Mental Health and Stigma

University Degree Subjects allied to Medicine

This assignment will discuss the stigma that is attached to having a mental illness, it will detail why this is an issue, what is being done to fight stigma, and what model of mental health can better help us to understand this issue.

Having and living with mental illness each and every day can be extremely traumatic for the sufferer, this without having to face the stigma they often do.

Stigma is “a mark or sign of disgrace or discredit” as defined by the Oxford Handy Dictionary. Stigma causes people to feel uncomfortable around an issue, or can also cause people to mock the issue in order to make it less threatening to them. People who feel uncomfortable will often refuse to talk about mental illness therefore causing a silence around the subject. People usually tend to attach stigma to others that are different from them. Or often, due to mistaken beliefs, the mentally ill are thought to be dangerous. The stigma attached to mental illness is the main obstacle to better mental health care and better quality of life for people who have the illness, for their families, for their communities and for health service staff that deal with psychiatric disorders.

For people with mental health issues, stigma is a huge problem faced every day, causing difficulty in many, often everyday, things, for example finding employment, getting a mortgage, or simply getting up in the morning. It discourages victims of mental illness to seek the help they need, this leads to problems escalating due to lack of medical input, and in worst case scenarios, suicides. According to the Department of Health (1999) on average, two people with mental health problems commit suicide every day. In a study on student suicide by researchers from the University of Central

Lancashire with King’s College London, Stanley et al found (of twenty case studies of student suicides which occurred between May 2000 and June 2005) that many of the students were concerned about the stigma associated with use of mental health services and therefore some were unwilling to use them. Also the students’ friends and parents reported that a number of those who had died had viewed taking antidepressants as stigmatising and ineffective.

Stigma directed from others is not the only type of stigma that can occur, self-stigma is also a problem in which the patient has experienced stigma or “knock backs” from others.

If a patient is diagnosed as having a mental illness, their friends may suddenly abandon them - because of the mental illness and the uncertainty surrounding it – a domino effect can ensue - they can feel as if there is no point trying to make new friends because of the stigma attached to their illness, we can query whether this enhances depressive feelings, and worthlessness. The question arises of why does mental illness cause such stigma?

There are two main answers to this question, firstly, cultural beliefs and then secondly the attitude and reporting of the media. Many people from different cultures see mental illness as shameful and therefore do not seek treatment until absolutely necessary.

“Stigma and a lack of education about mental illness cause great suffering for Latino families, MaJosé Carrasco, M.P.A., director of the NAMI Multicultural Action Center, told attendees at the Congressional Hispanic Caucus Institute.

In the minds of some Hispanics, "mental illness is associated with danger and violence and is often attributed to a lack of character or to punishment from God.” (Levin, 2007)

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In the minds of some Hispanics, "mental illness is associated with danger and violence and is often attributed to a lack of character or to punishment from God.” (Levin, 2007)

The media (especially tabloids) tend to lack sensitivity towards the mentally ill and fuel stigma and negative attitudes. By using words such as “psycho” and “bonkers” the media seems to be encourage people’s unfounded beliefs that stigma is acceptable and to believe that all mentally ill patients are dangerous. We have recently seen in many tabloids the case of “Gazza” (Paul Gascoigne) and his prolonged struggle with mental health issues, tabloid scrutiny and misrepresentation do little to discourage stigmatisation. The media also tends to report on only negative aspects of mental illness, for example news on a murder of an innocent bystander by a mentally ill person, when the reality is that nearly all victims of mental illness are harmless.

“Killings by people with mental disorders in England and Wales have fallen by two-thirds in the past quarter century, and are now at historically low levels.

The finding, based on an analysis of official homicide statistics from 1946 to 2004, reveals that public concerns about increasing violence by mentally ill people are unfounded.” (Nowak, 2008)

Through television, the population see characters (with mental illness) on programmes or films that are (in character) dangerous, sadistic and volatile. Obviously this type of mental illness does occur, but this makes for better viewing figures, and does not reflect the illness of the majority of mentally ill patients. It is the sad truth that mental health issues are not given the sensitivity that is necessary by the media. There are stereotypes all around us: popular films about murderers who have mental health issues. Then there is always news coverage of tragedies and violence caused by people with mental health issues. The media’s use of terms like "psycho" or "crazy." fuels the public’s impression of mental illness being dangerous and unspeakable. The use of the insanity defence in court cases, for example the case of the Hillside Strangler (Kenneth Bianchi) who raped, tortured and murdered a number of women in America. Bianchi claimed to have multiple personality disorder, thinking this would increase his chances of being found not guilty by reason of insanity - to try to escape what would inevitably be a life sentence in prison. Fortunately he did not convince psychologist Martin Orne and was deemed a clever liar, eventually having to change his plea to guilty.

“Unfortunately, it is the rare but highly publicised cases such as the Hillside Strangler…cases that seem to have the greatest impact and provoke public outrage and suspicion.” (Sue, Sue, Sue.1994. p612)

We often see news coverage of homelessness, (fairly frequently over Christmas) this is typically attributed to mental health issues, which may not be the cause in many instances. These representations distort the public’s outlook and reinforce inaccuracies about mental health issues.

It is not just the public who can adopt negative attitudes to the mentally ill, health professionals and GP’s can also stigmatise the mentally ill.

