Stigmatising Mental Health: It's Time For Change

There has been a stigma surrounding mental health for as long as I have been alive. This stigma is in part due to the general public having limited knowledge of mental illness. Unfortunately, when they do have knowledge of the topic, it is often factually incorrect. This disconnect in the transmission of crucial information is a significant factor in the lack of understanding mental health issues. The issue is now so prevalent, that the World Health Organisation (WHO) have also been campaigning to highlight the issues surrounding mental health stigma. However, there has been some progress on this front. A survey has found the general public are now less likely to discriminate on the basis of mental health. Whilst this is a step in the right direction, we must make further strides forward. There are so many points that I'd like to address in this post, but it simply wouldn't be feasible to go through every single line of argument. In this post, I define mental health stigma, what the impact is of said stigma to those suffering from mental health issues, before finally moving on to some suggestions on how we can curb this stigma. It is my hope that this post acts as a stepping stone to unlocking a broader conversation.

Before I dive in, I just want to remind you all of something. You are a beautiful human being. You are loved. You matter. You have so much good that you can offer this world. If you ever need someone to confide in, my details are on my 'about' page.

What is mental health stigma?

I'll start by looking at the general definition of a stigma, before turning directly to mental health. Stigma is when someone views another in a negative way because they have a distinguishing characteristic or personal trait that's thought to be, or actually is, a disadvantage (a negative stereotype).

Problematically, negative attitudes and beliefs toward people who have a mental health condition are all too common. For example, this stigma can manifest itself through the use of every day language. One study illustrates as many as 250 labels have been used to stigmatise people with mental illness. The terms that are often used include: "Disturbed, freak, nuts, psycho, crazy, spastic, insane, loony, dumb, demented, and retard". This supports the notion that many believe having a mental illness reduces intelligence and the ability to make decisions. It is completely without evidence. If anything, there are suggestions (previous studies, reported here) the inverse applies: a higher level of intelligence can be linked to mental health issues.

One further concern of note is those who are guilty of holding stigmatising beliefs about mental health problems. They are held by a broad range of individuals within society, regardless of whether they know someone with a mental health problem or have a good knowledge and experience of mental health problems.

There are two recognisable types of stigma in relation to mental health problems, which I will summarise in a nutshell (further information is available via: Health Assured (here), Psychology Today (here) and British Association for Psychopharmacology (here)).

The first is social stigma (also called public stigma); it refers to negative stereotypes of those with a mental health problem. These stereotypes come to define the person, mark them out as different and prevent them being seen as an individual. Social stigma is associated with discrimination. Discrimination may be obvious and direct, such as someone making a negative remark about mental illness or treatment. Alternatively, it may be unintentional or subtle, such as someone avoiding another because the person assumes they are unstable, violent or dangerous due to their mental illness.

The second is self-stigma, which occurs when a person internalises negative stereotypes. This can be detrimental to an individual's recovery; they are more likely to think there is something inherently 'wrong' with them and may put off accessing treatments.

What are the impact(s) of this stigma?

As noted above, the social stigma attached to mental ill health can lead to systemic discrimination against people in society. This discrimination and the experience stemming from the social stigma attributed to mental health issues can make an individual's difficulties worse. It has the compounding effect of make it harder to recover by generating a delay or impeding someone getting help and treatment.

I have explained that this stigma is not just from society generally, but also applies to members of one's family, their friends and their employers. Unfortunately, this is a very common experience: nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives. From a personal perspective, I can say that I've dealt with this too. For example, prior to my diagnosis and on an off day, I had been told that I was simply being 'lazy' and told to 'snap out of it'. I still remember being told shortly after opening up to someone about being diagnosed with depression that I needed to simply 'cheer up and be happier'. This hit me for six. I started questioning myself and simply felt awful about my existence. I have also noticed after a while that some people have started to act/treat me differently. Whilst I'm not saying this is good or bad, it's a noteworthy observation.

Looking back, it is incredibly frustrating as I like to think I am somewhat 'high functioning'; there seems to be a suggestion that individuals have to fit a certain description in order for them to be suffering from mental health issues. People with mental health issues have to work a lot harder than those who do not suffer such issues to find motivation to do things such as getting out of bed in the morning. They are NOT lazy. They are fighters. I think a large part of this ill perception comes down to a lack of understanding or knowledge on the subject matter.

Generally speaking, the impact of such a stigma is a largely practical; people with mental health problems are amongst the least likely of any group with a long-term health condition or disability to:

• find work;

• be in a steady, long-term relationship;

• live in decent housing; and

• be socially included in mainstream society.

