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Article
Publication date: 20 June 2019

Terry Krupa, Judith Sabetti and Rosemary Lysaght

The purpose of the present study was to advance a theoretical understanding of the mechanisms by which WISEs can influence the stigma associated with mental illness. Many…

Abstract

Purpose

The purpose of the present study was to advance a theoretical understanding of the mechanisms by which WISEs can influence the stigma associated with mental illness. Many people with serious mental illnesses want to work, but despite much attention to work entry strategies, unemployment rates remain exceptionally high among this population. Stigma has been identified as a particularly pernicious barrier to the full community participation of people with mental illnesses. If work integration social enterprises (WISE) are to positively impact the full community participation of people with mental illnesses, then addressing stigma will be integral to their operation.

Design/methodology/approach

A comparative case study approach was used to address the following research questions: “How is the stigma of mental illness experienced in the everyday operations of WISE?” and “What influence do WISEs have on the stigma of mental illness within the workplace and beyond?” Five established WISEs that pay workers at minimum wage or better were selected for inclusion. The maximum variation sample included WISEs that varied in terms of geographical location, form of commerce, business size, revenues and degree of connection with mental health systems and local communities. Data analysis was conducted in four stages using qualitative methods.

Findings

The study findings suggest processes by which WISEs can positively impact the stigma of mental illness. Three social processes are associated with the potential of WISE to contribute to stigma reduction: perception of legitimacy, perception of value and perception of competence. Each of these social processes is fueled by underlying tensions in practice that arise in the context of negotiating the dual goals of the business.

Research limitations/implications

This study advances theoretical understanding of the ways in which stigma may be perpetuated or reduced in WISE by revealing the social processes and practice tensions that may be associated with operation choices made by WISEs and their partners. Further research would be required to determine if the processes described actually lead to reduced stigma. Although efforts were made to select WISEs that demonstrate a variety of features, it is likely that some important features were absent. Additional research could further explore the findings identified here with WISEs from other sectors, including youth and workers with transient or less severe forms of illness. This work should be replicated internationally to explore how contextual factors may influence individual and public perceptions.

Practical implications

The findings provide guidance for WISE developers in the mental health sector concerning strategies that may help mitigate the development of stigmatizing features within a social enterprise and by extension improve the work experience and workforce integration of employees. The identification of these processes and tensions can be used to advance the development of consensus principles and standards in the WISE field and contribute to ongoing evaluation and research.

Social implications

WISEs have the potential to reduce stigma, an important goal to support their efforts to improve employment and integration outcomes for people with mental illnesses. Through their business structures and operations they may be able to impact stigma by positively influencing perceptions of legitimacy, value and competence – all issues that have been associated with public assumptions about mental illness that sustain stigma.

Originality/value

To the best of the authors’ knowledge, this study is one of the first to specifically focus on stigma in the WISE sector, particularly as it relates to the work integration of persons with mental illnesses. The findings provide a range of theoretical and practical implications for future development in the field and highlight factors that merit consideration more broadly in the sector.

Details

Social Enterprise Journal, vol. 15 no. 4
Type: Research Article
ISSN: 1750-8614

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Article
Publication date: 18 March 2022

Sami Saad, Jolan Ayman Bshawri, Sara Mohammed Alsaedi, Rahaf Emad Radi, Raneem Marwan Ghonim, Haya Mohammed Nasraldain and Abdullah Abdulqadeer Gadeer

Several previous studies showed strong social stigma toward mental illness patients from the health-care providers (HCPs) in Saudi Arabia. This stigma affects the level of…

Abstract

Purpose

Several previous studies showed strong social stigma toward mental illness patients from the health-care providers (HCPs) in Saudi Arabia. This stigma affects the level of care provided by HCPs. Stigma is a major barrier in treating schizophrenia and obsessive-compulsive disorder (OCD) patients. Thus, it is important to clarify the difference regarding the social stigma between both diagnoses. This study aimed to identify and compare the existence of social stigma among HCPs towards schizophrenia patients compared to OCD patients.