“The Mental Health Foundation research found that 44% of people who has experienced mental distress said that they had experienced discrimination from GPs. 35% of people surveyed said they had experienced discrimination from health professionals other than GPs.”

The main reason for these discriminatory behaviours is that some health care professionals are not knowledgeable or experienced in mental illness. Hence they may not actually be able to offer the best advice or care, patients should always be referred to the best available professional and health education may now need to look towards better training, and indeed recruitment, of future mental health workers. However ‘Moving People’ is planning a £7million advertising campaign to try to change public attitudes to people with mental health issues, in which ten thousand trainee doctors and teachers will be educated in a training programme about mental health issues.

To help combat stigma and to help understand the mentally ill, in some cases the medical model can be used. In the medical model, it is explained that abnormal behaviors can result from physical problems and should be treated medically. It shows that some mental disorders can be treated with medicine. It considers recovery to be a reduction in symptoms, a reduced need for medication and a reduced need for medical and social care services. In this approach recovery requires a 'cure' for the illness and tends to consider people with mental illness as passive recipients of treatment and services. Therefore this model shows that it is physical problems that result in mental health problems, such as a decreased brain dopamine (neurotransmitter) concentration is a contributing factor in Parkinson’s disease, while an increase in dopamine concentration has a role in the development of schizophrenia.

We can easily see here how the general public would better understand that someone who can show a physical symptom which may cause them to be mentally ill is not necessarily a “psycho” Which of us can say that being diagnosed with a terminal illness would not cause us severe depression or some associated symptom of mental illness, most people would follow the logic of this and sympathise, rather than stigmatise.

However, mental illness can also be caused by stress in everyday life, the workplace, and here people can mistakenly develop the view that the mentally ill are weak, all people are different and what one person feels stressed by will not affect another, we need to encourage empathy.

There are organisations fighting stigma, such as Rethink and The Royal College of Psychiatrists, the professional body for all psychiatrists working in the UK and the Republic of Ireland, which has public education as one if its main objectives.

Time to Change is an ambitious programme based in England to end the discrimination that victims of mental illness face, the programme is backed up by international evidence on the things that work, having people who have mental illness at its core. It is currently being launched. They have a vision that they will end stigma and improve the lives of people experiencing mental health issues. The programme is funded by two million pounds from Comic Relief and sixteen million from the Big Lottery Fund and is led by Mind, Rethink and Mental Health Media. It is evaluated by the Institute of Psychiatry at King’s College in London.

Time to Change wants to educate the public that;

Mental illness is a lot more common than the general perception of the public, that one in four people will acquire a mental health problem at some point in their life, so therefore; mental illness is an ordinary part of everyday life, not something that should never be talked about, or mocked.

Mental illness is still a taboo, why? When views and opinions towards so many other issues have changed and become more modern. It has been found that stigma and discrimination prevents nine out of ten people with mental health problems from doing normal, everyday things like going to the pub or shops or having normal relationships with family and friends. It prevents people speaking out, seeking help, attempting to find jobs and joining in social situations – it ruins lives. Time to Change wants mental illness to no longer be a taboo.
Time to Change also wants to acquire a behaviour change and challenge attitudes towards people with mental health issues, to achieve this Time to change will use a range of different activities such as;

Using advertisements, that will get people actually talking about mental health instead of ‘sweeping it under the carpet.’ Showing people who have experienced mental illness, talking about how it is to live with a mental illness and how people who surround them have helped or hindered them in their road to recovery.

Having local activity, with Time to Change projects being run locally, and having help from NHS organisations and voluntary sector groups involved in the campaign in their particular area.

Involving the public with free resources such as posters and leaflets, a toolkit will also be available to help the public to help the campaign themselves.

Rethink are the leading national mental health membership charity, they work to help everyone affected by severe mental illness obtain a better quality of life. Rethink were founded over thirty years ago to give a voice to people affected by severe mental illness and today, with over 8,300 members, they are still determined that this voice will continue to be heard. They help over 48,000 people every year through services, support groups and by providing information on mental health problems.

At the University of Central Lancashire, Rethink has been working on the need for anti stigma work, so that the university students are encouraged to seek early support when they feel something is wrong. The name of this project is ‘Rethinking student mental well being’ and is funded by the Big Lottery and Comic Relief and its overall aim is to challenge the increasing issue of mental health stigma, raising awareness throughout the student and staff population.

In conclusion there are several groups attempting to focus on reducing the stigma attached to mental health issues but generally it is the attitude of the general public that needs to be changed. By and large if the media could focus it’s attention, and it’s reporting, on more positive aspects of the illnesses, i.e. people’s recovery and more modern treatments, then obviously we would see an upturn in the everyday beliefs and attitudes of the public. An increase in the recruitment and better training of mental health personnel would also encourage the delivery of better care, leading to a lessening of negative attitudes, as patients become better placed and able to be part of everyday life.

2087 words

Naidoo. J, and Wills. J. 2001. Health Studies: an Introduction. Basingstoke, Palgrave.

Stanley, N, Mallon, S, Bell, J Hilton, S and Manthorpe, J. 2004 – 2006. Responses and Prevention in Student Suicide: The RaPSS Study. Papyrus.

Sue, D., Sue, D. and Sue, S. 1994. Understanding Abnormal Behaviour. Boston, Houghton Mifflin Company.