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Stigma and mental illness

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Stigma and mental illness

  1. 1. STIGMA AND MENTAL ILLNESS PREPARED & PRESENTED BY RICHARD OPOKU ASARE MEd, BEd (Hons) (Health Science), RN (Dip)-RMN, Cert. Ed
  2. 2. OUTLINE OF PRESENTATION asareor@yahoo.com©2014 2 1. Introduction 2. Definitions 3. Overt and subtle signs of stigma 4. What is difference between Stigma and discrimination 5. What is mental health stigma 6. Causes of stigma 7. Common examples of stigma 8. Consequences of stigma 9. Effect of stigma 10. Conditions stigmatized in mental health 11. Types of stigma 12. Process of stigma 13. Manifestations of stigma 14. Challenging/combating stigma 15. Other ways of fighting stigma 16. How to cope with stigma and discrimination (towards mental health & illness)
  3. 3. INTRODUCTION Stigma is a broad term which is used to describe the negative and stereotypical thoughts, attitudes, and feelings about people on the basis of the traits of a person, which can include gender, skin colour, sexual orientation, religion and mental illness. It has been used to label certain groups of people as less worthy of respect than others. These attitudes in the community are supported by ignorance, prejudice and discrimination, and are perpetuated when mental illness is represented in an inaccurate way by the media. asareor@yahoo.com©2014 3
  4. 4. INTRODUCTION – CONT’D There are still attitudes within most societies that view symptoms of psychopathology (i.e., mental illness) as threatening and uncomfortable, and these attitudes frequently foster stigma and discrimination towards people with mental health problems. Such reactions are common when people are brave enough to admit they have a mental health problem, and they can often lead on to various forms of exclusion or discrimination – either within social circles or within the workplace. 4 asareor@yahoo.com©2014
  5. 5. INTRODUCTION – CONT’D Stigma is therefore used as a negative label to identify people with mental health problems. It, thus, has its roots in fear and misunderstanding. Many people hold negative opinions towards people with mental health problems because they do not understand the issues involved and because they are relying on myths and misconceptions. As health professionals, we are committed to ensuring that people with mental health difficulties must enjoy the same rights on an equal basis with everyone without discrimination. 5 asareor@yahoo.com©2014
  6. 6. DEFINITIONS  Stigma is defined as a sign of disgrace or discredit, which sets a person apart from others (Bryne, 2000).  Erving Goffman (1963) defined stigma as the process by which the reaction of others spoils normal identity.  Stigma is an attribute, behaviour or repetition which is socially discrediting in a particular way; it causes an individual to be mentally classified by others in an undesirable, rejected or stereotyped rather than in an accepted normal one. 6 asareor@yahoo.com©2014
  7. 7. DEFINITIONS – CONT’D  Stigma results from a process whereby certain individuals and group are unjustifiably rendered shameful, excluded and discriminated against (WHO, 2002).  Stigma is the process of blaming a person wrongly and devaluing him or her for having an illness or being in an undesirable situation (Ofei & Abaka-Quansah, 2009).  Discrimination: means any distinction, exclusion or preference that has the effect of nullifying or impairing equal enjoyment of right. 7 asareor@yahoo.com©2014
  8. 8. OVERT AND SUBTLE SIGNS OF STIGMA  An overt stigma, example is making negative comments about people with mental illness or discriminating against them.  A subtle sign is believing and perpetuating the many destructive myths about mental illness, such as the idea that people with mental illness are violent or dangerous. Stigma can lead to discrimination. 8 asareor@yahoo.com©2014
  9. 9. WHAT IS THE DIFFERENCE BETWEEN STIGMA AND DISCRIMINATION?  Stigma is considered to be an opinion or judgement held by individuals or society. If these prepositions are acted upon, these actions may be considered to be discriminatory. Discrimination may be obvious and direct, such as someone making a negative remark about the person’s mental illness or his treatment. 9 asareor@yahoo.com©2014
  10. 10. WHAT IS THE DIFFERENCE BETWEEN STIGMA AND DISCRIMINATION? – CONT’D Or it may be unintentional or subtle, such as someone avoiding the individual living with mental illness because the person assumes the mentally ill person could be unstable, violent or dangerous due to his/her mental health condition. The one living with mental disorder may even judge himself/herself. Discriminating against someone at work, denying access to education, accommodation, entry to premises, membership of a club or association, or the provision of services under the guise of the individual having mental illness is unlawful (Mental Health Act 846, 2012; Disability Discrimination Act, 1992; visit the website of the Australian Human Rights Commission). 10 asareor@yahoo.com©2014
