Negative views of mental health problems are held by people in all walks of life and of all ages. People with mental health problems can experience stigma and discrimination from family members, friends, teachers, work colleagues and health professionals including GPs, psychiatrists and psychiatric nurses.
- The Stigma of Depression
- Stigma Still a Major Hurdle in Getting People the Mental Health Care They Need
- Types of Mental Health Stigma and Those Most Affected
- Some Advice From a Stigma Breaker
- Stigma and discrimination
- Are You Guilty of Stigmatizing the Mentally Ill?
- Subtle Signs of Stigma Against the Mentally Ill
- Stigma related to help-seeking from a mental health professional
Education campaigns can help reduce stigma. Most are targeted at the general public but they can also focus on specific groups, for example teachers, the police or medical students. ‘Time to Change’ is England’s largest mental health anti-stigma campaign and was launched in 2009. It is led by the mental health charities Mind and Rethink Mental Illness and is funded by the Department of Health, the Big Lottery Fund and Comic Relief. Education campaigns often involve individuals with a mental health problem telling their personal story, either through film clips or face to face in workshops, with an emphasis on hope and recovery. Such ‘social contact intervention’ is an effective way to reduce stigma. Providing accurate information and key messages is also important. Examples of key messages include that mental health problems are common and affect people of all ages, backgrounds and cultures but are not a barrier to living a fulfilling and successful life as shown by the many famous people who have suffered from depression and other psychiatric problems.
Educational campaigns often target the media to try and ensure a more balanced and accurate coverage of mental health issues. This is crucial as the media can perpetuate negative stereotypes through inaccurate and distorted reporting of news stories. Surveys of newspapers in England find that just under half of articles with a mental health theme are stigmatising, for example they use pejorative language or emphasise the risk of violence to others (8).
The fictional portrayal of people with mental health problems in cinema and television is often misleading and stigmatising. A recent report identified four main cinematic stereotypes of people with mental health problems; objects of fun and ridicule, fakers, people to be pitied or violent individuals (9). The last portrayal is closely linked to cinematic portrayals of psychosis. The media reflect society’s existing prejudices and cannot be blamed for the existence of stigma but these representations have been described as a ‘reservoir’ that perpetuates damaging stereotypes. On the other hand some depictions of mental illness, particularly in several recent television dramas, are accurate, positive and can help reduce stigma and increase public understanding.
Tackling stigma is not only the responsibility of those organising large scale education campaigns. A ‘bottom up’ approach is also needed. People who have suffered from a mental health problem, family members, health care professionals and the general public need to feel confident to challenge negative stereotypes that they encounter, whether at work or socially. An example of this occurring on a large scale was in 2003 when the Sun newspaper reported on the former world heavyweight champion boxer Frank Bruno being admitted to a psychiatric ward with the headline ‘Bonkers Bruno Locked Up’. There was an immediate outcry by members of the public and mental health charities and the paper was forced to change the headline to the more sympathetic ‘Sad Bruno In Mental Home’ for the second edition.
Another way to combat stigma is through anti-discrimination policy and legislation. This approach has proven successful in reducing discrimination experienced by people on grounds of gender, race and sexual orientation. The Equality Act 2010 made it unlawful in Great Britain to discriminate directly or indirectly against someone who has a disability in work, education, public services and several other specified situations. The Act defines a disability as a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on a person’s ability to carry out normal day-to-day activities. Long-term means the disorder has lasted a year, or is likely to last at least a year, or is likely to be recurrent. As such the definition could include people with a wide range of mental health problems such as learning difficulties, depression, schizophrenia and bipolar disorder. The Act also requires employers to make reasonable adjustments in the work place if a person’s disability puts them at a disadvantage compared to others.
Signs of progress
Progress has been made in reducing mental health stigma. Mental health is discussed far more openly than in the past as shown by the many magazine articles, books and radio and television programmes on this subject. One of the most successful current plays in the West End, ‘The Curious Incident of the Dog in the Night-time’, is the sympathetic fictional account of a young man with Asperger’s Syndrome. In the 1990s the award winning author William Styron wrote about his depressive illness in the book ‘Darkness Visible’ as did the biologist Lewis Wolpert in a book entitled ‘Malignant Sadness’. The current Time to Change anti-stigma and discrimination campaign in England has been supported by celebrities and high profile figures, including Stephen Fry, Frank Bruno and Alastair Campbell, who have discussed their experience of suffering from a mental health problem.
