What is stigma?

1. What is stigma? Knowledge, Attitude, and Behavior By Walker Karraa, PhD Founder, Stigmama

2. A mark • “A mark or sign of disgrace usually eliciting negative attitudes toward its bearer. If attached to a person with a mental disorder it can lead to negative discrimination. • (Thornicroft, et al., 2007, p. 192)

3. A process • “A process involving labelling, separation, stereotype awareness, stereotype endorsement, prejudice and discrimination in a context in which social, economic or political power is exercised to the detriment of members of a social group. • (Link & Phelan, 2001 as cited in Clement, et al., 2014, p. 1)

4. Our biggest challenge • “Stigma is the most damaging factor in the life of anyone who has a mental illness. It humiliates and embarrasses; it is painful; it generates stereotypes, fear and rejection; it leads to terrible discrimination. Perhaps the greatest tragedy is that stigma keeps people from seeking help for fear of being labeled ‘mentally ill’. – Former first lady, Rosalynn Carter • (Carter, 2010, p. 1)

5. TYPES OF STIGMA • Anticipated stigma (anticipating discrimination) • Experienced stigma (experience of discrimination) • Internalized stigma (holding negative views about oneself) • Perceived stigma (beliefs about how others view mental illness) • Stigma endorsement (stigmatizing others with mental illness through our own attitudes and behavior) • Treatment stigma (stigma associated with getting treatment for mental illness) • Clements, et al., 2014

6. The problem of stigma • It is estimated that between 52-74% of people with mental illness in USA and Europe are not treated (Alonso et al., 2004; Kessler, et al., 2005; Wittchen & Jacobi, 2005; Thornicroft, 2007) • The result?

7. Problem of Knowledge: Ignorance • Ignorance or lack of knowledge regarding mental illness • Also referred to as “mental health literacy” • Examples: “postpartum” in mainstream media is often used as a catch-all for all postpartum mental illness. • Thornicroft, et al., 2007

8. Problem of attitudes: prejudice • Negative thoughts, feelings, or emotional reactions about mental illness • Anger • Fear • Disgust • Resentment • These attitudes may be more predictive of discrimination than holding negative stereotypes. • (Thornicroft et al., 2007)

9. Problem of Behaviors: discrimination • Social distance • Social rejection • Avoidance

10. Stigma and perinatal period • Most women with severe mental illness have at least one pregnancy (Howard et al., 2001) • Significant differences in perceptions between care providers and women exist (Howard & Hunt, 2008). • Needs of pregnant or postpartum women with severe mental illness are different than general population with mental illness. • Childcare • Breastfeeding and medication • Sleep • Domestic violence • Social isolation (Howard & Hunt, 2008)

11. What to do • Knowledge- Mainstream media needs accurate information describing mental illness • Social and cultural pressure on media not accurately portraying or reporting on mental illness. • Routine public education regarding mental illnesses and the facts regarding violence. • Practice “storylines” discussing your mental illness in factual ways.

12. references • Alonso, J. Angermeyer, M.C., Bernet, S. Bruffaerts, R., Brugha, T. S., & Bryson, H. (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESMeD) project. ActaPsychiatricaScandinavica, 420, 47-54. • Carter, R. (2010). Within our reach: Ending the mental health crisis. New York, NY: Rodale. • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G. (2014). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine, 1-17. • Dennis, C. L., & Chung‐Lee, L. (2006). Postpartum Depression Help‐Seeking Barriers and Maternal Treatment Preferences: A Qualitative Systematic Review. Birth, 33(4), 323-331. • Howard, L., M., Kumar, R. & Thornicroft, G. (2001). Psychosocial characteristics and needs of mothers with psychotic disorders. British Journal of Psychiatry, 178, 427-324. • Howard, L.M. & Hunt, K. (2008). The needs of mothers with severe mental illness: a comparison of assessments of needs by staff and patients. Archives of Womens Mental Health, 11, 131-136. • Kessler, R., Demler, O., Frank, R., Olfson, M., Pincus, H., Walters, E., Wang, Pl, Wells, K., & Zaslavsky, A. (2005). Prevalence and treatment of mental disorders, 1990-2003. New England Journal of Medicine, 352, 2515-2523. • Rose, D., Thornicroft, G., Pinfold, V., & Kassam, A. (2007). 250 labels used to stigmatize people with mental illness. BMC Health Services Research, 7(1), 97. • Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination?. The British Journal of Psychiatry, 190(3), 192-193. • Thornicroft, G. (2006). Shunned: Discrimination against people with mental illness. Oxford. • Wang, P.S., Aguilar-Gaxiola, S., Alonso, J., et al. (2007). Use of mental health services for anxiety, mood and substance disorders in 17 countries in the WHO world mental health surveys. Lancet, 370, 841-850. • Wittchen, H. & Jacobi, F. (2005). Size and burden of mental disorders in Europe: a critical review and apprasial of 27 studies. European Neuropsychopharmacology, 15, 357-376. • FREE FULL-TEXT • Actions Speak Louder: The Experience of Stigma and Discrimination • 250 labels used to stigmatise people with mental illness Rose, Thornicroft, Pinfold & Kassam (2007) BMC Health Services Research, 7, 97.

13. Contact • Walker Karraa, PhD • walkerkarraa@gmail.com Stigmama www.Stigmama.com • stigmamainfo@gmail.com