Stigma in mental illness: a continuing concern

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As we live longer in the developed world our chances of experiencing a long-term condition grow, whether it is our own condition or that of someone close to us (Presho, 2008). The contemporary focus on 'survivorship' in cancer care (Bellury et al., 2011) is a good example of our changing experiences of health status. More people are living with cancer, rather than dying prematurely from it, and this has huge systemic ramifications for the individual and their social network. These ramifications include injury to the person's mental health. For example, postdiagnosis, people with cancer are vulnerable to developing debilitating depression (Slovacek et al., 2009).Deacon (2008) has argued that good mental health is a prerequisite for positive adjustment and effective self-management in the face of developing a long-term condition. Consequently she argues that promoting mental health should be considered as important and routine interventions given by all nurses to all patients. A particularly vulnerable group of patients are those with serious mental illness who also develop a long-term physical condition. There is a complex interplay of biopsycho- social factors that can impact negatively on their health outcomes and researchers are engaged in trying to understand these dynamic relationships as a pre-cursor to effecting change (Howard et al., 2010). Of critical importance is the stigma of mental illness. This stigma impacts on nurses' willingness to engage in mental and physical health promotion, leading to a systemic failure in person/family-centered care (Horsfall, Cleary, & Hunt, 2010).According to Lauber (2008) 'the common understanding of stigma is a severe social disapproval due to believed or actual individual characteristics, beliefs or behaviours that are against norms, be they economic, political, cultural, or social' (p. 8). Stigmatizing attitudes exist amongst health professionals including those employed in mental health, which may result from staffworking with patients when they are in the most disturbed phase of their illness, despite this not being a typical characteristic of everyday mental illness (Horsfall et al., 2010). Further, research shows that there are many prejudices and negative attitudes held towards people with a mental illness within the wider community, and that many people regard social interaction with mentally ill people as uncomfortable, viewing the behavior of the individual as potentially dangerous and/or violent (Lauber, 2008). For people living with a mental illness stigmatizing attitudes towards them are a common occurrence, which results in everyday discrimination and disparities. For example, disparities occur in education, housing, job opportunities, income and health care, so whilst stigma on its own is damaging, the discrimination that it can result in can be much worse (Pope, 2011). Discriminating against an individual may produce stigma resulting in social deprivation, such as the refusal of accommodation, which can lead to homelessness, which in turn generates additional stigma (Horsfall et al., 2010). Thus, stigma and discrimination impacts on the individual, and on the health and well-being of their families, and communities. For example, a study of mentally ill parents found that they were reluctant to bring their children for activities outside the home. The parents worried that their children would be stigmatized because of their mental illness. They also had constant worry that their children would be sent to a foster or children's home because of parental mental illness (Chan et al., 2011). This shows the impact of stigma not only affected the person living with a mental illness, but also their children and family.The experience of having a long-term mental health condition brings patients and their families into long-term relationships with health care providers. These relationships demand something different from nurses who may be more accustomed to rapid and task focused interactional contacts that promise quick fixes. …