Demi Lovato huddled in the back of her tour bus, eyes wet with tears as she watched a horde of fans streaming into the venue where she was about to play.
"I was young and successful and I was looking up at the venue where I was about to play, where I would be able to live out my dreams, something I dreamed of for years, and yet I was crying in the bus," Lovato, now 22, recalled. "I was feeling empty and for some reason I was feeling hopeless, even though I had hope right in front of me."
She didn't know it at the time, but Lovato was deep in the throes of a depressive episode, a symptom of her as-yet-undiagnosed bipolar disorder.
Lovato eventually got help. Now, the former "X Factor" judge and top 10 recording artist is lending her star power to a campaign aimed at encouraging others who struggle with mental illness to speak out and seek help.
Mental illness affects one in five Americans, and the "Be Vocal" initiative is urging anyone who feels out of sorts to speak up to family, friends and health care professionals. That's especially important for anyone not already receiving treatment, experts say.
Read: Facts about mental illness
"About 44 million adults are affected, and yet so many of them are not able to access treatment or they have not begun the process of seeking it out," said Allen Doederlein, president of the Depression and Bipolar Support Alliance, one of the five national mental health advocacy groups collaborating on the new initiative. "Understanding that these are serious, real conditions, but also conditions that people can and do achieve wellness within, is really what this is all about. We want to make sure people speak up and get help, and lead thriving lives because they've done so."
A matter of policy and treatment
The campaign also is asking patients and advocates to take political action, working with elected officials and community leaders to help remove the stigma associated with mental illness.
"We need to speak up about raising our expectations for what it is to experience a mental health condition in the United States," Doederlein said. "Complete and total wellness should not just be a matter of luck for some. It's a matter of policy and treatment for everybody."
Lovato debuted as a child actress in "Barney & Friends", and made her mark as a teenage singer in the lead role in the Disney Channel musical "Camp Rock". She has since released four albums and headlined several national tours.
Despite her success, Lovato struggled throughout her teens with drug and alcohol abuse, eventually landing in rehab in 2010. While in rehab, doctors diagnosed her with bipolar disorder, she said during a 2011 interview on ABC's "20/20".
Read: Alcohol abuse and dependence
The diagnosis made sense to Lovato. She knew that at times she could take on huge amounts of work and achieve at a manic pace, only to feel everything crash down around her during a depressive slough.
"Finally I can look back and say, there wasn't anything wrong with me, as a person," she said. "It was something that was happening inside my head, and now I've been able to live my life well."
By being open about bipolar disorder, Lovato has been able to build a happy and healthy life. She said her treatment team fully understands her symptoms and can respond effectively, and family and friends are there to give her the support she needs.
Now Lovato is urging others to do the same, particularly if they suspect something is amiss but can't quite put their finger on it.
Read: Creativity tied to mental illness
"People are afraid to vocalise how they're feeling – one, because they're going to be shamed by society; or then two, because they feel like they don't necessarily know this is even happening, they just feel different," Lovato said. "When I was younger, I didn't know that anything was wrong or anything was happening. I just felt something off.
"It's not something that anybody should be ashamed of in the first place. It's a disease like any other disease," she continued. "And it's hard to ask for help, but when you ask for help it's actually showing strength, rather than weakness."
Doederlein applauds Lovato's efforts, saying she is providing a strong example for others by showing that having a mental illness does not have to hold you back.
"We don't associate her with illness. We don't associate her with stigma," he said. "We associate her with being amazing and awesome. The path, as daunting and scary as it can be, is really about achieving whatever your version of that success would be."
Bipolar, or just moody?
The stigma of mental illness
Stigma keeps employees from revealing mental illness
Image: Demi Lovato from Shutterstock