Design/methodology/approach

A total of 283 HCPs from King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, were enrolled in this cross-sectional questionnaire-based study between middle and end of January 2021. The scale included a demographic questionnaire plus two vignette cases reflecting OCD and schizophrenia patients’ symptoms without mentioning diagnosis. Each case was followed with 18 questions, which measured some of the thoughts and attitudes of the social stigma of mental illnesses including negative stereotypes, discrimination, social distancing and emotional and cognitive prejudices against mental illness patients. The scale was validated by a pilot study (which included 15 other participants) with acceptable validity and reliability (Cronbach’s alpha: 81.4%).

Findings

Most participants’ responses were “low” in the total score of their stigma score for both diagnosis [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, those who responded “high” in their stigma score regarding the schizophrenia section were higher in their number than those who responded “high” in the OCD section (25.8% vs 15.9%). Most participants had “low” total stigma scores for both diagnoses [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, of those with “high” stigma score responses, more were for the schizophrenia section compared to the OCD section (25.8% vs 15.9%). Being flexible to recruit any of them was more related to promoting them if they deserve promotion. The sample that answered wrong regarding OCD vignette diagnosis and had “high” stigma score was higher (n = 40) than the sample that answered correctly and had “high” stigma score (n = 5). In contrast, the sample that answered wrong regarding the schizophrenia case diagnosis and had “high” stigma score (n = 41) was not significantly different in terms of its number compared to the one that answered correctly and had “high” stigma score (n = 32).

Research limitations/implications

One aspect that reduces the strength of this study is that the target number of the participants could not be reached, meaning a 95% confidence level with a ±5% margin of error could not be reached. Another limitation is the lack of contact between HCPs at the KAMC in Makkah with mental illness patients owing to lack of psychiatric inpatient departments. However, this limitation may be a strength for this study, as we were able to primarily measure medical HCPs rather than psychiatric HCPs. Although the vignette methodology in stigma studies has many benefits, the participants do not respond to real patients, and therefore miss appearance and other nonverbal cues that are typically present in real interactions.

Originality/value

The social stigma level among HCPs against schizophrenia patients is higher than that against OCD patients. The factor of knowing the diagnosis of the case has a positive effect on decreasing stigma toward OCD patients but not toward schizophrenia patients. Educational awareness about stigma against mental illness patients to HCPs, rather than focusing on increasing literature knowledge, may decrease stigma among HCPs.

Details

Mental Health Review Journal, vol. 27 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 5 December 2018

Peter Choate and Dorothy Badry

The purpose of this paper is to conduct a scoping review of the literature to explore the many ways stigma affects people with FASD and to highlight the disciplines and…

Abstract

Purpose

The purpose of this paper is to conduct a scoping review of the literature to explore the many ways stigma affects people with FASD and to highlight the disciplines and places where discourse on FASD and stigma is taking place.

Design/methodology/approach

Searches were conducted in PubMed, ERIC, Family & Society Studies Worldwide, Families Studies Abstracts and Google Scholar between 2008 and 2018. Search terms focused on stigma, shame and the connection to FASD with a view to looking across social and medical science literature.

Findings

Searches identified 39 full text manuscripts, 13 of which were included in the scoping review. Stigma toward people with FASD exists in multiple professional forums across disciplines. The relationship between mother’s use of alcohol and the lasting impact on the child is a focus in the articles identified from a public health perspective. The review showed there was limited cross-disciplinary discussion evident. In total 13 articles were selected for inclusion in this review.

Research limitations/implications

Negative discourses predominate with little attention being paid to possible areas of success as well as cases of lower FASD impacts. There is a significant void in work focusing on positive outcomes for people with FASD. Such discourse would support a better understanding of pathways to more positive outcomes.

Originality/value

This paper highlights the issue of FASD and stigma through identification of relevant literature and expands the conversation to offer insights into the challenging terrain that individuals with FASD must navigate. The issue of stigma is not linked only to individuals with FASD but also their support systems. It is critical to recognize the multiple attributions of stigma to FASD in order to effectively take up conversations across and between disciplines to promote new discourses focused on de-stigmatization.

