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Help is Not a Four Letter Word: Overcoming Stigma & Recommendations for Positive Change

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Help is Not a Four Letter Word: Overcoming Stigma & Recommendations for Positive Change

Mental health issues and substance use disorders can impact any law student, attorney or judge regardless of ethnicity, gender, age, orientation of socioeconomic status. But no matter the background, the legal profession seems to suffer in silence. Why? Stigma – the cultural prejudice and discrimination that labels an individual as defective or weak has the power to create a reluctance to speak about the issues and be a barrier to seeking treatment. This program will define the stigma, explain the reasons why stigma is so pervasive in the legal profession, and why it is critical to overcome these beliefs and identify effective means to ameliorate stigma and identify affirming aHtudes for recovery. Throughout the presentation, the speaker will focus on several different “life stages” of an attorney and how stigma affects each group and identify best practices to conquer stigma in the legal community.

Presenters

Tracy Kepler
Risk Control Consulting Director, Lawyers’ Professional Liability Program
CNA

Transcript

Tracy Kepler: Welcome to the program, Help Is Not a 4-Letter Word, Overcoming Stigma and Recommendations for Positive Change. My name is Tracy Kepler, and for the next hour, I'll be sharing some information on this important subject with you. To provide you with a roadmap for the next hour, I plan to give you an overview of the concept of stigma as it relates to mental health and substance use impairments. And then take a look at how this stigma affects law students, judges, and lawyers throughout their entire career. Together, we will also look at some variations of stigma and how it differs depending on illness or context. Lastly, I want to provide you with some guidance on how we can all go about conquering stigma.

  To begin, I want to pose a couple questions to the group. Raise your virtual hand if you went to see your primary care physician in the past year; or you were admitted to a hospital for any reason over the past year; or how about if you took an aspirin, Lipitor, prednisone, or used an inhaler over the past year; or raise your hand if you felt aches and pains, nauseated, woozy in the past year. Now, if I was to ask you to raise your hand, and no need to raise your hand but just think about it, to the following questions. You went to see a mental health professional over the past year or you were admitted to a treatment facility over the past year. You took Xanax, Ritalin, lithium over the past year. Or how about if you just felt anxious or depressed?

  Why are those same questions different and why might you be reluctant to answer the second set if we were in a giant conference room with other members of the legal profession? I'm going to suggest that it is the topic of our program today, the stigma. So what is stigma? Let's go through a general overview of the topic and the concept. Let's go back and start at the very beginning, sort of the Oxford English dictionary definition. The dictionary defines stigma as a mark of disgrace associated with a particular circumstance, quality or person. But it is really more pervasive and goes much deeper. It sets a person apart, makes them part of, and I'm doing air quotes here, the other.

  When people are labeled by their illness, they are seen by others as part of a stereotyped group. Stigma is all about beliefs and attitudes, often derived from the media, news sources, or those around us. Stigma is based on negative views of people simply because they have or they are seen as belonging to a particular group. Stigma often results in fear of members of the stigmatized group and it's often based on ignorance and lack of understanding. Negative attitudes also create prejudice, which then leads to negative actions and often discrimination.

  Stigma is made up of various components such as labeling, discriminating, prejudice, ignorance, stereotyping, devaluing, and stigma brings with it experiences and feelings of shame, blame, hopelessness, distress, and most importantly for our purposes here today, a reluctance to seek and/or accept necessary help and treatments. You can see the three elements of stigma. It's a problem of knowledge, attitudes and behavior. Let's break this down a little bit.

  The level of knowledge among the public regarding mental health issues truly is poor, and negative beliefs and attitudes are widespread. For example, one of the most common and damaging misperceptions is that people with schizophrenia are violent and a danger to others. This view has been perpetuated by misleading media reports and news reports. Research shows that although schizophrenia is associated with violent behavior, this accounts for less than 10% of violent crime in society. A person with schizophrenia is far more likely to be the victim of violence than to be violent to another person. They are also more likely to be the victim of violence than a person in the general population.

