A mental health service users perspective to stigmatisation

Investigating mental health service user views of stigma on Twitter during COVID-19: a mixed-methods study

Background: Mental health stigma on social media is well studied, but not from the perspective of mental health service users. Coronavirus disease-19 (COVID-19) increased mental health discussions and may have impacted stigma.

Objectives: (1) to understand how service users perceive and define mental health stigma on social media; (2) how COVID-19 shaped mental health conversations and social media use.

Methods: We collected 2,700 tweets related to seven mental health conditions: schizophrenia, depression, anxiety, autism, eating disorders, OCD, and addiction. Twenty-seven service users rated them as stigmatising or neutral, followed by focus group discussions. Focus group transcripts were thematically analysed.

Results: Participants rated 1,101 tweets (40.8%) as stigmatising. Tweets related to schizophrenia were most frequently classed as stigmatising (411/534, 77%). Tweets related to depression or anxiety were least stigmatising (139/634, 21.9%). A stigmatising tweet depended on perceived intention and context but some words (e.g. “psycho”) felt stigmatising irrespective of context.

Discussion: The anonymity of social media seemingly increased stigma, but COVID-19 lockdowns improved mental health literacy. This is the first study to qualitatively investigate service users' views of stigma towards various mental health conditions on Twitter and we show stigma is common, particularly towards schizophrenia. Service user involvement is vital when designing solutions to stigma.

Experiences of friendships of young people with first-episode psychosis: A qualitative study

Background

First episode psychosis and reduced social networks have been found to go hand in hand, but specific mechanisms are unclear. The manifestation of symptoms and the effect of stigma are two possibilities discussed in the literature but the experiences and views of young people with psychosis have been neglected.

Aims

To explore experiences of friendships of young people with first-episode psychosis, focusing especially on any perceived changes in their friendships or approach to peer relationships as a result of the illness.

Methods

Fourteen participants were interviewed using a semi-structured interview guide, which explored participants’ views and experiences of their friendships during the acute phase of illness and in the path to recovery, the impact of friendships on illness experience and of illness on patterns of social contact, and the potential role of services in supporting people with their friendships. Interviews were transcribed verbatim and analysed thematically.

Results

Identified themes included the loss of social contacts because both young people developing psychosis withdrew and because friends withdrew as illness developed. Regarding recovery, a unique role was identified for friends and participants were often making conscious efforts to rebuild social networks. Mental health services were viewed as having a limited direct role in this.

Conclusions

Supporting the development of opportunities and skills needed for social relationships following an episode of psychosis may be a useful focus.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study

BACKGROUND

Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way.

METHODS

A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews.

RESULTS

Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants.

CONCLUSIONS

The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

"An ongoing struggle with the self and illness": α meta-synthesis of the studies of the lived experience of severe mental illness

The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme "An ongoing struggle for reconciliation with the self and the illness". Other themes included amongst others: loss of identity, pain of having had one's life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.

South African mental health care service user views on priorities for supporting recovery: implications for policy and service development

PURPOSE

The paper documents the views of South African mental health care service users on policy directions and service developments that are required to support their recovery.

METHOD

Semi-structured interviews were conducted with forty service users and service user advocates. A framework analysis approach was used to analyse the qualitative data.

RESULTS

Service user priorities included addressing stigma, discrimination and disempowerment, and the links between mental health and poverty. They suggested that these challenges be addressed through public awareness campaigns, legislative and policy reform for rights protection, development of a national lobby to advocate for changes, and user empowerment. Users suggested that empowerment can be facilitated through opportunities for improved social relatedness and equitable access to social and economic resources.

CONCLUSIONS

This study suggests three strategies to bridge the gap between mental health care service users rights and needs on one hand, and unsupportive attitudes, policies and practices on the other. These are: giving priority to service user involvement in policy and service reform, creating empathic alliances to promote user priorities, and building enabling partnerships to effect these priorities.

Service users' personal experience and interpretation of mental illness: oriental narratives

BACKGROUND

Service users' perception of mental illness is vital because it points out a viable direction that practitioners can follow to fully understand service users in their own sociocultural context.

MATERIAL

Qualitative research findings include mental health service users' roles and identities, their perceptions of mental illness and their personal experiences of psychiatric stigma.

DISCUSSION

While there are similar phenomena regarding mental illness stigma between East and West, there are culturally distinctive characteristics found in Taiwan.