  11. 11. WHAT IS MENTAL HEALTH STIGMA? Mental health stigma can be divided into two distinct types: Social stigma is characterized by prejudicial attitudes and discriminating behaviour directed towards individuals with mental health problems as a result of the psychiatric label they have been given. Perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of discrimination (Link, Cullen, Struening & Shrout, 1989), and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes (Perlick, Rosenheck, Clarkin, Sirey et al., 2001). 11 asareor@yahoo.com©2014
  12. 12. CAUSES OF STIGMA  Ignorance/misconceptions – misperceptions about the cause or onset of the disease as a curse from the gods, punishment for one’s sins, witchcraft, black magic, demonic, spirit possession, etc.  Cultural factors/belief system – this about the myth and misunderstanding  Media – Stigma in the media is especially harmful because the media plays an important role in shaping and reinforcing community attitudes, i.e., spreading wrong information. For example, cinematic depictions of schizophrenia are often stereotypic and characterized by misinformation about symptoms, causes and treatment. Schizophrenic characters portray violence behaviour, carry dangerous act, and commit suicidal and homicidal behaviours. 12 asareor@yahoo.com©2014
  13. 13. CAUSES OF STIGMA – CONT’D  Fear – people fear the unknown outcome of the condition; the condition itself and burden of care.  Lifestyle – such as smoking and other drug use, and the act being seen as shameful.  Lack of treatment facilities – the presence of inadequate preventive facilities.  Lack of information systems – lack of education to both professionals and to the general public.  Economic instability – deals with poverty. 13 asareor@yahoo.com©2014
  14. 14. CAUSES OF STIGMA – CONT’D  Previous experience – most people have experience some form of the disease that might be similar to that particular disease that is stigmatized. They may also have seen people die from the condition in a bizarre circumstance due to family/societal neglect. Sometimes, people compare and test, and question the information they have heard with their own experiences, beliefs and common sense. 14 asareor@yahoo.com©2014
  15. 15. CAUSES OF STIGMA – CONT’D  Medical diagnosis – the medical model implies diagnosis, and diagnosis implies a label that is applied to a ‘patient’. That label may well be associated with undesirable attributes (e.g., ‘mad’ people cannot function properly in society, or can sometimes be violent), and this again will perpetuate the view that people with mental health problems are different and should be treated with caution. 15 asareor@yahoo.com©2014
  16. 16. COMMON EXAMPLES OF STIGMAS  People with mental illnesses are crazy  Schizophrenia is the same thing as multiple personality disorder.  People with mental illnesses are always dangerous and violent.  “Psycho” and “psychotic” mean violent and dangerous. (Psycho is more of a common slang meaning violent and crazy person. Psychotic when used medically actually refers to psychosis, or serious state of sickness where a person is suffering from very severe degrees of their symptoms, such as delusions, hallucinations and so forth.) 16 asareor@yahoo.com©2014
  17. 17. COMMON EXAMPLES OF STIGMAS – CONT’D  Cannot simply “get over their problems,” i.e., get your head straight, smarten up, etc.  Stigmas are often fixed ideas or judgements  Stigma often includes prejudice and/or discrimination.  The tone of voice or bodily language people might use when describing mental illness. 17 asareor@yahoo.com©2014
  18. 18. CONSEQUENCES OF STIGMA  It could lead to prejudice; for example, that mental disorders are dangerous.  Mistaking belief – that mental illness is a curse from the gods, witchcraft, black magic, etc.  Misleading media information.  Damaging self-belief, i.e., sense of personal worth and self-esteem is affected; the person becomes shameful and unwilling to seek medication attention, or disclose an illness.  It leads to negative attitude towards professionals who have dedicated their lives to serve and care for those suffering from the condition(s). 18 asareor@yahoo.com©2014
  19. 19. EFFECT OF STIGMA  Loss of confidence  Failing to seek medical attention  Low self esteem  Divorce  Keep people from accessing counselling  Stigma prevent others from caring for the mentally sick  Loss of job/lack of employment  Financial problems  Rejection 19 asareor@yahoo.com©2014
