stigma and barriers to care - Uniformed Services University of the ...

More documents

Recommendations

Info

Conceptualizing Stigma and Barriers to Care 55 stigma, occurs when people internalize the negative beliefs and responses of others. Another type is courtesy stigma. Ron Kessler discussed how much money goes into mental health research. Institutional stigma is enacted in organizations, including treatment sites. We have conducted studies of both long-term care facilities and acute psychiatric hospitals and find dramatically different attitudes toward people with mental illness in those two sectors of the mental health system. Finally, there is provider-based stigma. Here we are talking about whether or not people who come in for care are given a sense of hope or a sense of discouragement. Here are some of the findings from the national stigma studies we conducted. The first important finding is that the public has become more sophisticated over time. When we asked individuals, “What is mental illness” they were able to give us a much broader spectrum of problems that might be considered mental health problems than they could in 1950. The second finding is that there have been changes in formal and informal treatment responses to the onset of mental health problems. There were no dramatic changes in the use of the formal treatment sector; the people who were using avoidance as a strategy continue to use avoidance. In contrast, there has been a dramatic change in how proactive people are in response to mental health problems, and further, the American public has opened up to talk about mental health problems with their informal supports. Psychiatrists do not use the term nervous breakdown, but the question was whether or not the American public did. We set up a two-stage question. To have comparability with the earlier studies, the first part asked about the term ‘nervous breakdown.’ The second part asked about mental health problems, and we found that most people did respond to nervous breakdown. I would argue that if you watch one episode of Judge Judy you will see that it is still in the common parlance. The third finding from the national stigma studies shows that stigma is alive and well, that there are clear gradients, and that both the behavior and the label matter. What does this mean Approximately 50% of the American population indicates some form of prejudice towards people with a variety of mental health problems. I should mention that we did not ask, “Do you want to sit on the bus next to somebody with a mental illness” We did not even ask the second generation question, “Would you like to sit next to someone on the bus who has depression” We provided a vignette which is exactly what people confront in the community. We wanted to know one of the most important questions that other approaches did not provide: Do people recognize problems that would meet DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for mental health That turned out to be very important in understanding whether or not people want to respond to mental health problems. There are two clear gradients. First, the type of mental health problem matters. It turns out that schizophrenia is not at the end of the negative spectrum; drug dependence is, followed by alcohol abuse, schizophrenia, and then depression. The second gradient is the venue in which we are asking people to have contact matters. The more intimate the contact, the greater the levels of rejection. In America, and this turns out to be a particularly American phenomenon, the highest levels are in work and marriage. We see the marriage phenomenon everywhere, but the work phenomenon appears to be specific to the United States. In the 1970s there was a debate in the social science literature about whether it was the behaviors that people were rejecting or the label of mental illness. This debate went on for a number of years, and what we find in our studies is that both The first important finding is that the public has become more sophisticated over time.
56 Stigma and Barriers to Care — Caring for Those Exposed to War, Disaster and Terrorism The fourth finding from the national stigma studies shows that in some ways stigma has increased, and this is a uniquely American message. matter. People respond differently to the behaviors, but those people who went on to label the scenario as involving mental illness also had an elevation in their responses regarding stigma. The fourth finding from the national stigma studies shows that in some ways stigma has increased, and this is a uniquely American message. There are two findings that support this idea. The first is the work that Jo Phelan did, in which she showed that there has been a doubling of the spontaneous mention of violence and dangerousness in response to the question, “What is a mental illness” This is a direction that we had neither hoped for nor expected. The second finding comes from recent work by a young scholar who did an analysis of the major newspapers in the United States, Germany, and Iceland. She analyzed the content tone of all articles on mental