Stigma, discrimination and mental health

Mental illness stigma has been defined as the ‘devaluing, disgracing, and disfavouring by the general public of individuals with mental illnesses’ (Abdullah and Brown 2011).

The consequences of stigmatisation

Stigma often leads to discrimination, or the unfair treatment of individuals and can even result in the denial of their rights (Unite for Sight 2015). The World Health Organization (2018) has said that the violation of people with mental and psychosocial disabilities is routinely reported in most countries, by way of physical restraints, seclusion and refusal of basic needs and privacy, for example. Most countries do not adequately protect the rights of people with mental disorders and this is a huge concern.

Sometimes individuals can suffer disadvantage from stigmatisation, for instance by being refused employment or housing. Looking at society as a whole, stigmatised people can suffer from intense prejudice which impacts many areas of their lives. Furthermore, stigma and discrimination can prevent mentally ill people and their families from pursuing mental health care (WHO 2018), and from following treatment programmes. In spite of many effective treatments existing there is still an underlying belief that they are untreatable, or that people who have mental health disorders are difficult and incapable of making decisions.

In 2001, the World Health Organization (WHO) identified stigma and discrimination towards mentally ill individuals as ‘the single most important barrier to overcome in the community’, and the WHO’s Mental Health Global Action Programme (mhGAP) cited advocacy against stigma and discrimination as one of its four core strategies for improving the state of global mental health.

The mhGAP is still working towards its objective and particularly focusing on low and middle income countries. The WHO (2018) has estimated that while 14% of the global burden of disease is thought to be caused by mental health disorders, the majority of affected individuals, approximately 75% in low-income countries, are not able to access the treatment that they need.

Stigma and culture

The roots of stigmatisation are not constant across communities or cultures, but observed stigma by individuals living with mental illness is reported internationally. For example, the World Mental Health Surveys (Alfonso et al. 2008) revealed that stigma was closely connected with anxiety and mood disorders among adults reporting significant disability.

The survey data, which included responses from 16 countries in the Americas, Europe, the Middle East, Africa, Asia, and the South Pacific, showed that 22.1% of participants from developing countries and 11.7% of participants from developed countries experienced embarrassment and discrimination owing to their mental illness. However, the authors stated that these figures likely underestimated the true extent of stigma associated with mental illness since they only evaluated data on anxiety and mood disorders.

The importance of cultural sensitivity

Being able to present mental health care services in culturally-sensitive ways may be essential to increasing access to and usage of mental health care services. Cultural beliefs about mental health often vary from the Westernised biomedical model of mental illness.

One study compared Indian and American attitudes toward mental illness by looking at students at a university in the Himalayan region of Northern India and at a university in the Rocky Mountain region of the United States. The findings showed that Indian students were more likely to view depression as occurring from personally controllable causes such as failure to achieve goals. They were more inclined to ‘approve social support and spiritual reflection or relaxation’ as ways to cope with and alieve the symptoms of depression. The researchers stated that ‘conceptualizations and treatments’ for depression should take into consideration diverse perspectives on mental illness in order to maximise the effectiveness of mental health care delivery programs (Unite for Sight 2015).

We now know what mental health stigma is and how significantly it can affect sufferers, not only in terms of their recovery but also in their role and contribution to society (Davey 2017).

The fact is that negative attitudes and beliefs about mental health continue to persist regardless of a person’s age, knowledge of mental health or even personally knowing a person with a mental health issue.

To eliminate and change these long-held negative views that surround mental health disorders requires multifaceted campaigns that do more than impart knowledge about mental health, they also need to challenge existing stereotypes that are common in the media.

‘Time to Change’

In the UK the ‘Time to Change’ campaign is one of the largest programmes that has attempted to address mental health stigma, and has been supported by mental health charities and health service providers.

Analysis has shown (Henderson and Thornicroft 2013) that nationally, the public view of mental health issues became slightly more understanding over the first four years of the campaign, while there was also a small decrease in complaints of discrimination on grounds of mental health issues. The first phase of the ‘Time to Change’ campaign seems to have had an appreciable positive effect on the confidence and social mobility of vulnerable people.

Your task

• What further steps do you think could be taken to reduce stigma around mental health issues?

Post your thoughts in the comments area.

References

_{Abdullah, T. and Brown, T.L. (2011) ‘Mental Illness Stigma and Ethnocultural Beliefs, Values, and Norms: An Integrative Review’ Clinical Psychology Review 31, 934-948}

_{Alonso, J., Buron, A., Bruffaerts, R., He, Y., Posada-Villa, J., Lepine, J-P., Angermeyer, M.C., Levinson, D., Girolamo, G., Tahimori, H., Mneimneh, Z.N., Medina-Mora, M.E., Ormel, J., Scott, K.M., Gureje, O., Haro, J.M., Gluzman, S., Lee, S., Vilagut, G., Kessler, R.C. and Von Korff, M. (2008) ‘Association of Perceived Stigma and Mood and Anxiety Disorders: Results from the World Mental Health Surveys’ Acta Psychiatrica Scandinavica 118, 305-314}

_{Davey, G.,C. (2017) Psychopathology 2nd edn. Chichester: Wiley}

_{Henderson, C. and Thornicroft, G. (2013) ‘Evaluation of the Time to Change Programme in England 2008 -2011’ The British Journal of Psychiatry 202 (5), 45-48}

_{Unite for Sight (2015) ‘Module 7: Cultural Perspectives on Mental Health’ [Online]. available from https://www.uniteforsight.org/mental-health/module7#_ftn2 [16th November 2018]}

_{WHO (2018) ‘WHO Mental Health Gap Action Programme (mhGAP)’ [Online]. available from http://www.who.int/mental_health/evidence/mhGAP/en/ [16th November 2018]}