Stigma and Mental Health

According to the 2015 British Social Attitudes survey, 24% of people in the UK have experienced mental health issues in some way - and 59% of people know someone close to them who has had a diagnosis.1

Yet despite this prevalence there are still misconceptions about mental illness that result in negative social stigma. For example, one study found that people think schizophrenics are unpredictable and dangerous, people with mental disorders are “hard to talk with,” and people with eating disorders have brought it upon themselves.2 As a recent paper described, “many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common.”3 

Negative Effects of Stigma

These negative (and incorrect) opinions lead to prejudice and discrimination against those seeking treatment for their mental health and can compound the challenge by creating social isolation, distress and difficulties in employment.4 People with depression and schizophrenia may be much less likely to be promoted at work.5 And the stigma can also have a wider negative effect by impacting the patient’s “support system, provider network, and community resources.”When people internalise the stigma of mental illness, this can worsen their symptoms because they are less inclined to seek help, while also experiencing a loss of hope, self-esteem and empowerment.7 For example, young people often don’t seek help for their mental health because of perceived stigma and embarrassment.8 

The Origins of Stigma

The roots of this stigma are complex and can originate from cultural and social norms, as well as self-stigma arising from one’s own beliefs. In general, the stigma of mental illness is a “universal occurrence,”9  but there has also been research on specific communities, like Black and Minority Ethnic (BAME) communities in the UK,10 in which 93% of people who have mental health problems face discrimination because of them.11 In the BAME community, this is thought to arise because of “reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health.”12 

Recent Media Coverage - Is It Getting Better?

In recent years, many well-known celebrities and personalities have been more openly discussing mental health in a positive, productive, and destigmatising way.13 But media coverage still has a long way to go in its portrayals and generalizations about those with mental illness. In the US, analysis of news coverage from 1995 – 2014 found that there was an increase in the number of stories on the treatment of mental health, but that there was also “continued emphasis on interpersonal violence… disproportionate to actual rates of violence among those with mental illnesses.”14 Similarly, a study of news coverage in the UK between 2008 – 2014 revealed fewer articles promoting ideas about dangerousness or mental illness being selfinflicted, but more articles portraying people as incapable.15 Nevertheless, there are signs of improvement: the 2015 British Social Attitudes survey found that workplace stigma has lessened from 2000 – 2015, though it still has a long way to go.16

                                      Combating Stigma: Programmes and Initiatives

Building Mental Health Literacy

Mental health literacy refers to how much a person accurately understands, recognises and knows about the signs and symptoms of mental illnesses. It has been shown to directly influence people’s attitudes towards mental health.17 In other words, a good understanding of mental health means people approach the topic in a positive way, without feeling stigmatised about seeking help.18 Not only does positive mental health literacy help to reduce the stigma, but knowledge of how to obtain and maintain good mental health is also “a significant determinant of mental health.” Boosting the public’s knowledge of mental health issues can have “a crucial effect on the ability to recognise signs of mental illness, as well as on supporting help-seeking and accepting treatment,”19,20  It’s also important to clarify that mental health literacy doesn’t have to be obtained through rigorous study or elaborate programmes: even the simple act of having social contact with those with mental illness has been shown to be “the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term.”21 Building mental health literacy is important in helping shift behaviours and attitudes so that people don’t feel stigmatised for seeking support.22

Educational Programs

Many successful educational anti-stigma initiatives have been evaluated, including: 

       Mental Health Matters in the UK, “a mental health curriculum that is integrated with English language arts… [that] aims to increase knowledge and decrease stigma toward individuals with mental health disorders.”23

       Healthy Young Minds in Canada, a 1-hour classroom-based workshop, led by medical students, on mental illness stigma amongst secondary school students.24

       A three-semester program in Greece that promoted mental health among adults, which had a positive effect on their attitudes towards mental illness and their own mental health.25

       Anti-stigma educational interventions in the workplace, which have been shown to lead to improved employee knowledge and supportive behaviour towards people with mental-health problems.26

Marketing Campaigns

Anti-stigma marketing campaigns tend to have “mixed results,” often failing to generate significant awareness or behaviour change across society,27 though there are some success stories, e.g., a social media campaign from Time To Change that was found to effectively reduce stigma.28 In general, researchers tend to agree that anti-stigma marketing campaigns are most effective when they target specific groups, rather than being aimed at the broader general public.29,30

Media Literacy Programs

Media literacy programs help people understand, learn and think critically about the ways in which they are affected by media and the images that it portrays, e.g., in the case of anorexia, it helps combat distorted attitudes about weight and appearance.31 These programs can be particularly helpful in reducing the stigma of mental illness among teens, as shown by evaluations of the Let’s Talk initiative in Canada. This national school curriculum uses media literacy to teach students “about the portrayal of mental health and mental illness in the media.” It succeeds by creating natural opportunities to discuss stigma in a safe environment; that is, by using media examples as a conduit for discussing mental health, students can talk more freely instead of having to reveal personal examples.32 

Conclusions 

       One of the challenges in the prevention and treatment of mental illnesses is the associated stigma, which can prevent people from seeking help. 

       Stigma is often based on public misconceptions about mental illness – so better public knowledge, as well as social contact with people with mental illness, can help reduce stigma. 

       Recent media coverage has been more sympathetic to mental illness but needs to improve further – in particular by not disproportionately reporting violent incidents and by not routinely portraying people with mental illness as incapable. 

       Educational programmes (including media literacy) in schools and workplaces can reduce stigma – and one initiative suggested medical students can be a useful resource here. 

