When Sen. John Fetterman announced in mid-February that he had entered Walter Reed National Military Medical Center in Washington, D.C., to be treated for clinical depression, it was seen by many as a sign of progress in fighting mental health stigma, particularly in men.
Even as discussions of mental health increasingly enter the public conversation, aided both by public figures, such as Olympian Michael Phelps talking about his depression, and difficulties brought by the pandemic, men in particular still struggle to be open -- and seek treatment.
In addition to Phelps, Fetterman joins a relatively small group of male public figures discussing depression.
"Talk about a stigma buster," said Christine Michaels, CEO of the National Alliance on Mental Illness Keystone PA, in reference to Fetterman's announcement. "I don't think he has any idea how much good he did. There are anti-stigma campaigns that get funded that couldn't do what he did," she said.
Evidence shows that talking openly about mental health concerns and educating people about mental illness can reduce stigma. And a 2018 survey of 14- to 22-year-olds, conducted by the Hopelab and Well Being Trust, found that a majority of those experiencing mental health issues scoured online resources, like social media and podcasts, for personal anecdotes about similar struggles.
"People can relate to him and identify with him. A lot of times, that's all it takes for someone who's depressed to get help," said Michaels.
One person dies every 11 minutes by suicide, according to the Centers for Disease Control and Prevention. And suicide does not affect Americans equally: Men struggle more, as well as LGBTQ people compared to heterosexual individuals, and Native Americans compared to other races and ethnicities. And for every suicide, there are 275 people who consider it.
A CDC data brief in September reported that the number of people seeking mental health treatment since 2019 has increased, but that population was mostly women.
"Although it's a terrible situation, I love that he is sharing his journey about it," said Josie Badger, a consultant and disability rights advocate who recently started a commission to support legislation and change attitudes around men's mental health.
Fetterman's communications director, Joe Calvello, said in a statement last week that the senator was doing well as he continued treatment.
"We don't have a lot to update folks with since there's no real news to report except that John is doing well, working with the wonderful doctors, and remains on a path to recovery," Calvello said, noting that "this will be a weeks-long process."
And many see Fetterman -- a presence at 6 feet, 8 inches tall -- as a "manly man," Badger said. "He's a powerful individual with a beautiful wife and family, and he's being open in pursuing the help he needs."
Badger runs J Badger Consulting, which lobbies for legislation to help those with disabilities and provide training on the legislative system. She said she was called to support men's mental health after her life was turned upside down a couple of years ago.
In 2021, her parents sat her down. "I knew by the look on their faces that something was really wrong," she said. They told her that her cousin's husband had died by suicide. Both her cousin and her cousin's husband were finishing medical residencies and had a 3-month-old baby.
"It was an out-of-body experience," she said. "They had what looked like a perfect life ... even though I wasn't there and didn't see it, I felt it."
Badger pulled together experts from Highmark/Allegheny Health Network, UPMC and NAMI Keystone and created the MENtal Health Strategy Commission. Its mission, she said, aligns with funding allocated by then-Gov. Tom Wolf, $100 million earmarked for various mental health services around Western Pennsylvania. The funding was divvied up by the Behavioral Health Commission, which naturally disbanded after writing a report about how the money should be spent.
Badger wants to further the work of the Behavioral Health Commission to ensure that the funding is utilized, as well as to keep fighting stigma against men seeking mental health care.
"I want to make sure we see systemic change around men's mental health," she said.
She hopes to collaborate with microbreweries, gyms and schools to meet men where they are. Imagine QR codes and phone numbers subtly taped to the back of a beer bottle that men could scan, referring them to mental health services in their area.
She also wants to train staff -- like coaches, fitness trainers and bartenders -- in these places to recognize a crisis when they hear one.
"I want to make sure people are armed with mental health first-aid to direct them to services," she said.
"Mental health and suicide rates are higher in Western Pennsylvania, specifically rural areas," she went on. "We need to figure out why. There's a combination of things happening that are putting our men at risk in this part of the state."
Badger has seen a shift in stigma but says there's still more work to be done.
"We're getting there," she said. "The $100 million is an indicator of that, but it's still not available." The funding has been trapped in legislative limbo.
Michaels, who has worked with NAMI since 1998, agreed the nation has progressed in terms of mental health attitudes, but she said the workplace is one area where stigma persists.
"There's the idea that if you let anyone know you have a mental health problem or need medication, you might not get a promotion," she said. "Stigma is still real, still alive."
But the pandemic did a lot to break it down, said Michaels. In everyday conversations, people have opened up about their mental health, with young people in particular helping to normalize these struggles.
Increased use of person-first language in the zeitgeist has helped, too. A shift from calling someone "a schizophrenic" to "a person with schizophrenia" aids in dismantling the idea that people are attached to their illness, she said, something for which NAMI Keystone PA has long advocated. "People being informed is the best way to extinguish stigma," said Michaels.
"The more we share our struggles," Badger said, "the more likely someone feels like they can, too."