The Time to Change campaign has been accompanied by a decrease in stigma. Between 2008, the year before the campaign was launched, and 2011 there was a significant fall in the level of discrimination experienced by people using mental health services in England and a small increase in the proportion of people who reported experiencing no discrimination (2). Over the same period there was an increase in the proportion of anti-stigmatising newspaper articles (8). Unfortunately the proportion of stigmatising articles remained constant with the change being due to a decrease in the proportion of mixed or neutral articles. Between 2003 and 2013 there has been a small improvement in public attitudes to people with mental illness in England (10). A report published in 2014 concluded that television dramas were moving away from negative stereotypes towards a more accurate and sympathetic portrayal of people with mental health problems and that script writers were aware of mental health stigma and discrimination (11).
Despite the progress that has been made, mental health stigma remains widespread. Much of the reduction in stigma has centred on depression, bipolar disorder and other mood disorders while psychosis and schizophrenia remain highly stigmatised. A range of approaches are needed to tackle stigma. Reducing stigma can improve the quality of life of those with a mental health problem and is a major priority.
Celebrity supporters of the ‘Time to Change’ anti-stigma campaign discuss mental health problems in a series of video interviews
Information about Time to Change (England’s biggest programme to challenge mental health stigma and discrimination)
User friendly information leaflets on a wide range of mental health problems, produced by the Royal College of Psychiatrists
The authors wish to thank the various service users and professionals who made helpful comments on earlier drafts of this article.
- Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination. British Journal of Psychiatry 2007; 190: 192-3.
- Corker E, Hamilton S, Henderson C et al. Experiences of discrimination among people using mental health services in England 2008-2011. British Journal Psychiatry 2013; 202 (suppl 55):s58-s63
- Crisp A, Gelder MG, Goddard E, Meltzer H. Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry 2005; 4:106-113.
- Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence. British Journal Psychiatry 2002; 180:490-5.
- Brekke JS, Prindle C, Bae SW, Long JD. Risks for individuals with schizophrenia who are living in the community. Psychiatr Serv. 2001; 52(10):1358-66.
- Walsh E, Scott C, McKenzie K et al. Prevalence of violent victimisation in severe mental illness. British Journal of Psychiatry 2003; 183: 233-238.
- Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. British Journal Psychiatry 2012; 200(2):97-106.
- Thornicroft A, Goulden R, Shefer G et al. Newspaper coverage of mental illness in England 2008-2011. British Journal Psychiatry 2013; 202 (suppl 55):s64–s69.
- Screening Madness; A century of negative move stereotypes of mental illness. Peter Byrne. Time to Change (2009).
- Evans-Lacko S, Corker E, Henderson C and Thornicroft G. Effect of the Time to Change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003—13: an analysis of survey data. The Lancet Psychiatry 2014; 1:121 – 128
- Making a drama out of a crisis. Time to Change Campaign 2014.
The Stigma of Depression
The stigma of depression is alive.
When we have depression, we are “lesser people.” We are incapable of living a “normal” life, holding down a job, or keeping a relationship. We are the ones that “normal” people don’t know how to deal with. They keep away, because we are contagious. They don’t want to contract the “crazy.”
At least, this is what many people think. None of it is true, of course. This is the stigma that follows us around daily when we suffer from depression — like a mosquito we keep swatting away that keeps coming back to bite us.
On whom can we place the blame for the creation and longevity of the stigma? Our friends and family who don’t fully understand depression? The media? Society as a whole?
Probably all of them — they work together to form an unfriendly soup of stigma. Media portrayals of depression are not always so accurate, for example. Take the massive Internet backlash surrounding the Netflix series 13 Reasons Why — which included some unfortunate stereotypes about depression and suicide. Another thing to consider is that depression presents so differently in different kinds of people, so it’s almost impossible to depict every type.
It’s 2018. Why is there still such a stigma surrounding mental illness? Even depression, which is scarily common, is seriously misunderstood and stigmatized. According to the ADAA, 16.1 million adults in the US are depressed. Thats 6.7% of all the adults here, making it pretty prevalent compared to other mental illnesses and physical diseases.
The stigma results in so many misconceptions. The stigma can also be dangerous for the person who’s suffering from the condition. Why? The negative stigma can make someone embarrassed to confess the way they’re feeling or reach out to get help for fear of being shamed and being labeled pejoratively as something like a “basket case.” Also, we can stigmatize ourselves, feeling shame simply for being who we are because of the way that society makes us feel.