Details

Advances in Dual Diagnosis, vol. 12 no. 1/2
Type: Research Article
ISSN: 1757-0972

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Book part
Publication date: 4 July 2016

Kristen Marcussen and Christian Ritter

This chapter examines the effects of mental health services and stigma on changes in self-concept and well-being for individuals with SPMI.

Abstract

Purpose

This chapter examines the effects of mental health services and stigma on changes in self-concept and well-being for individuals with SPMI.

Methodology/approach

Data for this chapter come from structured interviews and service data for 140 individuals with severe and persistent mental illnesses. We use structural equation modeling to examine the relationship between perceived and internalized stigma, as well as the relationships among stigma, self-concept (self-esteem and mastery), and well-being (quality of life and functioning).

Findings

We find that case management is negatively related to quality of life and psychiatric services are positively related to functioning. Crisis services and assessment are associated with mastery in opposite directions. Internalized stigma is positively associated with self-esteem and mastery, and negatively associated with functioning. We do not find a relationship between services and stigma.

Research limitations/implications

A limitation to this chapter is the sample size, which prohibits us from examining a full range of services and outcomes. Nonetheless, our findings provide information about how services and stigma impact well-being, and may be used as a starting point for considering strategies for improving services and reducing stigma. Future work should consider pairing outcomes with services to determine their effectiveness.

Originality/value

This chapter builds on previous research that examines the relative effects of services and stigma among individuals in community health care by extending measures of both services and stigma, and by examining the relationship between them, in order to better determine their implications for self-concept and well-being.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

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Article
Publication date: 1 March 2021

Nada Alattar, Anne Felton and Theodore Stickley

Stigma associated with mental health problems is widespread in the Kingdom of Saudi Arabia (KSA). Consequently, this may prevent many Saudi people from accessing the…

Abstract

Purpose

Stigma associated with mental health problems is widespread in the Kingdom of Saudi Arabia (KSA). Consequently, this may prevent many Saudi people from accessing the mental health-care services and support they need. The purpose of this study is to consider how stigma affects people needing to access mental health services in the KSA. To achieve this aim, this study reviews the knowledge base concerning stigma and mental health in KSA and considers specific further research necessary to increase the knowledge and understanding in this important area.

Design/methodology/approach

This review examines the relevant literature concerning mental health stigma and related issues in KSA using the Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses frameworks. As a scoping review, it has used a systematic approach in literature searching. The results of the search were then thematically analysed and the themes were then discussed in light of the concepts of stigma and mental health.

Findings

Stigma around mental health impedes access to care, the nature of care and current clinical practice in the KSA. The voices of those with mental health issues in KSA are almost entirely unrepresented in the literature.

Originality/value

The review identifies that mental health stigma and cultural beliefs about mental health in KSA may act as barriers to accessing services. The voice of mental health service users in KSA remains largely unheard. If public discussion of mental health issues can increase, people’s experiences of accessing services may be improved.

Details

Mental Health Review Journal, vol. 26 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 6 May 2014

Liz Sayce

Biological understandings of mental illness are promoted by both anti-stigma campaigners and increasingly by activists protesting against social security cuts. The purpose…

Abstract

Purpose

Biological understandings of mental illness are promoted by both anti-stigma campaigners and increasingly by activists protesting against social security cuts. The purpose of this paper is to analyse the pitfalls of the “illness” conceptualisation for reducing discrimination, comments on divisions between those arguing for a right to work and those who seek a right not to work, and proposes bridge building and more effective messages, drawing on the UN Convention on the Rights of Persons with Disabilities.

Design/methodology/approach

Review of relevant evidence on the effectiveness or lack of it of the “mental illness is an illness like any other” message in anti-stigma work, and discussion of grey literature from campaigners and bloggers.

