Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents', Community Workers' and Service Providers' Perspectives

Protectors of Society: Understanding the Impact of Courtesy Stigma on the Experiences of Volunteers Working With Individuals Convicted of Sexual Offences

Volunteers are integral to the criminal justice system. For some, this involves providing support in the community to those convicted of sexual offences, which has been found to reduce the risk of reoffending. Currently, the impact on volunteers of working within this context is not well understood, despite the significant stigmatisation of those convicted of sexual offences. This study aimed to address this gap through Interpretative Phenomenological Analysis, focusing on how 'courtesy stigma' (Goffman, 1968), a type of stigma-by-association, impacted on this experience. Eleven volunteers within one organisation were interviewed. Volunteers strongly identified with the volunteer role, and stigma served to strengthen their role identity as individuals who helped those no-one else would help. Participants also exhibited some maladaptive coping strategies and symptoms indicative of burnout. These results contribute significantly to the small body of work on volunteer role identity, stigmatisation, and the social and psychological impacts of volunteer association with a highly stigmatised population.

Loneliness in older people and COVID-19: Applying the social identity approach to digital intervention design

The COVID-19 pandemic is worsening loneliness for many older people through the challenges it poses in engaging with their social worlds. Digital technology has been offered as a potential aid, however, many popular digital tools have not been designed to address the needs of older adults during times of limited contact. We propose that the Social Identity Model of Identity Change (SIMIC) could be a foundation for digital loneliness interventions. While SIMIC is a well-established approach for maintaining wellbeing during life transitions, it has not been rigorously applied to digital interventions. There are known challenges to integrating psychological theory in the design of digital technology to enable efficacy, technology acceptance, and continued use. The interdisciplinary field of Human Computer Interaction has a history of drawing on models originating from psychology to improve the design of digital technology and to design technologies in an appropriate manner. Drawing on key lessons from this literature, we consolidate research and design guidelines for multidisciplinary research applying psychological theory such as SIMIC to digital social interventions for loneliness.

Who helps and why? A longitudinal exploration of volunteer role identity, between-group closeness, and community identification as predictors of coordinated helping during the COVID-19 pandemic

Mutual aid groups have allowed community members to respond collectively to the COVID-19 pandemic, providing essential support to the vulnerable. While research has begun to explore the benefits of participating in these groups, there is a lack of work investigating who is likely to engage in this form of aid-giving, although early accounts suggest that existing volunteers have played a significant part in the mutual aid phenomena. Taking a social identity approach, the present study sought to identify what social psychological processes predict this continued engagement by exploring predictors of coordinated COVID-19 aid-giving for pre-existing volunteers. A two-wave longitudinal online survey study (N = 214) revealed that volunteer role identity among existing volunteers at T1 (pre-pandemic) was positively associated with volunteer-beneficiary between-group closeness at T1, which in turn was positively associated with community identification at T1. This in turn positively predicted coordinated COVID-19 aid-giving at T2 (3 months later). This paper therefore reveals the intra- and intergroup predictors of pandemic-related coordinated aid-giving in pre-existing volunteers. Implications for voluntary organisations and emergency voluntary aid provision are discussed.

The Political Psychology of COVID-19

The COVID-19 pandemic has given rise to unprecedented and extraordinary conditions. It represents a profound threat to health and political and economic stability globally. It is the pressing issue of the current historical moment and is likely to have far-reaching social and political implications over the next decade. Political psychology can inform our preparedness for the next phase of the pandemic as well as our planning for a post COVID-19 world. We hope that this special issue will play its part in helping us to think how we manage and live with COVID-19 over the coming decade. In this editorial, we review the key themes arising from the contributions to our special issue and, alongside existing knowledge highlight the relevance of political psychology to finding solutions during this time of crisis. The contributions to this special issue and the pandemic raise many classic topics of central interest to political psychology: leadership, solidarity and division, nationalism, equality, racism, and international and intergroup relations. In our editorial, we offer an analysis that highlights three key themes. First, the importance of sociopolitical factors in shaping behavior during this pandemic. Second, the relevance of political leadership and rhetoric to collective efforts to tackle SARS-COV-2. And third, how sociopolitical cohesion and division has become increasingly relevant during this time of threat and crisis.

