Abstract

Summary The social disadvantage of mental health disorders: epidemic, disablement or stigma Pople suffering from mental disorders are increasingly excluded from the labour market by a growing disability insurance use. Young adults are most affected by this phenomenon, with the largest increase of disability pensions for mental health disorders in European industrialised countries. Several hypotheses can explain this phenomenon: an increase in the number and severity of mental disorders; a market less adapted to the mental disorders; or an increase of stigma about mental disorders. Aim of this article is to discuss the role of stigma. Results: In mental disorders, stigma and disability have effects entangled in a vicious circle. Unlike physical disability, social disadvantage in mental disorders do not result linearly from a functional limitation. Machine as a “perfect worker” and the increasing demands of relational skills in employment do not favour mental disorders. Moreover, stigma and self-stigma worsen mental disorders and overlap with them. Some common psychological disorders such as depression or personality disorders are particularly sensitive to self-stigma. Conclusion: It is urgent to stop increasing the exclusion from the labour market of persons suffering from mental disorders. “Private” and “social” recovery must be enabled by pragmatic methods, whether exclusion is being due to stigma or disability. Some concepts such as a recovery model or a supported employment developed for severe and highly stigmatised mental disorders such as schizophrenia should be adapted for more frequent mental disorders like depression or personality disorders. Recovery model values the ability to retrieve a social role despite persistence of symptoms. Interventions like “individual placement and support” overturn usual medical logic that “cure precedes employment”. Integration in employment thus becomes an integral part of the recovery process and addresses simultaneously: disorder, job integration related stress and exclusion due to stigma.

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