Label Avoidance: A Dangerous Form of Stigma
By Kim LaMontagne, MBA
Label avoidance is when a person chooses not to seek care for a stigmatized mental health or physical condition–including substance misuse disorder–in order to avoid being assigned a stigmatizing label.
1 in 5 people live (and work) with a mental health condition. How many millions of Americans are suffering in silence, out of fear that a stigmatizing label could result in judgment, job loss, retribution and potentially block access to insurance, medical treatment and other necessary services?
This is my personal story of stigma and labels, based on my brave and responsible decision to mitigate any risk of dependance of prescription drugs.
Flagging My Chart: No Opioids
In 2010, I was just over a year into my sobriety from alcohol. A doctor prescribed Vicodin for pain management, after my tonsils were removed. I took the medication as directed, and immediately knew it was a problem for me.
I have an addictive personality. Whether it’s alcohol or opioids, I recognize I’m not able to have just one.
For a split-second, I thought about keeping it a secret. I enjoyed the feeling opioids gave me. I knew if I stayed quiet, I could get more prescriptions. But if I did that, I would become addicted.
I went back to my doctor and did the right thing. It took incredible strength and commitment to get myself there, but once I did, I knew I had a new partner in my sobriety. I asked my doctor to flag my chart with “No Opioids” and moved on knowing that together, we did the responsible thing that was best for my health.
I didn’t tell anyone about the ‘no opioids’ or my sobriety, because as a high performer, I felt weak and ahamed and believed that I would be judged. It was a decade before I really thought much more about it.
10 Years Later: Understanding the Fear and Frustration of Label Avoidance
On April 1, 2020, I left my corporate job and stepped into my purpose of speaking and training on mental health in the workplace.
For the first time in my life, I needed to secure my own health insurance to replace my previously-provided corporate plan. I found a great plan, applied, and expected my approval notice in the mail shortly.
A few months later, I, indeed, got a letter.
It was a denial “due to confidential reasons.”
I wrote a letter to the insurance company, asking for further details, and received this response:
“The confidential information for your medical record is history of alcohol abuse, history of drug abuse, and history of suicidal thoughts.”
That was a blow.
The health insurance company unfairly applied three highly stigmatizing labels to me without any attempt to open a dialogue about any of them.
Firstly, I was labeled an alcohol abuser, without any consideration to my 12 years (and counting) of sobriety;
Secondly, I was labeled a drug abuser, without any opportunity to provide insight into the “No Opioids” flag on my medical charts;
Thirdly, I was labeled as having suicidal thoughts, without considering that I have extremely well-managed mental health.
Does the same type of denial happen to those who have well managed diabetes, heart disease or high blood pressure?
It’s no wonder people choose label avoidance, and not to disclose their mental health and substance misuse disorders to anyone, including the workplace and medical professionals who can assist them in treatment.
However, the consequences of not disclosing and getting help are potentially catastrophic. Especially in the workplace.
If employees don’t feel safe enough to disclose, you, as their leader, are unable to provide an accommodation. Lack of accommodation can lead to further decline of mental health, accidents, errors, absenteeism, presenteeism, and turnover.
It’s critical to reduce stigma and have open conversations about mental health.
Stigma is the largest barrier that prevents employees from seeking help.
Stigma causes fear, anxiety, shunning, judgment, and exclusion. Stigma is detrimental to the person carrying it and causes shame and silence.
I still carry a stigmatized label, despite 14 years of sobriety. Ultimately, I found health insurance through another carrier and have risen above the stigma. I’ve decided to use this experience to inform others and create positive change.
We are people first and not the condition we live with.
Four Key Steps to Reduce Stigma in the Workplace
- Education – Stigma thrives on lack of knowledge and education. Educating leaders and employees about mental health and substance use prepares leaders to recognize the signs, open a safe conversation, and create more open communication, understanding, empathy, and support.
- Language – Shift to person centered language. Focus on the person first and not the condition they live with. Words such as crazy, psycho, junkie, alcoholic, nut job etc. are covered in shame and stigma. These words create a barrier for those who want to feel safe and ask for help. Shifting to ‘person living with a mental health condition’ or with substance misuse focuses on the person first.
- Peer Support – According to the National Alliance on Mental illness, “the most effective antidote to stigma in the workplace is direct contact between peers.” Peer support can inspire someone to take the first step, dispel myths, illustrate we are not alone, and remind us that we are a person first, and not the condition we live with.
- Creating a safe workplace – When people feel safe, seen, heard, and understood, conversations happen naturally. A safe workplace is created when the CEO commits to addressing mental health, leaders are trained and prepared, stigma is reduced, person centered language is adopted, and a peer support network is in place.
We spend a large majority of our lives at work. As a leader, you are in a unique position to see the signs, start a safe conversation, and crosswalk an employee to services. Leaders are not meant to be counselors, but it’s up to us to shift the culture, decrease stigma, and normalize the conversation about mental health.
The most powerful organizations create a safe culture where leaders are prepared, stigma is reduced, and employees are empowered to speak openly about mental health.
Are your leaders prepared?
Kim LaMontagne, MBA is a Corporate Mental Health Trainer, International Speaker, Author, and President of Kim LaMontagne, LLC. She is also the Wellbeing Director for HR Florida State Council, State Trainer & Speaker for National Alliance on Mental Illness, and is a Certified Facilitator of Addiction Awareness Training through ICARE. Kim prepares leaders to navigate the conversation about mental health in the workplace and create a safe culture where everyone feels safe asking for help.