Download STIGMA IN MENTAL HEALTH: A CONCEPT ANALYSIS

STIGMA IN MENTAL HEALTH: A CONCEPT ANALYSIS
L I N D A C AR M A N C O P E L , P H D , R N P M H C N S , B C , C N E , AN E F, N C C , FAPA
K H AM I S AL - M A M A R I , R N , M S
C O L L E G E O F N U R S I N G , V I L L AN O VA , PA
Goals & Framework of Concept Analysis
 The Goals of the Concept Analysis:
◦ Enhance understanding of the concept for use in research or
clinical practice.
◦ Bring the concept closer to being used for research
or for clinical
)
practice.
◦ Identify the commonalities and shared experiences of stigma in
the mentally ill population.
◦ Increase understanding and conceptual clarity of stigma.
◦ Contribute to instrument development and theory testing.
(Meleis, 2012)
 Framework for Concept Analysis: Walker & Avant (2005)
The Concept: Stigma
 Stigma in mental health is a universal health issue.
 The term “stigma” can be traced back to 1700s.
 The word “stigma” is derived from the Greek word root which means
“mark,” a brand impressed by an iron.
 It also referred to marks branded on cattle or on people who served
as slaves in ancient times in he Orient or in Greece.
 Stigma has a negative influence on people’s lives, creating social
distance which interferes with their interactions with people in the
society.
(New Catholic Encyclopedia ,2003)
The Concept: Stigma
 Recently, the concept of stigma was introduced into medical
science to describe the discrimination experienced by people
suffering from illnesses, such as HIV/AIDS, obesity, psoriasis, &
mental health disorders.
 Stigma disqualifies certain groups from full social acceptance
and the ability to conform to the typical standards of society.
 Stigma has a persistent influence on the individual’s health care
problems, as well as on the community, family, and national
political responses to illness.
(Goffman, 1963; New Catholic Encyclopedia, 2003)
The Concept: Stigma
 Stigma has a persistent influence on the individual’s health care
problems, as well as on the community, family, and national political
responses to illness.
 Stigmatized people suffer from chronic stress, which has additional
negative effects on their physical and mental well being.
 There is strong evidence that people with mental illness have less
access to primary health care.
 There is evidence that mental health clients receive inferior care for
medical problems. The rates of cardio-vascular disease, obesity, and
diabetes are increasing in people with mental illness.
(Corrigan & Watson, 2002; Bjorkman, Angelman, & Jonsson, 2008; Dehert et. al., 2009; Druss & Bradford, 2000;
Druss & Von Esenwein, 2006; Hatzenbuehler, Phelan, & Link, 2013)
Definition of Stigma
 Link and Phelan (2001) defined stigma as a process which occurs
when a person demonstrates noticeable social differences, and
thereby becomes unfairly labeled based on emotional or physical
symptoms or atypical characteristics.
 Gary (2005) defined stigma as “a collection of negative attitudes,
beliefs, thoughts, and behaviors that influences the individual, or
the general public, to fear, reject, avoid, be prejudiced, and
discriminate against people with mental disorders” (p.980).
Types of Stigma
Public Stigma
Self-Stigma
 Public stigma refers to the  Self-stigma is when a
attitudes and beliefs of the
person with mental illness
general public towards
internalizes stigma and
persons with mental health
experiences diminished
challenges or their family
self-esteem and selfmembers.
efficacy.
(Corrigan, Powell, & Rusch, 2012; Watson, 2007).
Types of Stigma
Stigma by Association
Double Stigma
 Stigma by association occurs  Double stigma occurs when
when negative characteristics
a person with mental illness
(e.g., psychological distress
concurrently experiences
and feeling of inferiority) are
more than one type of
attributed to individuals,
stigma such as a mental
family members, care givers,
health diagnosis and a
and healthcare providers
physical disability.
who are in close contact with
stigmatized people.
(Corrigan, Powell, & Rusch, 2012; Halter, 2008; Watson, 2007)
Assumptions
 There is a link between people’s negative attitudes and stigma
towards clients with mental illness.
 The more mentally ill clients believed that they are different
and devalued in the eyes of others, the more self-stigma
occurs.
 There is a relationship between stigma and loss of social
identity.
 Increased awareness and acceptance of mental illness may
lead to reductions in stigma.
(Corrigan & Watson, 2002; Major & O'Brien, 2005; Minas, Zamzam, Midin, & Cohen, 2011)
Antecedents: The Concept of Stigma






Individual with health problems
Prejudice
Blame
Feelings of rejection
Extreme self-conscious
Fear of others discovering health status
(Berjot & Gillet, 2011 & Hatzenbuehler, Phelan, & Link, 2013)
Characteristics: The Concept of
Stigma




Unfavorable attitude from an individual or group
Feeling devalued
Unpleasant personal experience
Perceived negative social norms
(Crocker, 1999; Link & Phelan, 2001;Berjot & Gillet, 2011)
Concept of Stigma: Consequences
Negative Consequences




Feeling inferior
Negative IPRs
Discrimination
Barriers to health care
 Mental health
 Physical health
 Decrease quality of life
 Social isolation
 Overall opportunity loss
Positive Consequences
 Being assertive by talking
about stigma
 Care-Seeking Behaviors
 Ongoing participation on
treatment
 Active participation in antistigma actions
 E.g., media, community
awareness program, etc.
(Corrigan, 2004; Link & Phelan, 2001; Hatzenbuehler et al., 2013; Bjorkman et al., 2008;
Schneider et al. 2011; Gary , 2005)
Recommendations
Nursing Practice:
 Examine own beliefs and values
 Individualized patient care
 Conduct research studies
Patients and Families:
 Provide support for patients and families
 Acceptance of mental illness
 Educate patients, families, and communities about
mental health and mental illness
Recommendations
Nursing Education:
 Evaluate current education practices and examine how
theoretical and clinical components of curriculum address
stigmatization.
 Evaluate whether the time allotted for mental health theory
and clinical education is sufficient to address stigma.
 The nursing profession must recognize all specialties area,
including mental health nursing, as equally valuable and
contributing to the health of individuals, families, and
communities.
Stigma Research
Current Studies
 The majority of studies
address schizophrenia
 Mostly qualitative and
descriptive studies
emphasizing on violence,
stereotypes, and
discrimination
 Few intervention studies
Proposed Studies
 More studies on types of
stigma and what people
encounter
 Strategies to address
stigma
 The effect of stigma on
families
 Nursing education studies
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References
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2, 33. doi: 10.3389/fpsyg.2011.00033
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Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness.
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Psychiatric Nursing, 22(1), 20.
References
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Hinshaw, S. P. (2007). The mark of shame : stigma of mental illness and an agenda for change.
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393-421. doi: 10.1146/annurev.psych.56.091103.070137
Minas, H., Zamzam, R., Midin, M., & Cohen, A. (2011). Attitudes of Malaysian general hospital staff
towards patients with mental illness and diabetes. BMC Public Health, 11, 317. doi: 10.1186/14712458-11-317
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