APA Responds Rapidly to Stigmatizing Billboard

The Great Billboard Controversy may be over but is certainly not forgotten.

Late in August, designer Kenneth Cole posted a billboard facing the Westside Highway in New York City that said “Over 40M Americans suffer from MENTAL ILLNESS. Some can access care. ... All can access guns.” The sign was visible to hundreds of thousands of commuters every day.

The billboard may have been intended to support gun control, but it also reinforced a stigmatizing canard linking perpetration of violent crime to people with mental illness.

Word of the sign filtered up to APA from local mental health advocates like Harvey Rosenthal of the New York Association of the Psychiatric Rehabilitation Services and psychiatrists like Hunter McQuistion, M.D., director of behavioral health at the NYC Health and Hospitals Corporation. Raj Loungani, M.D., M.P.H., a Downstate Medical Center PGY-4, then alerted APA President Renée Binder, M.D., about the sign.

“Kenneth Cole’s ads are usually enlightened,” said McQuistion, past president of the American Association of Community Psychiatrists, in an interview. “This one was not and was clearly misguided and/or poorly worded.”

“The fashion designer’s attempt at making a statement on gun reform creates a misleading impression that people who suffer from mental illness are violent,” responded Binder in a blog post.

“The vast majority of mentally ill people are not violent,” continued Binder. “Most violent acts are committed by people who are not mentally ill. The numbers simply do not bear out what Mr. Cole is implying on his billboard.”

In fact, more than one in four persons with serious mental illness is the victim of a violent crime, a rate more than 11 times higher than that of the general population, according to a 2005 report in Archives of General Psychiatry by Linda Teplin, Ph.D., of Northwestern University’s Feinberg School of Medicine, and colleagues.

APA went beyond simple rebuttal in countering Cole’s billboard, launching a social media campaign (#givestigmatheboot) to draw attention to the problem of stigma and to get out the facts on the myth linking mental illness and violence. Scores of psychiatrists and APA Twitter followers added their own voices to the campaign. For example, former APA President Paul Appelbaum, M.D., tweeted, “Disappointing to see @mr_kennethcole link gun violence, mental illness in this stigmatizing way.” APA member Michael Peterson, M.D., wrote, “Better access for mental health care, but gun violence not due to mental illness.” Kenneth Cole weighed in as well: “Intention was to highlight inadequate access to Mental Health Care & over access to guns—for all.”

APA did not stop there, mobilizing 23 psychiatric, mental health, and advocacy organizations—like the New York State Psychiatric Association, Mental Health America, the National Association of Social Workers, and the American Psychological Association—to send an open letter to Cole on September 11 urging him to take down the billboard.

“You are absolutely correct that many Americans with mental health issues don’t get the help they need,” they wrote. “Only 38 percent of adults with mental illness receive treatment. … Stigma about mental health is one of the biggest barriers preventing people from seeking care, and your billboard unfortunately adds to that stigma.”

A spokesperson for Cole’s company responded by saying that the billboard message would be replaced only “as normally scheduled,” which appeared to be September 17, when it was removed.

APA has invited Cole to join in efforts to eliminate stigma and improve access to treatment.

“This campaign was never a fight between the APA and Kenneth Cole, but rather a fight against stigma,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We are looking to further engage Mr. Cole, who clearly has an interest in mental health.” ■