Community identification, social support, and loneliness: The benefits of social identification for personal well-being

Levels of loneliness across the world have reached epidemic proportions, and their impact upon population health is increasingly apparent. In response, policies and initiatives have attempted to reduce loneliness by targeting social isolation among residents of local communities. Yet, little is known about the social psychological processes underpinning the relationships between community belonging, loneliness, and well-being. We report three studies which apply the Social Identity Approach to Health to examine the mechanisms underpinning the relationships between community identity, health, and loneliness. Hypotheses were tested through secondary analyses of the 2014-2015 UK Community Life Survey (N = 4,314) as well as bespoke household surveys in a more (N = 408) and less (N = 143) affluent community at high risk of loneliness. Studies 1 and 2a demonstrated that the relationship between community identification and well-being was mediated by increased social support and reduced loneliness. In Study 2b, community identification predicted well-being through reduced loneliness, but not through social support. Our results are the first to evidence these relationships and suggest that community-level interventions that enhance community identification and peer support can promote a potential Social Cure for loneliness.

The elephant in the room? Why spatial stigma does not receive the public health attention it deserves

In the context of health inequalities, spatial stigma refers to the ways that areas experiencing socioeconomic inequalities become negatively portrayed and labelled in public, official and policy discourses. With respect to the body of research on social determinants of health and health inequalities, and attention accorded to this issue in policy or practice, spatial stigma remains significantly under-represented compared with other possible causal factors. We suggest three explanations contributing to this neglect. First, the lack of research into spatial stigma originates from a more limited public health focus on the symbolic meanings of places for health, compared to their physical and social dimensions. Second, lay involvement and evidence of lived experiences of health inequalities continues to be under-represented in public health decision-making. Finally, it is the case that public health organizations may also be contributing to negative area portrayals in their communications of health inequalities. There are growing examples of social action being taken by groups of residents to resist this stigma through the promotion of more positive portrayals of areas and communities. Greater public health attention to this issue as well is likely to result in health gains and aid the development of more effective health inequalities strategies.

Personal and Political: Post-Traumatic Stress Through the Lens of Social Identity, Power, and Politics

Post-traumatic stress disorder (PTSD) has always been controversial and highly politicized. Here, using a social identity approach, we review evidence that trauma and its aftermath are fundamentally linked to social position, sociopolitical capital, and power. We begin this contribution by demonstrating how a person's group memberships (and the social identities they derive from these memberships) are inherently linked to the experience of adversity. We then go on to consider how it is through group memberships that individuals are defined by their trauma risk and trauma histories-that is, a person's group memberships and their trauma are often inherently linked. Considering the importance of group memberships for understanding trauma, we argue that it is important to see these, and group processes more generally, as more than just "demographic" risk factors. Instead, we argue that when groups are defined by their trauma history or risk, their members will often derive some sense of self from this trauma. For this reason, attributes of group memberships are important in developing an understanding of adjustment and adaptation to trauma. In particular, groups' status, their recourse to justice, and the level of trust and solidarity within the group are all central to the impact of traumatic events on individual-level psychological resilience. We review evidence that supports this analysis by focusing on the exacerbating effects of stigma and social mistrust on post-traumatic stress, and the value of solidarity and strong identities for resilience. We conclude that because of these group-related processes, trauma interweaves the personal with the political and that post-traumatic stress is fundamentally about power, positionality, and politics.

Healthcare provision inside immigration removal centres: A social identity analysis of trust, legitimacy and disengagement

The stressors of immigration detention and negative host country experiences make effective access to health care vital for migrant detainees, but little is known regarding the health experiences of this populations and the barriers to healthcare access. The present research investigates immigration detainees' experiences of health-related help-seeking in the distressing and stigmatised environment of UK immigration removal centres (IRCs), as well as staff members' experiences of providing help. Semi-structured interviews were conducted with 40 detainees and 21 staff and analysed using theoretical thematic analysis guided by the social identity approach. The findings indicate that the practical constraints on help provision (e.g. lack of time and resources, the unpredictable nature of detention) are exacerbated by the complex and conflictual intergroup relationships within which these helping transactions occur. These transactions are negatively affected by stigma, mutual distrust and reputation management concerns, as well as detainees' feelings of powerlessness and confusion around eligibility to receive health care. Some detainees argued that the help ignores the systematic inequalities associated with their detainee status, thereby making it fundamentally inappropriate and ineffective. The intergroup context (of inequality and illegitimacy) shapes the quality of helping transactions, care experiences and health service engagement in groups experiencing chronic low status, distress and uncertainty.

'It is surprising how much nonsense you hear': How residents experience and react to living in a stigmatised place. A narrative synthesis of the qualitative evidence

There are significant geographical inequalities in health. Spatial stigma - negative representations of particular localities - could be an important mechanism through which place influences population health. To explore this, we undertook a narrative synthesis of studies reporting residents' perspectives of living in stigmatised localities. Qualitative research (38 studies) was reviewed to identify how spatial stigma manifested in residents' lives, their strategies to cope with stigma and the health consequences. The review found residents internalised stigma, but also resisted it differently. Although relatively few studies purposefully investigated health, living somewhere stigmatised had psychological effects and constrained life opportunities that have implications for health.

