STIGMA IN MENTALILLNESSIt is dangerous to be different
Dr.AdenikeJesusanmiMB:BS,MRCPsych, MSc (University of Manchester)
What is stigma?
Stigmacan be traced back to early Greek society, wherestizeinwas amark placedon a slave indicating their place in society and their lower social value.This translates to a modern definition of ‘a mark of disgrace associated witha particularcircumstance, quality or person’.To stigmatise is essentially tomark someoneas different and treat them accordingly.
Effects of Stigma
Stigma can lead to prejudice and discrimination.Prejudiceis forming anopinion beforebecoming aware of and understanding the relevant facts.Discrimination istreating someone less positively or appropriately than other people becauseof thatprejudice.
Public stigmais a society-level stigma and includes the prejudicial attitudesand discriminatorybehaviours that people hold towards those with mentalhealth problems.Thiscan include beliefs that people with mental illness canneverrecover (leading to hopelessness),thatthey are violent and dangerous (leading to fear),that they are weak and could control their illness (leading to blame and anger) orthat they are like children (leading to a belief that they need decisions madefor them).Inturn, these beliefs lead to behaviours such as avoidance, coercionand colludingthat people with mental health problems cannot live independently.
Self-stigmais when people with mental health problems believe what isbeing saidabout their illness or about thempubliclyand agree with this view.This affectsself-esteem, can lead to a belief that there is no point in trying andmay causepeople to give up on life goals such as having a job, a long-termrelationship oreven seeking help for their condition.
Structural stigmaoccurs at an infrastructure level – in policy-making, lawsand institutions.Itcreates environments where people with mental healthproblems aredenied their human rights, are treated unfairly or where policies do notgive highpriority to mental health issues.
Questions for group reflection
Public stigma- what negative beliefs about people with mental illness do you know?Do you know any positive beliefs?Reflect on the effects mental illness can have on marriage, parenting, job prospects , and basic human rights in the community.Do you know of any Government policy/ law that negatively affects people that have or have hadmental illness?
Royal college of Psychiatrists Changing minds campaign (1997-2003)
The campaign set out to combat stigma in mental illnessA survey of attitudes towards mental illness was taken before and after the campaign.It chose to focus on six of the most common mental disorders
Changing minds campaign
"People suffering from mental disorders often attract fear, hostility and disapproval, rather than compassion, support and understanding," says Professor Arthur Crisp, Chairman of the Changing Minds Campaign. "Such stigmatisation not only causes people with mental health problems to feel isolated and unhappy, but may also prevent them receiving help and treatment."
Prevalence of common mental disorders.
Anxiety - affects more than 1 person in 10Depression - affects 1 person in 4Schizophrenia - affects 1 person in 100Dementia - affects 1 person in 5 over 80Alcohol and drug addiction - affects about 1 person in 3Eating disorders - affects 1 person in 50
1 in 4" reinforces the message that anyone can suffer from mental illness–"1 in 4 could be your brother, your sister. Could be your wife, your girlfriend... 1 in 4 could be your daughter... 1 in 4 could me... it could be YOU."
Research carried out among the general public at the start of the campaign in 1998 showed that stigmatising attitudes were common. In particular:Many people believed that those suffering from depression should "pull themselves together".People with schizophrenia and alcohol addiction were seen as dangerous.
Anyonewith a mental health problem was considered "difficult to talkto".The results of this baseline survey were released at the launch of the Changing Minds Campaign, on 7th October 1998.The Changing Minds Campaign closed on 7th October 2003, we are aware however that tackling the stigma of mental illness is an enduring task.
Lord anti stigma Bill
The Bill was voted for in the House of LordsEssentially it was the start of a process to legislate to put anend to archaic laws which interfere with the rights of people with mental healthproblems. E.g.-fromparticipating in jury service and becoming or remaining a company director.Itwill also change a law that currently stipulates that MPs themselves will lose their seats if sectioned under the Mental Health Act, regardless ofrecovery.
Examples of combating stigma associated with mental illness in the U.K.
Public Stigma- changing minds campaign.T.V. and other adverts by mental health charities.Education programmes on world mental health day.Programmes supporting people with mental health problems at work.Structural stigma- Disability discrimination act and Lord anti stigma Bill.
What can be done about stigma?
Differentstrategies for tackling stigma are required for the different typesof stigma.Public stigmaPublic stigma can be tackled through protest, education and contact. Eachof thesestrategies has its part to play depending on the situation.
ProtestHere an appeal is made to those holding stigmatising perceptions of mentalhealth problemsto stop, by using moral arguments.Specificprotests can be very effective, such as the joint response of anumber oforganisations to an article printed in The Sunday Times ‘I’m sorry, he’s nota differentlygifted worker – he’s a psycho’.Thisprotest brought an apologyfrom theauthor who had not intended that his article discriminate against peoplewith mentalhealth problems and withdrawal of the piece from the paper’swebsite.
Herethe facts about mental health problems are contrasted with the myths.Effects onattitudes can be variable but education is ‘widely endorsed forinfluencing prejudiceand discrimination’.
The See Me campaign (Scotland’snationalcampaign againstmental health stigma) in partnership with others is using education totackle discriminationexperienced by bus users in one area who also have a mentalhealth problem.This campaign also uses the third method for tackling stigma: contact.
Evidence suggests that contact with people with mental health problemswho allowstereotypes to be challenged is an effective way of reducing stigma.This can beformal through speaking at meetings or on education programmes orcasual throughdisclosing mental health problems to others.The Canadian programme Opening Minds combined the contact approachwith educationand was able to show a reduction in stigmatising attitudes overtime.
Challenging public stigma is most effective when strategies are targeted atpeople whohave frequent interactions with people with mental health problemsincluding healthand social care professionals.
TheSee Me campaign has targetingstigma inhealth and social care as one of its priorities (along with targeting stigmain youngpeople and employment).Itis a challenging fact that health and socialcare agencieshave the potential to discriminate against“25%”of the population,often withoutrealising that this is what they are doing.
Promotionof recovery-focused approaches to treatment underpins thereduction ofself-stigmaTackling self-stigma is about improving self-esteem and challenging thepublic stereotypesand can involve empowerment, advocacy and groupidentification
Itcan be seen that the different stigmas are interrelated and this is also the casefor structuralstigma.Structuralstigma is influenced by public opinion and vice versa.
Movingtowards equal treatment rights for those with mental healthproblems, achievingparity of esteem between mental and physical health in terms ofpolicy, resourceallocation and services ispivotalto tackling structural stigma.Afterall, thereis no health without mental health.
Peoplecan and do recover from mental health problems.Mentalhealth stigma may impact negatively on all aspects of a person’slive including health, their place in societyandwellbeing.Stigma occurs at a number of levels in any society.Thereis good evidence that stigma can be tackled using a numberof complementarystrategies.Reducingstigma improves health outcomes.Peoplewithmental illness havemuch to contribute to society in general:they can, for example, be a much-loved family member or friend, an employee,a parent, a student, and an educator.With the right support and treatment people withmentalhealth problems can recover and live fulfilling lives.
Do you believe that there is a stigma associated with mental illness in Nigeria?Is the stigma appropriate or justified?What can YOU do to combat the stigma?How can public stigma be combatted in Nigeria?How can structural stigma be combatted in Nigeria?What will you do different from today?