The reality is that depression is not one size fits all. It can be completely obvious that a person is depressed, or the case may be that you’d never in a million years guess that the person was depressed. Many people find it difficult to wrap their heads around the concept of high functioning depression.
If you’re feeling depressed, remember that:
- You can be beautiful and depressed.
- You can be successful and depressed.
- You can be young and depressed.
- You can have everything going for you and still be depressed.
Depression is a disease and a disability. It’s not a choice, and we can’t necessarily control it. Other chronic diseases like heart disease or arthritis aren’t looked down upon or stigmatized, so why is depression any different? Why do people condemn us for being depressed? Depressed people have enough on our plates already!
So, if you suffer from depression, I have a challenge for you. Make a conscious effort to help break the stigma. You can start by sharing this article! Post stories on Facebook or retweet things on Twitter that are informative so your friends and followers become more familiar with mental illness and get the facts.
If you don’t suffer from depression (lucky you) I have a challenge for you, as well. Be an ally! Educate yourself about depression, the symptoms, the risks, and the statistics. Ask your friends/family members who are sufferers what you can do to help them personally, and how to help on an even larger scale.
If we band together and do just a little bit of fighting each day, we can slowly but surely rid society of this stigma. Imagine a world where having depression is viewed just for what it is? A health condition like any other. Let’s make it happen.
Stigma Still a Major Hurdle in Getting People the Mental Health Care They Need
Experts estimate that one in four people have treatable mental or emotional difficulties, but up to 75 percent of Americans and Europeans don’t seek the help they need.
A recent study in the journal Psychological Medicine shows that the stigma associated with mental illness is still a major barrier to seeking treatment.
Researchers at the Institute of Psychiatry (IoP) at King’s College London examined data from 144 studies, which included over 90,000 participants from across the globe. They found that the stigma of mental illness remains one of the top reasons people choose to forgo care.
“We now have clear evidence that stigma has a toxic effect by preventing people seeking help for mental health problems,” senior author Prof. Graham Thornicroft said in a statement. “The profound reluctance to be ‘a mental health patient’ means people will put off seeing a doctor for months, years, or even at all, which in turn delays their recovery.”
According to the latest statistics from the National Institute of Mental Health (NIMH), 40 to 50 percent of all people with bipolar disorder or schizophrenia go untreated each year. The number of untreated people suffering from some other disorders, such as anxiety or depression, is even greater.
See the Famous Faces of Those Who Overcame Their Bipolar Disorder “
Types of Mental Health Stigma and Those Most Affected
The study concluded that the main types of stigma facing those with a mental illness included the stigma associated with using mental health services, and shame or embarrassment. Other barriers included fear of disclosing their mental condition, concerns about confidentiality, wanting to handle their problems on their own, and not believing they need help.
Those most affected by the stigma included young people, men, minorities, people in the military and, perhaps surprisingly, those working in the health field.
“We found that the fear of disclosing a mental health condition was a particularly common barrier,” lead study author Dr. Sarah Clement said. “Supporting people to talk about their mental health problems, for example through anti-stigma campaigns, may mean they are more likely to seek help.”
Ready for Help? Learn the Different Types of Mental Health Professionals “
Some Advice From a Stigma Breaker
Natasha Tracy, a mental health writer and recipient of the 2014 Erasing the Stigma Leadership Award by Didi Hirsch Mental Health Services, said the hardest stigma to beat is the stigma that “looks back at us in the mirror.”
Tracy helps her own bipolar disorder by writing about it on her wildly popular blog, Bipolar Burble.
“Every one of us sees anti-mental illness images and ideas in society and just getting a mental illness does make these go away,” she told Healthline. “We must consciously be aware of our own thoughts and feelings towards our own mental health and fight to ensure that any unhealthy thoughts are replaced by more reasoned ones.”
Acknowledging that it’s no easy task, Tracy said that it can take years for someone to get over feeling bad about having a mental illness. She said the important part is knowing that mental illness is a disease of the brain, just like pancreatitis or liver disease.
And just as with any physical illness, the pain of mental illness doesn’t go away unless you treat it. But instead of worrying about what others who doubt the necessity of mental health treatment think, focus on yourself and your own wellness.
“It can be difficult if people around you can’t accept your mental illness treatment but first and foremost, treatment is about getting you better and bringing people onside is a secondary concern,” Tracy said. “I recommend seeking out people who are supportive and using them to lean on at first.”
Stigma and discrimination
People with mental health problems say that the social stigma attached to mental ill health and the discrimination they experience can make their difficulties worse and make it harder to recover.
