Stigma? Time to change, time to challenge

Jul 05, 2019

Stigma is social injustice and an error of society. Hence, eradicating it is the responsibility and should be the priority of that society (Corrigan and Rao 2012)

Current research indicates that nine out of ten people have experienced stigma related to their mental ill health and that this has significantly affected their ability to recover.

Mental health difficulties are associated with great stigma and this has an effect on disclosure to friends, family and colleagues, acceptance and opportunities to take part in the activities that could support a persons' wellbeing.

It's clear from this that as a society we must continually work towards diminishing people's experience of stigma, especially in the workplace. However, before we can do this it's important that we fully understand what we mean by stigma. What exactly is it and how does it manifest in everyday life, especially when mental health awareness campaigns are everywhere?

What is stigma?

The term 'stigma' originates from a Greek word meaning 'mark of shame' and was applied to slaves and criminals as a sign of disgrace. In the middle ages, mental illness was considered a punishment from God and has been used throughout history to denote evil.

In these more modern times, stigma refers to the feelings of deep shame a person experiences when subjected to pervasive prejudice and discriminating behaviours. Rossler (2016) describes society's current attitude and behaviour towards those with mental health difficulties as, “unworthy of modern welfare states”.

Why does stigma occur?

In one piece of research, 56% of employers admitted they would not employ a person with depression even if they were by far the best candidate (Pescosolido 2010). In addition, 47% of respondents said they would be unwilling to work with a depressed person, and 30% thought someone with depression was potentially violent.

The prejudice and discrimination that ensues from these responses only serve to isolate the person further and delay their recovery. It's been found that neurobiological explanations of mental ill health only exacerbate people's experience of stigma, as others see them as 'defective' in some way.

Attitudes and behaviours that promote these views clearly need challenging and it's only through education, shaped by those with lived experience, that we'll see a change.

What types of stigma are there?

There are different types of stigma that we must challenge, namely social or public stigma and self-stigma or perceived stigma.

Social stigma refers to prejudicial attitudes and discriminatory behaviours directed towards a person with mental health difficulties and the stereotyping of people as unreliable or even violent.

This might affect a person's ability to retain employment or secure a job, maintain relationships with friends and family and limit their access to activities and hobbies which might otherwise support their wellness.

In the Thrive at Work report of 2017, it was found that 300, 000 people leave or lose their job due to poor mental health that hasn't been properly supported. The impact on individuals, families, communities and workplaces can be catastrophic in terms of lost quality of life and an organisation's ability to retain key members of staff.

Self-stigma or perceived stigma refers to the internalisation of indirect and direct messages from others and often makes individuals with mental health difficulties vulnerable to confirming or endorsing these stereotypes. The fear of stigma also means that people feel uncomfortable reaching out for much-needed help and support. This, in turn, can delay recovery and increase isolation.

It's also important to mention the reinforcement of negative stereotypes via the media and press, which often portray those with mental health difficulties as 'violent' or 'dangerous'. Terminology including 'crazy' and 'mad' is often more tolerated than other words would be when connected to other health problems.

Structural stigma is defined by Wahl, Link and Rossler as the “Societal level conditions, cultural norms and institutional practices that constrain the opportunities, resources and wellbeing for stigmatized populations.” This means that there are continuous barriers put in the way of people experiencing mental health difficulties from securing education and employment. There is a relatively poor investment in mental health services as opposed to physical health services and the treatment of those in existing employment.

What can we do to diminish stigma?

Campaigns that encourage social engagement between those with and without mental health difficulties have shown to be more successful than merely providing education in awareness campaigns. It's vital that employees with lived experience of mental health difficulties have a voice in shaping any work-based campaign aimed at reducing stigma.

It's also important to invest in targeted interventions, which tackle discrimination and prejudice in the workplace at source, reviewing processes and policies to ensure they're equitable and fair to those experiencing mental health difficulties. Educating line managers is also clearly important, as are routes of accountability for those who flout and undermine attempts of fairness and social justice within the workplace.

The current interest and focus on mental health in the workplaces offers many opportunities for us to work together to continually challenge the practices and attitudes that keep stigma alive.

Article reproduced with the kind permission of CABA, the organisation providing lifelong support to ICAEW members, ACA students and their close family around the world.