CONCLUSIONS

Based on personal perceptions and experiences, mental health service users have interpreted illness and performed the patient role in their own way.

Disease avoidance as a functional basis for stigmatization

Stigmatization is characterized by chronic social and physical avoidance of a person(s) by other people. Infectious disease may produce an apparently similar form of isolation-disease avoidance-but on symptom remission this often abates. We propose that many forms of stigmatization reflect the activation of this disease-avoidance system, which is prone to respond to visible signs and labels that connote disease, irrespective of their accuracy. A model of this system is presented, which includes an emotional component, whereby visible disease cues directly activate disgust and contamination, motivating avoidance, and a cognitive component, whereby disease labels bring to mind disease cues, indirectly activating disgust and contamination. The unique predictions of this model are then examined, notably that people who are stigmatized evoke disgust and are contaminating. That animals too show avoidance of diseased conspecifics, and that disease-related stigma targets are avoided in most cultures, also supports this evolutionary account. The more general implications of this approach are then examined, notably how it can be used to good (e.g. improving hygiene) or bad (e.g. racial vilification) ends, by yoking particular labels with cues that connote disease and disgust. This broadening of the model allows for stigmatization of groups with little apparent connection to disease.

Stories from the streets: people's experiences of homelessness

This study explores how people speak about their experiences of homelessness, and how these experiences have affected their identity claims and their mental health. The mental health of the homeless population is a growing concern for the UK government and non-governmental agencies. There is however, little research looking at the mental health needs of homeless people and their experiences. For this study, a qualitative, narrative approach was used. Eight people were interviewed who described themselves as homeless. The subsequent data were analysed through a narrative analysis process paying particular attention to how people construct their identities. Although each participant is homeless, they speak about their experiences very differently. People's identities have been affected by their experiences, and because of the trauma and indignity of homelessness, their identities have had to be reshaped. While it might be considered normal for people's identities to relate to families and occupation, homeless people construct identities around illness, drugs and exclusion. Experiences of homelessness negatively affect people's sense of identity to destructive proportions. Nevertheless, participants demonstrate a way of coping by forming strong opinions about policy and service provision.

Insight into mental illness, self-stigma, and the family burden of parents of persons with a severe mental illness

BACKGROUND

Parents of persons with severe mental illness (SMI) often experience burden due to the illness of their daughter or son. In the present study, the possibility that parents' self-stigma moderates the relationship between the parents' insight into a daughter's or son's illness and the parents' sense of burden was investigated.

METHODS

Levels of insight into a daughter's or son's mental illness, parent self-stigma, and parent burden of 127 parents of persons with an SMI were assessed. Regression analysis was used to test the putative moderating role of parents' self-stigma.

RESULTS

Self-stigma was found to mediate rather than moderate the relationship between insight and burden. Accordingly, parent insight into the mental illness of a daughter or son appears to increase parent burden because it increases parent self-stigma.

CONCLUSIONS

The implications of these findings for practice, theory, and future research are discussed.

Attitudes and physical distance to an individual with schizophrenia: the moderating effect of self-transcendent values

BACKGROUND

There is evidence that personal value priorities may influence prejudicial behaviors. In particular, it has been hypothesized that those who place a high priority on values such as equality, benevolence and social justice may be less likely to express any prejudicial personal attitudes in behavior. In the present study, we tested this hypothesis in the context of physical distance with reference to a person with schizophrenia. Self-transcendent value priorities and attitudes toward a young woman described as having schizophrenia were assessed in 95 university students. They were then led to anticipate meeting the person and the distance they sat from the expected location of the ill person was assessed.

RESULTS

Women sat closer to the anticipated seat of the person with schizophrenia. In addition, there was a significant interaction between priority placed on self-transcendent values and attitude toward the person in predicting seating distance. There was a significant relationship between favorability of attitudes and sitting closer for those who were low in self-transcendent values, but attitudes did not predict physical proximity for those with high self-transcendent values.

CONCLUSION

The impact of attitudes toward an individual with schizophrenia and subtle aspects of behavior such as physical proximity appear to be moderated by self-transcendent personal values. The role of implicit in comparison to explicit attitudes in explaining these results is worthy for further investigation.