Mental health problems are common. They affect thousands of people in the UK, and their friends, families, work colleagues and society in general.
- It is estimated that 1 in 6 people in the past week experienced a common mental health problem.
- 10% of children and young people (aged 5-16 years) have a clinically diagnosable mental problem.
- Depression is the predominant mental health problem worldwide, followed by anxiety, schizophrenia and bipolar disorder.
Most people who experience mental health problems recover fully, or are able to live with and manage them, especially if they get help early on.
But even though so many people are affected, there is a strong social stigma attached to mental ill health, and people with mental health problems can experience discrimination in all aspects of their lives.
Many people’s problems are made worse by the stigma and discrimination they experience – from society, but also from families, friends and employers.
Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.
We know that people with mental health problems are amongst the least likely of any group with a long-term health condition or disability to:
- find work
- be in a steady, long-term relationship
- live in decent housing
- be socially included in mainstream society.
This is because society in general has stereotyped views about mental illness and how it affects people. Many people believe that people with mental ill health are violent and dangerous, when in fact they are more at risk of being attacked or harming themselves than harming other people.
Stigma and discrimination can also worsen someone’s mental health problems, and delay or impede their getting help and treatment, and their recovery. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness.
The situation is exacerbated by the media. Media reports often link mental illness with violence, or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives.
This is far from the case.
Research shows that the best way to challenge these stereotypes is through firsthand contact with people with experience of mental health problems. A number of national and local campaigns are trying to change public attitudes to mental illness. These include the national voluntary sector campaign Time to Change.
The Equality Act 2010 makes it illegal to discriminate directly or indirectly against people with mental health problems in public services and functions, access to premises, work, education, associations and transport.
Are You Guilty of Stigmatizing the Mentally Ill?
Despite the fact that mental disorders are relatively common in the United States (according to the National Institute of Mental Health, more than 46 percent of Americans will experience a diagnosable mental disorder throughout their lifetime), stigma of mental illness remains an ongoing problem.
Only a few decades ago, many people with severe depression and other mental disorders were shunned, placed in straitjackets, and locked away in institutions. And while society has come a long way since then, we still have improvements to make in terms of getting people the help they need while treating them with dignity and respect.
“Stigma related to mental illness is a national health problem,” says Melissa Pinto, PhD, RN, an instructor in the School of Nursing at Case Western Reserve University who studies stigma related to mental health. “Young people hear messages about mental health disorders from an early age — as a result, many of them are scared to be around people with mental illness.”
One serious effect of the stigma around mental disorders is that two-thirds of affected people don’t seek help, says the National Alliance on Mental Illness; the main reasons people give to explain why include fear of disclosure, rejection, and discrimination.“Stigma reinforces attitudes and behaviors that prevent many people with symptoms of mental illness from seeking the treatment they need,” Pinto says.
According to the U.S. Surgeon General’s Report on Mental Health, in its most severe form mental health stigma can lead people to avoid socializing and working with — including renting to and hiring — people with mental disorders, especially severe disorders such as schizophrenia.
You may think you have no preconceived notions about people with depression or other forms of mental illness, yet you may unwittingly be guilty of perpetuating mental health stigmas. Expressions of mental health stigma are often displayed during daily interactions in fairly subtle and complex ways, Pinto says.
Subtle Signs of Stigma Against the Mentally Ill
The following examples of mental health stigma may help you reach an “aha” moment with regard to your own actions and attitudes:
Mental illness in the media. “On television, characters with a mental health disorder often play the villain,” Pinto says. “In order to eliminate mental illness stigma, these media portrayals need to become more accurate.” One step forward is the encouraging depictions of psychiatry on shows such as Monk,The Sopranos, and In Treatment, says Howard Belkin, MD, JD, an assistant professor at the Oakland University William Beaumont School of Medicine and a psychiatrist at the Birmingham Counseling Center in Royal Oak, Mich.
Phrases like “She’s lost her marbles” or “He’s not playing with a full deck.” It’s easy to throw terms such as these around in casual conversation, but doing so promotes mental health stigma. “Instead, use care in the way you describe someone with a mental health disorder,” Dr. Belkin says. “Remember: The mental illness is not the person’s fault, and she may be doing everything she can to try to get better.”
