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Stigma: ignorance, prejudice or discrimination?

  • Graham Thornicroft (a1), Diana Rose (a1), Aliya Kassam (a1) and Norman Sartorius (a1)
Summary

The term stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). Most research in this area has been based on attitude surveys, media representations of mental illness and violence, has only focused upon schizophrenia, has excluded direct participation by service users, and has included few intervention studies. However, there is evidence that interventions to improve public knowledge about mental illness can be effective. The main challenge in future is to identify which interventions will produce behaviour change to reduce discrimination against people with mental illness.

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Copyright
Corresponding author
Professor Graham Thornicroft, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Tel: +44(0)207 848 0735; fax: +44(0)207 277 1462; email: g.thornicroft@iop.kcl.ac.uk
Footnotes
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Declaration of interest

G.T. and A.K. undertake stigma-related research supported by an educational grant from Lundbeck UK Ltd.

Footnotes
References
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Chamberlin, J. (2005) User/consumer involvement in mental health service delivery. Epidemiologic Psichiatria Sociale, 14, 1014.
Corrigan, P. (2005) On the Stigma of Mental Illness. American Psychological Association.
Crisp, A., Gelder, M. G., Goddard, E., et al (2005) Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry, 4, 106113.
Department of Health (2003) Attitudes to Mental lllness 2003 Report. Department of Health.
Graves, R. E., Cassisi, J. E. & Penn, D. L. (2005) Psychophysiological evaluation of stigma towards schizophrenia. Schizophrenia Research, 76, 317327.
Jorm, A. F., Christensen, H. & Griffiths, K. M. (2005) The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Australian and New Zealand Journal of Psychiatry, 39, 248254.
Link, B. G. & Phelan, J. C. (2001) Conceptualizing stigma. Annual Review of Sociology, 27, 363385.
Sartorius, N. & Schulze, H. (2005) Reducing the Stigma of Mental lllness. A Report from a Global Programme of the World Psychiatric Association. Cambridge University Press.
Sayce, L. (2000) From Psychiatric Patient to Citizen. Overcoming Discrimination and Social Exclusion. Palgrave.
Thornicroft, G. (2006) Shunned: Discrimination against People with Mental lllness. Oxford University Press.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Stigma: ignorance, prejudice or discrimination?

  • Graham Thornicroft (a1), Diana Rose (a1), Aliya Kassam (a1) and Norman Sartorius (a1)
Submit a response

eLetters

Stigma: Managing the challenge

Meetiksha Malhotra, Senior House Officer
18 April 2007

We agree with Thornicroft et al, that the main challenge that lies ahead, is to identify the interventions, which will produce behaviour changes to decrease discrimination against people with mental illness.

The Department of Health initiated “Action on stigma - promoting mental health, ending discrimination at work”, (1) as a step in this direction. It provides guidance for employers to encourage a culture of respect and dignity by making them more aware of mental illness, encouraging measures which would help to recognise symptoms early and hence, seeking help appropriately. It is suggested that employment must not be refused on grounds of mental illness or disability. Appropriate adjustments to work environment, for people with mental health illness, are recommended, to encourage them to work. Some organisations already participating are BT, Royal Mail, Oxleas NHS Foundation Trust, BP, and Astra Zeneca.

The Royal College of Psychiatrists' campaign on “Changing minds”(2) further emphasises that the interventions to improve public knowledge about mental health illness can be effective. The results (3) of this campaign, showed a reduction in the negative opinions expressed by people about mental health illness. Fewer people endorsed the statement that people with mental health illness “feel different from us”. This is important as it reflects empathy (lack of empathy is considered an important aspect of stigma). The most stigmatised disorders were drug addiction, alcoholism and schizophrenia, however only 6% people believed that schizophrenics were to be blamed for their illness.

Byrne, P. (4) suggested methods for practical management of stigma. These include acknowledging stigma as the first step, implementing effective psychological interventions for the patients, developing advocacy services involving patients, peers, families, carers, community groups, civil rights activists with a view to utilize their valuable experience to develop better tools to deal with problems they may have faced due to stigma.

To summarise, there is positive evidence supporting that there are efforts being put in, to change peoples behaviour as a means of minimisingdiscrimination. Proactive measures need to be developed in this regard. Effective tools and policies to evaluate the result of these interventionswould prove beneficial.

References:

1)Department of Health (DoH), Action on Stigma: Promoting Mental Health, ending discrimination at work (Best Practising Guidance, Oct. 2006).

2)Royal College of Psychiatrists campaign, “Changing minds”(1998-2003), http://www.rcpsych.ac.uk/campaigns.aspx

3)Crisp, A., Gelder,M., Goddard, E., Meltzer, H.,(2005) Stigmatisation of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. Research Report. World Psychiatry 4:2-June 2005.

4)Byrne, P. (2000) Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6,65-72.
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Conflict of interest: None Declared

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Attitude of medics

Jinesh Shah, Senior House Officer in Airedale-Bradford rotation.
28 March 2007

I read with interest Thornicroft et al’s editorial on Stigma. Stigma faced by the people suffering from Schizophrenia from general public is very common place.

People suffering from other mental disorders, like depression, anxiety, also face a lot of stigma.

The medical staff stigmatises them. The GP trainees are placed in Psychiatry placements and their awareness of mental health problems is good, generally. However, the awareness in other hospital specialities is lacking.

Recently, I was referred a patient from a medical ward. When I went there and had a word with the medical doctor, she said something to the effect- “ this patient already has a history of depression in the past, so, I guess, when she came in the medical ward, she was not 100% normal.” The way she said was as if people who have had a history of mental health problems in the past are lesser mortals than others.

Also, the psychiatrist faces stigma in the world of medicine.

I was once admitted for surgery. I accidentally heard that my requestto change rooms was joked about, with comments like “is this psychiatrist nuts”.

Although these are individual scenarios, the experience of lack of understanding towards our patients and ourselves from medics and surgeons is not so uncommon.
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