Mental+health+and+social+stigma

Name: Leah Jordan Student Number: 6305016 Tutor: Colleen Niland.

[|Change our minds, Queensland Government Initiative]

=Cultural Artefact:=



This is a cartoon drawn by Mike Lake. Mike sufferers from a mental illness and this cartoon is his depiction of his treatment by society in regards to his illness. Mike posted it on his website WhyHope.com, which he established to attempt to protect the mentally ill by fighting discrimination and hate. His comment about the cartoon states that ‘This cartoon also shows why it is easier to write about these issues than to talk about them’. This is also written on his website. There is what people expect you to be, there is what you want to be, and what you must be to survive. (Mental health support tends to fail because it ignores these three faces of life.)
 * The Three Faces of Life: **

=**Public Health Issue:**= The public health issue is concerned with the prevalence of mental health in Australia and how well it is dealt with in society in regards to stereotypes and stigmas and if these act as barriers to sufferers accessing health care or their quality of life. Almost half of Australians aged between 16 and 85 will have a mental disorder at some point in their lives and one in five Australians will experience a 12 month mental disorder (ABS, 2008). According to the WHO, stigma, and its associated discrimination, comprises the 'single most important barrier' facing people with mental health and behavioral issues (WHO, 2005). The top-ranking factor that Australians with mental illness say would improve their lives is // reducing stigma //(Commonwealth Department of Health and Ageing, 2002).

=**Literature Review:**= Historically, stigma comes from the Greek word //stigmata,// which refers to ‘a mark of shame or discredit; a stain, or identifying mark or characteristic’ (Overton & Medina, 2008, p.143). This paper will look at the evidence that stigma towards mental health sufferers does exist and how resultant discrimination contributes to suffers quality of life Mental health stigma is a process that involves recognition of cues that a person has a mental illness, activation of stereotypes of people with mental illness, and prejudice or discrimination against that person (Overton & Medina, 2008, p.144). Social psychologists view stereotypes as knowledge structures that are learned by most members of a social group (Watson et al., 2007, p.1312). A PsycINFO and PubMed search with the keyword stigma found more than 4278 related articles, with more than half of the articles being published between the years 2000 and 2005 (Mak et al., 2007, p.246). This indicates a growing interest in the concept of stigma and its influence on psychological and medical research. (Mak et al., 2007, p.246)

Mak et al. (2007) conducted a meta-analysis of 49 research papers on mental health and stigma. The relationship between stigma and mental health was found to have a medium correlation effect, which indicated that it is strong enough to be observed in everyday life (Mak et al., 2007, p. 256). The meta-analysis showed a trend for the stigma mental health relation to be stronger in Europe and Australia than in North America (Mak et al., 2007, p.259) and the paper states that this could be due to the varying institutional and societal efforts that different regions have put into stigma reduction (Mak et al., 2007, p.259). The limitations of the study could be some error in results due to the number of sub-groups identified which is due to the diverse range of measures of stigma from all of the papers. The results provide support for the importance of stigma in relation to mental health and that efforts to combat stigma are worthy, as the mitigation of stigma may enhance people’s wellbeing (Mak et al., 2007, p.260). This is supported by results from the National Survey of Mental Health and Wellbeing, with the top-ranking factor that Australians with mental illness say would improve their lives is // reducing stigma //(Commonwealth Department of Health and Ageing, 2002).