“Crazy” Halloween costumes. Considering going next Halloween as a psycho killer or straitjacketed mental ward patient? Both costumes strongly promote mental health stigma and falsely portray all people with mental illness as violent. “Unfortunately, some people with mental illness, particularly paranoia, can have a tendency toward violence, and when they become violent it can be tragic, as well as heavily covered by the media,” says David M. Reiss, MD, interim medical director at Providence Behavioral Health Hospital in Holyoke, Mass. “However, what the media does not remind the public is that the vast majority of people with mental illness are not violent. Overall, statistically, a person with mental illness is no more likely to become violent than a person without mental illness.”
Common — but wrong — assumptions about people with mental illness. “For example, people may assume someone with depression or another mental illness is unstable, lazy, untrustworthy, unintelligent, or incapable,” when that’s not the case, says Mary Pender Greene, LCSW-R, a group psychotherapist in private practice in New York City.
Verbal innuendoes. As you talk about someone with a mental illness, you may pair certain words with a change in your tone of voice. For example, you may whisper the term “depression” or “bipolar.” “People pick up on these cues, which communicate depression stigma to the listener,” Pinto says.
Isolation of people with mental illness. When talking to someone with depression or another mental health problem, you may unconsciously step back to increase your physical distance from the person, or turn away from him or her. “You may also speak to the person with mental illness in an angry or condescending tone or as if he was a child,” Pender Greene says. People with mental health disorders are also more often ignored in group social situations and generally more rejected by others.
Disrespect for the gravity of depression and other mental health problems. Telling someone with mental illness to “get over it” or “snap out of it” is not only insensitive, it also promotes mental health stigma, Pender Greene says. Instead, she suggests pushing past the misconceptions floating around by educating yourself with the facts.
Overall, the best way to avoid promoting mental health stigmas is to give people with depression and other forms of mental illness the respect and kindness they deserve. “Good mental health is a goal we should all seek,” Belkin says. “We need to show understanding and compassion for those suffering from both minor and major mental health problems. If the topic of depression or other mental illness comes up in conversation, be empathetic. After all, you or one of your loved ones may one day suffer from mental health symptoms.”
The lives of people with mental health conditions are often plagued by stigma as well as discrimination. Stigma is a negative stereotype. Stigma is a reality for many people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life.
Stigma differs from discrimination. Discrimination is unfair treatment due to a person’s identity, which includes race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity, gender expression, age, marital status, family status or disability, including mental disorder. Acts of discrimination can be overt or take the form of systemic (covert) discrimination. Under the Ontario Human Rights Code, every person has a right to equal treatment with respect to services, goods and facilities, without discrimination due to the identities listed above.
Stigma is the negative stereotype and discrimination is the behaviour that results from this negative stereotype. Often, individuals with a mental illness are faced with multiple, intersecting layers of discrimination as a result of their mental illness and their identity. For example, a woman with a mental illness may experience discrimination due to sexism as well as her illness, and a racialized individual may experience discrimination due to racism in addition to their mental illness. In addition, living with discrimination can have a negative impact on mental health.
Media influence on public attitudes
Many studies have found that media and the entertainment industry play a key role in shaping public opinions about mental health and illness. People with mental health conditions are often depicted as dangerous, violent and unpredictable. News stories that sensationalize violent acts by a person with a mental health condition are typically featured as headline news; while there are fewer articles that feature stories of recovery or positive news concerning similar individuals. Entertainment frequently features negative images and stereotypes about mental health conditions, and these portrayals have been strongly linked to the development of fears and misunderstanding.
Impact of negative public attitudes
There are significant consequences to the public misperceptions and fears. Stereotypes about mental health conditions have been used to justify bullying. Some individuals have been denied adequate housing, health insurance and jobs due to their history of mental illness. Due to the stigma associated with the illness, many people have found that they lose their self-esteem and have difficulty making friends. Sometimes, the stigma attached to mental health conditions is so pervasive that people who suspect that they might have a mental health condition are unwilling to seek help for fear of what others may think. Experiences of stigma and discrimination is one of their greatest barriers to a satisfying life.
What you can do to stop stigma and discrimination
Use person-first language which focuses on the individual, not on the substance use. Language used is an important factor in reducing stigma and breaking down negative stereotypes associated with substance use disorders. By using non-stigmatizing language, those who are experiencing challenges may experience fewer barriers to accessing supports.
The following guide includes some suggestions of person-first language in mental health:
|Common / outdated terms||Person-first language|
|Mental health disorders||
Mental health issues, conditions or illnesses
| Individuals “struggling” or “suffering from”
or having a mental illness, mental health condition or issue
|Individuals living with mental illnesses, mental health condition or issue|
| Committed Suicide, “suicided”,
or successful / unsuccessful suicide
| Died by suicide
|Mental illnesses||A mental illness (or specify specific disorder, rather than generalize by using the term “mental illness” to capture all mental illnesses.)|
| Mentally ill person
Someone who is bipolar
|Someone who has a mental illness.
