3 Stigma and discrimination in mental health
3.1 Understanding stigma
In the first half of Section 3, the focus is on the nature of the stigmatisation and discrimination which can be experienced by people with mental health problems. The section then turns to consider racism in mental health services and the impact this has on black service users.
The ‘stigma’ of mental illness and distress refers to the idea that such experiences are a disgrace or an embarrassment, not only to the person concerned, but also to those around them. To be mentally distressed can sometimes be regarded as a sign of personal weakness or failing, something of a personal flaw. Mental illness is also often regarded as something from which people can never fully recover, and which therefore leaves them ‘tainted’, particularly when someone is diagnosed with an illness such as schizophrenia (Barham, 1997). The first activity in this section provides an opportunity to start thinking about how stigma might be defined by relating it to a media story surrounding the former world heavyweight champion boxer, Frank Bruno.
Activity 6: What's in a name?
Spend five minutes writing down all the different words you can think of that are used to describe people who are mentally ill or distressed. Include in your list words that might be considered offensive.
Next, read the two articles about Frank Bruno, linked below. Why do you think there was such an outcry about the original Sun newspaper article? What do you think this story tells us about attitudes towards mental health in the UK?
A comment from one tester was:
This article gave a negative view, the use of language was insensitive and portrayed a false image of [mental health service users]; it reinforced the misconceptions around mental health.
A survey by See Me Scotland (2004) found that the stigma associated with mental health issues had prevented 43 per cent of people applying for jobs because of their fear that they would be perceived negatively. Fifty-seven per cent of people in the same survey had actually concealed their history of mental distress when applying for posts.
The decision to conceal such information is perhaps hardly surprising, given the evidence that disclosure of mental health issues does indeed create problems. One survey by the National Schizophrenia Fellowship Scotland found that, whilst 15 per cent of the general public living in Scottish communities had been subjected to some form of harassment, a much higher proportion – 41 per cent – of people with mental health problems had experienced such harassment (See Me Scotland, 2004). This suggests that the ‘care’ in ‘community care’ is not experienced by all groups equally.
Stigma results in many people feeling that they need to keep their difficulties secret from others. This affects all of us because of the evidence that so many people will experience some form of mental distress at some point in their lives. According to a major survey carried out by the Scottish Executive into public attitudes to mental health:
more than two thirds of the large sample interviewed said that someone close to them had been diagnosed with a mental health problem at some point – the most common diagnosis being depression;
over a quarter had themselves been diagnosed with a mental health problem;
a third of those who had been diagnosed with a mental health problem had experienced negative attitudes from other people;
half of all the respondents said that if they developed a mental health problem they would not want anybody to know.
Scottish Executive Social Research, 2002
So, mental health issues and the stigma associated with them are relevant for everyone. In England, the Social Exclusion Unit of the government has conducted an investigation into the experiences of people with a mental illness (Social Exclusion Unit, 2004). The report produced by the unit outlines a sustained programme to improve public awareness of mental health issues and challenge discrimination. Ministers have also agreed that they should analyse complaints made against the media regarding their coverage of mental health issues, and also advise people as to how they can complain about programmes which stigmatise those with mental health problems. This is especially important because the media is by far the biggest source of information about mental health issues for the general public. These reports acknowledge the close link between the feelings of stigmatisation, which are often experienced by people with mental health problems, and discrimination.
Activity 7: Discrimination and mental health
Make a list of the different ways that people who experience mental distress might encounter discrimination. You might want to draw upon your own personal experience or that of those close to you, or you might consider your professional experience with people who have used mental health services. As you create your list, think about why you think this kind of discrimination occurs.
Your list is likely to have included some or all of the following areas, and you may well have thought of others:
People who have experienced mental distress may be less likely to have the same access as other people to employment opportunities.
They may be less likely to get promoted at work.
They might be considered unsuitable tenants when seeking housing.
People with a history of mental illness or distress may receive less favourable treatment in terms of accessing resources and services, such as insurance, mortgages and other financial arrangements.
They can experience difficulty when seeking treatment for physical health problems.
Young people with mental health problems can be discriminated against in terms of educational opportunities, such as gaining a place at university.
People with mental health problems can be wrongly assumed to pose a risk of violence to others.
When you considered the possible reasons for this kind of discrimination, you may well have included the fear and misunderstanding that surrounds mental illness and the negative attitudes that are often associated with it.
Evidence from surveys conducted in Scotland and elsewhere in the UK confirms that discrimination against people with mental health problems is indeed a serious problem. At the most extreme end of the scale, a survey by See Me Scotland (2004) found that 16 per cent of people with direct experience of mental health problems had been physically abused or intimidated at work, and 21 per cent had been verbally abused. In the vast majority of these cases, it was managers who were responsible. Thirty per cent of people in the survey felt that they had been turned down for employment because of their mental health problem. People who already experience discrimination on grounds such as race face an even greater risk that they will not receive equal rights when they experience mental illness, not only in terms of employment opportunities but also within mental health services themselves. Not only do these findings have important moral and ethical implications in terms of the rights of the individuals concerned, there are also important social and economic implications arising from them.
The ‘see me’ research shows that many people who have experienced mental ill-health do not enjoy equal rights in the workplace. People's attitudes and lack of awareness are at the root of the problem. Losing skilled and experienced individuals from the workforce is the last thing most employers want at a time when organisations across Scotland are struggling to recruit and retain staff.
My bosses spent 12 months trying to force me to leave and the only contact they made with me was to tell me my absence was costing money, it was too far to come and see me face to face and that I shouldn't have applied for the promotion to manager.
See Me Scotland, 2004
Evidence on discrimination against people with mental health needs, particularly in the workplace, has not gone unchallenged. See Me Scotland is running a series of publicity campaigns together with employer organisations to publish the results of its findings and to raise awareness of the problem. Also of great concern are the particular kinds of discrimination faced by black service users, who experience racism as well as discrimination because of their mental health needs.