Stigma just makes problems worse

Justin Frewen Photo/File

The world Health Organisation (WHO) has identified stigma and its associated discrimination as the "single most important barrier" facing people with mental health and behavioural issues.

Indeed, organisations such as the WHO, the World Psychiatry Association and the World Association have identified stigma as a key public health challenge.

The history of "stigma" can be traced back to ancient Greece, where it denoted the identifying marks imprinted on slaves to designate ownership. In the late 16th and early 17th centuries, "stigma" became an indicator of humiliation and degradation.

The contemporary meaning of stigma can be traced to Erving Goffman, a Canadian-born sociologist and writer, who developed the concept of "spoiled identity". This referred to how mental illness is frequently regarded as shameful, effectively depriving people with a mental health issue of their rights.

Goffman described how "courtesy stigma" - stigma by association - can result in family and friends being blamed for a person's mental health status and even risk being accused of sheltering a potentially dangerous person.

Stigma, or discrimination as it is commonly referred to in New Zealand today, entails a range of negative consequences. Potential mental health service users may be discouraged from seeking the care and assistance they require, lest other people find out about their condition.

Many mental health service users suffer from reduced employment prospects, and encounter difficulties in obtaining suitable accommodation and maintaining relationships. Unsurprisingly, this can lead to low self-esteem or even self-stigma, which occurs when an individual internalises feelings of culpability, shame and inadequacy as well as a desire to keep their condition secret.

Conversely, many members of the community may feel reluctant to be supportive of mental health users due to the socially ascribed negative connotations of mental health issues.

Stigma acts as a barrier to the active participation of mental health services users in the local community, and can effectively deter politicians, policy makers and other influential bodies from advocating for greater resources to tackle mental health concerns.

People with a mental health issue often experience discrimination, which is a natural outcome of stigma.

The negative consequences of stigma can therefore have a devastating impact, not only on the quality of life of people with a mental health issue but also on their recovery prospects. Many experts argue that mental health stigma can be more debilitating, constraining and longer lasting than the original mental health issue. Stigma can, therefore, create a cycle of worsening socio-economic prospects and persistent, ongoing mental health problems.

Discrimination is one of the biggest barriers to recovery. That is why stopping discrimination and championing respect, rights and equality for people with experience of mental illness is so important. It is as important as providing the best therapies or treatment.

At the personal level, one can provide empathetic support to family, friends or colleagues who may be experiencing a mental health problem.

Justin Frewen is a Wanganui-based United Nations consultant who has served the UN on humanitarian missions for almost 20 years.