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Mental Health Stigma Among Filipinos: Time For A Paradigm Shift

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Abstract

This paper aims to provide a review of mental health stigma in the Philippines, its implications on policy and programs, and interventions on addressing the issue. Stigma towards people with mental illnesses in the Philippines is rampant; there seems to be lack of sensitivity in referencing mental health issues. Many forms of stigma affect people with mental illnesses. Stigmatizing attitudes and discriminatory behaviors are evident at home, school, workplace and healthcare settings. Stigma is a major barrier in the recovery of mentally ill persons. Increasing the awareness of the public on mental illnesses through health education and promotion is already an established intervention. Various strategies can also be done such as by means of integrating culture and arts, by providing incentives to companies which have mental health policies, and by recognizing institutions and media agencies which promote positive portrayals of people with mental illnesses.
Mental Health Stigma Among Filipinos: Time For A Paradigm Shift
1 2
Ana Kriselda B. Rivera * and Carl Abelardo T. Antonio
*Corresponding author's email address: abrivera3@up.edu.ph
1College of Public Health, University of the Philippines Manila
2Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
Abstract
This paper aimed to provide a review of mental health stigma in the Philippines, its implications on policy and
programs, and interventions on addressing the issue. Stigma towards people with mental illnesses in the
Philippines is rampant; there seems to be lack of sensitivity in referencing mental health issues. Many forms of
stigma affect people with mental illnesses. Stigmatizing attitudes and discriminatory behaviors are evident at
home, school, workplace and healthcare settings. Stigma is a major barrier to the recovery of mentally ill
persons. Increasing the awareness of the public on mental illnesses through health education and promotion is
already an established intervention. Various strategies can also be done, such as integrating culture and arts,
by providing incentives to companies which have mental health policies, and recognizing institutions and
media agencies which promote positive portrayals of people with mental illnesses.
Keywords: social stigma, mental health, mental disorders, Philippines
SH O RT R E V I E W
Introduction
Stigmatizing attitudes date back to the 16th century
when manifestations of mental illnesses are associated
with witchcraft, magic and evil doings. People with mental
illnesses were treated harshly – they were placed in
asylums far from the public, while some are even detained
in jails and madhouses; they were ridiculed and called
names. It was not until the 19th century when mental
illnesses were slowly being viewed to be of medical causes
rather than supernatural in nature. Today, on account of
the advancements made in psychiatric research, we now
understand the science behind many mental illnesses, and
have explanations for management and treatment.
However, despite these developments, stigma remains in
our society. People with mental illnesses are still suffering
from the same stigmatizing attitudes and discriminatory
behaviors.
In the Philippines, stigmatizing attitudes towards people
with mental illnesses are typically demonstrated with humor
or hatred; whereas, media representations of them are
usually associated with harm and misconduct. Stigma exists
in school settings, in the workplace and even in medical
institutions among healthcare practitioners. Stigma
continues to be the biggest barrier to the development of
the mental health system in general – it affects planning and
organizing of mental health programs, influences the
allocation and prioritization of resources for mental health,
and impedes the delivery of mental health services.
This paper provided a brief discussion on the perception
of Filipinos on mental illness as influenced by stigma. This
paper also discussed the implications of stigma on people
with mental illness, the general public and on public health.
Lastly, this paper enumerated possible interventions and
strategies that may address the issue.
Mental health stigma among Filipinos
Abdullah and Brown [1], highlighted that stigma is
inextricably bound to culture. Culture influences behaviors
and beliefs, and sets the standard for what is considered
normal and acceptable to a society. Beliefs about mental
health and illness are, therefore, also culturally bound.
For the Filipino culture, having mental illness is viewed as
a family's mental illness [1]. In a study, private stigma (self-
stigma) is said to mediate the relationship between public
stigma and attitudes of seeking professional help; private
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Philippine Journal of Health
Research and Development
stigma also has a negative correlation with intentions to
seek professional help; while another study found that loss
of face has been found to be directly associated with
per c eived sti g m a for both seeking an d re c eiving
psychological help among Filipinos [2].