Findings

There is a growing body of evidence that the “illness like any other” message entrenches rather than reduces stigma and discrimination: this message should not be used in anti-discrimination work. At the same time some social security bloggers and campaigners have argued they are “sick” in order to resist efforts to compel them to seek work or face sanctions; whilst older disability rights campaigners have argued for the right to work. The paper argues for new bridge building and use of evidence based messages in campaigning.

Research limitations/implications

This paper is based on review of evidence on the impact of using the “illness” message to reduce stigma and discrimination; and on discussion of campaigns and blogs. It is not based on a systematic review of campaigns.

Practical implications

There is a need for campaigns that support rights holistically – the right to a decent standard of living and the right to work. This requires bridge building between activists, which could usefully be rooted in the UN Convention on the Rights of Persons with Disabilities. The “illness” conceptualisation is harmful to the effort to reduce stigma and discrimination. Mental health staff can act as allies to those they serve in securing all these rights.

Originality/value

This is the only recent paper to analyse the evidence that the “illness like any other” message is harmful in anti-stigma work, together with its implications for the recent phenomenon of mental health campaigners moving from opposition to the medical model, to a new argument that they are “too sick” to work. This paper suggests ways forward for everyone with an interest in combatting stigma and discrimination.

Details

Mental Health and Social Inclusion, vol. 18 no. 2
Type: Research Article
ISSN: 2042-8308

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Article
Publication date: 11 August 2021

Tara Walker

This study aims to examine how experience with mental illness influences perceptions of stigma and realism in a specific direct-to-consumer advertisement (DTCA) for…

Abstract

Purpose

This study aims to examine how experience with mental illness influences perceptions of stigma and realism in a specific direct-to-consumer advertisement (DTCA) for bipolar depression.

Design/methodology/approach

An online survey had participants watch a 90 s advertisement for a prescription bipolar depression drug and then answer 24 questions about stigma, mental illness experience and the realism of the portrayals in the advertisement.

Findings

Findings show that people who identify as having experience with mental illness tend to see the ad as more stigmatizing and less realistic. Additionally, people who expressed more stigmatizing beliefs also tended to see more stigma present in the ad. Finally, the study reconfirms conclusions of previous research that people who have experience with mental health conditions possess fewer stigmatizing beliefs overall regarding mental illness.

Research limitations/implications

The sample population, while diverse in age and somewhat diverse in location, were highly educated, suggesting that they were not representative of the general population. Future studies may want to use more representative samples. A more nuanced approach to understanding experience is needed. While the sample in this study was purposively derived from communities with a higher rate of mental illness, a comprehensive experience scale to measure degrees of experience with mental illness would enhance understanding of this construct. Researchers may also want to look more deeply into the emotional responses of consumers who view these ads. To develop a greater understanding of the trajectory of DTCA, studies of online advertising for psychiatric drugs are needed.

Practical implications

The results of the study suggest that respondents with experience with mental illness may find ads that sell psychiatric medications unrealistic. This study presents the topic of realism in DTCA as an important construct for determining how consumers may perceive portrayals of disorders.

Social implications

The fact that people who have experience with mental illness found the Latuda ad to be generally unrealistic suggests that DTCA may be failing to represent mental illness in a way that demonstrates care for patients. Additionally, this research confirms that people who have had exposure to and experience with mental illness tend to hold less stigmatizing beliefs, (Link and Cullen, 1986; Corrigan et al., 2001; Angermeyer et al., 2004) a finding which supports the continuing project of increasing mental health literacy and awareness in the general population.

Originality/value

This study investigates the reactions of people who identify as having some experience with mental illness to see if they accept the portrayals of mental illness in DTCA or resist them by challenging their realism or identifying stigmatizing elements.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 15 no. 4
Type: Research Article
ISSN: 1750-6123

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Article
Publication date: 15 June 2015

Patrick J. Michaels, Kristin Kosyluk and Ellen Butler

Advocates and researchers have made mental illness stigma elimination a public health priority. Research on stigma change strategies has highlighted programmatic delivery…

Abstract

Purpose

Advocates and researchers have made mental illness stigma elimination a public health priority. Research on stigma change strategies has highlighted programmatic delivery strengths; however, an area in need of further development is in messaging capable of attaining specific behavior change. The paper aims to discuss these issues.

