Mental Illness Stigma

Mental Illness Stigma

With the recent highlight of mental illness in our society, we need to start asking if we are doing enough to understand and treat mental illness in Singapore. Perhaps the first step would be to address the stigma against mental illness.

With one in six people in Singapore suffering from some form of mental illness, it’s quite likely that patients include our friends, colleagues or family members. Yet mental illness is still stigmatised by prejudice, ignorance and fear. There are still some within our society who view symptoms of psychopathology as threatening and inappropriate, and these attitudes foster stigma and discrimination towards people with mental illness. Numerous international studies have suggested that stigmatising attitudes towards people with mental health problems are widespread and commonly held. As recognised by the World Health Organisation, the image of mental illness is incorrectly associated with images of violence and laziness rather than with suffering, marginalisation and denial of basic rights.

It is crucial to reduce the stigma attached to mental illness. There are numerous government organisations and initiatives, such as the Silver Ribbon Project, that addresses this by portraying mentally ill individuals in more positive light.

Who Stigmatises?

Stigmatising beliefs about individuals with mental illness are held by a broad range of individuals. Surprisingly, research has shown that this is regardless of whether they know someone with a mental illness, have a family member with a mental illness, or even have a good knowledge and experience of mental illness. Mental illness stigma is even present in the medical profession, at least in part because it is given a low priority during the primary training of physicians.

This stigma stretches across a patient’s lifespan. For adolescents with mental illness, it is often in the form of distrust and friendship losses. Adult patients report stigma of fear, avoidance and gossip, while older adults with mental illness largely experience discrimination in the form of pity and an underestimation of their abilities.

Why does stigma matter?

Stigma includes both prejudicial attitudes and discriminating behaviour towards individuals with mental illness. A local study on help-seeking behaviour among those with mental illness indicated that only about half of those with a severe mental disorder had sought help in the last 12 months. The reason in part is the stigma attached. Critically, besides the treatment gap caused by stigma, we often see patients suffer self-stigma.

Self-stigma, the internalising of perceptions of discrimination, causes patients to feel shameful and leads to poorer treatment outcomes. Research has also shown that patients who suffer from self-stigma feel socially excluded and have low self-esteem.

In Singapore, several organisations such as the Institute of Mental Health (IMH) and Singapore Association for Mental Health (SAMH) have programs to help those with mental illness find work. However, the mentally ill may face discrimination and are fearful as they have not worked for a long time. The existing stigma also means that many with mental illness are undecided whether to declare their condition.

How can we eliminate stigma?

Acknowledging the existence of prejudice is an essential first step. A Singaporean study comparing views of cardiac and psychiatric outpatients indicated that majority of psychiatric patients felt the additional burden of stigma, whilst the cardiac patients reported very little stigmatisation.

If your friend had a broken leg and had just come out of the hospital after an operation, you probably would not think twice about asking how they were. Why do we console and empathise with that friend, whilst potentially shun another suffering from schizophrenia? Mental health problems are common and normal. Most people don’t feel ashamed when they come down with the flu, or when their back is hurting. They try to sort out the problem. We must recognise that our emotional and psychological health is just as important as our physical health.

You don’t have to be an expert to talk about mental illness. Anyone can experience a mental health problem, so being able to talk about it is important. Sometimes, little things like asking someone how they are, letting him know you're still thinking about him can make a difference to how he is feeling.

It is important also to remember that having a mental health problem is just one aspect of the person’s overall health and well being. Don't only talk about mental health either. People do not want to be defined by their mental illness. Do please try to avoid clichés. Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘You’ll get over it’ may not help. Try to be open minded and non-judgemental. You won't always understand what's going on for the other person, but lending a listening ear is the important part. Just spending time with the person lets him know you care and can help you understand what he is going through.

Sociologist Erving Goffman (1963), credited for his theory of social stigma, commented that the difference between a normal and a stigmatised person is a question of perspective, not reality. Just as much as our advancement for assessment and treatment into mental illness has developed, so has the stigma towards it. It will take time, but it is time to put an end to mental health discrimination.

Written by Dr. Joel Yang