Acknowledging Stigma as a Barrier to Engagement in Mental Health Services and Care
Stigma is defined as having negative attitudes or beliefs or behaviors toward those with a particular characteristic. That characteristic might be something like mental illness. But stigma is broad in its influence on how people behave or think toward others depending on a particular illness that they might have, or other characteristics such as demographic identities that they may also have. Stigma can be directed toward a person or an entire community.
Stigma to a mental illness is experienced by patients, and this is well established and well known. Many of us are familiar with that. For patients, it comes in different forms such as perceived stigma, anticipated stigma, experienced stigma, or internalized stigma.
Internalized stigma is particularly damaging to a lot of patients because it results in a devalued sense of self. It results in further psychological distress for patients. Going beyond the illness itself, there’s the influence of what the illness means in terms of how patients see themselves internally, but also how they see themselves in the world.
Stigma is also perpetuated and experienced by physicians, including psychiatrists and other mental healthcare workers. This is of particular significance because a lot of times we focus on patients and we focus on how they might view themselves and how they might view their illness, but we don’t always focus on how they experience their clinicians and their doctors.
When physicians possess stigma or clinicians possess stigma, that can be particularly difficult and challenging for patients to engage within health systems where they might experience stigma directly from those that they’re seeking help from.
Addressing mental illness stigma in an open way with your patients is important.
It’s very critical, particularly among patients who experience multiple different types of stigma. Remember, it’s about a characteristic, not just the illness itself.
So, the stigma might be directed to one’s race, to one’s gender, and/or to one’s illness. And when you combine all of those things for certain patients, you end up with patients who experience multiple different layers of stigma that can then have an exponential effect on their health outcomes, both their mental health outcomes and their general health outcomes in other areas of their life.
While it might be tempting to avoid sensitive topics like topics and stigma, it’s so critical that we’re thinking about the social determinants of health.
We’re thinking about sociodemographic factors. We’re thinking about how all of these factors might influence our patient’s experience from the moment they start to develop symptoms to the moment they walk in our doors and start to try to engage with treatment with the different clinicians who might encounter them. It’s important to engage with the lived experience of our patients outside of the diagnostic process, and, in fact, that lived experience of our patients is part of the diagnostic process, is part of understanding how to recommend treatments and how to recommend interventions to improve their wellbeing.
Stigma can influence the outcome of patients in terms of their overall health.
One thing to take away is that stigma can have worse consequences than the illness itself and needs to be addressed directly to improve mental health experiences for patients.
As we seek to engage with our patients and improve their outcomes when it comes to diagnosing a particular mental illness, we want to remember that other aspect of it, the aspect of trying to understand, for them trying to understand how this illness now impacts their overall wellbeing and the way the world sees them, the way they see themselves, that as clinicians, mental health experts, it’s important that we are able to have these conversations with our patients and provide them with tools to address the impact of stigma on their overall wellbeing.
Aderonke Pederson, MD is a psychiatrist at Massachusetts General Hospital and an assistant professor at Harvard Medical School.
This is Five Minute Pearls for The Journal of Clinical Psychiatry, in partnership with the American Society of Clinical Psychopharmacology.