The reason for this is apparent: a large contribution to this is due to the societal stereotype and individual views surrounding both mental illness(es) and how such illness(es) can affect(s) people. As I have written before, things such as: social isolation, poor housing, unemployment and poverty, are all linked to mental ill health. The result is concerning: the stigma can actually trap people in a cycle of illness. We need to break out of this cycle and start giving people opportunities to get better and to lead happy and healthy lives. I have previously written on the link between mental health and money (here). It is apparent

There is a widely held perception which suggests people with mental health issues are violent and dangerous. However, this is simply incorrect; it has been supported by studies that people suffering from mental health issues are more at risk of being attacked or harming themselves as opposed to harming other people. This understanding of mental health is exacerbated by the media. When we consider news reports, there is often a link between mental illness with violence. Similarly, with television shows, there is a tendency to portray people with mental health problems as: dangerous, criminal, evil, and/or very disabled and unable to live normal, fulfilled lives. However, the most common mental health problems (such as: anxiety, depression, PTSD, OCD, dementia, bipolar and phobias) have no significant link to violent behaviour. Furthermore, the proportion of people living with a mental health problem who do go on to commit a violent crime is extremely small. Usually, mental health is only one of a number of societal failings that leads to the imprisonment of an individual. To make the suggestion that someone is a criminal simply because they have a mental disorder is wholly unfounded.

Proposed Changes

In order to defeat this stigma once and for all, there needs to be a change in perception at both a societal and an individual level. We need to break the cycle that I have mentioned above, and put resources into mental health services. As I have argued previously, mental health is just as important as physical health; it seems bizarre to me that the two are not treated equally.

Some of the changes that may be helpful include the following:

• Opening the conversation up. I think that this one really speaks for itself. For those of you who do suffer from mental health issues, talk about your experience, or get involved in a campaign to support mental health/speak out against the stigma. There are also some fantastic communities on social media that you may find it useful to connect with. The more people that open up about their issues, and the more of a conversation we have, the better opportunity there is to educate others on the realities of mental health issues. This in turn can lead to a change in perception. For example, over a third of the public think people with a mental health issue are likely to be violent; a conversation on the topic can make the general public realise that this is simply not true. Furthermore, mental health problems are common. They affect millions of people in the UK alone. This number only includes people who have come forward. If we were to fully discuss it, this number would increase; it is likely that many people are holding back from treatment because of the societal pressures/stigma attached to mental health issues.

• Stop using rhetoric such which trivialises these conditions. As I've explained above, there are numerous terms used in every day language which are used to stigmatise people with mental illness. If we remove these references from our vocabulary, then in turn, we are not supporting the notion that people with mental health issues are 'bad' or there is something wrong with them.

• Better education of mental health. I feel like that this is a multifaceted concept. I have been previously critical of the media. However, the media can also play an important role in reaching out to the wider community to promote mental health literacy. Therefore they do have the ability to help undo the damage. Make sure you use reliable sources of information such as mental health charities/organisations to better inform yourself (NOT Karen from Facebook, who has shared some obscure link - no offence intended to anyone called Karen!). There is also a need for better education in schools, perhaps at GCSE level. This would in turn curb issues surrounding mental health ignorance for future generations. Furthermore, celebrities such as Stephen Fry (who has been diagnosed with bipolar) and many others, have spoken publicly about their illness. This seems to be effective in reducing stigma: people who are successful and constantly in the public eye can act as both fantastic role models and success stories for those suffering from mental health issues. Your illness does not define you.

• Understanding the causes of stigma and addressing them. There are 5 main causes of stigma. They are: attributing responsibility to someone for their own mental health issue (people do not choose to suffer from mental health issues), judging someone's condition based on the uncertainty of their situation (which can be seen as a 'waste of time'), a perceived unpredictability in behaviour (and consequent desire to avoid said person), judging someone to be incompetent/unable to make their own informed decisions and perceived dangerousness due to suffering from mental health issues. All of these factors play into the way that another person is viewed. We need to see the people, not the illness. Mental health issues are extremely common. It is likely that you know at least one person who is suffering from a mental health issue.

Useful Links

As usual, I've provided a series of links below which I hope will helpful, of which you can add to your existing collection of resources:

• https://mhfaengland.org/mhfa-centre/research-and-evaluation/mental-health-statistics/

• https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925070/

• https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/stigma-misconceptions/

• https://www.nursingtimes.net/roles/mental-health-nurses/how-does-stigma-affect-people-with-mental-illness-06-07-2012/

• https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477

• https://www.bap.org.uk/articles/mental-health-stigma/

• http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/priority-areas/stigma-and-discrimination

• https://www.healthassured.org/blog/mental-health-stigma-guide/

• https://www.psychologytoday.com/gb/blog/why-we-worry/201308/mental-health-stigma

• https://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index5.html

• http://www.health.wa.gov.au/docreg/Education/Population/Health_Problems/Mental_Illness/Mentalhealth_stigma_fact.pdf

• https://www.time-to-change.org.uk/news/latest-survey-shows-public-are-less-likely-discriminate-against-people-mental-health-problems

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007563/

• https://www.nami.org/Blogs/NAMI-Blog/December-2016/Understanding-What-Causes-Stigma

• https://www.treatmentadvocacycenter.org/storage/documents/backgrounders/what%20is%20the%20main%20cause%20of%20stigma%20against%20individuals%20with%20serious%20mental%20illness%20final.pdf

Remember: you are a beautiful human being. You are loved. You matter. You have so much good that you can offer this world.

Until next time,

J x