Design/methodology/approach

Change goals were incorporated into an existing model of stigma change to propose the TLC4 model (Targeted, Local, Credible, Continuous, Contact, Change Goals). This paper reviews health communications literature regarding tailored messaging, applying these principles to stigma change programs to enhance behavioral impact.

Findings

Tailored messages comprises four elements: capturing and maintaining attention, actively thinking about information, having emotional appeal, and making material relevant to each person. Incorporation of these elements enhances the likelihood of an individual making a behavior change.

Originality/value

This review can guide facilitators of stigma change programs to craft presentations with tailored messages in directive call-to-actions. Future directions for evaluation of message and behavioral change impact are discussed.

Details

Journal of Public Mental Health, vol. 14 no. 2
Type: Research Article
ISSN: 1746-5729

Keywords

Book part
Publication date: 22 November 2019

Andréa Becker

This chapter examines how women deploy gendered motherhood norms to publicly challenge abortion stigma. Drawing on a sample of 41 abortion stories from women living in…

Abstract

This chapter examines how women deploy gendered motherhood norms to publicly challenge abortion stigma. Drawing on a sample of 41 abortion stories from women living in Tennessee, I find that women evoke notions of intensive, total, and idealized motherhood in order to manage and challenge the stigma of an abortion. A large proportion of these stories were written by married mothers who emphasized their identities as good mothers and wives. A close qualitative analysis of these trends reveals two dominant forms of recasting abortion. First, abortion is framed as an extension of total mothering to spare an unborn baby from risky health conditions. Part of this includes casting abortion as an often-necessary choice in order for a woman to develop into the perfect mother for the benefit of her children – altruistic self-development. Second, abortion is construed as a form of maternal protection of current children to continue intensively mothering them. Both themes speak to women’s strategies for reframing abortion as a health practice to promote the well-being of children. These findings have implications for the study of medical stigma, reproduction, and the impact of gender ideals on women’s health choices.

Details

Reproduction, Health, and Medicine
Type: Book
ISBN: 978-1-78756-172-4

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Article
Publication date: 21 February 2019

Elizabeth Velazquez and Maria Hernandez

The purpose of this paper is to review current research on police officer mental health and to explore the reasons why police officers do not seek mental health treatment.

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Abstract

Purpose

The purpose of this paper is to review current research on police officer mental health and to explore the reasons why police officers do not seek mental health treatment.

Design/methodology/approach

A comprehensive, systematic search of multiple academic databases (e.g. EBSCO Host) were used to identify studies conducted within the USA, identified definitions of first responders, identified the type of duty-related trauma expected by police officers, how influential stigma is amongst the police culture and what current intervention strategies are employed to assist police officer mental health wellness.

Findings

This research was conducted to identify police officer trauma-related mental health and the stigma behind seeking treatment. The research highlights job-related trauma and stress leads to the development of post-traumatic stress disorder, depression, substance use disorder and suicide or suicide ideation. The stigma behind seeking mental health treatment is associated with law enforcement organizations and environmental factors. Organizational factors include occupational stress characteristics such as day-to-day of the job and environmental factors such as abiding by social and law enforcement culture ideologies. Further research should be conducted to understand why law enforcing agencies and personnel are unknowingly promoting stigmas.

Originality/value

This is the most current meta-review of research examining the severity of mental health in police officers, the stigma behind acquiring treatment and innovative treatment approaches in police officer mental health. This study will provide a useful resource for those researchers interested in continuing to examine the different aspects of police officer mental health and how to potently approach innovative interventions to help law enforcement personals mental wellness thrive in a field where trauma is experienced daily.

Details

Policing: An International Journal, vol. 42 no. 4
Type: Research Article
ISSN: 1363-951X

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