In other studies, using social distance as an indicator of mental health stigma has been commonly used. Social distancing is a common response to fear that rises from prejudice or discrimination (Overton & Medina, 2008, p.145). It prompts many individuals to avoid working, socialising, and living with persons who have a mental disorder (Anagnostopoulous & Hantzi, 2011, 452) <span style="font-family: 'Times New Roman','serif'; font-size: 13px;">. <span style="font-family: 'Arial','sans-serif';">Measures of social distance seek to assess a respondent's willingness to interact with a target person in different types of relationships. (Link et al., p.519). The Social Distance Scale (SDS) has been established as a valid and reliable measurement of social distance (Bell et al., 2009, p.8). Studies conducted by Link et al. (2004), Anagnostopoulous & Hantzi (2011) and Bell et al (2009) investigated stigma using this scale. The combination of these studies compare the existence of stigma in future primary health care professionals across different countries (Bell et al., 2009, p.5) as well as in college students (Anagostopoulous & Hantzi, 2011, p.453), in an attempt to determine whether social distance is consistently associated with stereotypical attributes (Bell et al., 2009, p.5). The small sample size of the studies, all fewer than 1000 participants, provides limitations in both the study design and the reliability of data collected. Bell et al. found that the students’ desire for social distance from mental health sufferers was significant and similar in all countries in which the survey was conducted (Bell et al., 2009, p. 8) but the stereotypes that determined stigmas and resultant desired social distances differed across countries (Bell et al., 2009, p.12). Unpredictability was most strongly associated with having a high social distance in Australia (Bell et al., 2009, p.8), with strong results for other countries consisting of ‘danger to others’, ‘difficult to talk to’, ‘have themselves to blame’ and ‘will not improve without treatment’ (Bell et al., 2009, p.8).

<span style="font-family: 'Arial','sans-serif';">Anagnostopoulos & Hantzi., found that people who are more familiar with mental illness hold stronger social care and weaker prejudiced beliefs, and consequently expressed a less strong desire for social distance. This is important evidence when considering how to address improving the quality of life for mental health sufferers.

<span style="font-family: 'Arial','sans-serif';">Not only does structural stigma, enforced by society and professionals, impact on the lives of sufferers, but they can begin to internalise the stigmas and apply the stereotypes to themselves. Research shows that this perceived stigma results in a loss of self-esteem and self-efficacy and in limited prospects for recovery (Watson et al, 2007, p.1312). This internalised judgment could be a result of messages received from societal norms but ultimately it is the individual who is creating the judgment towards themselves (Overton & Medina, 2008, p.144). <span style="color: black; font-family: 'Arial','sans-serif';">Not all stigmatised individuals go through the process of internalisation. Some individuals may not be aware of stigma, whereas others may be energized by the oppression and fight against the odds. (Mak et al., 2007, p.256). Watson et al. explored this concept further with their study into self-stigma of mental health sufferers. This study found that individuals who belong tostigmatisedgroups may internalize the negative statements aimed at that group, and on the other hand, individuals may develop a positive identity via their interactions with peers from thestigmatised group (p.1312). A previously established and validated, Self-Stigma of Mental Illness (SSMI) scale was used in this study (p.1314). The scale uses phrases such as ‘I think the public believes…because I have a mental illness’ and ‘because I have a mental Illness….’ (Watson et al., 2007, p.1314) in a series of questions to establish the prevalence of self-stigma. The study found that the type of mental illness diagnosed was not predictive of self-stigma constructs (p.1314).

<span style="color: black; font-family: 'Arial','sans-serif';">Evidence suggests that individuals suffering from mental illness constrict their social networks and opportunities in anticipation of rejection due to stigma, which also leads to isolation, unemployment, and lowered income (Watson et al., 2007, p.1312). They may also be less willing to seek treatment due to perceived stigma (Watson et al., 2007, p.1312). Along with internalized stigma, these ‘‘failures’’ result in self-esteem and self-efficacy decrements (Watson et al., 2007, p.1312). <span style="font-family: 'Arial','sans-serif';">Social and self-stigmas impact sufferers through lack of employment opportunities, limitations on finding adequate shelter; barriers to obtaining treatment services, including negative attitudes of mental health professionals and the role of media in perpetuating the negative image of people with mental illness (Overton & Medina, 2008, p.145).

=**Cultural and Social Analysis:**= <span style="font-family: 'Arial','sans-serif';">The above mentioned results from the Watson et al. study of self-stigma and its impact as potentially positive and empowering when they can associate themselves with the stigmatized group as opposed to potentially negative is an important concept for culturally and socially analysing this public health issue.

<span style="font-family: 'Arial','sans-serif';">As suicide is the main cause of premature death among people with a mental illness (ABS, 2008) the isolating effects of stigma presented above can be analysed using Emile Durkheim’s social theories involving suicide, particularly his Egoistic category. Durkheim’s theory of suicide refers to social integration and the degree that individualism of society is strongly correlated with the amount of suicide. Egoistic suicide category occurs when social bonds are weak which in turn causes the individual to detach him/herself from others. Without reaching the endpoint of suicide, this concept is interesting when addressing mental health as social relationships and networks can act as protective factors against the onset or recurrence of mental illness and enhance recovery from mental disorders (WHO, 2005).