  Further, public surveys show that eating disorders and problematic use of alcohol and other drugs are frequently seen as an individual's own fault; a sort of lack of self-control or willpower, someone who is weak. People with these disorders, and also depression and anxiety, are often viewed as needing to pull themselves together, just buck up. Such views would rarely be associated with cancer or heart disease. In reality, the cause of most mental health problems, like most physical health problems, is complex and multiple risk factors contribute. Some factors can be modified, which is important as it gives some people control over their health. For example, eating a healthy diet to reduce the risk of heart disease or ensuring a sensible work-life balance to reduce the risk of burnout. However, many risk factors for physical and mental health problems are beyond an individual's control.

  Other misperceptions include the view that mental health problems are uncommon, that sufferers seldom recover, and that treatment is ineffective. To the contrary, mental health and wellbeing issues are common. In fact, one in four adults will suffer from a mental health issue in any given year and mental health problems account for about one-third of all primary care physician consultations. Further, the evidence in the research suggests that treatment works and the illness does not impair an attorney's ability to practice and represent clients.

  Speaking of stigma, in a recent study conducted by the Australian Mental Health Commission, nearly one in four people felt depression was a sign of personal weakness and would not employ a person with depression. Around a third said that they wouldn't vote for a politician who suffered from depression. 42% thought people with depression were unpredictable. One in five said if they had depression, they wouldn't tell anybody. And nearly two out of three people surveyed thought people with schizophrenia were unpredictable and a quarter felt that they were dangerous.

  Why is this stigma additionally difficult when it comes to the legal profession? For so many reasons, the first of which is this concept of high self-efficacy. We are generally good problem solvers with a history of success. So why can't we figure out this issue by ourselves? In addition, as being the problem solvers or the counselor or the giver of the sage advice, we are not the ones asking for help, people come to us to solve their problems.

  I think the adversarial system in general is an issue, sort of the fear of being exposed as less than perfect, which leads into the concept of imposter syndrome. Pressure in law school and the additional pressure in the practice to be perfect. Lawyers are trained to look for risk, to be skeptics, to find the proof, to substantiate a claim or to defend an argument. Mastering these skills make for great lawyers, but truly, for honest, for terrible human beings; always looking for the flaw, what's hiding around that next corner, sort of the always winter never Christmas mentality where you cannot enjoy the present moment.

  In addition, law is a zero sum game. There's always a winner and always a loser with an everything it all costs mentality. We have high workloads, we need to be on and responsive 24/7, 365. We need to bill, we need to become partner. It always seems to be a competition. This is an odd point but maybe there's a place for it here, stigma makes friends and colleagues reluctant to intervene. Stigma makes other lawyers reluctant to intervene or call a lawyers' assistance program about a colleague because it feels like ratting the person out rather than I'm here to help or here to get you help.

  Many don't understand or believe that lawyers' assistance programs are confidential and separate from the disciplinary function. Often they are even reluctant to bring up the topic with the lawyer who appears to be struggling. It's too embarrassing, the lawyer might get angry, maybe I'm wrong, and the horror of having suggested that my friend might just be suffering from something else, having a bad day. We tell our colleagues all the time, "Go get that cough looked at," or, "Go see my podiatrist about that knee or that foot, I should say. He treated me for X and it really helped," or to discuss different allergy relief strategies with a fellow sufferer, but nobody wants to discuss or touch on mental health or substance use disorders. That is the stigma. It blocks us from offering help when it is needed.

  Stigma seems to be everywhere. It is pervasive. Stigma is one of the most prevalent and persistent obstacles hindering the transformation of any mental health system and of attitudes in the community. Many attorneys still under-utilize mental health or substance use disorders or legal assistance program services and remain an unserved portion of the legal population, in part because of the stigma against people with these types of issues. There's also a fear of discrimination being the key barrier that keeps many people from revealing symptoms, seeking help, services and treatments. Stigma often leads to low self-esteem, a sense of being misunderstood, hopelessness, shame, and guilt. And lastly, stigma deters people from all sorts of interactions, both personal and professional.

  With stigma, language matters. In a study by the Recovery Research Institute where survey participants were asked how they felt about two people actively using drugs and alcohol. They used two different terms for the two groups to define the individual. In one, they referred to the person as a substance user. In the other, they described the person as having a substance use disorder. The results were astonishing as to the negative perceptions for the substance abuser. The participants felt that the substance abuser was less likely to benefit from treatment, more likely to benefit from punishment, more likely to be socially threatening, more likely to be blamed for their substance related difficulties, and less likely that their problem was the result of an innate dysfunction over which they had no control. And lastly, they were more able to control their substance use without help.

