11 Sep Stigma Hampers Patients From Seeking Mental Health Care

MedicalResearch.com Interview with:
Patrick Corrigan Psy.D.
Distinguished Professor of Psychology
Illinois Institute of Technology
PI: National Consortium on Stigma and Empowerment
www.NCSE1.org

Medical Research:  What are the main findings of this review?

Dr. Corrigan: People with serious mental illness often do not seek out services, or drop out early, when in need. Stigma is a major reason for why this happens. Stigma refers to the stereotypes about a group that undermine status and lead to discrimination. Discrimination refers to the behaviors that block the opportunities of group members. Some employers do not hire people with mental illness, some landlords do not rent to them, and some primary care practitioners offer a substandard of care. Stereotypes and discrimination undermine engagement in mental health services in three ways (Corrigan, 2005):

Label Avoidance: In order to escape the pernicious effects of stigma, people avoid settings where they are labeled mentally ill; for example, people coming out of a psychiatrist’s office may be perceived as “nuts.”

Self-Stigma: Some people who internalize stereotypes suffer diminished self-esteem and self-efficacy leading to the “why try” effect. “Why should I try to get a job? Someone like me is not worthy.” “Why should I try to get mental health treatment? I am not able to benefit from it.”

Structural Stigma: Stereotypes and discrimination become institutionalized in the laws and practices of government and business. For example, insurance coverage for mental health services was significantly below that for most other conditions.  

Medical Research:  Were any of the findings unexpected?

Dr. Corrigan: Public health efforts in most of the major Western governments have sought programs to decrease the impact of stigma. Many of these have used educational programs that counter the myths of mental illness (e.g., People choose to act schizophrenic.) with the facts (Most mental illness has biological precursors. People do not choose to be mentally ill.) Research, however, has failed to show positive benefits from these programs either at the local level (showing improvements in individuals completing these programs) or at the population levels. In fact, population studies from the U.S., Canada, the EU and Australia show the stigma of mental illness worsening even though people seem to know more about symptoms and treatment (Schomerus et al., 2012).

Contact with people with mental illness yields more effective benefits. Contact represents programs where the public interact with people with mental illness who tell their stories of recovery. A recent meta-analysis (Corrigan et al., 2012) shows the effects of contact are significantly greater than those of educationand endure over time (Corrigan et al., 2014).

Medical Research:  What should clinicians and patients take away from your report?

Dr. Corrigan: A good place to start is language. Patient and clinician may be useful terms in the hospital but person first language yield the words of choice in the world: “people with mental illness.” Clinicians diminish stigma by being aware of their language and the stereotypes they endorse about mental illness. However, clinicians mostly have back-seat roles in stigma change. Stigma is an issue of injustice which is only erased through the power of the stigmatized. Advocates say, “Nothing about us without us.” Advocacy groups run by people with mental illness have grown in the past 15 years to tackle this problem. Support of these programs is essential for tearing down stigma. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes these efforts and is a fundamental booster of programs like these.

Medical Research:  What recommendations do you have for future research as a result of this study?

Dr. Corrigan: The challenge is to help contact programs go big time by determining which strategies help people with mental illness “come out” to undermine stigma (Corrigan & Kosyluk, 2013). SAMHSA has taken on this priority by partnering with the National Research Council of the National Academies of Science to set a plan for moving forward. The goal for scientists is to identify measures and methods to document the effects of these strategies.

References:

Corrigan, P.W. (Ed.) (2005). On the stigma of mental illness: Implications for research
and social change. (pp. 343). Washington DC: American Psychological Association

Corrigan, P.W., Druss, B.G. & Perlick, D.A. (2014). The impact of mental illness stigma on
seeking and participating in mental health care. Psychological Science in the Public Interest, 15, 37-30.

Corrigan, P.W. & Kosyluk, K.A. (2013). Erasing the stigma: where science meets advocacy.
Basic and Applied Social Psychology, 35, 131-140.

Corrigan, P.W., Morris, S.B., Michaels, P.J., Rafacz, J.D., Rusch, N. (2012). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric Services, 63, 963-973.

Schomerus, G., Schwahn C., Holzinger, A., Corrigan, P.W., Grabe, H.J., Carta, M.G. &
Angermeyer, M.C. (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 125, 440-452.

Citation:

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Patrick W. Corrigan, Benjamin G. Druss, and Deborah A. Perlick  
Psychological Science in the Public Interest October 2014 15: 37–70, doi:10.1177/1529100614531398

Last Updated on September 11, 2014 by Marie Benz MD FAAD