<span style="font-family: 'Arial','sans-serif';">From a public health perspective this is important when considering the most at risk group of suicide is rural men. Being from rural communities, opportunity to positively identify with other mental health sufferers may be restricted. They may be less inclined to seek help or may be less intimately connected to people who might otherwise be aware of problems or step in to assist (ABS, 2010). Negative self-stigmatisation by applying stereotypes to themselves may further affect their self-esteem and contribute to their feelings of distance from society. According to Emile Durkheim the structures that have high suicide rates all have in common a relative lack of cohesion, or a condition of relative normlessness (Bolender, para 5)

<span style="font-family: 'Arial','sans-serif';">Specifically as a culture, it is normative behavior to perceive people with mental illness as dangerous and violent (Overton, 2008, p.145). As mentioned above, the study by Bell et al. found that reasons for social distances differed from country to country and that ‘unpredictability’ was the greatest reason given of the need for social distance from people with a mental illness within Australia. This finding suggests there is a unique cultural aspect underlying the developments of social stigmas and stereotypes.

<span style="font-family: 'Arial','sans-serif';">From a public health perspective, the role that structure and agency plays in this problem is extremely significant and could be the key to improving the lives of mental health suffers, not only through minimising negative affects of stigma for acceptance in society but their individual willingness to seek out help. The concept of reducing structural stigma isn’t new and has been attempted to b addressed in Australia through various campaigns. The research presented above demonstrates the need for not only stigmas and stereotypes held by general society to be addressed but also the need for the issue to be addressed through medical and other service providers to this heavily marginalised group.

=**Artefact Analysis:**= <span style="font-family: 'Arial','sans-serif';">The cultural artefact is a representation of how a mental health sufferer feels he is treated by society and health professionals in response to his illness. It is a great representation as it is its simplicity is a complete contrast to the in depth academic studies that are designed to investigate this social phenomenon, yet he seems to sum it up the same stereotypes and how they have been applied to him. It represents his feelings of society being big and overpowering; this is shown in the size difference between the two figures in the picture. The smile on the ‘Society’ figures face also implies that he feels like society is very light –hearted about it all but the tear on the ‘mental illness’ figure shows how much it hurts him.

<span style="font-family: 'Arial','sans-serif';">The artefact is important for me in my understandings as I had previously thought of mental illness stigma as self-stigma, an internal self esteem issue due to having a mental illness but this assessment and artefact has made it clearer where that internalisation has come from and that societal stigma introduces and reinforces the self-stigma.

<span style="font-family: 'Arial','sans-serif';">The high prevalence of mental health amongst Australians makes the deeper understanding I have gained on social stigmas incredibly relevant. It is not only relevant to be aware of my actions towards someone who has a mental health issue, but also to have empathy that they may be reacting due to disempowerment by a discriminatory society. Awareness of the different social constructs and influences that may have contributed to the creation of stigmas for different cultural groups is also an extremely important concept to take away from this project.

=**References:**= <span style="font-family: 'Arial','sans-serif';">Anagnostopoulos, F., Hantzi, A., (2011) Familiarity with and Social Distance from People with Mental Illness: Testing the Mediating effects of Prejudiced Attitudes. //Journal of Community & Applied Social Psychology 21,// 451-460 doi: 10.1002/casp.1082

<span style="font-family: 'Arial','sans-serif';">Australian Bureau of Statistics (2010). //Family, community and social cohesion: Suicide.// Retrieved from [])

<span style="font-family: 'Arial','sans-serif';">Australian Bureau of Statistics (2008)//. National Survey of Mental Health and Wellbeing: Summary of Results.// Retrieved from <span style="color: windowtext; font-family: 'Arial','sans-serif'; text-decoration: none;">[] <span style="font-family: 'Arial','sans-serif';">=

