It is believed that the effects of stigma - the manifestations of discrimination - are far more serious than the direct consequences of mental illness itself. There are different forms of discrimination.
A. Direct discrimination.
This category covers cases where people with mental health problems suffer from a direct unjustified (stigma-based) negative attitude and related behavior. Discrimination finds expression both in what others do, and in what they do not. Below these aspects will be noted for the different spheres of life. In addition to the numerous stories that anyone with a mental illness can tell, there are studies that confirm the existence of these attitudes.

 People with mental health problems have difficulty finding a home: most homeowners and municipal housing administration prefer not to work with them and most often just refuse to rent a room.

Unemployment is a huge problem for people with mental health problems: According to estimates, 80 to 90 percent of people with serious mental health problems do not work in the US. The situation in our country is most likely similar, but data is missing. Employers most often simply refuse to take on people with mental health problems. They also do not adapt jobs for people with mental health problems, even if they have the opportunity and the financial incentive to do so.

The stigma is also manifested in working people with mental health problems. Many of them complain about the negative attitudes of the employer and colleagues. A disease that started when someone is employed is a guarantee that the employer will look for a way to get rid of the unwanted worker.

Similar is the problem of obtaining education. Access to education is restricted to people with mental health problems; Moreover, the curriculum and the training process are not adapted to their special needs.

Mental health problems dramatically reduce the likelihood of marriage. But the likelihood of divorce, if already married, is growing.

People often lose old friends and find it hard to create new ones. In general, social exclusion, including on the part of relatives, is one of the consequences of stigma.

People with mental health problems receive fewer and lower quality health and social services. Research shows that people suffering from schizophrenia are less likely to receive modern treatment after a myocardial infarction compared to people with the same cardiovascular problems that do not have a mental illness. Similar is the situation in psychiatric care. Stigma may change the quality of the health services offered, as well as the conditions under which they are offered. The latter may be related to excessive security measures (strong doors, lattices, latches, all the fruits of the belief that people with psychosis are dangerous) or the lack of sufficient means (which may cause the rooms to be dirty, unsupported and unpleasant ). Less research is being done to contribute to the development of psychiatry.
Stigma may contribute to changing the course of the disease in the negative direction. This is due to the stress that the stigmatized individual feels (related to the way of life and the attitude of others). Stress can contribute to the onset of new seizures or their more severe lesions.

Stigma may contribute to the development of another illness - besides, the individual is stigmatized.

Despite all health problems, stigma contributes to reduced demand for health care. Less than 30% of people with mental health problems seek treatment. It is not just about people with mild problems, as one might suppose; only 60% of people with schizophrenia take part in treatment, and this applies to those suffering from all serious disorders. Similar is the picture with people abusing alcohol or narcotics. These problems are exacerbated by patients' reluctance to adhere to the prescribed treatment: more than 40% of patients receiving psychotic disorder treatment do not fully adhere to the treatment regimen. It is believed that as a result, the number of hospital admissions increased threefold. People also refuse to use outpatient day care and rehabilitation programs. Or, they started to use them, give up at some time.

It is no secret that people with severe mental health problems live shorter than others (according to some estimates, up to 8.8 years less). This high figure also contributes to this figure. Suicide is one of the main causes of death in people with severe mental illness; it is believed that stigma, in turn, is a serious cause of suicide. Another reason for high mortality is the limitations in receiving healthcare (especially from cardiovascular diseases). There is a tendency for these people's complaints to be ignored because they often sound as part of the symptom of the disease.

People with mental health problems are easier victims of all kinds of violence and other crimes.

B. Structural Discrimination
The rights and capabilities of people with mental health problems can be restricted not only through direct refusal to access certain services or opportunities. Discrimination can occur through laws or regulations, unwritten norms and rules of conduct or practices that nobody disputes. For example, allocating fewer resources (compared to those allocated to other health problems) for the treatment of serious mental health problems and their rehabilitation, whether in hospital or in the community, is a manifestation of structural discrimination.

C. Self-discrimination (auto-stigma). People with mental health problems perceive existing attitudes and begin to limit their behavior themselves. They no longer need to be discriminated against - they themselves are being discriminated against. For example, they not only expect rejection from friends or current or potential partners, but they are already convinced they deserve rejection and do not make any attempts to get what they want. They are convinced that many things can not - work, take care of their own budget, have full links. If they do not believe that mental illness is workable, they have no reason to persist in getting health care and to be regular in taking drugs and taking side effects. In some cases
Behavior produces a vicious circle: desperate people refuse to fight for their rights and interests, they create the surrounding impression of incompetence and helplessness, which reinforces their negative ideas, which in turn strengthens the lack of faith in one's own powers.

D. Discrimination by association (proximity)
Relatives and friends can also suffer from stigma due to their relationship with a person with a mental health problem. In response, many of them are making an effort to hide the existence of problems.
Mental healthcare professionals also have difficulty recognizing that they suffer from mental health problems, even from the depression that is perceived as the least stigmatizing of all serious mental illnesses. If a relative or colleague gets sick, psychiatrists are trying to conceal this fact.

Who and how is stigmatized

Most accept people with mental health problems as members of society but prefer to avoid having a closer relationship - such as working or living with them. In English, this phenomenon is called "Not In My Back Yard" (shortened NIMBY). A study conducted in 6 German cities within the Anti-Gypsy Campaign of the World Psychiatric Association focuses on attitudes towards people with schizophrenia. Only about 10% of the 7,246 respondents considered that they would be concerned about talking to someone with schizophrenia. But almost 16% would be a problem to work with someone with this disease. One third would worry if a group of 6 to 8 people with schizophrenia lives in their neighborhood. More than 40% would oppose sharing a room with schizophrenia (for example, in a hospital). Over 70% would not marry a person with schizophrenia.
Is there a personality type more prone to stigmatization? There are studies of people prone to prejudice: they can not tolerate ambiguity, have rigid authoritarian beliefs and are hostile to other ethnic groups (ethnocentricity). Other studies have shown that people with "cynical outlook" are more likely to stigmatize.
The very people with mental health problems seem to talk most about the discrimination they have to endure from the mental health system, the doctors in general and their relatives. They seem to be most impressed by such attitude from the people they would like to rely on most.
For example, a study by the British organization Mind shows that one-third of the participating patients complain of unfair treatment from their personal doctors. They point out that personal doctors are indifferent, they are quick to dismiss them and rely heavily on prescribing medication. The negative attitudes of doctors tend to change over time to worse: according to a 1986 study, at the end of the follow-up period, the number of stigmatizing doctors has doubled.

Author: Dimitar Germanov


Онконавигатор - всичко за болните с онкологични заболявания

Health news

P&HSee the latest health news and objective comments and analyzes of events without prejudices. Read more ...

External quality control

nsvokCPRH coordinates the National System for External Quality Assessment of Clinical Laboratories. Look more ...