Someone who is living with bipolar disorder.
|Patient / Client||People with lived experience or individuals we serve|
|Addict / Substance abuser||He/she has a substance use condition.
He/she has lived experience of substance use
CMHA Ontario has also developed a one page primer on talking about substance use to help.
Use the STOP criteria to recognize attitudes and actions that support the stigma of mental health conditions. It’s easy, just ask yourself if what you hear:
- Stereotypes people with mental health conditions (that is, assumes they are all alike rather than individuals)?
- Trivializes or belittles people with mental health conditions and/or the condition itself?
- Offends people with mental health conditions by insulting them?
- Patronizes people with mental health conditions by treating them as if they were not as good as other people?
If you see something in the media which does not pass the STOP criteria, speak up! Call or write to the writer or publisher of the newspaper, magazine or book; the radio, TV or movie producer; or the advertiser who used words which add to the misunderstanding of mental illness. Help them realize how their words affect people with mental health conditions.
Start with yourself. Be thoughtful about your own choice of words. Use accurate and sensitive words when talking about people with mental health conditions.
Mental illness, stigmatization, discrimination, help-seeking
Researchers commonly suggest that the stigma attached to mental illness is one of the major confounding factors in help seeking from mental health professionals.
Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning . Stigma has been defined as the negative effect of a label and a product of disgrace that sets a person apart from others . There are a number of distinct constructs that comprise stigma. These include stereotype, prejudice, and discrimination. A stereotype is a belief held about a certain group of people. For example, believing that all people with a diagnosed mental illness are dangerous is a stereotype. Prejudice is an agreement with the said stereotype that results in a negative emotional reaction . Further, prejudice has also been defined as an unfavorable opinion formed without just grounds or before sufficient knowledge . An example of prejudice might be agreeing that persons with mental illness are indeed dangerous, causing an emotional reaction such as fear or anger. Discrimination is the behavioral response to prejudice, which might include, for example, avoiding a person with mental illness because of the fear from the prejudice and the belief that the person is dangerous .
Authors have reported negative attitudes from the general population regarding social distance and adults with mental illness . People with mental illness were believed to be mentally retarded, a public nuisance, and dangerous. Less than half of the participants believed that such people could be treated outside of a hospital and only 25% believed that they could work regular jobs. Poor knowledge about mental illness also was prevalent among the participants. Participants were unwilling to have social interactions with those with a mental illness – 83% reported that they would be afraid to have a conversation, 78% said that they would be upset or disturbed about working on the same job, 81% reported that they would not share a room, and 83% responded that they would feel ashamed if people knew that someone in their family had been diagnosed with a mental illness. Only 17% reported that they could maintain a friendship with a person with a mental illness. The authors concluded that there is poor knowledge about the cause and nature of mental illness and that education is needed so that stigma towards those with a mental illness can decrease .
Stigma is defined as a combination of perceived dangerousness and social distance. People with mental illness suffer from societal stigma everyday. Wherever they go, whatever they do, the pressures of conforming to a society that neither accepts nor understands them can be overwhelming. The impact of stigma must seem to be as difficult to overcome as the direct effects of the disease itself . Only by thoroughly understanding the origins of stigma can society’s views towards individuals with mental illness be changed.
Stigma affects people with mental illness in all aspects of their lives including employment and housing difficulties, social issues, and a decreased quality of life and self esteem. These individuals are also thought to be very dangerous by others in society .
The History of Mental Illness
During the primitive era, mental illness was directly tied to religion. Hinshaw and Cicchetti 9 mentioned that dating back 500,000 years people put circular holes in the skulls of individuals thought to have a mental illness in order to let the evil spirits out. Views changed dramatically in the Greco-Roman era. In the early Greek times the supernatural beliefs regarded as causes for mental illness continued .
In ancient Greece “Hippocrates believed that abnormal behavior originated from internal bodily causes, particularly imbalances of the four basic fluids (yellow bile, black bile, phlegm, and blood) ”. Hippocrates also believed that the brain was responsible for mental and emotional purposes. The Middle Ages witnessed a shift back to belief in the supernatural model. Society used exorcisms, torture, death by fire, and starvation to rid the person of evil.
