Abstract
BackgroundStigma related to mental illness affects all ethnic groups, contributing to the production and maintenance of mental illness and restricting access to care and support. However, stigma is especially prevalent in minority communities, thus potentially increasing ethnically based disparities. Little is known of the links between stigma and help‐seeking for mental illness in African‐descended populations in the UK.Objective and study designBuilding on the evidence that faith‐based organizations (FBOs) can aid the development of effective public health strategies, this qualitative study used semi‐structured interviews with faith groups to explore the complex ways in which stigma influences help‐seeking for mental illness in African‐descended communities. A thematic approach to data analysis was applied to the entire data set.Setting and participantsTwenty‐six men and women who had varying levels of involvement with Christian FBOs in south London were interviewed (e.g. six faith leaders, thirteen ‘active members’ and seven ‘regular attendees’).ResultsKey factors influencing help‐seeking behaviour were as follows: beliefs about the causes of mental illness; ‘silencing’ of mental illness resulting from heightened levels of ideological stigma; and stigma (re)production and maintenance at community level. Individuals with a diagnosis of mental illness were likely to experience a triple jeopardy in terms of stigma.Discussion and conclusion‘One‐size‐fits‐all’ approaches cannot effectively meet the needs of diverse populations. To ensure that services are more congruent with their needs, health and care organizations should enable service users, families and community members to become active creators of interventions to remove barriers to help‐seeking for mental illness.
Highlights
People with mental illness experience more stigma than those with other health problems.[1]
Key factors influencing help-seeking behaviour were as follows: beliefs about the causes of mental illness; ‘silencing’ of mental illness resulting from heightened levels of ideological stigma; and stigmaproduction and maintenance at community level
Three key themes emerged from the data which are illustrated by direct quotes related to the following: the sociocultural beliefs about mental illness and the production of stigma, the social consequences of stigma mental illness, the impact of avoidance behaviour on helpseeking and the reproduction of stigma in faith communities
Summary
People with mental illness experience more stigma than those with other health problems.[1]. African-descended groups in the UK (primarily people with origins in Africa and the Caribbean) experience poorer outcomes against a number of key social and health indicators.[8,9,10,11,12] They are more likely to be diagnosed with psychotic illnesses and are over-represented in inpatient psychiatric services.[13] There is evidence that they are confronted with ethnically based prejudice and discrimination by health professionals.[14] These factors partly explain low levels of engagement between members of these communities and mainstream mental health services, access through adverse pathways, poorer experiences and outcomes.[15] Delayed and non-engagement have been consistently reported in the UK in relation to inferior access to mental health services by African-descended people, resulting in longer duration of untreated illness, which is associated with more severe and chronic presentation at contact with services.[15] Alongside mistrust of services, stigma is implicated in delayed help-seeking.[16] Stigma emanating from and reinforced within ethnic communities and families was reported by Anglin et al.[17] whose study identified and linked stigmatizing attitudes to messages about mental illness communicated by family.
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