Managing a moral identity in debt advice conversations

Previous research has found that stigma can be a barrier to service use but there has been little work examining actual service encounters involving members of stigmatized groups. One such group are those with problematic or unmanageable debts. Providing advice to members of this group is likely to be particularly difficult due to the stigma associated with being in debt. Using conversation analysis and discursive psychology, this study examines 12 telephone advice conversations between debt advisors and individuals in debt. Both clients and advisors oriented to the negative moral implications of indebtedness and typically worked collaboratively to manage these issues. Clients often claimed a moral disposition as a way to disclaim any unwanted associations with debt, but could find it difficult to reconcile this with an insolvency agreement. Moreover, the institutional requirements of the interaction could disrupt the collaborative management of stigma and advisors could manage the subsequent resistance from clients in either client‐centred or institution‐centred ways. The findings suggest that the products offered by debt advice agencies, as well as the manner in which they are offered to clients, can either help or hinder debtors negotiate the stigma‐related barriers to service engagement.

The importance of social identities in the management of and recovery from 'Diabulimia': A qualitative exploration

INTRODUCTION

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort.

METHOD

Transcripts from five online focus groups with 13 members of an online support group for individuals with 'Diabulimia' were thematically analysed.

RESULTS

Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery; these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions.

CONCLUSIONS

While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

'Everyone here wants everyone else to get better': The role of social identity in eating disorder recovery

Retention of a positively valued illness identity contributes to poor outcomes for individuals with eating disorders (EDs). Consequently, dis-identification from the illness identity and the adoption of a recovery identity are vital for successful recovery. While social identity processes have been shown to influence ED maintenance, their role in recovery is rarely considered. This study explores how a sense of shared identity helps individuals with EDs manage their condition and promotes recovery. Transcripts from 18 online support sessions involving 75 participants were thematically analysed. Our findings suggest that the illness identity initially operates as a social identity that forms the basis for connections with similar others. For those wishing to recover, identity-based support is then perceived to be more effective than that found outside the group. Online interactions also facilitate construction of a new shared recovery identity which promotes a shift from the illness identity as a primary source of definition and endorses group norms of illness disclosure and treatment engagement. While in the clinical literature, ED identity is seen as problematic and interventions are targeted at challenging an individual's self-concept, we suggest that interventions could instead harness identity resources to support a transition to a recovery identity.

Collectively coping with contact: The role of intragroup support in dealing with the challenges of intergroup mixing in residential contexts

The social identity approach to stress has shown how intragroup support processes shape individuals' responses to stress across health care, workplace, and community settings. However, the issue of how these 'social cure' processes can help cope with the stress of intergroup contact has yet to be explored. This is particularly important given the pivotal role of intergroup threat and anxiety in the experience of contact as well as the effect of contact on extending the boundaries of group inclusion. This study applies this perspective to a real-life instance of residential contact in a divided society. Semi-structured interviews with 14 Catholic and 13 Protestant new residents of increasingly mixed areas of Belfast city, Northern Ireland, were thematically analysed. Results highlight that transitioning to mixed communities was fraught with intergroup anxiety, especially for those coming from 'single identity' areas. Help from existing residents, especially when offered by members of other religious denominations, signalled a 'mixed community ethos' to new residents, which facilitated adopting and sharing this identity. This shared identity then enabled them to deal with unexpected intergroup threats and provided resilience to future sectarian division. New residents who did not adopt this shared identity remained isolated, fearful, and prone to negative contact.

The Social Psychology of Citizenship, Participation and Social Exclusion: Introduction to the Special Thematic Section

The aim of this special thematic section is to bring together recent social psychological research on the topic of citizenship with a view to discerning the emerging trends within the field and its potential contributions to the broader interdisciplinary area of citizenship studies. Eight papers spanning diverse theoretical traditions (including social identity, social representations and discursive approaches) apply an array of methods to consider different aspects of citizenship across a variety of cultural and national contexts. Some focus on individuals’ perceptions and discussions of citizenship, others examine the group dynamics which flow from these understandings, and the rest examine the potential for citizenship to exclude as well as include marginalised communities. While diverse, the contributions share some core commonalities: all share a concern in trying to understand citizenship from the perspective of the citizen; all conceptualise citizenship as an active and reflective process occurring between members of a community; and all highlight the irreducibly social and collective nature of the experience and practice of citizenship in everyday life. We propose that these elements of convergence have the potential to give the social psychology of citizenship a solid basis and recognisable profile in order to contribute to the broader arena of citizenship studies.