Although mental health stigma evidently persists in the
Philippines, there is very limited information on the depth of
its burden among Filipinos with mental illness. The
Department of Health (DOH) cons iders the lack of
promotional programs on mental health a reason for the
persistently high stigma in the country [3]. Derogatory terms
such as “abnoy” and “baliw” are easily incorporated in
casual conversations. People often use mental illness insults
in describing annoying politicians [4]; the President himself
is not spared of these insults. Restraining of people with
mental illness is not something new; sometimes, their
family members are even the ones who detain and keep
them far from the public. The Filipinos' knowledge on
mental illness appears to be simplistic, the opinions can be
quite unforgiving, and the stigmatizing behaviors seem to
be uninhibited.
Implications of stigma
Stigma towards people with mental illness is conceived
not only by the public, but by those with mental illness as
well, towards themselves. Public stigma is the negative
attitudes and discriminatory response of the people
towards people with mental illness. Self-stigma results
when people with mental illness internalize the stigmatizing
notions of the public towards them [5].
Stigmatizing attitudes have been found to increase over
time [6]. Stigma entails a great deal of negative outcomes to
individuals suffering from mental illness. Public stigma
presents as danger to social opportunities. Results of a study
in the U.S. revealed that 56% of Americans are reluctant to
spend an evening socializing with people who have mental
illness, 58% are reluctant to work closely with them, and
68% would not allow them to marry into their family [1].
Des p i t e t h e i r w i lli n g n es s to w o r k , e m p loy m e n t
opportunities of people with mental illnesses are also
compromised. It is evident from the limited data available,
that people with mental health problems, particularly those
wit h p sycho t i c d i sorde rs, have ve r y l ow rate s o f
employment [7]. Furthermore, a study found that more
than 50% of its sample population have deliberately
concealed their condition (schizophrenia) from co-workers
and friends out of fear of being stigmatized [8].
Media plays a critical role in shaping the public's
perceptions of mental illness. Tragic news concerning
people with mental illness is often sensationalized. An
analysis of tabloids made by Angermeyer & Schulze [9] in
Germany found that news articles included very little
information on the mental illness of people involved with
serious crimes. Meanwhile, a different analysis by Corrigan
[10] in the U.S. found that 39% of violence may be
attributed to mental illnesses. Similarly, people with mental
illness face stigmatizing responses from the police. A study
showed that they are more likely to be arrested by the
police [11]; meanwhile, a survey on the attitudes of police
officers in Greece found that 60% believed that people with
mental illness are more dangerous than the general
population, 47% thought that these people should be on
continuous medication, 67% thought that they should be
permanently hospitalized, more than 60% believed that
they are rarely or never able to work, and 75% believed that
they are rarely capable of building a family and living
independently [7].
Moreover, self-stigma presents as a danger to self-
esteem. Because of their condition, people with mental
illness may believe that they are less appreciated and less
respected by others. These negative feelings may lead to
demoralization and decreased self-worth and self-efficacy
[5]. Those who disclosed their mental illness to a greater
extent have been found to experience significantly higher
damaging effects on their self-esteem. Social interactions
are also affected by self-stigma. People with mental illness
tend to have negative expectations from other people and
so they are likely to act defensively when interacting but
appears to have less self-assurance [1].
Stigma affects the willingness of people with mental
illness to seek help [5]. A study in the the U.S. by Alvidrez et
al. [12] found that 32% of its participants did not initially
recognize the need to seek help for their mental problems
because of stigma. Furthermore, Cooper et al. [13] stated
that stigma influences people in considering other
alternatives of help seeking, such as informal sources.
