WHY DO PATIENTS EXPERIENCE SOCIAL STIGMATISATION AND SOCIAL EXCLUSION RELATING TO THEIR MENTAL HEALTH PROBLEMS? WHAT IS THE IMPACT OF THIS EXPERIENCE ON THE PATIENT AND THEIR SITUATION?
The following essay aims not only to identify, discuss and explore different sociological reasons for the social stigmatisation and social exclusion of people with mental health problems, but also to investigate the extent of the impact that this has on the patient and their situation. This assignment will incorporate different sociological approaches, and will draw on personal clinical experience.
Raguram et al (2004) define the term ‘stigma’ as the “adverse social responses” directed towards an individual and their associates as a result of a “disvalued health problem”. When an individual experiences stigmatisation they become “disqualified from full social acceptance” (Bond and Bond, 1994, p.263). Social stigmatisation can promote and cultivate social exclusion, and occurs in response to an “attribute or trait” which is largely considered throughout society to be “different and diminishing” (Stuart and Sundeen, 1995, p.992).
Chapman (2001) states that the problem presented by the social exclusion of certain social groups is extensive and widely recognised, prompting New Labour to set up the ‘Social Exclusion Unit’ when they came into office in 1997; the aim of this was to promote the reintegration of such excluded social groups into society.
The Social Exclusion Unit (1997) describes the term ‘social exclusion’ as:
“A shorthand label for what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown”.
Richardson and Le Grand (2002) report that the term ‘social exclusion’ pertains to the processes in which a member of society is denied access to and prevented from participating “in the normal activities of citizens in that society”; adding that the individual “would like to so participate, but is prevented from doing so by factors beyond his or her control”.
In response to research into the stigmatisation of people with mental illness, and the publication of alarming statistics which revealed that many individuals with mental illness are treated in a discriminatory or abusive manner within society, the Department of Health (2001a) promotes a “major new publicity campaign” to reduce the stigmatisation of and encourage the social inclusion of “users of mental health services”. Bonner et al (2002) report that in recent years there has been a succession of government campaigns and policies aimed at challenging and reducing the social stigmatisation and social exclusion of those with mental health problems.
Historically the mental health services have been associated with and accused of prejudiced and discriminatory treatment of patients (Symonds, 1995), and even abuse of patients (Krosnar, 2003); and although the progression and development of mental health services has undoubtedly been significant and widespread since the bygone era of the ‘asylum’ described by Goffman (1963), it is reported by the Nursing Standard (1998) that “there is a long legacy of association which continues to have impact”. Therefore, one may argue that this implicitly lays blame and responsibility for the social stigma surrounding mental illness partially with the mental health service itself (Crawford and Brown, 2002).
Johnstone (2006) further reinforces this argument by suggesting that the healthcare system continues to be ”one of the biggest harbourers of stigma”; in addition to this, Forchuk (2002) and Ramjan (2004) both report that it is not uncommon for people suffering with mental illness to encounter stigmatisation associated with their illness from the very people providing their care.
Significant weight is added to the argument for the existence of stigmatisation within the healthcare system by the case of David ‘Rocky’ Bennett, a patient who was tragically killed in 1998 during a botched restraint in a psychiatric hospital (Gray, 2005); it is reported by both Pinfold (2004) and Dinsdale (2005) that the subsequent inquiry into his death recognised and acknowledged that he experienced stigmatisation as a mental health inpatient in the form of “institutional racism”. The implications of this for clinical practice are many and vast, however it is obvious that such stigmatisation of patients at the hands of healthcare professionals is likely to have a negative impact on the delivery of effective patient-centred care (Mandy et al, 2004). Not only is such an experience “terrifying” for users of the healthcare system (Gray, 2005), but such behaviour can also cause healthcare professionals to become dismissive of and neglect the individual needs of their patients (Miller, 2002).
Dexter and Wash (1991) state that dismissing the needs of our patients can be potentially dangerous; therefore one may assume that healthcare professionals must be cautious of stigmatising patients if they are to deliver safe, holistic and patient-centred care. Consequently, Forchuk (2002) proposes that there is a need for healthcare professionals to reflect upon their own “acceptance or rejection” of stigmatising attitudes regarding mental illness. In addition to this, Kaminski and Harty (1999) suggest that “healthcare professionals inadvertently condone the stigma associated with mental illness”; this calls for all healthcare professionals to make a conscious effort to endeavour to “practice a non-discriminatory approach to care” (Pinfold, 2004).
