The document discusses stigma associated with mental illness. It notes that stigma involves negative stereotypes and attitudes that label people with mental illness as less worthy. These attitudes are perpetuated by misrepresentations in media and a lack of understanding. The document outlines various factors that contribute to stigma, including fear, economic issues, lack of treatment facilities, and cultural beliefs. It also discusses the negative impacts of self-stigma, discrimination, and social exclusion that people with mental illness often face. Interventions like social contact and education are mentioned as ways to potentially help address stigma.

1. Presenter : Dr. Harneet kaur
Moderator : Prof. B.S.Chavan

2.  Stigma is a broad term which is used to
describe the negative and stereotypical
thoughts, attitudes, and feelings about people
on the basis of the traits of a person, which can
include gender, skin color, sexual orientation,
religion and mental illness. It has been used to
label certain groups of people as less worthy of
respect than others.
 These attitudes in the community are
supported by ignorance, prejudice and
discrimination, and are perpetuated when
mental illness is represented in an inaccurate
way by the media.

3.  There are still attitudes within most societies
that view symptoms of psychopathology (i.e.,
mental illness) as threatening and
uncomfortable, and these attitudes frequently
foster stigma and discrimination towards
people with mental health problems.
 Such reactions are common when people are
brave enough to admit they have a mental
health problem, and they can often lead on to
various forms of exclusion or discrimination –
either within social circles or within the
workplace.

4.  Stigma is therefore used as a negative label to
identify people with mental health problems. It,
thus, has its roots in fear and misunderstanding.
 Many people hold negative opinions towards
people with mental health problems because they
do not understand the issues involved and
because they are relying on myths and
misconceptions.
 As health professionals, we are committed to
ensuring that people with mental health
difficulties must enjoy the same rights on an
equal basis with everyone without
discrimination.

5.  Stigma is a Greek word that in its origins
referred to a type of marking or tattoo that was
cut or burned into the skin of criminals, slaves,
or traitors in order to visibly identify them as
blemished or morally polluted persons. These
individuals were to be avoided or shunned,
particularly in public places. (Wikipedia)
 Sign of disgrace or discredit which sets a
person apart from others. (Bryne 2000)

6.  Stigma results from a process whereby certain
individuals and group are unjustifiably rendered
shameful, excluded and discriminated against.
[WHO 2002]
 “a buzz word, arousing more emotional reaction
than words like devaluation and
discrimination”[Clausen 1981]
 In his 1963 book, Goffman E. Stigma: Notes on
the Management of Spoiled Identity. Erving
Goffman defines stigma as
The phenomenon whereby an individual with an
attribute which is deeply discredited by his/her
society is rejected as a result of the attribute.
Stigma is a process by which the reaction of
others spoils normal identity.

7.  Gullekson (a clinical psychologist in California)
(in Fink & Tasman, 1992) writes about her
brother's schizophrenia:
“For me stigma means fear, resulting in a lack
of confidence. Stigma is loss, resulting in
unresolved mourning issues. Stigma is not
having access to resources… Stigma is being
invisible or being reviled, resulting in conflict.
Stigma is lowered family esteem and intense
shame, resulting in decreased self-worth.
Stigma is secrecy… Stigma is anger, resulting
in distance. Most importantly, stigma is
hopelessness, resulting in helplessness.”

8.  Economic instability – deals with poverty.
 Lack of information systems – lack of education
to both professionals and to the general public.
 Lack of treatment facilities – the presence of
inadequate preventive facilities.
 Lifestyle – such as smoking and other drug use,
and the act being seen as shameful.
 Fear – people fear the unknown outcome of the
condition; the condition itself and burden of
care.

9.  Previous experience – most people have
experience some form of the disease that might
be similar to that particular disease that is
stigmatized. They may also have seen people die
from the condition in a bizarre circumstance due
to family/societal neglect.
 Medical diagnosis – the medical model implies
diagnosis, and diagnosis implies a label that is
applied to a ‘patient’. That label may well be
associated with undesirable attributes (e.g., ‘mad’
people cannot function properly in society, or can
sometimes be violent), and this again will
perpetuate the view that people with mental
health problems are different and should be
treated with caution.