Similarly, the effects of stigma persist not only in initiating
help seeking but as well as when treatment has already
started. Studies by Sirey, et al. [14] found that stigma affects
antidepressant medication noncompliance and premature
treatment discontinuation, particularly among older
clients. Underutilization of mental health services is
influenced by stigmatization even in countries where
services are offered free of charge [7]. Family shame also
serves as a significant predictor of treatment avoidance [5].
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Mental Health Stigma Among Filipinos
Stigma presents as a barrier in all the levels of prevention
of public health. It serves as an obstacle to acquiring
information about mental health problems [1]. Current data
is needed in order to address the persisting mental health
issues in the country. However, there is definitely a lack of
accurate and relevant information that will assist the
government in formulating comprehensive mental health
policies (primordial level of prevention). Moreover, stigma
can affect the willingness of policy makers in investing in
mental health. In turn, it leads to lower prioritization in the
allocation of government funds for mental health and
subsequently resulting to poor delivery of services.
Furthermore, stigma may affect the eagerness of the public
to participate in awareness and promotional campaigns
(primary prevention) about mental health which are
designed to minimize the onset of mental health illness in
the public. Likewise, when there are already mental illness
cases involved, stigma serves as a barrier to the utilization of
programs that aim early case detection and management
(secondary prevention), as well as to the continued
participation in treatments to lessen severity of illness
(tertiary prevention) [15].
Interventions addressing stigma
Byrne [16] points out that the starting point for all target
groups at every level of intervention is education. He said
that education in the form of research helps the public,
particularly the professionals, in understanding the
complexities of stigma. It also provokes discussions among
scientific communities which, in turn, results to even more
investigations on the subject matter. Studies on the
interaction of varying aspects of self-stigma and care
seeking can be done, as well as conducting regular surveys
on the public attitudes to mental health, mental well-being
and me ntal illness es whic h may serve as basel ine
information to other studies and as reference for future
policies [5]. Interactions with people having mental illness
further supplement educational approaches [17,18].
Contact may be direct, face-to-face interaction, or indirect,
through watching video interviews.
Anti-stigma campaigns have already been introduced
from around the world, mostly from developed countries.
Some campaigns target mental hea lth stigma and
discrimination in general for all groups like the See Me
campaign of Scotland [19], the Time to Change of U.K. [20],
and Elephant in the Room of Canada [21]; while other
campaigns are more directed to a particular mental
disorder like the Beyond Blue campaign of Australia which
targets depression and anxiety [22], and the Open the Doors
campaign, an international movement started by the World
Psychiatric Association (WPA) focused on reducing stigma
among schizophrenia patients [23]. An awareness campaign
in Australia was conducted to improve mental health
literacy and help-seeking attitudes among young people.
The campaign had a significant impact on self-identified
depression, increased awareness of suicide risks, improved
help-seeking behaviors, and reduced perceived barriers to
help-seeking [7].
According to Lauber [24], targeted interventions may be
more effective because the objectives and messages are
more specific. Targeted groups can be workplaces, schools,
police as well as mental health professionals. The labor
agency of the government must work with the human rights
commission in assuring that the rights of mentally ill persons
are lawfully maintained. Employers can offer possible
working arrangements with mentally ill employees like
working from home or giving additional time to finish their
tasks. Meanwhile, increasing awareness in the school
setting can be done through educational workshops and
watching video interviews, documentaries or movies about
mental illness. Interventions among police officers may
include training seminars on dealing with mentally ill
persons, on being cautious and more careful in interacting
with them.
Mental health professionals are encouraged to go
beyond educating within the confines of their clinics to
participating in programs of public education. According to
Byrne, every intervention must convey the importance of
stigma and discrimination, challenge the stereotypes within
ourselves, and continue to explain the nature of prejudice
[16]. In the U.S., the National Alliance of the Mentally Ill
(NAMI) has pushed for better legal protection in terms of
housing and working conditions for people with mental
illness through education. The group has also been
successful in pointing out negative representations of
mentally ill people in the media [6].