  20. 20. EFFECT OF STIGMA – CONT’D  Missed opportunities  Defensive  Become withdrawn  Become or feel ostracized  Might start avoiding confrontation at all costs  Might bottle it up and ‘explode’ or get angry about it  Undervalued Some of the harmful effects of stigma can include: 20 asareor@yahoo.com©2014
  21. 21. EFFECT OF STIGMA – CONT’D  Reluctance to seek help or treatment.  Stigma hinders efficient and effective recovery from mental health problems.  Lack of understanding by family, friends, co-workers or others the patient know.  Fewer opportunities for work, school or social activities or trouble finding housing.  Bullying, physical violence or harassment.  Health insurance that doesn’t adequately cover the patient’s mental illness treatment.  The belief that the patient will never be able to succeed at certain challenges/jobs/profession or that s/he can’t improve his/her situation. 21 asareor@yahoo.com©2014
  22. 22. CONDITIONS STIGMATISED IN MENTAL HEALTH  Epilepsy  Schizophrenia  Mental retardation  Substance abuse  Post-traumatic disorder (anxiety)  Depression  Dementia  Delirium  Antisocial personality disorder 22 asareor@yahoo.com©2014
  23. 23. TYPES OF STIGMA  Self stigma – is where individuals with mental illness feel they are being judged by others, so they feel disgraced, blame and isolate themselves from people. It is one of the most harmful effects of stigma. Self stigma occurs when it alters how the person views himself/herself. The person living with mental illness may mistakenly believe that his/her condition is a sign of personal weakness or that s/he should be able to control it. Besides, self- stigma is the acceptance of prejudiced perceptions held by the patient. 23 asareor@yahoo.com©2014
  24. 24. 24 asareor@yahoo.com©2014
  25. 25. SELF STIGMA – CONT’D This can lead to reluctance to seek treatment, excessive reliance on others; social withdrawal, poor self-worth and it may also lead to abuse of alcohol and drugs. Thus, self stigma can lead to self-blame and low self-esteem. 25 asareor@yahoo.com©2014
  26. 26. TYPES OF STIGMA – CONT’D  Felt stigma – the perception or feeling one has towards people with same specific disease or condition which they also have.  Enacted stigma/Discrimination – this is where there is discrimination against individuals living with mental illness or people who have some of the condition or disease in their community. 26 asareor@yahoo.com©2014
  27. 27. OTHER TYPES OF STIGMA 1. Physical deformity (external or overt deformity) – deals with stigma against one’s physical disability such as having scars, leprosy, cleft lip or palate, muscular dystrophy. 2. Poor personal trait – such as being perceived rightly or wrongly, as weak-willed, domineering or having unnatural passions, and rigid beliefs, and being dishonest may be seen as deviations in personal trait. Besides having mental disorder, having criminal record, and once imprisoned, unemployed, drug and alcohol addiction, homosexuality, suicidal attempt, and radical political behaviour are stigmatized against in this way under personal trait deviation. 27 asareor@yahoo.com©2014
  28. 28. OTHER TYPES OF STIGMA – CONT’D 3. Tribal outgroup status (Tribal stigma) – are traits, imagined or real, of ethnic groups, nationalities, race or religions that are deemed to constitute a deviation from what is perceived to be the prevailing normative ethnicity, nationality, race or religion. For example, being African American or being of Arab descent in the United States after the 9/11 attacks may carry a tribal stigma (Campbell & Deacon, 2006). 28 asareor@yahoo.com©2014
  29. 29. PROCESS OF STIGMA The stages in the process of stigmatization include: 1.Labelling – the process of stigma begins when individuals with mental illnesses are first identified, marked and labelled, and seen to be different from others. 2.Negative reaction – there is negative behaviour towards individuals with mental illnesses because their situations are seen as a result of their sinful behaviour or a curse from the gods. 29 asareor@yahoo.com©2014
  30. 30. PROCESS OF STIGMA – CONT’D 3. Shunning – they are shunned, rejected, avoided, and separated from other people, family or community because of their disease state. 4. Lose of status – these individuals lose their respect, position, dignity, statuses, and even be isolated from the family or community. Some individual’s rights are even trampled upon and are sacked from their work place, school, or even ejected from their place of residence. 30 asareor@yahoo.com©2014