  So what do we do? How do we go about overcoming this issue on a global scale, changing attitudes, hearts and minds so that we make speaking about mental health as easy as speaking about breaking a leg? To improve the health and wellbeing of the legal profession, it is going to be critical to overcome stigma. We really need to make a difference; to take action to reduce discrimination and social exclusion, to educate and to show that discrimination, stigma, social exclusion are unacceptable. We have a moral imperative to do so. We also have to understand that overcoming stigma will bring benefits to individuals who are currently suffering in silence and who would seek treatment but for the perception. And we also need to understand that smashing stigma will bring benefits to us all.

  So let's set the stage as to some studies about stigma and how it's affecting the profession, not only with law students but with lawyers. Two relatively recent studies about perceptions, about usage, about mental health concerns were done for lawyers and law students. The first with regard to law students was called Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help. The second is called The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys.

  Taking law students first and with regard to alcohol usage, it was a study of 15 law schools with 3,300 law students. The data revealed that one quarter of the students were at risk for alcoholism and certainly problematic alcohol use. You can see some of the statistics and the data on binge drinking for law students versus other graduate students. In addition, the students were asked questions about mental health concerns. 17% described that they felt symptoms of depression, 14% severe anxiety, 23% mild or moderate anxiety, and I actually think these figures are probably much higher, and 6% reported having suicidal thoughts in the past year.

  When asked, these same law students, why weren't you seeking help? Why weren't you seeking treatment for some of these concerns? They said, "I can handle this myself. I've got this. I take care of everything else in my life. I don't need anybody to help me with this." They feared that seeking treatment or reaching out or talking about the issue would pose a threat to their job or academic status. They also thought that it might be a threat to character and fitness or bar admission. And we saw social stigma really at the core of one of the reasons why law students weren't seeking treatments. Half of the students reported that they felt they had a better chance of getting admitted to the bar if a mental health or a substance use problem was hidden and not discussed.

  With regard to law students and stigma, eight out of 10 said that they would be very likely or somewhat likely to seek help from a professional for an alcohol or drug problem or a mental health problem, but that the stigma was preventing them from doing so. And 4% actually indicated that they had ever sought treatment from a health professional related to these issues. Over 40% of the law students surveyed thought that they actually needed help in the past for mental health issues. And of those who thought that they needed help, only roughly half actually received counseling from a health professional.

  Almost one in three would be willing to speak to a lawyers' assistance program representative about the issue. And actually, which is a good number, eight out of 10 believed that their conversations with the LAP or the lawyer assistance program would be confidential. However, almost half thought that their admission to the bar would be delayed if they had this conversation. And as I said, almost half thought they had a better chance of being admitted if they hid the problem all together.

  Some reasons why law students don't seek help all centered around this stigma issue, privacy concerns, social stigma, potential threat to job or academic status, potential threat to bar admission. And that is the same whether the issue is around problematic alcohol use or mental health concerns.

  Other questions that were asked were about whether alcohol and drug use seminars, classes, topics were ever asked in law school. Almost 70% said no. When asked a similar question about whether mental health topics were covered in law school, you can see a similar result. Nearly 69% said that no, mental health topics were not covered. In addition, we see some significant trends from the study. The top three factors were more prevalent in 3Ls than 1Ls, which seems to suggest that we're doing something wrong in this process of law school where 1Ls coming into the law school setting are much more willing to talk about, discuss, seek treatment for these issues.

  In addition, of the 6% who manifested multiple issues, almost three in four believed that their chances of bar admission, as I said, are better if it is hidden. And the same goes with respect to the mental health issues. The problem here is that those most in need of help are the most likely ones to hide the problem. When we talk to law and students, we surveyed law students about encouraging others to seek help. Many were likely to do so. However, one in three were likely to do nothing. Particularly, the third year students were more likely to do nothing.

  When we talk about matriculating and we get to later stages in life, you've passed the bar, you're now starting your career, I think stigma affects people differently in this part of your career; whether it be early career attorneys who are facing certain financial, professional or personal stressors, or mid-career attorneys who are facing similar struggles. And when we look at the data from the second survey, it was about 13,000 attorneys from all areas; all around the country, urban, rural, a lot of different demographic factors, diversity factors taken into consideration when doing the survey, firm size.

