EDGES MAGAZINE Issue 32

March 2003

The Stigma of
Mental illness
 
William Little is the Press & Public Affairs Officer for the Mental Health Foundation
.

There isn’t a week that goes by without another story in the press about increasing levels of depression, stress or other mental health issues. With such a high level of coverage about something that seems only to be getting worse, you’d think that mental health would be a number one priority. The reality is that society is too eager to label mental health as an illness and problem, which can lead to discrimination and stigma. Instead we should be focusing on ways to improve the emotional wellbeing and resilience of everyone. We have to reach a point when people can truly believe that having a healthy mind is a fundamental and basic human right. In this way we can all learn to embrace mental health rather than run away from it.

The stigma of mental health, however, has yet to be tackled effectively. The Mental Health Foundation report Pull Yourself Together which looked at the discrimination felt by people living with mental health problems found that 70 per cent of respondents had experienced discrimination in response to their own or another’s mental distress. One person described the pervasive subtlety of discrimination: ‘Always being asked if the way I’m feeling is due to my mental health problems. Not allowed to express emotions good or bad like ‘normal’ people’. Highlighting the way that discrimination and stigma affects every level of society, most people said that the most common sources of discrimination came from family (56 per cent) and friends (52 per cent). Family and friends had ignored one person for six years. Many felt ostracized and socially isolated. Many had been called names, labelled and told to ‘pull themselves together.’

For many with mental health difficulties work is an important coping mechanism, providing a sense of purpose and value as well as important social contacts. Yet all too often people with mental health issues are excluded from work on grounds of discrimination. Of the working UK population, only 17 per cent of people with a diagnosis of serious mental health illness are economically active. A staggering 85 per cent of people with long-term mental illness are unemployed. In the Mental Health Foundation report, ‘Out at Work’ over half of the respondents believe they had definitely or possibly been turned down for a job in the past because of their mental health. Only one third felt confident in disclosing their experience of mental health problems on job application forms. Less than 60 per cent of people with anxiety and depression – the group most likely to be employed – were employed on a full-time or part-time basis. And one in three believe that bullying at work had contributed to their mental health problem.

So how do we deal with stigma? Well, we need to start talking about mental health because until we are happy doing so, the stigma, which may stop people admitting to themselves the nature of their illness or even prevent them from seeking help, will remain.

We also need to recognise the expertise of people with experience of mental health problems or mental distress such as depression. Somebody with diabetes can very effectively manage their own medication and know what does or does not help them. We need to recognise that each person with mental illness is also the primary expert in their own mental health.

Strategies for Living, an ongoing research project at the Mental Health Foundation looks at ways service users and survivors have coped with mental health difficulties. All too often, mental health service users and survivors have been the subjects of research - giving up details of their lives to be used by others. In this research the power balance is different - everybody who participates knows that we aim to record the positive, to look at what works for individuals so that others can learn from their experience.

The Strategies for Living team is led by people who have used mental health services for their own mental or emotional distress. The idea that people with mental health problems will respond better to being interviewed by others with similar experiences is gaining ground. One reason for this is that service users are seen as being more independent than the professionals involved in providing the services.

In one of the early discussions with the interviewers, it was suggested that a key finding of the study might be that 'everyone is different'. However, some strong themes emerge on living and coping with mental distress.

People's strategies could be categorised into ongoing survival strategies, crisis or life-saving strategies, symptom management and healing strategies. The 'most helpful' overall strategies and supports were relationships with other people, personal strategies, medication, physical exercise, religious and spiritual beliefs, money and other activities, e.g. hobbies and interests, home, information, and creative expression.

The overwhelmingly predominant theme running through these supports was the role and value of relationships with other people, in all of their different forms. This could be family or friends, or people encountered through local day centres or self-help groups. For others, the important people in their lives were mental health professionals: counsellors or community psychiatric nurses, support workers or social workers.

Strategies for Living shows that when friends and family don’t discriminate and stigmatise then they can offer support and love that can be helpful in coping with mental health difficulties. One woman talking about her husband said: "He accepted me as I was… If I get angry or upset he doesn’t just keep calm, he gives me physical hugs, physical love… The love of my husband has been a really big help. I don’t think I would have survived… he’s helped a lot through it.’ While another man said that when he became ill he felt that his friends treated him like he’d: "Got some disease, stigma or plague, or whatever." This clearly shows that the need to talk about mental health and destigmatise it is a priority. The way that people with poor mental health are treated by society can have a major impact on their experience and recovery.

It is worth noting that the most important sources of help were mostly found outside statutory mental health services. Self-management and self-awareness is crucial for people experiencing mental health problems. It may be as simple as recognising when you are feeling fragile or unwell and making an effort to take some time out, slow down, or just find someone to talk to. It could be knowing when to use alternative therapies, learning some cognitive behavioural therapy techniques, or even agreeing with your GP or psychiatrist the parameters within which you can control your own medication according to whether you are well or experiencing a crisis.

Self-management not only gives people an element of control over their own lives, but also provides other tools and strategies that are helpful either to supplement medication or to work in place of it. A recognition of the importance of self-management, and an investment as a society in helping everybody identify what works for them will place value on individual's own expertise. For many people it may also lessen the risk of a severe crisis through the ability to use their own strategies for living when they first start to feel unwell, rather than having to wait until there is a need for in-patient care.
 

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