10.  Media -Stigma in the media is especially
harmful because the media plays an important
role in shaping and reinforcing community
attitudes, i.e., spreading wrong information.
For example, cinematic depictions of
schizophrenia are often stereotypic and
characterized by misinformation about
symptoms, causes and treatment.
Schizophrenic characters portray violence
behavior, carry dangerous act, and commit
suicidal and homicidal behaviors.

11.  Self stigma
 Enacted stigma
 Felt stigma

12.  SELF STIGMA
is where individuals with mental illness feel
they are being judged by others, so they feel
disgraced, blame and isolate themselves from
people. It is one of the most harmful effects of
stigma. Self stigma occurs when it alters how
the person views himself/herself. The person
living with mental illness may mistakenly
believe that his/her condition is a sign of
personal weakness or that s/he should be able
to control it.

13.  Enacted stigma/Discrimination – this is where
there is discrimination against individuals
living with mental illness or people who have
some of the condition or disease in their
community.
 Felt stigma – the perception or feeling one has
towards people with same specific disease or
condition which they also have.

14. The stages in the process of stigmatization
include:
 Labeling – the process of stigma begins when
individuals with mental illnesses are first
identified, marked and labeled, and seen to be
different from others.

15. Stereotypes of mental illness
 Psycho killer / maniac
 Indulgent, libidinous
 Pathetic sad characters
 Figures of fun
 Dishonest excuse: hiding behind
‘psychobabble’ or doctors

16.  Negative reaction – there is negative behavior towards
individuals with mental illnesses because their
situations are seen as a result of their sinful behavior or
a curse from the gods.
Factor type Example Likely to increase prejudice
 Attribute of stigmatized Gender- Male gender
 Appearance- Unkempt appearance
 Behavior -Acute illness episode
 Financial circumstances- Homelessness
 Perceived responsibility- Not responsible for actions
 Perceived severity- History of hospital admission
 Perceived course- Incurable/“chronic”
 Perceived treatments- “Needs drugs” to stay well
 Perceived danger -Criminality or violence

17.  Shunning – they are shunned, rejected,
avoided, and separated from other people,
family or community because of their disease
state.
 Loss of status – these individuals lose their
respect, position, dignity, statuses, and even be
isolated from the family or community. Some
individual’s rights are even trampled upon and
are sacked from their work place, school, or
even ejected from their place of residence.

18.  It's difficult to be diagnosed with a serious
mental illness such as schizophrenia, bipolar
disorder, panic disorder, obsessive-compulsive
disorder and major depressive disorder. It's also
difficult when a loved one is experiencing one
of these diseases. When a person is living with a
serious mental illness, the whole family may be
affected.

19.  Serious mental illnesses often have a biological
component. They are not the result of bad
parenting. Even still, after the diagnosis it's
normal for most of the parents to feel a range of
powerful and often unpleasant emotions.
 It's not uncommon to feel ashamed, or hurt, or
embarrassed by a family member whose
behaviors can be difficult to understand and
deal with.

20.  Many people also feel anger at the circumstances
and even at the person who has been diagnosed.
And though it may not be logical, parents often
engage in some degree of self-blame. Such
feelings of shame and anger may also go hand-
in-hand with feelings of guilt. Grief is also
common.
 Parents, in particular, often have to readjust their
hopes or expectations for the future when their
child develops a serious mental illness. If they
have a child (whether a minor or an adult) with a
serious mental illness, they may find themselves
focusing less attention on their other children.

21.  Healthy siblings may feel anxiety and frustration
at the extra responsibilities they are expected to
take on.
 Relationships can be wonderful but challenging
under the best of circumstances. When one
partner has a serious mental illness, the situation
can become even more complex. Many times, the
partner without a diagnosed disorder will
assume more responsibilities, at least for the
short term. For a person who is already worried
about what is happening with his or her partner,
having to spend more time maintaining the
household or taking care of the children can be
especially hard.

