THE Worst Mental Health Disorder: STIGMA

GM@W Mission: Great Minds @ Work: (1) Making the business case for hiring people with behavioral health challenges. (2) Aiding job seekers with behavioral health challenges return to work. (3) Eliminate Stigma in the workplace. Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people. Although research has gone far to understand the impact of the disease, it has only recently begun to explain stigma in mental illness. Much work yet needs to be done to fully understand the breadth and scope of prejudice against people with mental illness. Fortunately, social psychologists and sociologists have been studying phenomena related to stigma in other minority groups for several decades.

Disclaimer/Disclosure The views, opinions, and content expressed herein do not necessarily reflect the official position of DSHS, SAMHSA or HHS.  NO official support of or endorsement by SAMHSA or HHS for these opinions or for the instruments or resources described are intended or should be inferred.

Definition: Stigma: a mark of disgrace associated with a particular circumstance, quality, or person: "the stigma of mental disorder" synonyms: shame · disgrace · dishonor · ignominy · humiliation · (bad) reputation Source: Oxford Dictionary Stigma has many meanings, from marks of disease on the skin, to a part of a flower, to a mark of disgrace. Unfortunately for those of us with mental illnesses, it is the last definition that comes closest to what we experience as stigma. In fact, some dictionaries even use "the stigma of mental illness" as an example in their definitions. I found one dictionary definition that I feel sums it up very well: "A feeling that something is wrong or embarrassing in some way." A look at dictionaries that list synonyms is very telling. Words like black mark, defect, blame, disgrace, dishonor, fault, stain and taint, shame and guilt are just some of the concepts that apply to the social stigma of mental illness.. A person who has been stigmatized on account of mental illness, real or even only perceived, often suffers discrimination at work, in school, in social situations even the loss of friends and family members. Stigma stems from ignorance, prejudice or fear. For example when a person tells a friend or coworker that he or she has bipolar disorder. These People are often rejected by others in their lives because of the perception that they are dangerous, irresponsible, or just too difficult to deal with - all without any real understanding of the illness and often without knowing them well enough to make any sort of fair judgment.

The Way It Is “The more intangible or hidden the disorder, the more society believes the individual should be able to control it & the greater the negative impact of not being able to do so.” Although stigmatizing attitudes are not limited to mental illness, the public seems to disapprove persons with psychiatric disabilities significantly more than persons with related conditions such as physical illness (34-36). Severe mental illness has been likened to drug addiction, prostitution, and criminality (37,38). Unlike physical disabilities, persons with mental illness are perceived by the public to be in control of their disabilities and responsible for causing them (34,36). Furthermore, research respondents are less likely to pity persons with mental illness, instead reacting to psychiatric disability with anger and believing that help is not deserved (35,36,39).

2014 Survey of people with a mental health diagnosis: Hey! It’s Almost 2016… 2014 Survey of people with a mental health diagnosis: 90% had experienced some form of public stigma 65% had experienced it on the job or with friends 57% with family members 38% in a dating situation …this can’t still be a problem? Right?

Stigma Comes in 2 Flavors… Public stigma Stereotype Negative belief about a group (e.g., dangerousness, incompetence, character weakness) Prejudice Agreement with belief and/or negative emotional reaction (e.g., anger, fear) Discrimination Behavior response to prejudice (e.g., avoidance, withhold employment and housing opportunities, withhold help) . Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. Both public and self-stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination. Social psychologists view stereotypes as especially efficient, social knowledge structures that are learned by most members of a social group (1-3). Stereotypes are considered "social" because they represent collectively agreed upon notions of groups of persons. They are "efficient" because people can quickly generate impressions and expectations of individuals who belong to a stereotyped group (4). The fact that most people have knowledge of a set of stereotypes does not imply that they agree with them (5). For example, many persons can recall stereotypes about different racial groups but do not agree that the stereotypes are valid. People who are prejudiced, on the other hand, endorse these negative stereotypes ("That's right; all persons with mental illness are violent!") and generate negative emotional reactions as a result ("They all scare me!") (1,3,6). In contrast to stereotypes, which are beliefs, prejudicial attitudes involve an evaluative (generally negative) component (7,8). Prejudice also yields emotional responses (e.g., anger or fear) to stigmatized groups. Prejudice, which is fundamentally a cognitive and affective response, leads to discrimination, the behavioral reaction (9). Prejudice that yields anger can lead to hostile behavior (e.g., physically harming a minority group) (10). In terms of mental illness, angry prejudice may lead to withholding help or replacing health care with services provided by the criminal justice system (11). Fear leads to avoidance; e.g., employers do not want persons with mental illness nearby so they do not hire them

Self-stigma Stereotype Negative belief about the self (e.g., character weakness, incompetence) Prejudice Agreement with belief, negative emotional reaction (e.g., low self- esteem, low self-efficacy) Discrimination Behavior response to prejudice (e.g., fails to pursue work and housing opportunities) (12). Alternatively, prejudice turned inward leads to self-discrimination. Research suggests self-stigma and fear of rejection by others lead many persons to not pursuing life opportunities for themselves (13,14). The remainder of this paper further develops examples of public and self-stigma. In the process, we summarize research on ways of changing the impact of public and self-stigma.

And Why Shouldn’t They? History Media Pop Culture “Words like mad have been used to mean insanity or dementia since the 1500s, but over the past couple centuries, it’s been used more as a general descriptor of a concept or personality than an indicator of mental illness”—a la March Madness Throughout history people with mental health problems have been treated differently, excluded and even brutalized. This treatment may come from the misguided views that people with mental health problems may be more violent or unpredictable than people without such problems, or somehow just “different”, but none of these beliefs has any basis in fact (e.g. Swanson, Holzer, Ganju & Jono, 1990). Similarly, early beliefs about the causes of mental health problems, such as demonic or spirit possession, were ‘explanations’ that would almost certainly give rise to reactions of caution, fear and discrimination. Even the medical model of mental health problems is itself an unwitting source of stigmatizing beliefs. First, the medical model implies that mental health problems are on a par with physical illnesses and may result from medical or physical dysfunction in some way (when many may not be simply reducible to biological or medical causes). This itself implies that people with mental health problems are in some way ‘different’ from ‘normally’ functioning individuals. Secondly, the medical model implies diagnosis, and diagnosis implies a label that is applied to a ‘patient’. That label may well be associated with undesirable attributes (e.g. ‘mad’ people cannot function properly in society, or can sometimes be violent), and this again will perpetuate the view that people with mental health problems are different and should be treated with caution. Barak Obama, 2nd Presidential debate – October, 2012: “So my belief is that, (A), we have to enforce the laws we've already got, make sure that we're keeping guns out of the hands of criminals, those who are mentally ill.” Donald Trump: “I feel that the gun-free zones and, you know, when you say that, that’s target practice for the sickos and for the mentally ill,”

The Real Problem Only 33% of the people who need help will get it, because of the social stigma, the fear of repercussions at work and the lack of quality, affordable accessible care.

A Little Personal Perspective…

There IS Hope… #IWILLLISTEN As civic leaders and large purchasers of healthcare, the CEO’s of employers of choice are in a unique position to drive change for employees and their families by identifying and filling unmet employee needs related to mental health and wellness. #IWILLLISTEN CEOs from around the country are coming together to talk about how formally and informally incorporating mental wellness into the corporate culture is good for employees’ mental health and also good for business. Over 40 Heads of HR and Benefits will come to observe the CEO Roundtable discussion

http://naminyc.iwilllisten.org/workplace/ @GreatMindsatWrk GreatMindsatWork www.linkedin.com/groups/8295328

In Conclusion… Ain’t it the Truth!