Hospitals for the insane began to develop in the 16th century. The treatment in these asylums was cruel and inhumane . The fear of individuals with mental illnesses in other places made the number of asylums increase. During the time of the French Revolution Philippe Pinel (1745-1826) advocated for a humanitarian approach to the treatment of people with mental illnesses. Pinel demanded the removal of chains on inmates in asylums. He believed that doctors should treat people with mental illnesses .
The early 20th century included an increase in beliefs of a biological basis for mental illness, which Hinshaw and Cicchetti explained. The Mental Hygiene movement, which encouraged the humane treatment of people diagnosed with mental illnesses, was founded in 1908 . Psychotropic medications were invented in the 1950’s according to Hinshaw and Cicchetti and Rosen and Gregory . The second half of the 20th century focused on improving psychotropic medications and fighting stigmas . These treatments all stem from the biological model that was predominant during this period of history.
Deinstitutionalization of the mentally ill
Deinstitutionalization, a time period when asylums and institutions were closed and patients were moved into the community, gained attention in the 1960’s . The Community Mental Health Centers Act, passed in 1963, encouraged the deinstitutionalization process . The use of medications to treat mental illnesses caused a drop in the number of patients in mental hospitals. Although there were many benefits to the deinstitutionalization process, a major problem with this movement is that many of the patients were not prepared to function independently in the community because they had lived in institutions for most of their lives.
Yet, without constant follow-up, the mentally ill were not supported back in normal society. They were shunned by the general population and often had to turn to crime in order to support themselves. At this time, the government mandated the use of community mental health centers. By creating centers of care for the mentally ill, it was thought that they would have a better chance of becoming acclimated into a normal role in society. By the 1980’s, however, the community-based clinics were vastly underfunded creating an increase in unemployment, homelessness, and premature deaths .
As of today there is not one correct method of treatment nor is any one type the standard . Treatment, however, will not stop the forces of misinformation that lead to the creation of stigma .
Formation of Stigma
In order to understand the relationship between stigma and mental illness, the origins of stigma must be defined. Corrigan and Penn , consider stigmas as “negative and erroneous attitudes about these persons”. Stigmas have their roots in many different areas, and are reinforced in several ways. Many facets of society must be examined in order to understand fully the impact of stigma on people diagnosed with mental illnesses .
The media has one of the largest impacts on society’s views of individuals with mental illness. Corrigan and Penn stated that the media portrays people diagnosed with mental illnesses in one of three ways “homicidal maniacs who need to be feared, they have childlike perceptions of the world that should be marveled or they are rebellious, free spirits”. The media tends to portray individuals with mental illnesses as violent and law breakers. The stigma that individuals diagnosed with mental illnesses face can translate into prejudice and discrimination at a later time . These labels and stereotypes reduce their dignity and alienate them from other people .
Public perception also plays an integral role in the formation of stigma. Herrman explained that there is a need for promoting community understanding of mental illness as well as the illness itself. Herrman suggested that understanding by the public would help those who suffer from mental illnesses to be able to get and maintain a job more easily, help in education, and their health as well as assist in making laws and policies that help people instead of hurting them
The perceptions can start in youth and continue for life. The mentally ill can often have as hard a time combating stigma as they do coping with the effects of their illness itself. Now, it is necessary to understand the effects of stigma. Without looking at the effects, the general public cannot begin to understand what the mentally ill go through on a daily basis. In general, according to Penn and Martin , the public perceives people with mental illnesses as dangerous. This may play a big part in why the public stigmatizes individuals with mental illnesses .
Effects of Stigma
The mentally ill face many challenges in adapting to life in a society that does not fully understand them. Often, the effects of the stigma that they face are overwhelming. The following section will discuss how stigmas affect people with mental illnesses.
The forms and definitions of mental health vary from person to person. The Commonwealth Department of Health and Aged Care & Australian Institute of Health and Welfare referred to mental illness in 199918 as a broad range of problems including cognitive, emotional, and behavioural that impact the daily lives of people in their jobs or home and affect their relationships with others. This shows that people who have a mental illness not only have difficulties at home or at work but also in all aspects of their lives. Having a mental illness causes a person to undergo much stress in their daily lives, many to the point of total disability. Self-stigma occurs when mental patients assimilate social stereotypes about themselves as persons with severe mental illness. This results in a loss of self-esteem, diminished self-efficacy and a hesitancy to participate in society.
The stigma of mental illness and discrimination against mental patients are believed to be a significant obstacle to development of mental health care and to ensuring quality of life of those suffering from mental illness .