22.  It is important for the couple to keep in mind
that most people diagnosed with a serious
mental illness improve over time, and that a
partner's attitude and behavior can make an
important contribution to recovery. It helps to
maintain an accepting and positive attitude,
while holding realistic expectations for the
partner with serious mental illness.
Participating in specialized family therapy for
serious mental illnesses can be very useful.

23.  It leads to negative attitude towards
professionals who have dedicated their lives to
serve and care for those suffering from the
condition(s).
 Damaging self-belief, i.e., sense of personal
worth and self-esteem is affected; the person
becomes shameful and unwilling to seek
medication attention, or disclose an illness.
 Mistaking belief – that mental illness is a curse
from the gods, witchcraft, black magic, etc.

24.  It could lead to prejudice; for example, that
mental disorders are dangerous.
 Financial problems - Loss of job/lack of
employment.
 Stigma prevent others from caring for the
mentally sick .
 Keep people from accessing counseling.
 Divorce
 Low self esteem

25.  Failing to seek medical attention.
 Physical violence or harassment.
 Fewer opportunities for work, school or social
activities or trouble finding housing.
 Lack of understanding by family, friends, co-
workers or others the patient know.
 Stigma hinders efficient and effective recovery
from mental health problems.

26.  Mental disorder and violence are closely linked
within public mind. A combination of factors
promotes this perception. Sensationalized
reporting by the media whenever a violent act
is committed by a formal mental patient,
popular misuse of psychiatric terms psycho or
psychopath and exploitation of stock formulas
and narrow stereotypes by entertainment
industry the public justifies its fear and
rejection of people labeled mentally ill and
attempts to segregate them in the community.

27.  In this connection it is important to refer to the
unfortunate role which media in our country
like cinema TV or press has played in
perpetuating the prejudice against mental
disorders.
 Stigma in the media is especially harmful
because the media plays an important role in
shaping and reinforcing community attitudes,
i.e., spreading wrong information.

28.  For example, cinematic depictions of
schizophrenia are often stereotypic and
characterized by misinformation about
symptoms, causes and treatment.

30.  Schizophrenic characters portray violence
behavior, carry dangerous act, and commit
suicidal and homicidal behaviors.
 Cultural factors/belief system – this about the
myth and misunderstanding.
 Ignorance/misconceptions – misperceptions
about the cause or onset of the disease as a
curse from the gods, punishment for one’s sins,
witchcraft, black magic, demonic, spirit
possession.

33.  Discrimination and stigma scale (DISC)
(Health Service and Population Research
Department, Institute of Psychiatry, King's
College London, May 2013.)
The purpose of the DISC is to collect information
on how having a diagnosis of mental illness
influences an individual’s personal and social
life. This interview-based instrument collects
quantitative and qualitative experiences of
discrimination in key areas of everyday life and
social participation, including work, marriage,
parenting, housing, leisure, and religious
activities.

34.  It also considers the extent to which
participants limit their involvement in areas
of life due to anticipated discrimination. The
DISC is designed for use by a trained
interviewer and the ratings are those
reported by the mental health service user.

35.  Mental illness clinicians attitude scale (MICA)
The MICA scale was developed at the Health
Services and Population Research Department,
Institute of Psychiatry, King’s College London.
The MICA scale is self- administered and
usually requires about 5 minutes to complete it.
A person’s MICA score is the sum of the scores
for the individual items. The scores for each
item are summed to produce a single overall
score. A high overall score indicates a more
negative (stigmatizing) attitude.

36.  Questionnaire on anticipated discrimination
(QUAD)
The QUAD is designed to assess the extent to
which people with mental health problems
anticipate personally experiencing mental health-
related discrimination. This 14 item scale can be
considered as a comprehensive measure of
anticipated discrimination which covers a broad
range of contexts in which mental health
discrimination may be anticipated. It is suitable
for use with adults with mental health problems.
The QUAD is a self-complete scale and takes
around three minutes to complete.