  It really brought some interesting data about problematic alcohol use and kind of turned everyone upside down where originally it was believed that older attorneys were suffering from these issues in greater numbers. It is the younger attorneys, the ones under 30 years old, who have a higher percentage of problematic drinking. In addition, nearly 50% of those attorneys surveyed reported that their problematic alcohol use started within the first 15 years following law school. When asked about mental health concerns, we can see some similar numbers to the law school study; 28% rates of depression, 19% severe anxiety, and I do think that those numbers are higher. Sadly, we see the percentage of suicidal ideation going up in law firms who are currently in practice from 6% in the law school setting up to 11.5%.

  When asked what the barriers to treatment were in this regard, again, focusing on the stigma, not wanting anybody else to find out that they needed help. No one could know that they might have a problem or an issue. They also cited concerns regarding privacy or confidentiality on the issues. There's been some recent surveys come out since the two surveys that we've been talking about in the law school and the legal profession. Recently, a 2019 survey by ALM Intelligence and Law.com around mental health and substance abuse. It was 3,800 attorneys, a majority of them at law firms of 500 lawyers or more. And we can see those numbers going up even further. 33% reported an increased drug or alcohol use as a result of their work or work environments, nearly 50% admitted to dealing with their stress, coping with their stress by using alcohol, and the suicide numbers are higher here. 17.9% admitted to contemplating suicide during their career, which is two times higher than the general population.

  One recent survey that just came out in May of 2021 is called Stress, Drink, and Leave: An Examination of Gender-Specific Risk Factors for Mental Health Problems and Attrition Among Licensed Attorneys. This survey was about 3,300 attorneys in California and Washington DC. The data showed that roughly half of all lawyers are experiencing symptoms of depression, anxiety, with approximately 30% falling in the mild range and just under 20% in the moderate to severe range. Over half of the lawyers screened positive for risky drinking and 30% actually screened for high risk hazardous drinking.

  Women are experiencing meaningfully worse mental health than men and are actually drinking more hazardously, and one in four women is contemplating leaving the legal profession due specifically to mental health problems, burnout or stress. Sadly, despite 30% of the attorneys screening positive for disordered drinking, only 2% report ever having received an alcohol disorder diagnosis. I think this disparity suggests a problem and a problem may be the stigma associated with these illnesses.

  Additionally, when we talk about stigma and the life stages of attorneys, I think the problem shifts a little bit when we talk about retirement, succession and encore careers. So many of us have our whole identity wrapped up in the fact that we're a lawyer or a judge. That's who we are not just what we do. And it's difficult to get to a place when you retire or start that encore career to let that identity fall to the wayside and let some others come in. Additionally, there's an increased desire for intellectual simulation, problems with reduction of social network because you're not in the work sphere. And I think there are similar albeit a little bit different stressors around financial, professional and personal reasons when you get to this stage.

  With regard to the judiciary, they have an all together different sort of problems when it comes to stigma and talking to others about their issues or the need to seek treatments, sort of almost a true isolation as well as a work isolation. They are the arbiter, they are the deciders, they are the ones issuing the judgements and to admit or to talk to others about a mental health concern or a substance use disorder may lead to certain embarrassment or be perceived as a weakness.

  In addition, there are many variations with stigma depending on the illness itself as well as the context. I think denial is associated with many illnesses and people in diverse or minority groups may already feel pressure to overperform. They have to succeed doubly as a result of where they are. In addition, it's maybe not safe to acknowledge that you actually need help in a particular work environment or culture. Sometimes it's taboo and people don't speak of it at all. And in addition, there are certain other life or situational stressors involved with these areas.

  Conquering stigma. What works? Does language matter and what are some ways to talk about mental health or addiction issues that are less negative or stigmatizing? As I said, I really do believe that language matters. Stigmatizing language is inaccurate, hurtful, and disempowering to vulnerable people and when internalized to ourselves. As a society, it's time that we shift our language to reflect the evidence and our understanding of mental health issues, substance use, and substance use disorders. We really can make a difference by using words that respect the dignity of all people who use substances, focus on the medical nature of mental health issues, substance use disorders, and promote wellbeing.