Research has found that the factors underlying the stigma attached by the public to mental illness are fear, ignorance, and intolerance . The stigma that the public feels toward individuals with mental illnesses is manifested in several different ways . First, they fear and exclude them. Second, the public feels they cannot care for themselves or make a decision (which is known as authoritarianism). Third, the public assumes that they are child-like . The stigmas portrayed by the media are a constant battle for the mentally ill to fight. Perceived devaluation and discrimination as well as stigma play a big role in the reduction of self-esteem .
Those who reported more concerns of stigma had more problems with social functioning outside their family but no problems within the family. These patients tended to be secretive or withdraw from the outside world, outside their family, in order to minimize their discrimination . Many people are reluctant to seek professional help, they feel uneasy or ashamed speckled or believe that seeking help is a weakness or failure. As a result, it is no surprise that, according to many studies, people seek help from relatives and friends and last by professionals . They are reluctant to reveal their problems to others because of fear of social rejection, social isolation and hostility. In the early stages of psychosis, these individuals may attribute the symptoms to causes not related to mental illness. Others may try to manage their symptoms alone, without any external help for as long as they can .
Mental illness is not considered merely a personal failure but also disgrace the family. These beliefs can affect family members. Therefore, the family of psychiatric patients often conceal the fact from others .
Stigma and Help-Seeking Behaviour
Stigma is attached to seeking help with mental illness. For some, this stigma may be harder to face than the effects of the illness. Reluctance in seeking mental health treatment is still a large factor in getting rid of the stigma that accompanies mental illness .
The results of the Komiya et al., study found that a greater stigma is negatively correlated with a more favorable attitude toward seeking psychological help. Studies have shown that stigma is formed in several different ways. The perceptions can start in youth and continue for life . Individuals diagnosed with mental illnesses can often have as hard a time combating stigma as they do coping with the effects of their illness itself. Now, it is necessary to understand the effects of stigma. Without looking at the effects, the general public cannot begin to understand what people with mental illnesses go through on a daily basis.
Stigma Associated with Seeking Professional Psychological Help
In light of the advances made in the counselling profession, a stigma is still experienced by individuals who need or use psychological and mental health services . This stigma appears to be associated with treatment , denial of the problem or lack of problem recognition , and a sense of self-reliance with regard to solving personal problems . Schonrt-Reichl and Muller’s research indicates that people who are in need of help often fail to use helping resources because it represents an open admission of inadequacy. Even in children, the stigma associated with mental health treatment is a major barrier for receiving professional help. Simmons said that as high as 85% of children who need mental health treatment are not receiving any because of the perceived stigma associated with mental illness. Moreover, some parents are afraid they will be blamed for their child’s state of mental illness . Stigma is often singled out as the primary factor inhibiting psychological and mental health service utilization.
Social stigmatization and negative feedback from family and friends are potential inhibiting factors to seek professional psychological help. Leaf et al., found that those in need of services who had not used the specialized mental health sector, those in the service gap, perceived higher stigma barriers associated with utilizing such services than those who had utilized mental health services. The rate of perceived stigma is almost twice as high for non-users as it is for users. Therefore, stigma barriers were relatively more important for creating the phenomena of service gap. That is, when individuals need mental health services but they are not receiving them. Because of the stigma mentioned, the need continues for more public education to modify or alter misconceptions about mental and psychological services and even about mental and psychological disorders.
Mental illness, social distance, and familiarity
The results revealed that the subjects who were familiar with mental illness were less likely to believe the population is dangerous. These respondents also were found to be less afraid of the mentally ill. Therefore, the more information provided to the subjects, the greater their understanding of individuals diagnosed with mental illnesses, and thus a greater level of acceptance. This study shows that a key to reducing stigmas may be to offer the public more information and make them more familiar with mental illness .
Younger populations, the more educated, and those with previous exposure to people with mental illness tended to have more enlightened views and have more accepting attitudes about schizophrenia. Older individuals were less knowledgeable, wanted more social distance, and had more stereotypes about mental illness .
Stigma is a variable consisting of many smaller components. Social distance, familiarity with mental illness, knowledge of mental illness, and perceived dangerousness are a few of the components that form the framework for stigma.
Attempts to increase awareness of mental illness have shown to be effective in reducing stigma and perceived violence.
Younger people and people with higher educational level expressed more positive attitudes towards social contact with psychiatric patients . Public education and the direct social contact reduce the stigma of mental patients. The stigma affects the lives of mentally ill in various ways. Minimizing the effects of stigma is a priority for mental health policy, particularly regarding schizophrenia.