<span style="font-family: 'Arial','sans-serif';">Australian Institute of Criminology (1996//). Trends and Issues in crime and criminal justice: Social Factors in Suicide in Australia (52)// Retrieved from Australian Institute of Criminology website <span style="color: windowtext; font-family: 'Arial','sans-serif'; text-decoration: none;">[]

<span style="font-family: 'Arial','sans-serif';">Bell, J.S., Aaltonen, S.E., Airaksinen, M.S., Volmer, D., Gharat, M.S., Mucenience, R., Vitola, A., Foulon, V., Desplenter, F.A., Chen, T.F. (2009). Determinants of Mental health Stigma Among Pharmacy Students in Australia, Belgium, Estonia, Finland, India and Latvia. //International Journal of Social Psychiatry, 56(1),// 3-14. Doi: 10.1177/0020764008097621

<span style="font-family: 'Arial','sans-serif';">Bolender Initiatives (n.d). Emile Durkheim 1858-1917,The work. Retrieved from []

<span style="font-family: 'Arial','sans-serif';">Commonwealth Department of Health and Ageing, Mental Health Branch (2002). //National Survey of Mental Health and Wellbeing Bulletin 6, Stigma and Discrimination.// Retrieved from [|http://www.mentalhealth.gov.au]

<span style="font-family: 'Arial','sans-serif';">Link, B.G., Yang, L.H., Phelan, J.C., Collins, P.Y. (2004). Measuring Mental Illness Stigma. //Schizophrenia Bulletin 30(3)// 511-541. Retrieved from <span style="color: windowtext; font-family: 'Arial','sans-serif'; text-decoration: none;">[|http://schizophreniabulletin.oxfordjournals.org]

<span style="font-family: 'Arial','sans-serif';">Mak, W.W.S., Poon, C.Y.M., Pun, L.Y.K., Cheung, S.F. (2007). Meta-analysis of stigma and mental health. //Social Science & Medicine 65,// 245-261 Retrieved from [|www.elsevier.com/locate/socscimed]

<span style="font-family: 'Arial','sans-serif';">Overton, S.L., Medina, S.L. (2008). The Stigma of Mental Illness. //Journal of Counseling and Development 86(2),// 143-151. Retrieved from <span style="color: windowtext; font-family: 'Arial','sans-serif'; text-decoration: none;">[|http://search.proquest.com] <span style="font-family: 'Arial','sans-serif';">.

<span style="font-family: 'Arial','sans-serif';">Watson, A.C., Corrigan, P., Larson, J.E., Sells, M. (2007) Self-Stigma in People with Mental Illness. //Schizophrenia Bulletin 33(6),// 1312-1318. doi:10.1093/schbul/sbl076

<span style="font-family: 'Arial','sans-serif';">World Health Organization (2007). //What is Mental Health? Online Q&A//. Retrieved November 1, 2011 from <span style="color: windowtext; font-family: 'Arial','sans-serif'; text-decoration: none;">[]

<span style="font-family: 'Arial','sans-serif';">World Health Organization (2005). //Promoting Mental Health: Concepts, Emerging Evidence, Practice.// Retrieved from http://www.who.int/mental_health/evidence/MH_Promotion_Book.pdf

=**Reflections:**=

I really like the way that you used an artefact to show the influence of the media has on female body image and then related it to the females in sport. It is so true and such a shame that even girls striving to be athletes, who are already surrounded by media pressure and influence of ‘beautiful’, then have the added pressure of their successful sporting heroes being marketed as sexy!
 * Don't Break a Sweat Girl, You'll Bring Attention to Yourself!**

'**It's bad enough that people are dying of AIDS, but no one should die of ignorance' - Elizabeth Taylor (actress)..wiki** This is such a great artefact to have used. I was so shocked, surprised and disappointed when I found out the story behind this poster. Your comments that ‘The increasing rates of HIV diagnosis are such a concern because they indicate that the safe sex message is not getting through to young people.’ And ‘men who have sex with men are one of the most significant groups at risk of contracting HIV/AIDS’ sum up exactly why advertisements like this are so necessary. It is such a public health issue, especially in a multi-cultural country like Australia to be aware that religion and beliefs can get in the way of access to healthcare and promoting safe practices.