  We need to stop using stigmatizing slang and all too common expressions that are harmful. Instead, we need to implement person-first language. Well, what do I mean by that? What is person-first language? Person-first language is language that acknowledges someone as a person before describing their personal attributes or health conditions. Person-first language does not identify people by secondary or incidental qualities or conditions. Things like substance use disorder versus substance abuse. When a person has bulimia, we talk about an eating disorder, not a food abuse problem.

  I also think that there's a lingering belief that addiction is a moral failure rather than an illness even though it was defined as an illness way back in 1956 by the American Medical Association. In 1987, it was identified as a disease, just like cancer, heart disease, or diabetes. Calling it something else really colors the discussion even today. Think about how we talk about someone with a substance abuse disorder who has a relapse versus how we talk about someone struggling to follow a strict diet for diabetes or a heart condition. We have more empathy for the diabetic who strays from their program versus someone who has a relapse.

  We also need to consider labeling, sort of descriptions versus value laid in terms. A person with a substance use disorder versus an addict, abuser, or a junkie. Having a brain injury versus being brain damaged. A diagnosis of bipolar disorder versus he, she, they is bipolar. A person is not the disease, the person has the illness. A positive urine screen versus a dirty drop. And using diagnostic terms to describe behavior, like that's so OCD.

  Okay. I hear some of the language choices, what can I do? What actually works in this area? Well, here's some examples. When you hear someone say, "When I see those addicts downtown, I can't imagine why they don't do something about their lives. You think they'd show a little self-respect. It's disgusting how they choose to live." What you might say is, "What someone suggested to me was to imagine a child in front of me who had done their very best. Then ask myself what problems they must have encountered as they grew up and be dealing with today to be suffering so much. Once I started doing that, it struck me that they must be leading a life that they never imagined. I wonder if there's something we can do to help. At the very least, we can offer our respect for their humanity and use first-person language."

  Or another example. "Well, I see Fred's finally back at work. It's been 28 days, so it's a no brainer where he's been. I wouldn't have the nerve to show my face if they had to send me to detox. He must really be desperate for money to have come back. Keep an eye on your stuff." What you could say is, "I was really worried about Fred's health as well. I read up on substance use disorders so I could have a better understanding of what he's going through. Did you know that stigma is one of the largest barriers to getting help? I think that's why the law firm has medical benefits that cover substance use disorders to support them in getting help so we don't lose valuable employees to a health condition. I'm going to make a point of welcoming Fred back to work to help encourage him."

  We've talked about language, what else works? What else can we do? And as you saw in one of the examples that I just posed as to what you can do, compassion, candor, encouragement, and empowerment works. In addition, education and outreach works. We need to know the facts. We need to engage in some self study. We need to do it for ourselves and we need to do it for others. Other things that help and that we're going to go into in more detail are stories of recovery as well as individual volunteers and support groups.

  Speaking of support groups and lawyers assistance programs, back to this study of lawyers that was done in 2016, a question was asked about, are you aware of a lawyer assistance program in your state? And happily, gladly the results were nearly 84% of the attorneys polled or studied were aware. This is good to know. We should see that level at 100%. In addition, questions were asked about, are you aware of support groups for lawyers in your state? Again, nearly 80% were aware. We need to get that level to 100%.

  Another question that was asked is if you needed services, how likely were you to utilize a LAP or a lawyers' assistance program? Unfortunately, many people said neutral, unlikely, or very unlikely. It was only nearly 40% that said they were likely or very likely to use these services. And I think that is a result of the stigma and this misperception that it's not confidential or it's not secure, which is wrong and we need to re-increase that so we have 100% saying we would be very likely to utilize those services.

  Question was also asked about how likely a lawyer was to use a lawyers' assistance program. Again, 60% saying neutral or very unlikely. And then when asked if you're not going to use it, what are the concerns? And they're similar to what we saw earlier with regard to privacy and confidentiality. Maybe they won't understand my needs. But one of them, and particularly important for this topic, the stigma about asking for help.

  Let's talk a little bit about what's happening in the law schools. Oh, before we do that, I want to go back and talk a little bit about individual volunteers. When a well respected lawyer or judge who has a good recovery from a mental health concern or a substance use disorder sits down with a lawyer who is struggling and afraid to go to counseling or attend a support group, truly you can see the relief on the attorney or the law student's face; sort of the relief that I am not alone, relief that this highly competent person has been down this road and is still well respected and doing well today. The relief that I can tell someone and hope.

