noticed it before. He was really committed to creating change and bringing down barriers at his hospital, and we spent quite a lot of time doing training there, which helped to shape his thoughts about shifting the culture.
I remember speaking with him many months later, and he indicated that they had seen a significant reduction in the use of seclusion and restraint in the months that followed our series of trainings, and he felt there was a definite correlation. Very interesting to see how addressing the root belief system can have so many ramifications.
There’s stigma between substance use and mental health as well. One of the things that happened when we merged our administrations to become the Behavioral Health Administration was that we had to deal with the cultural differences and issues between our substance use and mental health counterparts. It was clear that people working on the substance use side didn’t understand mental health and vice versa. So we had to address the stigma within our own organization. You simply can’t be effective working in silos.
What do you think has changed in terms of that interdisciplinary stigma?
I think we’re getting better but there’s still more to do. It’s important for folks to understand that a system of care is about working together – physicians, social workers, direct care staff – everyone plays a part. Actually, when it comes to working with clients, the direct care staff actually do most of the work! I remember I had a client who wanted to work at a real estate office but the treatment staff disagreed – they thought that we were feeding into his delusions. But those of us who worked with him every day, not just for 15 minutes every month, knew what his strengths were, what his goals were, what his coping skills were. Every team member has something important to contribute – it’s really important to address that. I had to keep advocating for him – and in a sense for direct care workers as well – to get them to see him more clearly. Ultimately he did go back to work in that real estate office, and worked there for several years.
You’ve been such a strong advocate on so many levels – for individuals, programs, policies.
I remember one of the state legislators didn’t want to approve a housing program for folks with substance use disorders in one of Maryland’s jurisdictions, so I, along with one of our department representatives, went to meet with him. It was clear to me that he didn’t understand addiction or mental health issues. He certainly didn’t get that addiction is a health issue – he saw it as a choice. And I said, “You know what? I thought that at one time too, but then learned what I didn’t know.” I spoke with him about the importance of people receiving the support and treatment services that they need and deserve, of being treated fairly, of realizing that they have human rights. I gave him information about our local behavioral health authority , on the public mental health system, and information about the Anti-Stigma Project and On Our Own of Maryland. He said he gained a much better idea of the bigger picture, and had never really thought of things that way. Ultimately the approval went through.
I find there is such value when you can say, “Hey, I’ve been there – I’ve done this, I’ve thought this.” People don’t feel attacked or shamed and can actually hear your message. It’s also a great example of the impact even one conversation can have – think of how many people’s lives improved due to your conversation with one person.
One of the things I’ve always loved about the Anti-Stigma Project campaign is the emphasis on dialogue. Dialogue is one of the key elements in reducing stigma – combining education and contact. The project has been very well-received, and I have absolutely seen change in the system because of it. There’s been so much work through the years, much of it with providers, bringing awareness and providing training and technical assistance. Also with young people – when we do trainings at colleges, they often come back and say that they appreciated the dialogue and the opportunity to look at things differently and how they can make changes, not just with their family members and themselves, but also addressing stigma and discrimination on campus. Addressing stigma has even contributed to changes in terms of addressing funding for peer support initiatives on the state and federal level, and making that more of a priority. At the time that the ASP first started, peers weren’t typically at the decision-making tables like they are now. We were committed to making sure that people with lived experiences were involved in a significant way, actively involved in the dialogue.
I know you’ve had to advocate for your own family as well. I recall a situation with your aunt?
Yes, ten years ago, my aunt was taken to the hospital; she was suicidal. Her husband had died and she just felt like she couldn’t go on. They took her to a local acute care hospital, to the same ER she had been in three weeks earlier with congestive heart failure. But this time, they put her in a separate ER just for mental health patients. She was put in a waiting room, then told to get undressed (by security guards, not hospital personnel). They treated her like a criminal. When she was here with a heart problem, they did blood work within 15 minutes and kept coming to see how she was doing. This time, she got there at 11:00 in the morning, and by 3:00 no one had even seen her. I demanded to see a psychiatrist. They saw my badge and asked if I knew Brian Hepburn, who was the head of MHA at the time, and I said yes and that I was going to let him know what was going on. “Well, we’ll make this better, I’m sorry you’ve had to wait so long.” After twelve hours in the ER, the social worker finally came to check on her. I later wrote a letter outlining the difference between how mental and physical medical issues were being treated and shared my experience at an mental health advisory council meeting. The discussion further addressed the concern that patients in crisis were “crowding the ERs.” Well, yes, if you don’t get the help you need, you’re going to end up needing acute services. Which speaks to another issue in the system – there aren’t enough crisis programs and community resources to prevent this from happening. If there had been a local crisis unit to help my aunt, she wouldn’t have sat in that hospital all day and all evening.
The Anti-Stigma Project expanded its reach beyond the behavioral health system itself a long time ago, reaching out to related arenas such as faith communities and education. What should be on our radar screen in this moment?
Hospitals for sure, legislators, and of course the police are a huge priority, especially in light of their interactions with Black males. We need to examine the attitudes and perceptions that lead to behavior. Of course that is tied in with creating a better approach to crisis services, as I said earlier. Some police departments are getting Crisis Intervention Team (CIT) training but not exercising what they learn. And of course not all CIT training is the same.
I don’t know of any other CIT curriculum where anti-stigma has its own module, besides the pilot we are doing right now for Baltimore City Police. Any final thoughts or words of wisdom about stigma and behavioral health?
We still have work to do; it never ends. We need to address the whole person, to have supportive measures in place. We need to continue to make addressing stigma a priority. To support projects like the Anti-Stigma Project – it’s wonderful what the project has done, including at so many colleges and universities, like Coppin State, where I did a lot of workshops. It’s so important to keep reaching younger people. We need to make sure people with mental health issues aren’t stigmatizing people with substance use challenges and vice versa. It’s important to keep supporting the peer movement, to have peers doing workshops, etc. And it’s really important to make legislative and policy changes that support all of that. We can’t stay silent; we need dialogue. Change starts at the top, which is evident from the implementation of behavioral health integration in Maryland, with the leadership from the Department of Health. That process has helped us to address the whole individual and bring all stakeholders to the table – people with lived experience, parents, educators, etc.
Change can happen at the top as well … I remember sitting at a behavioral health conference, listening to a high level official use stigmatizing language in speaking about people with mental health issues. And the ASP was working on language issues at the time, and so I sent an email to my boss, who then forwarded it to this official. Their reply was gratifying to see, saying that “this is the kind of awareness that we need.” That’s change.
Folks need to understand how effective the kind of dialogues the ASP facilitates can be. How effective awareness, even about something as seemingly small as a comment at a conference, can be. It’s tough work to change attitudes and perceptions, as we both know, but awareness, education, and contact really creates change.