37.  A striking aspect of stigma about mental
disorders is its universality. Stigma has been
recognized as important in mental health care
in countries with extensive services( stuart and
arboleda 2001)

38.  Against the universality of stigma, studies
across the globe present different pictures of
stigma experiences in different countries and
communities. In Ethiopia, 75% of family
members are stigmatized.
 Urban residents experience more stigma, as
well as the older age group (Shibre et al 2001).
 In Canada, persons of 60 years and older are
more socially distancing (Stuart and arboleda
2001).

39.  Studies from Bangalore, India found that
persons presenting with somatic forms of
depression are less stigmatized than those
with psychological symptoms (Raghuram R et
al 2001).
 Persons with depression in London experience
restricted disclosure as stigma, while Indian
patients experience discrimination in the
marital area (Raghuram R et al 2001).

40.  In the recently completed WPA stigma project
from India, conducted in four cities with 463
ill persons with schizophrenia and 651 family
members, two thirds reported discrimination
(Srinivasa murthy et al 2001).
 Women were more stigmatized, as well as
those living in urban areas.
 Males experienced greater discrimination in
the job area, while women experienced more
problems in the family and social area.

41.  Relatively high experience of subtle
discrimination (decreased love, avoidance,
rejection, distance, excessive caution) was
reported in the family area. The differing types
and areas of stigma emphasize the need to
consider the 'local' experiences.
 Programmes to fight stigma and
discrimination should address the study of
local experiences in different groups using
qualitative and quantitative methods; the
interventions should be group specific and the
effort at mental health literacy (Goldney et al
2001) should focus on the understandability of
mental phenomena.

42.  Stigma is a multifaceted concept, and even
well-established measures have their
limitations.
 These measures are self-report questionnaires,
which are at risk of social desirability bias. Mass
media interventions may reduce prejudice, but
there is insufficient evidence to determine their
effects on discrimination.

43.  Social contact is the most effective type of
intervention to improve stigma-related
knowledge and attitudes in the short term.
However, the evidence for longer-term benefit
of such social contact to reduce stigma is weak.
In view of the magnitude of challenges that
result from mental health stigma and
discrimination, a concerted effort is needed to
fund methodologically strong research that will
provide robust evidence to support decisions
on investment in interventions to reduce
stigma.[Thornicroft et al 2015]

44.  Although contact and education both seem to
significantly improve attitudes and behavioral
intentions toward people with mental illness,
contact seems to yield significantly better change, at
least among adults. This is especially evident in
studies that used more rigorous research designs,
such as RCTs. Mean effect sizes for contact when
assessing overall effects as well as effects on
attitudes and behavioral intentions were
significantly greater than those found for education.
Meeting people with serious mental illness seems to
do more to challenge stigma than educationally
contrasting myths versus facts of mental illness.
Face-to-face contact with the person, and not a story
mediated by videotape, had the greatest
effect.(Corrigan 2010)

45.  Programs like NAMI’s Stigma Busters have
targeted stigmatizing advertisements, news
stories, and entertainment through strategic
letter-writing campaigns. Anecdotally, these
seem to have had some effects—for example,
one campaign led the American Broadcasting
Company to pull its television
drama Wonderland in 2000 after two episodes.
The show stoked stereotypic connections
between mental illness and violence. Research
is needed to determine whether anecdotes like
these translate to meaningful impact on stigma
in the media.

47.  Approaches to changing public stigma have
been divided into three paradigms on the basis
of a review of social- psychological research
related to racial-ethnic and gender minority
groups: education, contact, and protest
(Corrigan et al 2012)

48.  Educational approaches to stigma challenge
inaccurate stereotypes about mental illnesses,
replacing them with factual information.
 for example, contrary to the myth that people
with mental illnesses are homicidal maniacs,
the difference in the rate of homicides by
people with serious psychiatric disorders
versus the general public is very small.

49.  Educational strategies have included public
service announcements, books, flyers, movies,
videos, Web pages, podcasts, virtual reality,
and other audiovisual aids (finkelstein,2008).
 Some benefits of educational interventions
include their low cost and broad reach.

