How does stigma affect people with mental illness?

1 Nursing Practice Keywords: mental health/ mental illness/. stigma / discrimination Discussion mental health This article has been double-blind peer reviewed mental health service users experience stigma in many aspects of their lives as a result of their mental illness; a review examined its impact How does stigma affect people with mental illness? In this 5 key efining stigma D. points The kinds of stigma faced by people with mental illness 1 stigma can affect many aspects of Recommendations to combat stigma people 's lives Author Siobhan Parle is community psychiatric nurse, Berkshire Health Alliance for mental Health (2010) observed that people with mental health problems 2 Self- stigma is the process in which people turn Foundation Trust. are frequently the object of ridicule or stereotypes Abstract Parle S (2012) How does stigma derision and are depicted within the media towards affect people with mental illness?

2 Nursing as being violent, impulsive and incompe- themselves Times; 108: 28, 12-14. people with mental health problems experience many different types of stigma . tent . It also found that the myth sur- rounding violence has not been dispelled, despite evidence to the contrary. 3 How the general public perceive people This article explores the attitudes and In light of this, the Department of with mental health beliefs of the general public towards Health (2004) funded a programme called problems depends people with mental illness, and the lived Shift, which aimed to reduce the discrimi- on their diagnosis experiences and feelings of service users and their relatives. nation that those with mental ill health face. The DH (undated) found that many 4 stigma can be a barrier to S. people with mental health problems say seeking early tigma can pervade the lives of that the biggest barrier to getting back on treatment, cause people with mental health prob- their feet is not the symptoms of illness, relapse and hinder lems in many different ways.

3 But the attitudes of other people . recovery According to Corrigan (2004), it diminishes self-esteem and robs people of social opportunities . This can include Reviewing the literature EBSCO was used to access the CINAHL, BNI. 5 Future research should investigate being denied opportunities such as and MEDLINE databases to search for avail- the experiences of employment or accommodation because able literature with the keywords stigma service users and of their illness. and mental in article titles. This produced their families to stigma in the form of social distancing a total of 428 articles. The search was then understand and has been observed when people are limited to narrow down the number of measure the unwilling to associate with a person with results. Limits were applied as follows: impact of stigma mental illness. This might include not Publication date was set between Jan- allowing the person to provide childcare, uary 2000 and December 2010.

4 Or declining the offer of a date (Corrigan et Original research studies and journal al, 2001). Self- stigma or internalised articles were specified;. stigma is the process in which people with The age range was limited to over 17. mental health problems turn the stereo- years old. types about mental illness adopted by The refined search resulted in 155. the public, towards themselves. They articles. assume they will be rejected socially and so In order to assess which articles were believe they are not valued (Livingston and relevant, further inclusion and exclusion Boyd, 2010). criteria were set. For example, articles that Being discriminated against has a huge included the general public's perception impact on self-esteem and confidence. and attitudes towards mental health were This can increase isolation from society included, and only primary research arti- and reinforce feelings of exclusion and cles were used.

5 Twelve articles matched the Experiencing stigma can make people social withdrawal. The Queensland criteria. with mental illness feel isolated 12 Nursing Times / Vol 108 No 28 / Nursing For articles on mental health care, go to Findings the views the public expressed in surveys Many felt they could tell their partner or The literature reviewed suggested that the and the actual behaviour as experienced parents about having a mental illness and way in which the general public perceive or witnessed by service users and service still feel supported, but only 12% felt able people with mental health problems providers. to tell colleagues (Bos et al, 2009). depends on their diagnosis. Those with schizophrenia are seen as dangerous and The media Social stigma unpredictable (Crisp et al, 2000). people The media have often been accused of sen- Service users reported social discrimina- with alcohol and drug addictions are not sationalism by portraying mental illness tion in the community, giving accounts of only seen as dangerous, but the public also inaccurately in their quest to gain higher being physically and verbally attacked by blame them for their addiction (Crisp et al, ratings.)

6 However, the media can also play strangers and neighbours, their property 2005). There still seems to be a general con- an important role in reaching out to many being vandalised, or being barred from sensus that anyone with mental illness is different audiences to promote mental shops and pubs; those with addictions or unreliable, especially in terms of looking health literacy. Celebrities such as Stephen psychotic illness tended to experience this after children. Many believe having a Fry (diagnosed with bipolar disorder) have more than those with non-psychotic ill- mental illness reduces intelligence and the spoken publicly about their illness and ness. Reports also included examples of ability to make decisions (Angermeyer and being spoken to as if they were stupid or Matschinger, 2005). || |||| like children, being patronising and, in discrimination and stigma have been || 16-19 year olds some instances, having questions |||.

7 The age group with the ||||||. linked to ignorance and studies show the QUICK addressed to those accompanying them most negative attitudes |||||. majority of the public have limited knowl- FACT rather than service users themselves towards people with ||. |||. edge of mental illness, and the knowledge |||| mental illness (Lyons et al, 2009). they do have is often factually incorrect. Dinos et al (2004) found service users Many still believe schizophrenia means felt a range of emotions surrounding their having a split personality. In addition, this seems to be effective in reducing experiences of discrimination , including many do not understand the difference stigma (Blenkiron, 2009). Chan and Sire- anger, depression, fear, anxiety, isolation, between mental illness and learning disa- ling (2010) described a new phenomenon guilt, embarrassment and, above all, hurt.

8 Bilities and there is still a common mis- in which patients are presenting to psychi- conception that those with depression can atrists claiming to have and seeking a diag- Health and relationships snap out of it (Thornicroft, 2006). nosis of bipolar disorder. Service users also encountered discrimina- Depression and anxiety disorders do not However, the lived experiences of tion when accessing services such as GPs. have the same weight attached to them as mental health service users tell a different They reported professionals as being dis- psychotic illnesses but they are nonethe- story to the findings on public attitudes . In missive or assuming that physical presen- less stigmatised. people with depression the articles reviewed service users said tations were all in the mind (Lyons et al, are often seen as lazy and hard to talk they experienced stigmatising attitudes 2009).

9 This can result in reluctance to to (Thornicroft, 2006). Public opinions and behaviours in many aspects of their return for further visits, which can have a seem to be held across the board, with no lives. Common themes emerged across the detrimental effect on physical health. This significant differences in relation to articles. Many people felt stigmatised as is especially significant, as evidence sug- gender, education level and income. How- soon as they were diagnosed with a mental gests people with mental illness are at ever, there were differences between age illness, and attributed this to the way in greater risk from physical health prob- groups, with those in their teens or early which their illness had been portrayed in lems, including cardiovascular disease, 20s and those over 50 expressing the most the media (Dinos et al, 2004). diabetes, obesity and respiratory disease.

10 negative attitudes (Alonso et al, 2009; Receiving a stigmatising label has such they also have a higher risk of premature Crisp et al, 2005). a negative effect on people that the Japa- death (Social Exclusion Unit, 2004). Crisp et al (2005) noted those in the nese Society of Psychiatry and Neurology Developing mental illness can also lead 16-19-year age range had the most negative at the demand of the patients' families to breakdowns in relationships with part- attitudes towards people with mental ill- group changed the name of schizo- ners, family and friends. The SEU (2004). ness, particularly towards those with phrenia from mind-split-disease to reported that a quarter of children had alcohol and drug addiction. These results integration disorder (Sato, 2006). been teased or bullied because of their par- are surprising considering widespread ents' mental health problems.