The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward

The aim of this literature review is to explore stigma as experienced by individuals with mental health problems, focusing primarily on schizophrenia. The concept of stigma has been examined. Service users' reports of their experiences of stigma have been outlined. The role of the media, public perceptions and the role of the nurses and mental health services have been discussed. Proposals have been suggested to address stigma.

Older adults' perceptions of mentally ill older adults

OBJECTIVES

Many mentally ill older adults are stigmatized, which reduces quality of life and discourages help-seeking. This study's goal was to identify factors associated with stigma.

METHODS

Community-dwelling older adults (N = 101) were asked to indicate their attitudes toward and reactions to three hypothetical older women with depression, anxiety, or schizophrenia.

RESULTS

The results suggest that schizophrenic persons are viewed as most dangerous and dependent, while anxious persons are seen as most responsible for their illness. Age, gender, and educational level of participants were associated with desired social distance and differing perceptions of the hypothetical persons.

CONCLUSION

These findings can be used to improve educational efforts that seek to reduce the stigma associated with mental illness in older adults.

A decade of stigma and discrimination in mental health: plus ça change, plus c'est la même chose (the more things change, the more they stay the same)

In recent years, efforts to combat stigma and discrimination experienced by mental health service users have ranged from small local initiatives to national and international campaigns. Success has been mixed, with significant, lasting benefits appearing to be elusive. This paper explores the current nature and extent of stigma and discrimination in an area of the north of England and compares findings with those from a study undertaken a decade previously in 1997. Qualitative responses to a postal questionnaire received in 2007 were thematically analysed and compared and contrasted with findings from the 1997 study. Four broad categories of discrimination--(1) employment; (2) professional; (3) communities; and (4) family and friends--arose from the 2007 data, the most common being discrimination in employment. There were close similarities in both sets of data. Stigma and discrimination remain largely as strong, damaging and enduring as they were a decade ago. A range of pre-emptive interventions that support people prior to the escalation of mental health crises could limit the impact of stigma.

Art in Mind: implementation of a community arts initiative to promote mental health

The arts and health agenda has experienced considerable expansion in the UK in recent years, against a backdrop of increasing social inequality and rising incidence of mental health problems. This paper explores the role of community arts in combating social and mental health inequalities as exemplified by one particular project, Art in Mind, in Nottingham, which is funded by England's New Deal for Communities programme and is designed to promote mental health. In describing Art in Mind's conceptualisation and implementation, attention is given to the importance of developing community networks that are designed to build social capital for participating groups and individuals, in order to combat health and social inequalities.

Mental illness stigma in the Israeli context: deliberations and suggestions

BACKGROUND

In this paper we deliberate mental illness stigma in the Israeli context and suggest ways to reduce it, emphasizing the community's role in the rehabilitation of persons with mental illness.

MATERIAL

A literature review of Israeli and international literature of mental illness stigma.

DISCUSSION

Community mental health, in addition to its traditional focus on developing community-based services, should focus also on community-based interventions such as the delivery of anti-stigma interventions.

CONCLUSIONS

Providing individualized rehabilitation services in the community while addressing stigma-induced social barriers may create a better recovery ground for Israelis with mental illness.

Newspaper coverage of a violent assault by a mentally ill person

The media is an important source of public information on mental ill-health. A man with a serious psychiatric illness attacked a minister with a knife at a Remembrance Sunday service in a remote, rural part of the Highlands, inflicting a severe facial wound. We aimed to identify lessons for the National Health Service (NHS) from the media coverage of the incident and of a subsequent court case and NHS Highland inquiry and in addition to explore how newspaper reporters approached reporting such incidents. We searched local and regional, national Scottish, and the Scottish editions of three UK newspapers for relevant coverage. We also conducted structured telephone interviews with eight reporters who had attended the inquiry press conference. Most of the media coverage was associated with the assault and the court case, rather than the inquiry results. Only three of 10 inquiry recommendations were mentioned in any reports. Coverage largely dealt with identified shortfalls, rather than proposed solutions. The NHS had made little comment in advance of the announcement of the inquiry results. Most of the newspaper coverage had already occurred. The NHS therefore limited its opportunity to influence newspaper coverage. The interpretation of the results is limited by the size of the study, but the coverage of such events forms part of the discourse on mental health in the media episodes and may have some affect on public perception of mental health issues. We conclude that, without providing confidential information, the NHS should take a more active stance in providing information on the nature and treatment of mental illness in such instances, even in advance of court cases.