  31. 31. MANIFESTATIONS OF STIGMA Stigmatization manifests in the following forms of behavior: 1.Physical stigma. People living with mental illness, HIV/AIDS, and other infections are isolated physically (not allowed into shared spaces, not allowed to share clothing, eating utensils, etc.) or, in extreme cases, may even experience forms of physical attack. 2.Social stigma. When people are isolated socially and they start losing their social identity and their social structure starts dissolving (not being invited to social events, loss of communication with loved ones, not being visited, loss of friendships, etc.). But there is also the loss of privacy, the fact that his/her (your) illness is forced into the open. 31 asareor@yahoo.com©2014
  32. 32. MANIFESTATIONS OF STIGMA – CONT’D 3. Verbal stigma. When people use pejorative language when referred to someone living with mental illness, HIV/AIDS, etc. or in reference to the illness itself. 4. Institutional stigma. When people lose their jobs or any other form of discriminatory practice. 32 asareor@yahoo.com©2014
  33. 33. CHALLENGING/COMBATTING STIGMA The three most successful ways of reducing stigma are: 1.Education involves replacing misperceptions with actual facts. 2.Contact involves changing public attitudes about mental illness through direct interactions with people who have experienced mental illness. 3.Protest is used as a way to suppress negative behaviour, and is most commonly used to challenge the way that the media present mental illness. 33 asareor@yahoo.com©2014
  34. 34. CHALLENGING/COMBATING STIGMA – CONT’D To challenge stigmatization, Campbell, Foulis, Maimane, and Sibiya (2005) summarise three main approaches: Firstly, there are efforts to educate individuals about the non-stigmatising facts and why they should not stigmatise. Secondly, there are efforts to legislate against discrimination. Thirdly, there are efforts to mobilize the participation of community members in anti-stigma efforts, to maximize the likelihood that the anti- stigma messages have relevance and purchase, according to local contexts. 34 asareor@yahoo.com©2014
  35. 35. OTHER WAYS OF FIGHTING STIGMA  Breaking the culture of silence about causes mental illness.  Using group dynamics to discuss issues of stigma.  Sharing knowledge on issues at stake.  Being a role model.  Counselling individuals.  Passage of law, e.g., Mental Health Act 846 (2012).  Mental health taught as a subject in the schools.  Establishment of health care facilities. 35 asareor@yahoo.com©2014
  36. 36. OTHER WAYS OF FIGHTING STIGMA – CONT’D  Stigma against mental illness should be part of political agenda.  Create more supportive environment with people with mental illness.  Serve as an advocate.  NHIS should cover drugs and other treatment for mental illness.  Media should talk positively about mental health.  Dissemination of information in the community.  People with mental illness could also form association. 36 asareor@yahoo.com©2014
  37. 37. PEOPLE LIVING WITH MENTAL DISORDERS SHOULD, WHERE POSSIBLE, BE ENCOURAGED TO:  Go public and share their experience of illness and of discrimination.  Participate in information and education campaigns.  Join (or where necessary form) associations and support groups.  Express their needs to service providers, NGOs and government.  Join in planning services that avoid stigma and discrimination.  Challenging and reporting any professional practice that is stigmatising or discriminatory. 37 asareor@yahoo.com©2014
  38. 38. HOW TO COPE WITH STIGMA AND DISCRIMINATION (TOWARDS MENTAL HEALTH & ILLNESS) 1. Educate yourself, help yourself first 2. Educate others (after you have a good knowledge of issues and the science behind it, and symptoms, and medications, etc.). Be an advocate for those that can’t voice proper knowledge about mental health issues. 3. Have an understanding of our illness. It is unfortunate that often people with the illness do not believe they even have it, and turn down medication. It often takes an event of hospitalization or severe sickness or illness to make people realize they do actually have an illness, so more education is needed to prevent some of these things from happening. 38 asareor@yahoo.com©2014
  39. 39. HOW TO COPE WITH STIGMA AND DISCRIMINATION (TOWARDS MENTAL HEALTH & ILLNESS) – CONT’D 4. Find people with similar values and beliefs (even in areas outside of mental health) 5. Be aware of your thoughts and reality test them 6. Assertiveness (be assertive), it can help combat a lot of troubles such as low self-confidence and low self-esteem that are often a symptom of mental illness. Positive affirmations - We are not alone - We have choices - We can have a say 39 asareor@yahoo.com©2014
  40. 40. END OF LECTURE THANK YOU 40 asareor@yahoo.com©2014

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