The Social Psychology of Citizenship: Engagement With Citizenship Studies and Future Research

In this article we review the argument outlined in the opening article in this special thematic section: that the current social psychology of citizenship can be understood as the development of longstanding conceptualisations of the concept within the discipline. These conceptualisations have contributed to the current social psychological study of the constructive, active and collective (but often exclusive) understandings of citizenship in people’s everyday lives, as evidenced by contributions to this thematic section. We consider how this emerging body of work might fit with current citizenship studies and in particular how it may contribute to the current trend towards conceiving citizenship as an active practice embedded in everyday social life. Specifically, we highlight three areas of future research that we think are particularly promising: citizenship and recognition; displays and enactments of citizenship in public space; citizenship and lived coexistence. Although this is far from an exhaustive list of possibilities, we propose that research in these areas could enable the way for social psychology to articulate a distinct, recognisable and valuable contribution to citizenship studies.

Occupational choice of youth in a disadvantaged community

Introduction

The ability to make daily autonomous occupational choices has been identified as a human right and positively linked to wellbeing. Those marginalized from choice are considered at risk of occupational injustice. Disadvantaged young people are one group who may be marginalized from making such choices. Occupational choice is largely assumed to be an internal, individual process based on abilities and motivation, within environmental boundaries. From an external, contextual standpoint, this process has been scantly explored. This research, underpinned by an occupational justice perspective, sought understanding of disadvantaged young peoples’ daily choices.

Method

Qualitative and participative methods were used. Nine young people, aged 11–14 participated in Photovoice and photo elicitation interviews. Data were analysed thematically.

Findings

Occupational choices are contextually informed and constrained, as illustrated by three themes: a limited perception of choices, choices informed by a need to stay connected to others and choices as a vehicle for social positioning.

Conclusion

Occupational choices do not appear to emanate from internal interests and abilities but rather from necessitated and mandated actions based on socio-cultural expectations. This suggests that occupational therapists must pay closer attention to the social context that informs choices to improve wellbeing of at-risk young people.

Stigma and treatment of eating disorders in Ireland: healthcare professionals’ knowledge and attitudes

Objectives

This study examines aspects of healthcare professionals’ knowledge and attitudes about eating disorders (EDs), which might impede the effective detection or treatment of EDs in Ireland.

Methods

A total of 1,916 healthcare professionals were invited to participate in a web-based survey. Participants were randomly allocated to view one of five vignettes depicting a young person with symptoms consistent with anorexia nervosa, bulimia nervosa, binge-eating disorder, depression or type 1 diabetes. Study-specific questions examined participants’ responses to the vignettes and ED knowledge and experience.

Results

In total, 171 clinicians responded (9% response rate). Participants had an average of 15.8 years of clinical experience (s.d.=9.2) and included psychiatrists, GPs, psychologists and counsellors. Although participants’ knowledge of EDs was moderately good overall, responses showed poor recognition of the symptoms of EDs compared with depression [χ2 (4, n=127)=20.17, p<0.001]. Participants viewed EDs as chronic disorders that primarily affected females. Participants believed that clinicians like working with patients with depression and diabetes more than with AN patients [F (4,101)=5.11, p=0.001]. Among the professionals surveyed, psychiatrists were the most knowledgeable about EDs [F (4,82)=9.18, p<0.001], and were more confident in their ability to diagnose and treat EDs than professionals of all other disciplines, except psychologists [F (4,85)=8.99, p<0.001]. Psychiatrists were also the most pessimistic about ED patients’ long-term life prospects [χ2 (4, n=65)=15.84, p=0.003].

Conclusions

This study recommends that specific attention should be given to EDs in professional educational programmes across healthcare disciplines. This training should not be restricted to improving healthcare professionals’ knowledge of EDs, but should also strive to increase service-providers’ awareness of how their own potentially stigmatising attitudes can undermine engagement with treatment.

How social context impacts on the development, identification and treatment of mental and substance use disorders among young people - a qualitative study of health care workers

Introduction Social context has a major influence on the detection and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas from the perspectives of health care workers.

METHOD

Semi-structured interviews were conducted with health care workers (n=37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner's Ecological Theory to guide analysis.

RESULTS

Health care workers' engagement with young people was influenced by the multilevel ecological systems within the individual's social context which included: the young person's immediate environment/'microsystem' (e.g., family relationships), personal relationships in the 'mesosystem' (e.g., peer and school relationships), external factors in the young person's local area context/'exosystem' (e.g., drug culture and criminality) and wider societal aspects in the 'macrosystem' (e.g., mental health policy, health care inequalities and stigma).

CONCLUSIONS

In socioeconomically disadvantaged urban areas, social context, specifically the micro-, meso-, exo-, and macro-system impact both on the young person's experience of mental health or substance use problems and services, which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings.