Each day, people living with mental illness encounter stigma and
discrimination that can prevent them from attaining life goals that others may
take for granted.
While antistigma programs are often helpful in dispelling harmful myths
associated with mental illness, they can worsen attitudes in some cases,
according to three psychiatry residents in the APA/Bristol-Myers Squibb
fellowship. The fellows, who spoke at APA's Institute on Psychiatric Services
last month in New York City, discussed some of these campaigns and highlighted
those that have achieved positive results.
According to Sarah Altman, M.D., a PGY-4 psychiatry resident at Cambridge
Hospital in Cambridge, Mass., three of the most pervasive misconceptions about
people with mental illness are that they are unpredictable and dangerous, are
incompetent and can't make decisions for themselves, and lack willpower.
Such mistaken beliefs have harmful consequences for people with mental
illness, who are "less likely to be hired and have apartments rented to
them" than people without mental illness, she noted. They are also more
likely to be rejected by family and friends, be falsely accused of a crime,
and spend more time in jail than those without mental illness for the same
When such misconceptions are internalized by people with mental illness, it
can lead to a variety of self-defeating behaviors, she added, such as avoiding
mental health treatment.
"If you know that being labeled with mental illness will get you
something you don't want, you won't show up at the clinic, you won't get
treatment, and you won't tell anyone about what you're experiencing,"
Altman pointed out.
Some families with a mentally ill relative may experience "courtesy
stigma," meaning that they also feel a "tremendous sense of shame,
blame, and hopelessness" about the mental illness and do not disclose
information about it to those outside the family.
Altman cited data from a study by Christoph Lauber, M.D., in the June 2004
Journal of Community Mental Health on the attitudes of 844 people in
Switzerland toward people with mental illness measured in terms of"
social distance." The authors defined social distance as the
willingness to engage in relationships of varying intimacy with a mentally ill
person. The level of social distance increases if situations imply"
Subjects were asked to react to a series of situations that would bring
them into increasingly closer contact with a mentally ill person. Among the
findings was that 27.5 percent of respondents said they would be"
definitely willing" to work with someone with mental illness, but
only 4.5 percent indicated that they would be willing to let someone with
mental illness care for their child.
Lauber also showed that compared with a diagnosis of depression, a
diagnosis of schizophrenia tended to increase social distance in members of
the community. In addition, he found that presenting people with a biomedical
approach to explaining mental illness increased social distance, according to
"If people believed that mental illness was caused by a dysfunction
of the brain, they actually wanted that person to stay further from
them" than if they didn't hold that view, Altman noted.
Karen Hopp, a PGY-5 resident in family medicine and psychiatry at the
University of California, Davis, reviewed a number of studies on how
antistigma campaigns around the world affected knowledge and attitudes about
people with mental illness. However, she cautioned attendees not to read too
much into the findings. "There are lots of limitations to these
data," she noted, including uncontrolled trials, small controlled
trials, and use of self-reported attitudes as outcome measures.
Hopp cited data from a study by Vanessa Pinfold, Ph.D., in the April 2003
British Journal of Psychiatry on the impact of two one-hour mental
health awareness workshops on 472 secondary-school students in the United
A week after the workshops, students' mean positive attitude scores rose
significantly but fell slightly after six months. Also, workshops in which
students listened to people with mental illness speak about their experiences
were associated with a lessening of social distance, according to Hopp.
"There was a change only in willingness to talk to someone with
mental illness," she noted.
Studies that measured the effect of mental health courses among police have
found the courses to be of varying success, according to Hopp. For instance, a
British study noted that after one eight-hour course, police were
significantly more willing to work with someone with mental illness. Levels of
knowledge about mental illness also increased.
A similar course for Boulder, Colo., police that included a presentation by
an eloquent woman with schizophrenia increased officers' knowledge scores. But
despite the improvement in scores, "almost 71 percent of the officers
continued to hold at least one mistaken belief about schizophrenia,"
Hopp pointed out.
Lauren Swager, M.D., highlighted some of the current programs designed to
educate the public about mental illness and decrease certain prevailing
negative attitudes. She is a PGY-4 psychiatry resident and first-year child
and adolescent psychiatry fellow at the University of North Carolina at Chapel
Swager described successful antistigma programs such as "In Our Own
Voice," "Family to Family" support groups, and"
Stigmabusters" of the National Alliance on Mental Illness.
Other noteworthy programs are "Stigma Watch" by the National
Mental Health Association and the Resource center to Address Discrimination
and Stigma and Voice Awards of the Substance Abuse and Mental Health Services
Swager urged psychiatry training directors to discuss stigma with their
trainees and called on all psychiatrists to ask their patients about
experiences in which they encountered stigma.
"We must continue to include consumers in antistigma efforts,"
she said. "They are the experts." ▪