The media serves as a highly influential instrument in
reframing public perception of mental illnesses. Hostile and
violent representations of people with mental illness should
be discontinued. Instead, media should focus on reporting
accurate descriptions and explanations of mental illnesses.
In addition, the media should not only focus on the illness
itself but also on ways of coping with the illness and assisting
support groups [25]. Guidelines on reporting mental
illnesses can be developed to ensure responsible journalism
22 Phil J Health Res Dev April-June 2017 Vol.21 No.2, 20-24
Mental Health Stigma Among Filipinos
among news agencies. Media prizes and awards may be
given to media outlets showing positive and innovative
representations of people with mental health problems
[15].
Culture and arts can also be incorporated in anti-stigma
awareness campaigns. Concerts, theater performances and
art exhibits focusing on mental illnesses are organized in
different parts of the world, all with the same goal of
diminishing stigma and discrimination. The World Health
Organization (WHO) compiled these efforts in a report on
global advocacy campaigns to end mental health stigma.
Some of the activities mentioned in the report were the Indian
theater play entitled, Mind Matters, which portrayed a
journey through a person's mind, and The Hidden Artist art
exhibition which showcased the paintings of persons with
mental illness from Israel. Events like these were included in
mental health festivals or fairs, wherein free diagnosis and
consultation services were also provided [26]. In the
Philippines, a free art exhibit organized by the nonprofit
organization, NoBox Transitions Foundation, Inc., entitled Still
Life, featured the works of local artists with drug use and
addiction as the subject [27].
Other strategies done in the Philippines were mostly
spearheaded by private individuals and non-government
organizations. Students of the University of the Philippines
Manila College of Nursing initiated a fundraising event for
their psychiatric patients at the National Center for Mental
Health (NCMH); this event later prompted the students in
organizing other activities such as a symposium on mental
health awareness and a socializing event for the patients of
NCMH [28]. According to a report by Corrales [29], the
Janssen Pharmaceutical Companies of Johnson & Johnson
has collaborated with the National Institutes of Health,
University of the Philippines Manila (NIH-UPM) and the
Foundation for the Advancement of Clinical Epidemiology,
Inc. (FACE) in creating the country's first integrated mental
health information system; this collaboration is a product of
the Into the Light project of Janssen aimed to promote
awareness and eliminate stigma towards mental illness. As
stated in the report, Prof. Maria Lourdes Amarillo, the project
leader of the mental health information system, said that the
identification of the magnitude of mental illness will be the
first step in ending stigma, thus, gathering baseline data will
result in the creation of effective solutions that will address
the needs of people with mental illnesses [29]. The Philippine
Psychiatric Association (PPA) released awareness videos and
started the petition #MHACTNOW to encourage the public to
support the Philippine Mental Health Act of 2014 [30].
Conclusion
The mere avoidance of people in engaging in discussions
on mental illnesses has a lot to say about how it is perceived
by the public. There is undeniably high stigma associated
with mental illnesses in the country. These stigmatizing views
are translated in the way the public uses offensive labels in
describing mentally ill persons, as well as in equating them
with people, particularly politicians, who the public
considers dishonorable and undesirable. Moreover, media
reports of people with mental illness who are involved in
crimes are almost always overemphasized and lacking in the
information needed that will, at the least, attempt to explain
the rationale for their conduct. As a result, people with
mental illnesses are faced with enduring stigmatizing
attitudes and responses from the public which may further
exacerbate their mental well-being and compromise their
physical conditions and social relations.
Interventions which aim to reduce stigma can be
integrated in the community, school, workplace and other
settings. Promotion and education strategies are considered
effective and efficient means of increasing awareness of the
public on mental health problems. Targeted interventions
are b e lieve d t o b e m o re succe s sful due to the i r
responsiveness to individual needs. Creating events which
incorporate culture and arts is a more enjoyable and
interactive way of increasing awareness on mental illnesses.