illness in one year in those countries. She found that the dominant themes regarding mental illness vary across society, so culture matters both in the micro and the macro sense. In the United States, 46% of the articles had a dominant theme of fear and danger. That was not the case in Iceland where the dominant themes were inclusion and integration. In Germany the major theme centered on fear of repeating the past in terms of dealing with difference, particularly people with mental illness. We are currently analyzing data from samples of individuals in 15 countries looking at stigma and we find there is tremendous global variation. But unlike the World Health Organization (WHO) international study of schizophrenia, these findings do not have to do with societies that are more simple and open. There had been a notion from the Insurance Services Office’s studies that individuals in developing societies recovered faster and better from schizophrenia than individuals in developed societies. They suggested that perhaps this was due to differences in stigma. We find just the opposite. In our sample the three most stigmatizing countries are Bangladesh, Bulgaria and Cyprus. The United States does not anchor the bottom, Iceland does again. However, we do find that competence and public health spending matter for lower levels of tolerance at the societal level. The fifth finding from the national stigma studies is that sociodemographics are unrealistic, inconsistent, or impotent predictors of public health literacy, treatment predispositions, and stigma. However, we do find occasional correlates. For example, women experience more prejudice, yet they are more tolerant. But that does not exist in all societies or for all kinds of stigma that we might measure. Although there has been a great deal of assumption about how African Americans feel in this country, our research indicates that African Americans are actually more positive about the potential of the treatment system than are Caucasians. This is not the case for all kinds of services, but it does indicate that we need to understand culture rather than make assumptions about culture based on sociodemographic characteristics. Can we change stigma We did an evaluation of the Public Service Announcement (PSA) campaign that the Substance Abuse and Mental Health Services Administration (SAMHSA) put out called What a Difference a Friend Makes. This campaign was a result of the 1999 Surgeon General’s report, which itself is an indication of stigma. There were Surgeon General Reports on cancer in the 1960s, but it was not until 1999 that there was a Surgeon General report on mental health. Following the Surgeon General’s report was the 2003 President’s New Freedom Commission whose first recommendation was a national anti-stigma campaign. SAMSHA took that recommendation and ran with it, developing three PSAs with the Ad Council. The first PSA was, The Door, in which the person approaches a door,
Page 1 and 2:
FORUM ON HEALTH AND NATIONAL SECURI
Page 3 and 4:
From the Conference Series: FORUM O
Page 5 and 6:
9 Day 1 Discussion ................
Page 7 and 8:
ii Bruce G. Link, Ph.D. Professor,
Page 9 and 10:
iv Alisha H. Creel, Ph.D. Assistant
Page 11 and 12:
vi Kenneth W. Schor, D.O., M.P.H. C
Page 14 and 15:
Executive Summary 1 Executive Summa
Page 16 and 17:
Executive Summary 3 about stigma in
Page 18 and 19: Executive Summary 5 value, cost-eff
Page 20 and 21: Executive Summary 7 •• Reinforc
Page 22 and 23: Introduction 9 1 Introduction Mark
Page 24 and 25: Mental Health, Stigma and Barriers
Page 32 and 33: Stigma and Barriers to Care in Mili
Page 42 and 43: Stigma and Barriers to Care in Disa
Page 54 and 55: Stigma and Barriers to Care in Terr
Page 64 and 65: Conceptualizing Stigma and Barriers
Page 78 and 79: Mitigating Stigma and Barriers to C
Page 90 and 91: Optimizing Access to Care 77 8 Opti
Page 92 and 93: Optimizing Access to Care 79 risk f
Page 94 and 95: Optimizing Access to Care 81 those
Page 96 and 97: Optimizing Access to Care 83 with i
Page 98 and 99: Optimizing Access to Care 85 were s
Page 100 and 101: Optimizing Access to Care 87 develo
Page 102 and 103: Day 1 Discussion 89 9 Day 1 Discuss
Page 104 and 105: Day 1 Discussion 91 Directorate at
Page 106 and 107: Day 1 Discussion 93 tools to addres
Page 108 and 109: Day 1 Discussion 95 DR. SUTTON: It
Page 110 and 111: Conference Recommendations 97 10 Co
Page 112 and 113: Conference Recommendations 99 Sever
Page 114 and 115: Conference Recommendations 101 ence
Page 116 and 117: Conference Recommendations 103 ment
Page 118 and 119:
Conference Recommendations 105 help
Page 120 and 121:
Conference Recommendations 107 you
Page 122 and 123:
Conference Recommendations 109 thei
Page 124 and 125:
Conference Recommendations 111 good
Page 126 and 127:
Conference Recommendations 113 mode
Page 128 and 129:
Conference Recommendations 115 fitn
Page 130 and 131:
Conference Recommendations 117 like
Page 132:
Center for the Study of Traumatic S
show all

stigma and barriers to care - Uniformed Services University of the ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?