Keep Quiet About It

The dictionary defines stigma as “a distinguishing mark of social disgrace”. Mental health experts suggest that it refers to the “negative effects of a label placed on any group including those who have been diagnosed as having mental health problems.” (1) For example, if a man threatens his neighbour, the neighbour will view him even more negatively if he believes the man’s behaviour is caused by mental health problems. In this sense, the experience might be called the “stigma” of mental health problems.

Research on the stigma shown towards people who have mental health problems has found that it does exist within the general population. For example, people with a history of mental health problems did badly when compared with other disabled people when returning to work following a period of illness. (2) Furthermore they were denied services such as life insurance. (3)

The existence of mental health stigma means that people with a history of mental illness may worry that they will be less accepted, if not shunned outright, should others find out about their illness. Furthermore, mental health stigma may mean that some people will not even seek help or will delay seeking help because they do not wish to be identified as someone with a mental health problem. Reasons for such reluctance might include fears of rejection, discrimination and job loss; and difficulty in gaining a job interview. The result is that often people have to overcome the effect of their mental health difficulties and other people’s misunderstanding and prejudice about it.

It is against this background that the study by North West Wales NHS Trust aimed to increase the understanding of what mental health stigma means for the person who experiences it.

Seventy-five people took part in the study. An adapted postal version of the “personal experience of the stigma of mental health questionnaire” was used to gather data.4 The questionnaire asks respondents about experiences of stigma such as “other people have avoided me when they found out I have a mental health problem”, and their experiences of discrimination such as “I have had difficulty finding accommodation when my experience of a mental health problem was known.”

Three out of four respondents reported the following experiences of stigma:

1. Avoiding telling others outside their immediate family that they had a mental health
   problem.
   
2. Hearing other people say negative things about mental health problems.
   
3. Worrying about being viewed unfavourably by others.
   
4. Being treated as less competent by others or avoided when they found out that they had a mental health problem.
   
5. Advised to lower their expectations in life because of their mental health problem.

Against this negative background, 85 per cent of responses indicated that friends who knew that a respondent had a mental health problem had been understanding, supportive and had treated that individual fairly.

A lower proportion of discrimination was reported compared to the experience of stigma. This may be accounted for by the fact that respondents indicated that they had avoided putting information about their mental health problem on application forms such as for jobs or driving licences in case it would be used against them. Nevertheless, about one in three respondents reported they had been turned down for a job when it became known that they had been treated for a mental health problem.

In two out of three cases colleagues or supervisors at work (whether the respondent was or had been in paid or unpaid work) were supportive when they learned respondents had a mental health problem. Few respondents indicated that they had not been able to do voluntary work or join in social activities either outside or within the mental health services because others knew of their mental health problem. Similarly, few respondents stated that they had experienced discrimination in finding accommodation, insurance or educational opportunities when their experience of their mental health problem was known.

Stigma is very much a part of the lives of those people who participated in the study. Not surprisingly, four out of five respondents indicated that they have attempted to conceal their mental health history from others by, for example, avoiding writing details on application forms in case that information might be used against them. By using such a coping strategy negative reactions such as distress, lasting damage to self-esteem and social relations might be reduced. This, it might be surmised is related to a lower proportion of self-reported discrimination.

What our study seem to suggest is that levels of discrimination associated with stigma in recent research may not be as severe as claimed.

It seems that respondents reduce possible stigma effects by keeping their mental health history hidden, thereby avoiding situations in which discrimination might occur. A key issue therefore concerns how effective such a coping strategy is in terms of producing more “good” than “harm” for the individual where the stigma of mental health is concerned.

The most effective way to address stigma and social exclusion is through legal reform, public education, and local initiatives. But further research needs to explore what causes stigma and the best ways of combating it on both a personal and social level.

Training and Learning

The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract

This article looks at the personal experience of the stigma of mental health in a sample of people with mental health problems. Results show that stigma and the fear of negative reactions from others because of mental health problems are prevalent. A lower proportion of discrimination was reported compared to the experience of stigma. Future research will need to examine strategies found to be helpful in coping with stigma.

References

1. P Hayward and J A Bright, “Stigma and Mental Illness: A review and critique”, Journal of Mental Health, 6, 4, 345-353, 1997
   
2. Office of National Statistics, The Labour Force Survey 1997/8, 1998
   
3. L Sayce, “Stigma, Discrimination and Social Exclusion: What’s in a Work Place?”, Journal of Mental Health, 7, 4, 1999
   
4. O F Wahl, Consumer Experience of Stigma. Results of a National Survey, George Mason University, 1997

Contact the Author

mike.carter@nww-tr.wales.nhs.uk
or 01248 360491

BOXTEXT: Michael Carter
is a consultant counsellor/psychotherapist and senior manager at the North West Wales NHS Trust.