Indian Journal of Health Social Work
Stigma and Mental Illness
Narendra Kumar Singh
Stigma is a serious impediment to the well-being of those who experience it. It affects people while they are ill, while they are in treatment, and healing, and even when a mental illness is a distant memory. “Powerful and pervasive, stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others”, US Surgeon General (1999). Stigma is a social phenomenon which has a strong influence on the policies that govern the nature of, access to and funding for treatment and support, eligibility for social assistance or the right to refuse treatment. It may have its influence on different levels, such as at the level of the community, stigma may affect how organizations including social service agencies, employers, health care providers, or schools respond to individuals with a mental illness and to their families. At the individual level, stigma prohibits people from seeking the treatment they need, creates profound changes in identity and changes they way in which they are perceived by others. Stigma is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and/or avoidance. Stigma leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders, especially severe disorders such as schizophrenia.
A. CAUSES OF STIGMA
- There is lot of culturally embedded attitudes and beliefs which often involves negative associations with mental illness. These attitudes and beliefs leads to reactions such as avoidance, ridicule, rejection and fear. These attitudes may also include beliefs such as mentally people are weak, incurable, bad and dangerous.
- The lack of knowledge about the interaction of stressors and different bio- psycho- social factors to cause mental illness is also suggested as a cause for developing stigma (Rooney et al, 1997).
- Lack of knowledge about how one can help a mentally ill person.
- Different kinds fears including being unemployed, a migrant and having mental illness.
- The cultural traditions in different communities.
- Lack of assistance and marginalization of mentally ill person may enlarge the negative attitude towards mentally ill in a community and it itself may produce stigma.
- In developing countries the lack role models to show the exact benefits from the adequate treatment is also said to contribute for formulating stigma.
B. IMPACT OF STIGMA
- Impact on Help-Seeking: stigma prevents nearly two-thirds of all people with diagnosable mental disorders to seek treatment. The stigmatization of mental illness and the lack of information on the symptoms of mental illness are seen as the main barriers to seeking help for mental health problems.
- Impact on Employment: Stigma and associated attitudes of public may manifest in workplace also, such as the negative attitude of the employers may prevent them to give job for a mentally ill person, or they may not allow them to continue in the job. Studies revealing that the experience of individuals with severe mental illness and pervasive discrimination in the workplace prevents psychiatric patients from reaching their full professional and personal potential.
- Impact on Self-Worth: Stigma can leads to low self-esteem, isolation, and hopelessness (12) and these negative feeling in response to stigmatization found to be a predictor of poorer social adjustment.
- Impact on Families: Stigma affects not only people with mental illnesses, but their families as well. Families commonly report ‘stigma by association’ resulting in discriminatory and prejudicial behaviors towards them.
C. WAYS TO REDUCE STIGMA ABOUT MENTAL ILLNESS
Rooney et al. (1997) had given the following two set of guidelines to design a programme to reduce stigma of mental illness
I. Reduce stigma through increasing community acceptance of mental illness and knowledge of mental illness
It is important to know about the identification, causes, treatment, and services for different types of mental illness as knowledge of mental illness is not enough for patients, family members, cares and community especially in developing countries. Acceptance through changes in feelings, attitudes and behaviors towards those living with a mental illness can only take place through a multi- level community education process where members of the community provide positive examples for other members about ways to respond, and counter the negative beliefs within the community which stigmatize those with a mental illness.
II. Stigma must be reduced at different levels operating simultaneously. There are three levels as follows
- Service delivery
- Community level
- Individual level
To reduce the stigma surrounding mental illness in communities, strategies need to be multifaceted to provide the maximum chance of accessing all members. At the community level, community change can take place via a number of strategies which involve the whole of the community at various levels. It must be from within the community, such as through key community representatives who act as role models in showing positive attitudes and behavior towards those with mental illness. However, strategies must also operate at the individual and service delivery and policy levels. An example of strategies outlines by Rooney et al. includes:
- Policies and practices that addresses the issue of diversity.
- Programmes that cater for communities.
- Employing bilingual bicultural staff.
- Employ ethno-specific workers where appropriate.
- Collaborating with other sector and services.
- Use translated materials.
- Use of ethnic media (radio and TV).
- Develop links with strategic community mobilizes to act as role models.
- Forums and work shops to bring community members and role models together.
Rooney, R.,O‘Neil,K., Bakshi, & Tan- Quigley,A.,(1997). Investigation of stigma and mental illness amongst non- English speaking background communities and development of approaches to its reduction, www.research.stigma1.html
U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services Administration, Centre for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
(Narendra Kumar Singh)