Running head: STIGMA IN MENTAL HEALTH TREATMENT 1

Stigma in Mental Health Treatment

Student’s Name

Institutional Affiliation
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Stigma in Mental Health Treatment

Historically, the mental health profession has utilised the medical model of disability

which considers mentally impaired people as needing treatment to fix their issues even when the

disability does not cause challenges (Nettleton, 2013). Over time, the model has been replaced

by the social model of disability which rather than seeing the disabled person as ‘having

something wrong' considers society and the barriers that prevent these individuals from

achieving their aspirations and progress (Nettleton, 2013, p.27). The restrictions can be

environmental, attitudinal, or organisational with different impacts on the individual. Among

these, the most prevalent are attitudinal barriers derived from the medical barrier of disability.

People often delay or avoid soliciting for professional help for mental health issues.

According to Kessler et al., 2005, approximately 52% to 74% of people with mental disorders do

not receive treatment with the numbers rising among low and middle-income populations. The

delays are associated with adverse pathways to care with longer duration of untreated illness

leading to worse outcomes for psychosis, major depressive disorder, and bipolar disorder. One of

the main factors causing delays in seeking treatment is stigma. Stigma refers to a process

involving labelling, separation, prejudice, and discrimination where political, social, and

economic power is used to place members of a specific social group at a disadvantage. In the

context of mental health, researchers have identified three distinct levels of stigma: the social

level, the structural level, and the internalised level (Szcześniak et al., 2018). The social level

categorises mentally ill people due to their disease. The discrimination of mentally impaired

people results from beliefs in stereotypes originating from the medical model of mental illness.

Structural stigma has a direct connection to social stigma although it influences institutional
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practices and cultural norms. Livingston and Boyd define internalised stigma as the adoption of

negative attitudes, malformed behavior, and the change of identity through integration of

stereotypes originating from experience, perceptions, or anticipation of negative social reactions

based on their mental conditions.

A systematic review by Clement et al. (2015) found that internalised and treatment stigma

had a consistent negative correlation with help seeking. While some studies indicated significant

negative associations with perceived and endorsement stigma, they had negligible effect sizes.

The review concluded that stigma was the fourth-highest barrier to help-seeking with 21% to

23% of participants reporting fear of shame/embarrassment, employment-related discrimination,

and negative social judgment (Clement et al., 2015). Moreover, a longitudinal survey by Corker

et al., (2013) from 2008 to 2011 found that individuals using mental health services in England

have frequent experiences of discrimination causing untreated individuals to delay seeking

professional help.

Social Stigma

Anticipated stigma is a subgroup of social stigma and refers to the expectation of being viewed

or mistreated after a positive diagnosis of a mental health condition. The anticipated stigma

results from an incongruence between an individual's preferred identity and contemporary

misconceptions about mental illness that it results in craziness (Clement et al., 2015).

Consequently, such individuals often avoided telling others about their issues and hid the

symptoms. The effect of social stigma was pronounced among African Americans who were

more likely to associate mental illness with weakness, and encouraging individuals to ‘keep it

within the family' and ‘non-disclosure.' Furthermore, studies of people aged less than 18
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included the sub-theme ‘not normal' and ‘stigma for family' (Clement et al., 2015). All of these

negative social and cultural connotations drive individuals to postpone asking for help with their

mental health issues leading to worse outcomes and pathways to care.

Structural Stigma

Structural stigma refers to the cultural norms, societal-level circumstances, and institutional

processes that limit the resources and opportunities available to disadvantaged populations

(Hatzenbuehler & Link, 2014, p. 2). Mentally ill people encounter discrimination throughout

their lives including housing and employment discrimination. A review of mental health

legislation shows that approximately 3% restrict liberties such as compulsory community

treatment, 1% are discriminatory such as restrictions on parental rights and gun ownership.

While 4% reduce privacy through allowing sharing of mental health information in specific

situations (Corrigan et al., 2005). One of the major shortcomings with existing regulations is the

use of broad and homogeneous inclusion criteria. Analysis of barriers indicates that stigma has

much more significant influence on people in the military compared to other professions

especially in the context of employment-related stigmatization. Furthermore, health professionals

state confidentiality concerns in addition to social judgment as the main barriers against seeking

help (Clement et al., 2015). The continuance of interpersonal discrimination despite legal

protections such as the Mental Health Act of 1985 reflects how stigma can persist even with

structural changes aimed at reducing it. Additionally, even with regulations protecting patient

confidentiality, other variations of clandestine stigma may happen through institutional practices

that use other characteristics usually associated with mental impairment such as employment

gaps, disability as an income source, and a criminal history.

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Internalized Stigma

Internalised stigma is the adoption of negative stereotypes by an individual with mental health

conditions. It affects the individual's quality of life in multiple ways such as social exclusion,

inability to participate in their day to day activities, and reduced likelihood of seeking treatment.

Strong internalised stigma leads to reduced self-esteem, poor recovery, and self-efficacy for

people with mental health conditions. Since a person's identity forms through association with a

specific group, individuals with mental health issues may internalise the negative stereotypes in

the media (Lawler, 2008). Stuart (2006) found that both entertainment and news media render a

distorted and dramatic portrayal of mental disabilities focusing on unpredictability, criminality,

and dangerousness. Furthermore, the media emphasises adverse societal reactions to mentally

impaired people such as rejection, fear, and ridicule. The internalised stigma may lead to

anticipated and treatment stigma where individuals are afraid of ridicule if they admit to having

mental health problems and seeking treatment for the same.

Conclusion

The main problem with providing equitable and fulfilling lives for individuals with

mental health issues is distinguishing between impairment and disability. Bill Hughes posits that

the usefulness of Foucault’s work for disability studies is limited in this regard. While Foucault's

theories have some insights based on cultural studies and sociology of the body, it provides

minimal resources that can improve the lives of disabled people (Hughes, 2005). Additionally,

other insights to disability studies provided by Foucault's work can be derived through other

means which makes the theories counterproductive for disability theorists. Therefore, there is a
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need for additional research to determine how to reduce and eliminate social, structural, and

internalised stigma.
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References

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Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-

seeking? A systematic review of quantitative and qualitative studies. Psychological

medicine, 45(1), 11-27.

Corrigan, P. W., Watson, A. C., Heyrman, M. L., Warpinski, A., Gracia, G., Slopen, N., & Hall,

L. L. (2005). Structural stigma in state legislation. Psychiatric Services (Washington,

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Populations. Current Directions in Psychological Science, 23(2), 127–132.

doi:10.1177/0963721414523775.

Hughes, B. (2005). What can a Foucauldian analysis contribute to disability theory. In S.

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Nettleton, S. (1995). The sociology of health and illness. Cambridge: Polity Press.

Stuart, H. (2006). Media portrayal of mental illness and its treatments. CNS drugs, 20(2), 99-106.

Szcześniak, D., Kobyłko, A., Wojciechowska, I., Kłapciński, M., & Rymaszewska, J. (2018).

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