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Mental Health Stigma Among Filipinos
... In the Philippines, mental health stigma remains a significant problem hounding communities and social institutions such as schools (Rivera & Antonio, 2017). Previous studies in the Philippines revealed that cultural and social factors contribute to mental health stigma. ...
... Studies recommended increasing public awareness about mental disorders by addressing mental health misconceptions and increasing mental health literacy (Adia et al., 2018;Rivera & Antonio, 2017;Tanaka et al., 2018). However, these mental health promotion interventions must be contextualized in the Philippine setting. ...
... Mental health stigma, including misconceptions and discrimination, remains pervasive in contemporary Philippine society (Rivera & Antonio, 2017). This stigma leads to various individual and adverse social consequences (Tanaka et al., 2018). ...
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... In contrast, media depictions are typically correlated to harm or wrongdoings. While there are undoubtedly stigmatic mental health issues in the Philippines, research into the extent to which they affect Filipinos with mental illness is comparatively insufficient (Rivera & Antonio, 2017). According to the Department of Health (DOH), inadequate mental health awareness campaigns are among the factors contributing to the country's continuous stigma (Department of Health, 2008, as cited in Rivera & Antonio, 2017). ...
... While there are undoubtedly stigmatic mental health issues in the Philippines, research into the extent to which they affect Filipinos with mental illness is comparatively insufficient (Rivera & Antonio, 2017). According to the Department of Health (DOH), inadequate mental health awareness campaigns are among the factors contributing to the country's continuous stigma (Department of Health, 2008, as cited in Rivera & Antonio, 2017). ...
... The National Statistics Office revealed that mental health illnesses are the third most common form of morbidity for Filipinos reporting 88 cases of mental health problems for every 100,000 Filipinos. Despite these statistics, the figures may still be underreported due to stigma and taboo related to the country's mental health problems (Dalida et al., 2018;Rivera & Antonio, 2017). In a country where both natural and manmade disasters are common, psychological problems are probable, yet mental health has not been a top priority (Tolentino, 2004). ...
... Similarly, 58% of the psychiatrists in the country, together with 44% board-certified specialists (Tolentino, 2004) practice in the capital region of Metro Manila (Samaniego, 2017). The lack of access to mental health services and information in the country contributes to the stigma and taboo associated with mental health (Rivera & Antonio, 2017). The present study attempts to address this limitation by focusing on individuals from rural communities in the Philippines. ...
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Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80% of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals’ human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
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Background: Public interest in mental health in the Philippines can change after the Mental Health (MH) act approval and during the COVID-19 pandemic. To determine these changes, online searches in Google can be analyzed as an alternative measure. Aims: To determine the trends of public interest in mental health before and after the MH act approval and during the COVID-19 pandemic. Method: Aggregated search volumes for mental health using the keyword, "Mental Health (Topic)" were gathered from Google Trends. Search volume indices (SVIs), and related queries were analyzed. SVIs from the different periods were compared using means, t test, ANOVA, and ARIMA. Results: Public interest in mental health increased after the MH Act approval and during the COVID-19 pandemic. The top and rising related queries revolved around mental health definitions, translations, factors, services, policy, adverse mental state, and its context during the pandemic. Conclusions: These increased public interests may stem from aspirations for mental health after legislation and higher mental health needs during the pandemic. Related queries may indicate that the public may be using online information to search for mental health services and concepts. Thus, there is a need to improve reliable and trustworthy online mental health information and services.
