Interventions and Stigma

• Stigma


  Originally meant a mark of disgrace associated with a particular circumstance, quality, or person
• Stigma


  (Erving Goffman definition) Attributes which are deeply discrediting to the individual
• Stigma

  Negative attitudes or discrimination against someone based on a distinguishing character like a mental illness, health condition or disability
• Stigma can be related to other characteristics like gender, sexuality, race, religion, culture etc.
• Any characteristic visible or otherwise, that marks a person different to others around them can be a source of stigma
• Process of stigma development (Link and Phelan, 2001)


  1. Labelling differences

  2. Ordering people into categories

  3. Associating differences with negative stereotypes

  4. Separation of "them" and "us"

  5. Loss of status and discrimination
• Components of stigma

  • Public stigma
  • Self-stigma
• Components of stigma (Thornicroft et al., 2007)


  • Knowledge (ignorance)
  • Attitudes (prejudice)
  • Behaviour (discrimination)
• Stereotypes


  Efficient, social knowledge structures that are learned by most members of a social group
• Prejudice/Attitudes


  Not just negative thoughts but also emotions such as anxiety, anger, resentment, disgust
• Discrimination/Behaviour


  The unfair treatment of people or groups based on characteristics such as race, gender, age, or sexual orientation
• Research often focuses on imaginary scenarios instead of actually observing real world behaviours
• Social desirability bias can influence self-reported responses about discrimination
• Stigmas can only be understood within a social context
• The media is a huge culprit in contributing to the stigma of individuals with mental illness and other types of stigmas
• The media may not cause the stereotype, but it helps to perpetuate it
• Mental illness tends to be sensationalised and linked with violence in films
• People with mental illnesses are more likely to be the victims of crime compared to the perpetrators
• Research suggests that reporting on mental illness in the media may be improving over time
• Young people pick up on views that are expressed in popular culture and media regarding mental illness
• Young people had a nuanced view of mental illness, with initial thoughts being quite extreme and stigmatised, followed by more insight from personal experiences
• Steps to develop, conduct, and evaluate an intervention on mental illness stigma for adolescents in school


  1. Find out what we already know

  2. Go to the source (young people)

  3. Design and pilot (test) your intervention

  4. Conduct your intervention

  5. Analyse your results
• Stigma may prevent help-seeking
• Mental illness usually starts in childhood and adolescence
• We need to make sure that children and adolescents feel comfortable help seeking
• We need to address stigma in children and adolescents
• Participants who receive education combined with contact will report more positive attitudes to mental health, increased mental health knowledge and literacy, and improved well-being outcomes compared to participants who receive the educational component alone
• Acceptability


  Do the participants like the intervention? Did they find it useful?
• Feasibility


  How practical was the intervention? Was it possible to adapt to different schools? Did it work well in different types of school?
• The impact of stigma can affect whether or not someone who has a developing mental illness seeks help
• Intervention steps


  1. Step 4: Conduct your intervention

  2. Step 5: Analyse your results
• We collected measures on stigma, mental health literacy, emotional well-being, resilience, and help seeking attitudes two weeks before and two weeks after the intervention, and conducted focus groups
• Impact of stigma


  Impact on help-seeking
• Stigma related to mental disorders and other mental health services is often thought to be primary reason for poor help seeking
• A meta-analysis from 2017 looked at the impact that stigma may have on seeking help for mental illnesses from a doctor, a friend, a family member etc.
• They found that holding stigmatising attitudes towards people who have a mental illness meant that participants were less likely to say that they themselves would seek help if they developed a mental illness
• Participants who had more negative attitudes towards mental health services were less likely to seek help
• Stigma does sometimes stop people from getting the help that they need which is important
• Impact on self-esteem and suicide risk


  Various different types of stigma including how much discrimination people had experienced was related to self esteem in people with schizophrenia
• Internalised stigma has also been related to suicide risk