Mental illness is defined as a health problem resulting from complex interactions between an individual’s mind, body and environment which can significantly affect their behavior, actions and thought processes. A variety of mental illnesses exist, impacting the body and mind differently, whilst affecting the individual’s mental, social and physical wellbeing to varying degrees. A range of psychological treatments have been developed in order to assist people living with mental illness, however social stigma can prevent individuals from successfully engaging with these treatments. Social or public stigma is characterized by discriminatory behavior and prejudicial attitudes towards people with mental health problems resulting from the psychiatric label they possess (Link, Cullen, Struening & Shrout, 1989). The stigma surrounding labelling oneself with a mental illness causes individuals to hesitate in regards to seeking help as well as resistance to treatment options. Stigma and its effects can vary depending on demographic factors including age, gender, occupation and community. There are many strategies in place to attempt to reduce stigma levels which focus on educating people and changing their attitudes towards mental health.
Prejudice, discrimination and ignorance surrounding mental illnesses results in a public stigma which has a variety of negative social effects towards individuals with mental health problems (Thornicroft et al 2007). An understanding of how stigma can be gained through the Attribution Model which identifies four steps involved in the formation of a stigma (Link & Phelan, 2001). The first step in the formation of a stigma is ‘labelling’, whereby key traits are recognized as portraying a significant difference. The next step is ‘stereotyping’ whereby these differences are defined as undesirable characteristics followed by ‘Separating’ which makes a distinction between ‘normal’ people versus the stereotyped group. Stereotypes surrounding mental illnesses have been developing for centuries, with early beliefs being that individuals suffering from mental health problems were possessed by demons or spirits. ‘Explanations’ such as these, promoted discrimination within the community, preventing individuals from admitting any mental health problems due to a fear of retribution (Swanson, Holzer, Ganju & Jono, 1990). The final step in the Attribution model described by Link and Phelan is ‘Status Loss’ which leads to the devaluing and rejection of individuals in the labelled group (Link & Phelan, 2001). An individual’s desire to avoid the implications of public stigma causes them to avoid or drop out of treatment for fear of being associated with negative stereotypes (Corrigan, Druss and Perlick, 2001). One of the main stereotypes surrounding mental illness, especially depression, and Post Traumatic Stress Disorder is that people with these illnesses are dangerous and unpredictable (Wang & Lai, 2008). Wang and Lai carried out a survey whereby 45% of participants considered people with depression as dangerous, however these results maybe subject to some reporting bias, yet a general inference can be made. Another survey found that a large proportion of people also confirmed that they were less likely to employ someone with mental health problems (Reavley & Jorm, 2011). This study highlights how public stigma can affect employment opportunities, consequently creating a greater barrier for anyone who would benefit from seeking treatment.
Certain types of stigma are unique and consequently more severe to certain groups within society. Approximately 22 soldiers or veterans commit suicide every day in the United States due to Post Traumatic Stress Disorder (PTSD) and depression. A study was performed surveying soldiers and found that out of all the people who met the criteria for a mental illness, only 38% would be interested in receiving help and only 23-30% actually ended up receiving professional help (Hoge et al, 2004). There is an enormous stigma surrounding mental illness within the military, due to their high values in mental fortitude, strength, endurance and self sufficiency (Staff, 2004). A soldier who admits to having mental health problems is deemed as not adhering to these values thus appearing weak or dependent, therefore placing a greater pressure on the individual to deny or hide any mental illness. Another contributor to soldiers avoiding treatment is a fear of social exclusion as it is common in military culture for some personnel to socially distance themselves from soldiers with mental health problems (Britt et al, 2007). This exclusion is due to the stereotype that mental health problems make a soldier unreliable, dangerous and unstable. Surprisingly, individuals with mental health problems who seek treatment are deemed more emotionally unstable than those who do not, thus the stigma surrounding therapy creates a barrier for individuals to start or continue their treatment (Porath, 2002). Furthermore, soldiers are also faced with the fear that seeking treatment will negatively affect their career, both in and out of the military, with 46 percent of employers considering PTSD as an obstacle when hiring veterans in a 2010 survey (Ousley, 2012). The stigma associated with mental illness in the military is extremely detrimental to the soldiers’ wellbeing as it prevents them from seeking or successfully engaging in the treatment for mental illnesses which have tragic consequences.
