Abstract
Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.
Highlights
In 2016, the rate of suicide in Montana was the highest in the United States—almost double the national average at 26 per 100,000 people, compared to 13.4 per 100,000 people nationwide [1].For Montanans between the ages 25–44, that rate jumps to 40.3 per 100,000
In response to RQ2, “How does stigma about mental illness and mental health treatment affect help-seeking behavior among Eastern Montana young adults?”, our results indicated that defensive-avoidance reactions fueled fears that others are negatively judging emotional vulnerability and mental health treatment and may constitute a significant barrier to help-seeking among Eastern
In response to RQ3, “What are the differences in collective vs. individual orientation expressed by Native Americans (NA) and Caucasian adolescents and young adults?”, we found that the cultural differences in how Native American and Caucasian young adults view stigma is rooted in their perspective of mental health problems, and depression in particular
Summary
In 2016, the rate of suicide in Montana was the highest in the United States—almost double the national average at 26 per 100,000 people, compared to 13.4 per 100,000 people nationwide [1].For Montanans between the ages 25–44, that rate jumps to 40.3 per 100,000. In addition to the “lethal triad” that plagues many rural communities—greater numbers of firearms, drug and alcohol abuse, and limited access to health services [2]—factors exacerbating the distressingly high suicide rate in Montana include long, dark winters, a stoic “cowboy up” mentality [3], lack of mental health awareness [4], and social isolation [5]. This lethal combination contributes to suicidal ideation and behavior, but to a precursor factor—stigma [6]. Research has shown that mental illness stigma reduces patients’ perceived need for help [8], impairs adherence to treatment regimens [9], decreases self-esteem [10], and increases social isolation [11]
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