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Isang pangkaraniwang kaisipan ng mga tao na kapag nababanggit o nababasa ang salitang “kultura”, ito ay konektado na sa kahulugan rin ng “tradisyon; nangangahulugang mga kasanayan at kinatawang motibo ng lipunan. Higit sa rito, positibong damdamin ang tumatanghal sa kaisipan ng nakakarami kapag pinag-uusapan ang kultura, gayon sa paraan na ang konteksto ay laging patukoy sa pagpapahalaga ng mga pamana ng kasaysayan na nagbigay ng ebolusyon sa ating musika, arte, at literatura, mga pamaraan sa pagluluto, mga natatanging kaugalian at pagpapahalaga, at maging sa Estetika. Bagamat ang mga nasabi ay tiyak sa sarili nitong kahulugan — na positibong impresyon ang kadalasang bumubulwak sa kaisipan, na laging batayan ng kultura ay ang mga makalumang pananamit, sayawan, piyesta, at kaugalian tulad ng pagiging makabayan — may natatanging aporismo ang nakakaligtaan: kabuntot ng negatibo ang positibo, gayun rin ang positibo sa negatibo.
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Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed. © The Author(s) 2014.
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This study aims to provide a review of potential barriers to seeking mental health services among Filipinos. Research on help-seeking behaviours among Filipinos living in the Philippines and other countries (e.g., US, Canada, and Australia) suggest that mental health services in the Philippines are inaccessible and monetarily prohibitive, and beliefs about the aetiology and nature of mental illness are inconsistent with the medical model. Other cultural variables such as shame, stigma, and collectivist beliefs also discourage Filipinos from seeking help from mental health professionals. Furthermore, these variables could account for the preference for folk healers and lay networks in treating mental illnesses. As such, cultural and economic factors need to be accounted for in conceptualizing Filipinos’ utilization of mental health services. Implications and suggestions to aid practice were also discussed.
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Poor mental health has substantial personal and economic impacts across the European Union. Stigma and discrimination exacerbate these impacts. Consistently, the evidence points towards strongly negative attitudes towards people with mental health problems: in particular there is an inaccurate view that they represent a danger to the community, a view strongly reinforced in the media. Negative attitudes are not only found among the general public and media, but even among mental health professionals. These and other elements of stigma increase social distance and lead to social exclusion: they, for instance, reduce the likelihood of an individual becoming employed or accessing health care services. It is important that strategies to counter stigma are evidence-based. To date evidence on both their effectiveness and cost effectiveness is highly limited. Anti-stigma campaigns are difficult to evaluate but the limited evidence available suggests that campaigns targeted at specific population groups such as the police or school children may be more effective than those for the general population. Other measures to consider include investment in schemes to help individuals reintegrate into employment, schemes to increase the empowerment of people with mental health needs to choose the services that best meet their needs, and better enforcement and exchange of information on the use of legal instruments to tackle discrimination. This Research Note has been produced for the European Commission by David McDaid from the Health and Living Conditions Network of the European Observatory on the Social Situation and Demography. The views expressed are those of the authors and do not necessarily represent those of the European Commission
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Stigma and discrimination associated with mental health problems is an important public health issue, and interventions aimed at reducing exposure to stigma and discrimination can improve the lives of people with mental health problems. Social contact has long been considered to be one of the most effective strategies for improving inter-group relations. For this study, we assess the impact of a population level social contact intervention among people with and without mental health problems. This study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England's Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4-6 weeks later. This study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England's Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4-6 weeks later. Campaign events facilitated meaningful intergroup social contact between individuals with and without mental health problems. Presence of facilitating conditions predicted improved stigma-related behavioural intentions and subsequent campaign engagement 4-6 weeks following social contact. Contact, however, was not predictive of future willingness to disclose mental health problems. Findings emphasise the importance of facilitating conditions to promote positive social contact between individuals and also suggest that social contact interventions can work on a mass level. Future research should investigate this type of large scale intervention among broader and more representative populations.
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The authors' goal was to examine the extent to which perceived stigma affected treatment discontinuation in young and older adults with major depression. A two-stage sampling design identified 92 new admissions of outpatients with major depression. Perceived stigma was assessed at admission. Discontinuation of treatment was recorded at 3-month follow-up. Although younger patients reported perceiving more stigma than older patients, stigma predicted treatment discontinuation only among the older patients. Patients' perceptions of stigma at the start of treatment influence their subsequent treatment behavior. Stigma is an appropriate target for intervention aimed at improving treatment adherence and outcomes.
