CLINICAL HANDBOOK OF SCHIZOPHRENIA

534 VII. POLICY, LEGAL, AND SOCIAL ISSUESPublic StigmaThe general population primarily demonstrates public stigma through negative reactionsand behaviors toward people with severe mental illness. Public stigma describes society’snegative beliefs, reactions, and behaviors toward individuals with mental illness. As outlinedin Figure 51.1, public stigma consists of stereotypes, prejudice, and discrimination.First, stereotypes provide cognitive structures that categorize information about socialgroups: “Those crazy people are incompetent, commit dangerous acts, and possess weakcharacters.” Second, prejudice includes the endorsement of a stereotype and in turn an emotionalresponse: “Yes, those crazy people commit dangerous acts and that scares me.”Third, discrimination contains a behavioral reaction to the prejudice: “I will not employ orrent to people with mental illness, because they commit dangerous acts that scare me.”Public stigma negatively impacts the lives of individuals with mental illness. First,stigma may rob individuals of important life opportunities, including gainful employment,safe and comfortable housing, relationships, community functions, and educationalopportunities. Specifically, individuals labeled with mental illness find it difficult toobtain these important life goals because of discriminating practices endorsed by employers,landlords, neighbors, friends, family, community members, and education professionals.Second, stigma negatively interacts with the criminal justice system; mental illness becomescriminalized rather than being treated as a mental health problem. Individualswith psychiatric symptoms more often face the likelihood of being arrested than do membersof the general public; this leads others to treat individuals with mental illness ascriminals rather than to provide mental health treatment for psychiatric symptoms.Third, health care systems withhold appropriate medical services from individuals due tostigma. Specifically, individuals with mental illness receive fewer insurance benefits andmedical services than do members of the general public, and insurance plans providefewer mental health benefits than physical health services. Moreover, when individualswith mental illness present with physical symptoms, health care providers may be morelikely to attribute any health concerns to psychiatric symptoms, such as delusions orparanoia, rather than to actual physical ailments.FIGURE 51.1. The cognitive components of stigma that influence public stigma and self-stigma.