Adolescents and young adults with mental illness have the lowest rate for seeking professional help and treatment, despite the high occurrence of mental health problems. (Rickwood, Deane & Wilson, 2007). Adolescents’ lack of willingness to seek help and treatment for mental health problems is catalyzed by the anticipation of negative responses from family, friends and school staff. (Chandra & Minkovitz, 2006). A Queensland study of people aged 15–24 years showed that 39% of the males and 22% of the females reported that they would not request help for emotional or distressing problems (Donald, Dower, Lucke & Raphael, 2000). A 2010 survey of adolescents with mental health problems found that 46% described experiencing feelings of distrust, avoidance, pity and prejudice from family members. This portrays how negative family responses and attitudes impact an individual by creating a significant barrier to seeking help (Moses, 2010). Similarly, a study on adolescent depression also noted that teenagers who felt more stigmatized, particularly within the family, were less likely to seek treatment (Meredith et al., 2009). Furthermore, adolescents with unsupportive parents would struggle to pay expenses for treatment and transportation, further preventing successful treatment of the illness. Unfortunately, the generation of stigma is not unique to just family members, adolescents also report having felt discriminated by peers and even school staff (Moses, 2010). The main step to seeking help and engaging in treatment for mental illness is to acknowledge that there is a problem and to be comfortable enough to disclose this information to another person (Rickwood et al, 2005). However, in another 2010 study of adolescents, many expressed fear of being bullied by peers, subsequently leading to secrecy and shame (Kranke et al., 2010). The role of public stigma in generating this shame and denial is significant and thus can be defined as a factor in preventing adolescents from seeking support for their mental health problems. A 2001 study testing the relationship between adherence to medication (in this case, antidepressants) and perceived stigma levels determined that individuals who accepted the antidepressants were found to have lower perceived stigma levels (Sirey et al, 2001). This empirical data clearly illustrates the correlation between public stigma levels and an individual’s engagement in treatment, thus inferring that stigma remains a barrier for treatment. Public stigma can therefore be defined as a causative factor in the majority of adolescents not seeking support or treatment for their mental health problems.
One of the main strategies performed by society to assist in the reduction of the public stigma surrounding mental illness is education. Educating people about the common misconceptions of mental health challenges the inaccurate stereotypes and substitutes them with factual information (Corrigan et al., 2012). There is sufficient proof that people who have more information about mental health problems are less stigmatizing than people who are misinformed about them (Corrigan & Penn, 1999). The low cost and far-reaching nature are beneficial aspects of the educational approach. Educational approaches are often carried out on adolescents as it is believed that by educating children about mental illness, stigma can be prevented from emerging in adulthood (Corrigan et al., 2012). A 2001 study testing the effect of education on 152 students found that levels of stigmatization were lessened following the implementation of the strategy (Corrigan et al, 2001). However, it was also determined that by combining a contact based approach with the educational strategy would yield the highest levels of stigma reduction. Studies have also shown that a short educational program can be effective at reducing individuals’ negative attitudes toward mental illness and increases their knowledge on the issue (Corrigan & O\’Shaughnessy, 2007). The effect of an educational strategy varies depending on what type of information is being communicated towards people. The information provided should deliver realistic descriptions of mental health problems and their causes as well as emphasizing the benefits of treatment. By delivering accurate information to people, the negative stereotypes surrounding mental illness can be decreased and the publics views on the controllability and treatment of psychological problems can be altered (Britt et al, 2007). Educational approaches mainly focus on improving knowledge and attitudes surrounding mental illness and do not focus directly on changing behavior. Therefore, a link cannot be clearly made as to whether educating people actually reduces discrimination. Although this remains a major limitation in today’s society, educating people at an early age can ensure that in the future discrimination and stigmatization will decrease. Reducing the negative attitudes surrounding mental illness can encourage those suffering from mental health problems to seek help. Providing individuals with correct information regarding the mechanisms and benefits of treatment, such as psychotherapy or drugs like antidepressants, increases their own mental health literacy and therefore increases the likelihood of seeking treatment (Jorm and Korten, 1997). People who are educated about mental health problems are less likely to believe or generate stigma surrounding mental illnesses and therefore contribute to reducing stigma which in turn will increase levels of successful treatment for themselves or other individuals.
The public stigma surrounding mental health problems is defined by negative attitudes, prejudice and discrimination. This negativity in society is very debilitating towards any individual suffering from mental illness and creates a barrier for seeking out help and engaging in successful treatment. The negative consequences of public stigma for individuals is to be excluded, not considered for a job or for friends and family to become socially distant. By educating people about the causes, symptoms and treatment of mental illnesses, stigma can be reduced as misinformation is usually a key factor in the promotion of harmful stereotypes. An individual will more likely engage in successful treatment if they are accepting of their illness and if stigma is reduced.
2016-10-9-1475973764