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Increasing help-seeking and referrals for at-risk individuals by decreasing stigma has been defined as Aspirational Goal 10 in the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force’s 2014 prioritized research agenda. This article reviews the research evidence on the impact of mass media awareness campaigns on reducing stigma and increasing help-seeking. The review will focus on both beneficial and iatrogenic effects of suicide preventive interventions using media campaigns to target the broad public. A further focus is on collaboration between public health professionals and news media in order to reduce the risk of copycat behavior and enhance help-seeking behavior. Examples of multilevel approaches that include both mass media interventions and individual-level approaches to reduce stigma and increase referrals are provided as well. Multilevel suicide prevention programs that combine various approaches seem to provide the most promising results, but much more needs to be learned about the best possible composition of these programs. Major research and practice challenges include the identification of optimal ways to reach vulnerable populations who likely do not benefit from current awareness strategies. Caution is needed in all efforts that aim to reduce the stigma of suicidal ideation, mental illness, and mental health treatment in order to avoid iatrogenic effects. The article concludes with specific suggestions for research questions to help move this line of suicide research and practice forward.
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Stigma is defined as a sign of disgrace or discredit, which sets a person apart from others. The stigma of mental illness, although more often related to context than to a person's appearance, remains a powerful negative attribute in all social relations. Sociological interest in psychiatric stigma was given added vigour with the publication of Stigma – Notes on the Management of Spoiled Identity (Goffman, 1963). More recently, psychiatrists have begun to re-examine the consequences of stigma for their patients. In 1989, the American Psychiatric Association's annual meeting's theme ‘overcoming stigma’ was subsequently published as a collection of articles (Fink & Tasman, 1992), and last year saw the launch of the Royal College of Psychiatrists' five-year Changing Minds anti-stigma campaign.
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The current literature on the problem of mental illness stigma in the United States must be expanded to better account for the role of culture. This article examines the relationship between mental illness stigma and culture for Americans of American Indian, Asian, African, Latino, Middle Eastern, and European descent. In this review, culture refers to the shared beliefs, values, and norms of a given racial or ethnic group. The reviewed literature indicates that there are differences in stigma among the various cultural groups; however, explanations as to why these differences exist are scant. Qualitative and quantitative studies indicate that cultural values are important with regard to stigma, particularly for Asian Americans and African Americans. Less is known about the interaction between cultural values and mental illness stigma for other cultural groups. Continued research in the area requires better organization and more exploration of the role of cultural history and values as they relate to mental illness stigma. To that end, a detailed, systematic approach to future research in the area is proposed.
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Little is known about how stigma affects Black people receiving mental health treatment. For a project to develop a consumer-based stigma intervention, qualitative interviews were conducted with public-sector Black mental health consumers (N=34). Primary themes from the interviews regarding stigma concerns, experiences, and coping strategies were examined. Concerns about stigma prompted most consumers initially to avoid or delay treatment; once in treatment, consumers commonly faced stigmatizing reactions from others. Consumers identified numerous strategies to deal with stigma, including seeking support from accepting members of their existing social networks, and viewing their own health as more important than the reaction of others. These consumer perspectives may be valuable to Black individuals who are contemplating seeking mental health treatment.
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Notes that there has been a great deal of speculation that mentally ill persons are being processed through the criminal justice system rather than the mental health system. To date, this thesis has been based more on intuition than on empirical research. Data from a study of 1,382 police–citizen encounters are presented that suggest that the mentally ill are indeed being criminalized. Specifically, it was found that, for similar offenses, mentally disordered citizens had a significantly greater chance of being arrested than non-mentally-disordered persons. This finding has public policy implications for the basic tenets of the community mental health movement, as well as for optimal functioning of the criminal justice system. Several public policy modifications are suggested. (56 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)