Mental Health stigma and Discrimination

 Mental Health Stigma and Discrimination

For over four decades, particularly, since an influential work by Goffman (1963), the notion of stigma has attracted a great deal of attention in sociology and social psychology. Stigma is a complex phenomenon involving an interplay between social and economic factors in the environment and psychosocial issues of affected individuals. A basic thesis of the sociological literature on stigma is that individuals who (for some reason) have failed to conform to social norms could be persistently denied full acceptance by the society (Goffman, 1963). Seminal work by Goffman (1963) and Thomas Scheff (1966) described the stigmatizing process that may follow from being identified as having a mental illness, and numerous research studies have attempted to demonstrate the unfavourable effects of mental illness labelling. Labelling and discrimination against people with mental disorders is widespread, often formalised, and sometimes even codified in law. For example, although Zambia has a mental health law, the 1951 mental disorders Act, the law stigmatises people living with mental illness by using an unpalatable language and the law does not have any provisions for disability benefits. Another example of systematic discrimination is exclusion of mental disorders from exemption to free care. In a KAP study of health workers in Mumbwa and Lusaka, it was noted that staff had high levels of negative attitudes toward people with mental illness and staff tend to create wide social distances by sharing the same negative opinions towards mental illnesses.

 

 Types of Stigma

 

Goffman (1963) identifies three types of stigma: (i) abominations to the body or stigma related to deformities (ii) stigma related to the blemishes of individual character and (iii) tribal stigma. Mental illness stigma is a matter of great concern to mental health advocates. This stigma has two faces. The first one is enacted stigma and the second one self stigma.

 

Enacted stigma that is projected on a person by members of society. It is projected in form of:

 

1. Labelling or verbal stigma. Society does select labels to which they attach meanings. Sometimes use of fingers, insulting, cursing, judgemental statements, taunting or blaming occurs. An example from the country report will suffice:

 

2. Stereotyping. Stereotypes are efficient knowledge structures that represent a social group. Stereotypes are considered "social" because they represent collectively agreed upon notions of groups of persons (e.g., “People living with mental illness will fail to recognise colours," "most people with mental illness are dangerous"). "Sean is mentally disordered, so he's likely to be dangerous driver." In some ways, stereotypes are considered to be both valueless and without affect (Crocker et al. 1998; Fiske 1998). Many Zambians have heard the statement that all people with a mental disorder cannot fend for themselves and as such it may be assumed that a person who has a mental illness should not be pregnant at all.

 

3. Discrimination. This third aspect of the stigma process occurs when social labels connote a separation of "us" from "them." It may be institutional or personalised. For example, in an outpatient setting, we create a screening room only for people with mental disorders and when a new hospital is constructed, we do not even consider having a mental annex or integrating mental ill health beds within the general health care. This form of structural discrimination, in which institutional practices work to the disadvantage of stigmatized groups, is common in Zambia. Another example, in 2006, mental illness receives low levels of funding for treatment relative to other illnesses. the proportion of the total budget spent for mental health services by the Ministry of Health was a paltry 0.38% (K 218 1151 743.00) in the year under review Out of this 48 percent was ascribed to the only mental hospital.

 Felt or self stigma is constructed by projected on a person with a mental disorder. Self stigma is said to exist when people have negative attitudes about and against themselves as a result of internalizing stigmatizing ideas held by society (Corrigan and Watson, 2002).  How does this internalising create self stigma? First, persons who turn prejudice against themselves agree with the stereotype: “That’s right; I am weak and unable to care for myself!” Second, self-prejudice leads to negative emotional reactions, especially low self-esteem and self-efficacy (Wright et al., 2000). Also self-prejudice leads to behaviour responses. Because of their self-prejudices, persons with mental illness may fail to pursue good health behaviours.  If they fail to reach this goal this is often not due to their mental illness itself but due to their self-discriminating behaviour (Link et al., 1989). Many persons with mental illness know the stereotypes about their group such as the belief that people with mental illness are incompetent (Hayward and Bright, 1997). For example, people may perceive depression as being due to a weak personality. Such stigmatizing views may impact on help-seeking (not seeking care or not to care for one self) because sufferers do not wish to show their ‘weaknesses’ to others. In addition, people living with mental illness may isolate themselves.

Consequences of Stigma

 

Stigma harms people who are publicly labelled as mentally ill in several ways. Stereotype, prejudice, and discrimination can rob people labelled mentally ill of important life opportunities that are essential for achieving life goals. People with mental illness are frequently unable to obtain good jobs or find suitable housing because of the prejudice of key members in their communities: employers and landlords. Several studies have shown that public stereotypes and prejudice about mental illness have a deleterious impact on family and community support for individuals who may have a mental disorder. Individuals with a mental disorder have the burden of being rejected by family and friends and may even be accused of ―contaminating‘or tainting a family‘s name.  It’s easy to label someone else and overlook what’s really inside. Stigma is not just the use of the wrong word or action. Stigma is about disrespect. It is the use of in many settings of negative labels to identify a person living with mental disorder. Stigma is a barrier and discourages individuals and their families from getting the help they need due to the fear of discrimination. Psychiatric stigma may be especially severe in non-Western communities because of the meagre expenditure on mental health care, limited access to medical information, unpopularity of the human rights discourse, prohibitive risk of disclosure of psychiatric treatment, and the paucity of advocacy work (Lee, 2002). ‘‘Mental health professionals should recognize that improving public attitudes is an intrinsic part of their every day work. If professionals deliver good care, people get better, and the public see that for themselves.’’ (Prior, 2004).

 

What can we do to reduce and prevent mental health related stigma?

There are number of steps we can take to reduce and overcome mental health related stigma.

 

1.               We need to develop anti stigma programs with substantive elements targeting all types of stigma paying attention to the following:

·       Myths about the causes of mental disorders.

·       Causes of mental disorders.

·       Ensuring that our communities have a deep understanding of what mental illness is.

·       Creating recognition and understanding of mental disorder stigma including what it is ; how it is harmful to ourselves, our families and our communities and the role each person has to play in reducing it. 

2.               At the outset, as in charges of health facilities, we need to translate the existing mental health policies and develop institutional and care practice plans and activities to improve mental health and reduce the burden of mental disorders.

3.               We need to support the new legislation which intends to guarantee human rights, ensure mental health integration into general health care.

4.               We need to advocate for inclusion in our health care settings - mental health agenda in all clinical activities (budgeting, drug supply and programming).

5.               Ensure the availability and access of essential medicines for people living with mental disorders by including psychotropic drugs in the general health care essential drug kit. Since medicines are often not available in health-care facilities, patients and families need to be helped to access them.

We need to know that some words and acts could be poison and others could heal. For poisonous words, we do not have to speak them.