       Anti-stigma marketing campaigns can also be effective but usually when targeting specific groups. 

       The media, schools, employers and mental health charities can all help reduce stigma – and there may be potential for medical students to help, particularly with young people. 

By building awareness and reducing the stigma of mental illness, there is a greater chance that people will seek the support and treatment they need.

Jennifer Jamieson July 2018

 

References

 

[1] NatCen Social Research. Attitudes to mental health problems and mental wellbeing: Findings from the 2015 British Social Attitudes survey. 2015. Available from http://www.bsa.natcen.ac.uk/media/39109/phe-bsa-2015-attitudes-to-mental-health.pdf

[2] Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. British Journal of Psychiatry. 2000; 177(1): 4-7.

[3] Jorm AF. Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry, 2000; 177(5): 396-401.  

[4] Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. British Journal of Psychiatry. 2000; 177(1): 4-7.

[5] NatCen Social Research. Attitudes to mental health problems and mental wellbeing: Findings from the 2015 British Social Attitudes survey. 2015. Available from http://www.bsa.natcen.ac.uk/media/39109/phe-bsa-2015-attitudes-to-mental-health.pdf

[6] Corrigan PW, Druss BG, and Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest. 2014; 15(2): 37-70.

[7] Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine. 2010; 71: 2150-2161

[8] Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010; 113(10).

[9] Koschorke M, Evans-Lacko S, Sartorius N, Thornicroft G. Stigma in Different Cultures. The Stigma of Mental Illness - End of the Story? 2016: 67-82.

[10] Time to Change UK. Challenging mental health related stigma and discrimination experienced by Black and Minority

Ethnic communities – a summary. 2012. Available from https://www.time-to-change.org.uk/sites/default/files/black-minority-ethnic-communities-position-statement-summary.pdf

[11] Time to Change UK. Black and Minority Ethnic communities faced with double the levels of discrimination. 2014. Available from https://www.time-to-change.org.uk/news/black-and-minority-ethnic-communities-faced-double-levels-discrimination

[12] Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, de Visser R. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open. 2016; 6: e012337.

[14] McGinty EE, Kennedy-Hendricks A, Choksy S, Barry CL. Trends In News Media Coverage Of Mental Illness In The United States: 1995–2014. Health Aff (Millwood). 2016; 35(6): 1121–1129.

[15] Rhydderch D, Krooupa A-M, Shefer G, Goulden R, Williams P. Thornicroft A, Rose D, Thornicroft G, Henderson C. Changes in newspaper coverage of mental illness from 2008 to 2014 in England. Acta Psychiatrica Scandinavica. 2016; 134(S446), 45-52.

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[17] Jung H, von Sternberg K, Davis K. The impact of mental health literacy, stigma, and social support on attitudes toward mental health help-seeking. International Journal of Mental Health Promotion. 2017; 19(5): 252-267.

[18] Gorczynski P, Sims-schouten W, Hill D, Wilson JC. Examining mental health literacy, help seeking behaviours, and mental health outcomes in UK university students. The Journal of Mental Health Training, Education and Practice. 2016; 12(2): 111-120.

[19] Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. 2016; 16(1).

[20] Bjørnsen HN, Espnes GA, Eilertsen M-E B, Ringdal R, Moksnes UK. The Relationship Between Positive Mental Health Literacy and Mental Well-Being Among Adolescents - Implications for School Health Services. The Journal of School Nursing. 2017.

[21] Mehta N, Clement S, Marcus E, Stona AC, Bezborodovs N, Evans-Lacko S, Palacios J, Docherty M, Barley E, Rose D, Koschorke M, Shidhaye R, Henderson C, Thornicroft G. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry. 2015;207(5):377-84.

[22] Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest. 2014; 15(2): 37–70.

[23] Weisman HL, KiaKeating M, Lippincott A, Taylor Z, Zheng J. Mental Health Stigma Prevention: Pilot Testing a Novel, Language Arts CurriculumBased Approach for Youth. Journal of School Health. 2016; 86 (10), 709-716.

[24] Ke S, Lai J, Sun T, Yang MMH, Wang JCC, Austin J. Healthy Young Minds: The Effects of a 1-hour Classroom Workshop on Mental Illness Stigma in High School Students. Community Ment Health J. 2015; 51(3): 329–337.

[25] Tomaras VD, Ginieri-Coccossis M, Vassiliadou M, Malliori M, Ferentinos S, Soldatos CR, Tylee A. Education in mental health promotion and its impact on the participants' attitudes and perceived mental health. Ann Gen Psychiatry. 2011; 10: 33. 

[26]Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. 2016; 16(1).

[27]Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. 2016; 16(1).

[28] Sampogna G, BakolisI, Evans-Lacko S, Robinson E, Thornicroft G, Henderson C. The impact of social marketing campaigns on reducing mental health stigma: Results from the 2009–2014 Time to Change programme. European Psychiatry. 2017; 40: 116-122.

[29] Clement S, Lassman F, Barley E, Evans-Lacko S, Williams P, Yamaguchi S, Slade M, Rüsch N, Thornicroft G. Mass media interventions for reducing mental health-related stigma (Review). Cochrane Database of Systematic Reviews. 2013; 7.

[30] Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. 2016; 16(1).

[31] Anorexia on Agewatch.net, available from https://www.agewatch.net/mind/anorexia/

[32] Mak C, Johnson M. Let’s Talk: A Mental Health Program for Canadian Youth, available from https://pdfs.semanticscholar.org/presentation/0343/d386f2e4ca738129364643824f935fd4327f.pdf