Ending Discrimination Against People with Mental and Substance Use Disorders The Evidence for Stigma Change (2016) / Chapter Skim
Currently Skimming:
2 Understanding Stigma of Mental and Substance Use Disorders
2 Understanding Stigma of Mental and Substance Use Disorders
Pages 33-52
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From page 33... ...
This chapter offers a brief overview of what is currently understood about stigma, including influencing factors and consequences of stigma from the level of society as a whole to the experience of people with behavioral health disorders. Targets for change and interventions for changing stigmatizing attitudes, beliefs, and behaviors are discussed in Chapter 4.
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From page 34... ...
, as detailed in Chapter 1, found that some common reasons reported for not receiving behavioral health care included inability to afford the cost of care (48%) , believing that the problems could be handled without treatment (26.5%)
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From page 35... ...
This ordering reflects the committee's views on the relationships among the three levels of stigma and on the importance of addressing structural stigma and its consequences as a means for also reducing public and self-stigma. Societal structures reflect public norms and values, and many of the factors that influence structural stigma are the same as those that influence public stigma.
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From page 36... ...
. Overall, promulgation of the brain disease model of addiction does not appear to have reduced public stigma about substance use disorders and may decrease perceptions of self-efficacy and ability to cope among people with behavioral health disorders (Trujols, 2015)
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Knowledge about Mental and Substance Use Disorders Knowledge about mental and substance use disorders can positively influence public norms, yet there is evidence that reframing these disorders as brain diseases produces mixed results on people's attitudes and behavior toward people with mental and substance disorders. As noted above, public education campaigns that frame mental and substance use disorders as brain diseases can have unintended consequences, including increased perception of difference and disbelief in the likelihood of recovery (Pescosolido et al., 2010; Schomerus et al., 2012; Trujols, 2015)
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From page 38... ...
. Health care practitioners outside fields of behavioral health also lack knowledge about mental illness, and there is evidence that this can lead to misdiagnosis of both mental and physical conditions, and to selection of improper and inadequate treatment regimens (Wang et al., 2002)
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From page 39... ...
. Media Portrayals The media provide ideas about and images of behavioral health that influence public attitudes, beliefs, and behaviors toward people with mental and substance use disorders (Edney, 2004; Klin and Lemish, 2008; Nairn et al, 2011; Nawková et al., 2012)
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Moreover, recent research suggests that, given the broad reach of U.S. media, the volume and intensity of negative coverage about mental and substance use disorders are increasing mental health stigma in other countries as well (Jorm and Reavley, 2014)
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From page 41... ...
. Provision of physical and behavioral health services in integrated care settings has been shown to increase participation in mental health treatment for racial and ethnic minorities (Giacco et al., 2014; Schraufnagel et al., 2006)
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From page 42... ...
As shown in Figure 2-1, structural stigma is the societal and institutional manifestation of the attitudes, beliefs, and behaviors that create and perpetuate prejudice and discrimination. This section discusses structural stigma using examples of persistent prejudice and discrimination in public and private institutions, including government and legal systems, legislative bodies, employers, and educational institutions; health care and treatment systems; and the criminal justice system, including law enforcement, correctional institutions, and the courts.
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From page 43... ...
Basic
Types
Targets
Interven.ons
Terms
STRUCTURAL
STIGMA
:
INSTITUTIONS
SDgma:
A
mark,
Prejudice
and
discrimina.on
Legislators
Legal
Strategies
condi.on,
or
status
by
policies,
laws,
and
that
is
subject
to
cons.tu.onal
prac.ce
Policy
Makers
Policy
Strategies
prejudice
and
(also
called
ins.tu.onalized
discrimina.on
by
Employers
Advocacy
Strategies
s.gma)
others
.
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From page 44... ...
. On a positive note, NAMI's 2014 review of state legislation found examples of states addressing housing discrimination by enacting rules prohibiting homeless and emergency shelters from refusing services to persons with mental illness and providing funds for home ownership to families of children with disabilities.
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From page 45... ...
. Even when students with mental and/or substance use disorders do seek treatment, they often receive inadequate services, experience delays in obtaining supportive services, face segregation from other students, and receive harsher academic discipline than other students (Livingston, 2013; Losen and Welner, 2001; Skiba and Peterson, 2000; Wald and Losen, 2003)
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From page 46... ...
Recent efforts to address structural stigma in the health care system through parity laws have been accompanied by evolving public attitudes regarding behavioral health in the United States. A 2015 Harris Poll found that close to 90 percent of U.S.
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From page 47... ...
. Even with the availability of providers and insurance coverage, insurance benefits have traditionally been more prohibitive of behavioral health services than physical health services, for example, by imposing constraints such as higher deductibles or requiring patients' mental health status to deteriorate before treatment coverage is allowed (Angermeyer et al., 2003; Corrigan et al., 2004a; Livingston, 2013; Muhlbauer, 2002)
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Public stigma persists in part because structural stigma in the form of laws, regulations and policies appears to endorse prejudice and discrimination against people with behavioral health disorders. A recent systematic review (Parsespe and Cabbassa, 2013)
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From page 49... ...
. Self-Stigma As people with mental and substance use disorders become aware of public stigma and of related discriminatory practices, they internalize the perceived stigma and apply it to themselves.
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. The National Stigma Study-Children, which was the first to include a nationally representative sample of participants to examine public stigma of childhood mental disorders specifically focused on attention-deficit/ hyperactivity disorder (ADHD) and depression, comparing public attitudes and knowledge of these disorders with asthma or "daily troubles." One set of analyses showed that 81 percent of the adult sample perceived children with depression to be dangerous to themselves or others, compared with children who had asthma or "daily troubles" (Pescosolido et al., 2007)
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As shown in Figure 2-1, targets of structural stigma would include legislators, institutions, and policy makers of systems and organizations that fund and regulate the places and situations where discrimination, lack of opportunities, and lack of access to quality treatment persist. The interventions that would be appropriate for this level are legal, policy, advocacy, and professional education strategies.
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From page 52... ...
Examples of such interventions include use of media for mass messaging to dispel myths regarding behavioral health disorders and treatment, education to counter the lack of knowledge about disorders and treatment, contact with people with behavioral disorders, and protest strategies against discrimination. The general effects of self-stigma and the "why try" effect may be diminished by interventions that target individuals with behavioral disorders.
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