  Sharing stories of recovery is also incredibly important. The American Bar Association on its website has a story called The Besden Redemption. It is a video of a highly respected lawyer who struggled greatly with addiction as a law student and as a young lawyer and tells of her downward spiral and her recovery and the reinstatement of her law license.

  In addition, I think a focus on wellbeing, on wellness or resilience or happiness draws more people to lawyer assistance programs than sort of focusing on suicide, substance use disorders and the grim statistics. There's not really any stigma, it's sort of in the framing, right? There's no stigma attached to wanting to be a resilient or a hearty or a gritty lawyer. No one has trouble admitting that the practice of law is stressful. And again, I think back to the labeling and reframing, it may be helpful to focus the conversation and the education and the outreach on those issues.

  So what's happening in law schools? Well, a lot is changing. A lot is changing with regard to the active engagement with the legal community and partners to address the systemic stigma issues. Faculty, staff, and students are all being trained on wellbeing issues. Many campuses, law school campuses, have full-time counselors, social workers, and wellness resources and events. And even in addition, some schools are creating curriculum around wellbeing topics, whether it be mindfulness in the law, professional identity; talking, discussing, and educating on these issues.

  Further, I think that the boards of law examiners are contributing to the amelioration of stigma in their own way. And I go back to the question about, can we do something with the questions that are asked on the bar application that create concerns for law students? The mental health questions that are being asked are both over inclusive and under inclusive. What do I mean by that? Well, I think many applicants are being flagged for further inquiry based on their responses to those questions even though they pose no reasonable risk to clients because their condition is in remission, they're in treatment or otherwise under control, while many others who perhaps do pose a risk for reasons other than mental health are allowed to pass through.

  In addition, bar examiners are being asked to assess applicants' mental health even without any training in mental health professions. Across the country, law students, lawyers, law professors, and others are really questioning both the unintended consequences of mental health questions on character and fitness exams and also whether those questions are even useful in fulfilling their stated purpose of protecting the public. There really is a movement underway to revise or eliminate these questions. In many cases, towards a question that asks if the applicant has engaged in any conduct that may present a risk rather than whether they have been diagnosed with and/or treated for a mental health condition. States are eliminating questions directly related to mental health in favor of questions about conduct.

  Support groups for lawyers. Found to be incredibly helpful in reducing stigma. Working with a lawyers' assistance program or a bar association to create a group if one doesn't already exist to talk about issues. Creating committees to organize and plan and educate and have outreach. Putting on various continuing legal education programs on these topics and subjects. Having those groups meet at a regular time and date so there's some consistency, so that there's regularity. And also most importantly, stressing the confidential nature of the meetings.

  I think the first time a lawyer attends a group session or a group support meeting and looks around the room and recognizes many faces in the room, sort of the faces of good actively practicing attorneys who he/she or they respect, the relief is visible on the newcomers face because now, they used to think that they were the only one. They were the only attorney to feel like this, or that I can't do it by myself. Now they have a group support to help them through this to discuss it.

  In addition, education on these issues. Research shows that the most effective way to reduce the stigma is through direct contact with someone who has personally experienced a relevant disorder. Some of this really does fall on us. The advantage of educating all lawyers about mental health, including substance use disorders, is that more will recognize when someone else is suffering. A law partner or an associate, judge or a client will hopefully be more willing to intervene. As we have seen, research has identified multiple factors that can hinder seeking help for mental health conditions: failure to recognize symptoms, not knowing how to identify or access appropriate treatment or believing it a hassle to do so, a culture's negative attitude about such conditions, fear of adverse reaction by others whose opinions are important, feeling ashamed, viewing help seeking as a sign of weakness, having a strong preference for self-reliance and/or having a tendency toward perfectionism, fear of career repercussions, confidentiality concerns as we've discussed, and frankly, lack of time.

  The research also suggests that professionals with hectic, stressful jobs like many lawyers and law students are more likely to perceive obstacles for accessing treatment which can exacerbate depression. The result of these barriers is that rather than seeking help early, many wait until their symptoms are so severe that they interfere with daily functioning. And I think similar dynamics likely apply for aging lawyers seeking assistance.

  We can remove these barriers. We can do it through education, skill building and stigma reduction strategies. Viewing videotaped narratives is also useful in addition to a direct in-person contact, but not as effective. The military has a great program. It's called The Real Warrior Mental Health Campaign. I think it can serve as a model for the legal profession. It's designed to improve soldiers' education about mental health disorders, reduce stigma and encourage help seeking. Because many soldiers, like many lawyers, perceive seeking help as a weakness, the campaign has also sought to reframe help seeking as a sign of strength that is incredibly important to resilience. It also highlights cultural values that align with seeking psychological help.

  As I mentioned, the ABA has done a lot to combat stigma. In fact, they have produced an anti-stigma video that is designed to raise awareness about the nature of addiction and mental health distress in our profession, and to challenge the biases and stigma that surround these problems. It was created by the American Bar Association's Commission on Lawyer Assistance Programs, and it created a profession wide anti-stigma campaign that features a series of videos highlighting the personal recovery stories of lawyers, judges, and law students who have overcome these issues. These videos really do send a message that recovery from addiction and mental health problems is entirely possible for legal professionals. The goal of the videos is to ensure that fewer of our colleagues face these challenges alone.

  The first video is called Fear Not: Speaking Out to End Stigma, and it features a diverse group of lawyers, a judge, and two law students who openly talk about the challenges with behavioral health issues, including depression, anxiety, alcoholism, and drug addiction, and their recovery, and the vital importance of overcoming stigma to get more people to seek treatment who need it.

  When we talk about resources, there are so many available to lawyers, law students and judges. The first, as I mentioned, is the American Bar Association's Commission on Lawyer Assistance Program. They have an incredible amount of resources, links, videos, contacts related to mental health, related to substance use disorders and seeking treatment. In addition, another incredibly valuable tool is the Institute for Well-Being in Law. This is a recently formed nonprofit corporation that grew out of the National Task Force on Lawyer Well-Being. If you're not familiar with the National Task Force on Lawyer Well-Being, it was a group of stakeholders in the profession from all areas, the judiciary, bar association, regulators, lawyer malpractice carriers, law schools, all coming together to talk about the issues and to make recommendations, 44 of them in fact, on how we can improve the wellbeing in the profession, and eliminating stigma being one of the core recommendations.

 

Robert Kelleher:     Alcoholism.

 

Lynn Garson:    Depression.

 

Lacy Durham:    Suicide.

 

Parker Cragg:   Drug addition.

 

Alessandra Frit...:  Anxiety and depression.

 

Lynn Garson:    What kind of person do you imagine when you hear these terms? Do you picture me?

 

Parker Cragg:   Or me?

 

Donovan Frank:  Or me?

 

Eduardo Juarez:      Chances are you pictured someone who isn't a professional.

 

Lanee Borsman:  Someone who isn't successful and certainly not a lawyer.

 

Thomas Smith:   But we now know, thanks to national studies, that lawyers experience these challenges to their physical, mental, and professional wellbeing at rates significantly higher than the general public.

 

Lacy Durham:    We also know that lawyers rarely seek help for conditions such as depression, alcohol and substance use disorders.

 

Donovan Frank:  It was often a status symbol if you could drink a lot, party hard, get very intoxicated, and yes, still do well.

 

Lynn Garson:    I come from a no talk family where everything was swept under the rug. It took me a long time to move past the family fairytale and decide that I deserved help and would do whatever it took to get it.

 

Parker Cragg:   I didn't get help because I truly believed I was an outlier. I knew I couldn't control my addiction, but I was so successful at school and in work that I thought I was invincible.

 

Lanee Borsman:  Fear kept me from getting help; fear that you would look at me differently, fear that you would judge me, fear that you would think I was a weakling.

 

Dennis Walsh:   Pride in everything that I had accomplished and fear that I was going to lose it all, those were the things that kept me from seeking help for my alcoholism.

 

Alessandra Frit...:  I didn't ask for help because I thought I was smart enough that I could figure out my own never-ending sadness and nervousness by myself.

 

Eduardo Juarez:      The shame and guilt I felt about my alcoholism is what kept me from seeking help.

 

Robert Kelleher:     I was afraid; afraid of admitting I had a problem, afraid of being labeled an alcoholic and the stigma that I thought would be associated with that.

 

Bob Carlson:    Don't let fear keep you from getting the help you need. Today, real courage is about reaching out and asking for help when you're struggling.

 

Thomas Smith:   Know that your fellow members of the bar want you to seek help when it's needed.

 

Dennis Walsh:   Recovery is possible.

 

Lacy Durham:    We want to send a clear message to the whole profession, you don't have to face these issues alone.

 

Donovan Frank:  Help is available for you through your state's assistance program for lawyers, judges, and students, or employee assistance program.

 

Eduardo Juarez:      Once I got help, I was able to become the person and the lawyer I knew I could be.

 

Lynn Garson:    My life story became one of hope and resilience.

 

Dennis Walsh:   Of gratitude, fulfillment, fellowship, and service.

 

Parker Cragg:   And today, with over eight years of sobriety, I'm present in my relationships and grateful every day.

 

Thomas Smith:   Because I received help, I was able to put things in perspective and visualize a meaningful life ahead of me.

 

Alessandra Frit...:  I'm empowered and I'm flourishing.

 

Robert Kelleher:     I have peace, serenity, pride, and happiness.

 

Lanee Borsman:  My life now is freedom, freedom from fear and mistrust.

 

Donovan Frank:  My life is fulfilling, serene and successful.

 

Judy Perry Mart...:  Seeking help is a sign of strength, not weakness. Please don't wait.

 

Tracy Kepler:   On an individual basis, we've talked about support groups, we've talked about bar associations, we've talked about coming together as groups, but what can we do on an individual basis? What can we do to cope with this stigma and to help others? I think an old adage is very appropriate here. It is one person cannot do everything, but everyone can do something. There's something that everyone can do to smash the stigma and to raise awareness and to show that compassion, care, empathy that I discussed earlier.

  So to cope with stigma, if you are the person who is encountering or feels like they need to seek treatment, or is looking to seek treatment but afraid to do so for any of those barriers that we've talked about during the program, the first thing to do is to surround yourself with supportive people. Find people who can provide that care and empathy, who are educated on these subject matters and who can talk openly but confidentially with you about the matter.

  Second, I think it's important to remember that you are not your illness. Treatment works and you are not alone. One of the great benefits of the support groups and of the videos that I've been talking about is to show that there are other people out there who have these illnesses who have sought treatment, who are in recovery and they are still well established, well respected members of their community.

  In addition, some other ideas about ways to cope while we work to smash the stigma, being hopeful, not letting the illness, the disease drag you down, knowing that there are people and resources out there to help you navigate the process, remaining active, as well as remembering that you or your loved ones have choices. And lastly, to make sure that people know your expectations.

  In addition, and sort of my last comment on the stigma issue, as we've covered, we know what the stigma is, we know of what it consists. We've seen some of the data and some of the statements by lawyers about why they don't seek treatments. This pervasive stigma, the fear of being exposed, the fear of it not being confidential. And we've looked at some ways to overcome through education, through outreach, through individual one-on-one contact, through support groups, through working with lawyers assistance programs. And I think it's incredibly important to remember when navigating this and working to improve stigma, that help is not a four letter word. Seeking treatments, reaching out, talking about the issue is the way that we are going to overcome.

  So as an overview of what we've covered in the past hour, we've talked about stigma. We've defined the term, looked at its components, elements, and other factors. We've looked at the pervasiveness of stigma in the legal profession, and we've looked at some reasons why it is critical to overcome stigma to get to a sense of wellbeing where we can talk about these issues and come forward without fear of redress. We also talked about stigma and the life stages of an attorney. We went through and set the stage looking at some empirical data. We looked at the law school data. We looked at certain data for the legal profession throughout the career.

  We also looked at various stages of careers: middle, retirement and encore career, the judiciary, as well as variations on the concept of stigma depending on the illness and the context. And lastly, we talked about the importance of conquering stigma. That language and semantics does make a difference, it matters. We talked about the importance of education and outreach, discussing issues around substance use disorders and mental health concerns so that people are aware and it's not seen as a taboo subject.

  We talked about some of the things that are happening in law schools to combat the stigma in that setting, and we also covered some resources, things that really help to deflate or overcome the stigma, whether it be contacting a peer, having a one-on-one conversation, support groups, reaching out to a LAP, or doing your own research on one of the websites. We hope that this overview has been helpful and will really guide you to smashing the stigma and recognizing that reaching out for help or help is not a four letter word. Thank you and be well.

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On demand
1h 51s

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