Mental Health and the Stigma

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem and Uchechukwu Chukwuemeka  


What is Stigma?

According to Crocker and colleagues[1] ''Stigmatized individuals possess (or are believed to possess) some attribute, or characteristic, that conveys a social identity that is devalued in a particular social context.’’ Simply, stigma is a way of negative judgement associated with certain characteristics/conditions, develops on a social level and not specific to a person[2].

When the society adopt a certain image with subtle characteristics, often negative, upon a specific group of individuals it is called stereotype.

Stigmatization is a complex phenomenon that has political and social influences.

Prevalence of Mental Illness Related Stigma

According to the World health organization, people suffering from mental health illness are often exposed to violations of human rights, stigma and discrimination[3].

Several studies showed public beliefs towards mental illness to be correlated to drug abuse, prostitution and criminality. Other surveys reported public response to mental illness to be less pity, with a high percentage believing this group doesn't deserve help. This may have an impact on the right of people with mental illness to enjoy safe housing, healthcare and job opportunities[4].

The stigma and negative beliefs are not exclusive to the public. Healthcare professionals show some undesirable attitudes towards mental-illness population[5].

In healthcare sectors, stigma and discrimination could be observed on different levels[6]. On a large scale, mental-illness may receive less investment, lower quality of standards and biased culture. Moving to healthcare individuals, interaction with patients may be influenced by pre-based stereotype thoughts, discriminatory behaviours and negative attitudes. Patients report feelings of devalued, dismissed, and dehumanized by many health professionals[7].

Healthcare professionals may unconsciously show negative attitudes towards people with mental-illness. Excluding them from decision-making,not taking their symptoms seriously[8], not giving sufficient information about their condition, either physical or mental, and showing paternalistic or demeaning behaviour[7].

A study that investigated Turkish physiotherapy students beliefs towards people mental-illness using Beliefs towards Mental Illness Scale found moderate positive attitudes. Students who have a relative with mental illness or those who needed psychiatrist/psychotherapist help at some point showed better scores[3].

The Impact of Stigma on People with Mental Illness

People with mental illness face both the challenge of the disease along with the stereotype and other's judgmental thoughts. The public stigma is not the only type of stigma these people are dealing with, there is also the self-stigmatization[4]. Self-stigmatization is an obstacle in the way of personal development and can challenge obtaining good position in personal and professional life.

Higher levels of cortisol and depression were found between stigmatized people. Those who stigmatize have feelings of disgust[9].

Stigma in healthcare has another dimension. Because mental-illness is associated with beliefs of less productivity, healthcare professionals may not seek help when needed and fear judgments from their peers with increased risk of suicide[10].

From another point of view, some authors reported a positive impact of stigma on people with mental illness. While it could be threatening for some people, others may be energized and motivated further into therapy [4].
[11]

Tackling the Issue

One of the major drivers of stigma is the media. People with mental illness are often featured in films and drama as homicidal. This triggers fear and sends messages to the public that this group should be avoided and expelled of communities.

Education plays a significant role in challenging stigma. Campaigns that protest against biased judgement and stereotyping of mental-ill population in the media are another solution to change these negative thoughts and misconceptions.

Education is particularly important for healthcare professionals. Since many of the stigma-related attitudes are being unintentional or produced unconsciously, receiving anti-stigma training could be helpful to prevent similar attitudes[12]. Adding mental-health specific courses, particularly to healthcare schools was suggested by Yildirim et al[3] to tackle stigma among healthcare professionals.

''What to do'' and ''what to say'' programs have been introduced to many healthcare systems, delivered by trained instructors who recovered mental illness themselves. First, to target unconscious myths and biased judgments and second to show healthcare professional the role they play in facilitating recovery from mental illness[13].

Communities should encourage engaging people with mental-illness with the public. It is a way of understanding them and challenging the stereotype[4].

[14]

Resources

The Working Mind: aiming to reduce stigma and encourage healthcare professionals on early seeking of professional help.


References

  1. Crocker J, Major B, Steele C. Social stigma: the psychology of marked relationships. The handbook of social psychology. 1998;2:504-53.
  2. Setchell J. What Has Stigma Got to Do with Physiotherapy? Physiother Can 2017; 69(1): 1–3. doi:  [10.3138/ptc.69.1.GEE]
  3. 3.0 3.1 3.2 Yildirim M, Demirbuken I, Balci B, Yurdalan U. Beliefs towards mental illness in Turkish physiotherapy students. Physiotherapy theory and practice 2015; 31(7):461-5.
  4. 4.0 4.1 4.2 4.3 Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World psychiatry 2002;1(1):16.
  5. Baker JA, Richards DA, Campbell M. Nursing attitudes towards acute mental health care: development of a measurement tool. Journal of advanced nursing 2005;49(5):522-9.
  6. Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest 2014;15(2):37-70.
  7. 7.0 7.1 Hamilton S, Pinfold V, Cotney J, Couperthwaite L, Matthews J, Barret K, Warren S, Corker E, Rose D, Thornicroft G, Henderson C. Qualitative analysis of mental health service users’ reported experiences of discrimination. Acta Psychiatrica Scandinavica 2016;134:14-22.
  8. Thornicroft G, Rose D, Kassam A. Discrimination in health care against people with mental illness. International review of psychiatry 2007;19(2):113-22.
  9. O’Brien KS, Daníelsdóttir S, Ólafsson RP, Hansdóttir I, Fridjónsdóttir TG, Jónsdóttir H. The relationship between physical appearance concerns, disgust, and anti-fat prejudice Body Image. 2013;10(4):619-23.
  10. Papish A, Kassam A, Modgill G, Vaz G, Zanussi L, Patten S. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial. BMC Medical Education 2013;13(1):141.
  11. Imagine There Was No Stigma to Mental Illness | Dr. Jeffrey Lieberman | TEDxCharlottesville. Available from: https://www.youtube.com/watch?v=WrbTbB9tTtA
  12. Knaak S, Patten S. A grounded theory model for reducing stigma in health professionals in Canada. Acta Psychiatrica Scandinavica 2016;134:53-62.
  13. Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. SAGE:Healthcare management forum 2017;30 (2):111-116).
  14. Reducing the Stigma of Mental Health. Available from: https://www.youtube.com/watch?v=7a1Q-nPWKKs