Brunton (1997) and Crawford and Brown (2002) both report that many studies blame the media for the stigma towards and the poor public perception of those with mental illness; the media portrayal of people experiencing mental health problems is largely “ill-conceived”, and often serves to “reinforce stigma and prejudice in the general public” (Mental Health Foundation, 2000). Persaud (2003) supports this notion, reporting that “the media still stigmatises people with mental illness”, highlighting the media coverage of the story that Frank Bruno, a much respected and admired “national hero” had been admitted to and detained for assessment in a psychiatric hospital, prompting ‘the Sun’ newspaper to run a front-page headline on the 23rd September 2003 exclaiming “Bonkers Bruno Locked Up”; unsurprisingly many complaints were received with regard to this headline, but it is a clear example of how stigmatising attitudes are expressed by the media towards those with mental illness.
Irrespective of blame, there is an unquestionable widespread public belief that individuals with mental illness are more “dangerous” than those who do not experience mental health problems (Brunton, 1997); Raguram et al (2004) supports this claim, emphasising the “role of perceived violence and dangerousness” in the perpetuation of stigmatising attitudes associated with mental illness within society. The attitude that “people with mental health problems are more likely to be violent” is rife among the general public, promoting the widespread use of “derogatory language” (Department of Health, 2001b); this “climate of fear, ignorance and prejudice surrounding mental health and mental illness” only serves to strengthen the poor understanding of such issues within the general public, and needs to be challenged (Pinfold, 2004).
Despite this, Kaminski and Harty (1999) assert that numerous studies confirm that many of the negative stereotypes and much of the derogatory colloquial language pertaining to mental illness “can be traced directly to media outlets”; adding that the negative portrayal of mental illness by the media “distorts” public perception and also “influences” how society interacts with individuals with mental health problems. For instance, Brunton (1997) states that it is not unusual to observe a character in a film or on television with a mental illness to be depicted as a “homicidal maniac”; adding that such imagery instils negative stereotypes of those with mental health problems, and an unfounded “fear of violence”.
The reality is far separated from the common views of wider society. Silver et al (2005) state that contrary to the prevalent misconceptions that “people with mental disorders are dangerous”, they are, in fact, “more vulnerable to harm from others than non-mentally disordered people”. Kaminski and Harty (1999) report that a high proportion of people with mental health problems experience “hostility” from their neighbours; suggesting that this is propagated from a fear held by the general public of living near to those with mental illness. Unfortunately, many of the patients I have met during clinical placements would agree, with a considerable number reporting having experienced social stigmatisation and victimisation by their neighbours, with some even being attacked and robbed. Silver et al (2005) report that those with mental illness are more frequently the victims of violent crimes within society, experiencing “significantly higher rates” of both threatened and completed “physical assaults and sexual assaults”. However, the rare incidents whereby a member of society is assaulted or attacked by an individual with mental health problems are so “highly publicised” that “efforts to reduce stigma” are significantly undermined (Brunton, 1997).
The social stigma associated with mental illness is further reinforced by the popular belief that the behaviour of individuals with mental health problems is largely “socially disruptive” (Raguram et al, 2004). Chapman (1987, p.45-46) reinforces this, reporting that mental illness is often classified as social deviance, suggesting that the “behaviour exhibited by the mentally ill deviates from the social norms”; however, it is important to acknowledge that such behaviour is likely to “elicit grievances in others” (Silver et al, 2005).
Chapman (1987, p.140) states that throughout society “the mentally sick person is portrayed as engaging in bizarre behaviour, often dangerous in nature”, adding that such individuals are considered “not only to act differently from the main population but also to look different”; however Crawford and Brown (2002) reiterate that society possesses a distinct lack of tolerance to such deviant behaviour. According to Giddens (1993, p.717) the ‘Marxist’ sociological approach places “emphasis on class divisions, conflict, power and ideology”. Chapman (1987, p.78) suggests that Marxist sociologists may describe the mental health service as the “bourgeoisie” and those with mental illness as the “proletariat”, viewing the mental health services an agent of social control over the apparent deviant behaviour of those with mental health problems (Raguram et al, 2004 and Silver et al, 2005).
Giddens (1993, p.754) also describes the ‘Functionalist’ sociological approach, which attempts to explain social events “in terms of the functions they perform”, and their contribution to society. Watson et al (2005) highlight how mental illness can also be considered to be deviant in the context of this sociological perspective, reporting that the impairments presented by mental illness to the functioning of an individual can potentially prevent that individual from fulfilling their role within society as a consequence of being “less able to function in an adaptive manner”. Howard et al (2001) demonstrate the significance of this in the context of women with mental health problems who have been deemed too unwell to perform the role of a mother, subsequently having their children taken into the care of social services.
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- Timothy John Whittard (Author), 2007, Why are patients with mental health problems stigmatized and what is the impact of this behaviour?, Munich, GRIN Verlag, https://www.grin.com/document/470796