50.  A second strategy for reducing stigma is
interpersonal contact with members of the
stigmatized group. Individuals of the general
population who meet and interact with people with
mental illnesses are likely to lessen their levels of
prejudice.
 Social-psychological research has identified factors
that seem to moderate contact effects (Alport G
1954), including one-to-one contact so that people
who engage with one another can learn of similar
interests and potentially cultivate a friendship,
contact that includes a common goal , and
interactions with a person who moderately
disconfirms prevailing stereotypes.

51.  Social activism, or protest, is the third form of
stigma change we examined. Protest strategies
highlight the injustices of various forms of
stigma and chastise offenders for their
stereotypes and discrimination.

52. “SHAME ON THEM FOR
PERPETUATE THE IDEA
THAT PEOPLE WITH
MENTAL ILLNESS ARE
JUST ‘BIG KIDS’ UNABLE
TO CARE FOR
THEMSELVES.”

53.  There is anecdotal evidence suggesting that
protest can reduce harmful media
representations (Wahl o 1995).
 However, some research implies protest
campaigns that ask people to suppress
prejudice can produce an unintended
“rebound” in which prejudices about a group
remain unchanged or actually become worse.
 In one set of studies, Macrae and colleagues
found that research participants directed to
suppress stereotypes about skinheads showed
greater stereotype activation and increased
distance from members of that group.

54. 

55.  Education involves replacing misperceptions
with actual facts.
 Contact needs to be targeted.
 Rather than focusing on the population as a
whole, contact is more effective when targeting
key groups, typically people in positions of
power like employers, landlords, healthcare
providers, legislators, and media outlets.
 Targeting stigma not only suggests the ‘who’ of
strategic contact but also the corresponding
‘what’; what needs to be changed. These are
affirming behaviors that seek to increase
employer hires and landlord leases and the
provision of quality health services to people
with mental illness.

56.  Local contact programmes are more effective.
 ‘Local’ has several meanings but may include
geopolitical and diversity factors.
 Sociopolitical factors within more narrowly
defined areas are also important. Large cities
will include neighborhoods of differing
socioeconomic status that are likely to influence
target-group interests.
 for example, employers in impoverished parts
of a city will require different contact than
peers located in wealthy suburbs.

57.  In addition, rural and urban resources differ
calling for distinct contact programmes. Given
research on health and healthcare disparities,
consideration of ethnicity and religious
background is additionally important for
crafting local programmes.
 Contacts must be credible
 The contact person should be similar to the
target. This could mean employers, landlords,
healthcare providers and police officers with
mental illness present to other employers,
landlords, healthcare providers and police
officers.

58.  Messages like “The person in recovery can be
successful” and “people with mental illness
recover!” needs to be provided by a member of
the target group.
 For example, employers should tell peers that
the person will be a good worker.
 Contact ‘partnerships’ are a good solution,
combining consumers with representatives of
the target group; think of the compelling civic
group meeting where a person with mental
illness talks about her recovery followed by the
boss who discusses the success resulting from
having hired her.

59.  Contact must be continuous.
 One-time contact may have some positive
effects but these are likely to be fleeting.
Contact must occur multiple times with the
quality of contact varying over time. This calls
for different consumer and target partners,
messages, venues and opportunities.
 It also reminds advocates that stigma change is
not easily accomplished and requires not only
ongoing efforts, but continual quality
assessment of those efforts.

60.  Partnership with skilled investigators like
Clement et al helps achieve this goal.
Continuous and local priorities also call for
participatory action research, investigations
that are equally directed by advocates and
researchers.
 Proper training of healthcare staff .
 There are difficulties in communication with
patients affect professional staff, including
psychiatrists, as well as members of the public.

61.  Good communication with patients requires
that professionals listen, and learn about their
patients as people with individual concerns and
needs.
 To achieve this end, staff need to have
sympathetic opinions and to receive
appropriate training, but they also need
adequate time.
 Thus, that part of any anti-stigma campaign
intended to improve communication with
patients is necessarily part of a wider campaign
to obtain adequate staffing for all sectors of the
health and social services involved in the care
of people with mental disorders.

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