lecture 1-Mental Health Stigma

Question 1

define stigma

Answer 1

individual who is disqualified from full social acceptance
Stigma … based on ignorance, prejudice and fear of a particular group (Rethink Mental Illness)
Three components:
Ignorance
Prejudice
Discrimination

Stigma focuses on prejudice and ill-educated statements
Depressed people are lazy
People with mental health problems are violent
Depressed people are self-indulgent
You have got everything – job, family, wealth – what have you got to be depressed about
Pull yourself together
Suicide is selfish cowardice

Question 2

what is discrimination?

Answer 2

Discrimination is an ACT preventing people with mental health problems equal access
Not inviting someone for a job interview is disclosing a mental health problem
Sacking someone for having mental health problem
Employers not making reasonable adjustments at work
Expecting someone with mental illness to be fit for work – even though they ‘look OK’
Harassment and intimidation

Question 3

negative impact of stigma stats

Answer 3

Time to Change Stigma Shout survey (2008):
87% of respondents reporting negative impact of stigma
46% …accessing employment was particularly worrying
Because of stigma and feared discrimination

Question 4

Impact of mental health

Answer 4

Prevents range of activities: 
Applying for jobs
Making new friends
Going out to pubs and shops
Prevents access to services 
People often withhold information about current/past mental illness
Fear of being treated unfavourably

Cross-sectional survey - 27 countries - 732 participants with schizophrenia (Thornicroft, et al. 2009)
Negative discrimination experienced by:
344 (47%) in making/keeping friends
315 (43%) from family members
209 (29%) in finding a job
215 (29%) in keeping a job
196 (27%) in intimate or sexual relationships
Anticipated discrimination affected:
469 (64%) in applying for work, training, or education
402 (55%) looking for a close relationship
526 (72%) felt the need to conceal their diagnosis

Question 5

socially damaging effects of mental illness

Answer 5

Socially damaging (Sartorius & Shulze, 2005; Thornicroft, 2006)
Contributes to ‘social and economic’ burden (Sharac et al. 2010)
Lost productivity
Lower rates of employment/income
Contribute to negative outcomes
Perpetuating self-stigmatisation
Internalisation of public beliefs/attitudes (Evans-Lacko et al. 2011)
Self-stigma outcomes
Lower self-efficacy (Link et al. 2001; Corrigan et al. 2006)
Worse functioning (Alonso et al. 2009)
Less treatment seeking (Conner et al. 2010)
Higher rates of hospitalisations (Rusch et al. 2009)

Question 6

what are the effects of the ‘themes’ on the MI patients?

Answer 6

Shunned:
Participants spoke of being ‘rejected’ (because of MI diagnosis)
By friends
Ignored by neighbours
Being isolated at school/college/university
Being ignored by family
Most instances were interpersonal
Rather than ‘public’ life

Mocked:
Participants spoke of being teased…
Being humiliated
Being called names (verbal abuse)
By friends, neighbours, school/college, family, work and public transport
More like to occur in ‘public’ life (than shunned theme)

Abuse:
Very strong form of discrimination
Participants reported being abused, physically and sexually
By family, friends, and in intimate relationships
In some cases by the police and mental health staff

Lack of understanding:
Participants talk of poor understanding from personal sources
Friends, dating and family
And public
Neighbours, education, and (physical) health care
Types of lack of understanding
That they are unable to ‘help’ behaving the way they do
That they might be violent
That they are weak or lazy
In some cases own GP did not understand

Question 7

impact on those with MI empirical evidence

Answer 7

Comparing high vs. low ‘stigma’ countries (Evans-Lacko et al. 2012)
Public stigma in 14 European countries – compared to…
…reports from 1835 ‘service users’ in those countries
Self-stigma, perceived discrimination, and empowerment
Those from countries with less stigma (and better information)
Higher rates of help-seeking
Lower rates of self-stigma/perceived discrimination
Countries where ‘general public’ feel ‘more comfortable’ talking to people with mental illness
Service users showed less self-stigma and felt more empowered

Who do you tell?
Employer?
Recent survey: 1 in 5 people said would not tell boss
Fear of being sacked
World Maddest Job Interview (Channel 4, July 2012)
All 3 ‘employers’ - would not employ someone with MI
“Got to be on their game”
“Must be able to rely on my staff”
“Must be fit for purpose”
School friends/university mates?
Often very hard to talk