The ripple effects of stigma
Half of Canadians will face mental health concerns, but we still can’t talk about it.
Imagine a university-aged youth who has just experienced his first episode of psychosis, a common symptom of psychotic illnesses such as schizophrenia. Let’s call this young man Ben.
Research has shown that early intervention treatment programs in young people with a first episode of psychosis can have a huge positive effect on the trajectory of the illness, reducing negative health impacts of the illness and rates of disability. However, due to stigma, Ben hides his struggles and instead turns to alcohol and cannabis to self-medicate. There is a university health centre with an active mental health clinic that could help, but Ben doesn’t reach out for fear of being labelled. Eventually, his episodes of psychosis worsen, but now he has a second problem: he’s developed a dependence on substances. He is kicked out of his academic program.
His parents don’t understand his drug use and, because they aren’t aware of the severity of his mental health symptoms, they nag Ben to stop using substances but don’t help Ben see a psychiatrist. Ben gets a job but can’t keep it due to his erratic behaviour and substance use. His parents once again try to help, but Ben becomes violent at home, and eventually they have to ask him to leave. He ends up living on the streets, and his psychotic illness deteriorates further.
A few times, Ben decides to get help but, because he is drunk or high when he goes to the emergency department, the focus is on his addiction and his psychosis gets missed. If only Ben had not been afraid to tell his family or go to his university health clinic to talk about his first psychotic episode, he may have been referred to the early intervention program for early psychosis at his local mental health centre, and his story might have ended differently.
Instead, Ben now lives in an encampment. He hears voices and talks to people who aren’t there. His neighbours fear him, and their stigma of mental illness is further increased. In this way you can see how stigma ripples out from the individual to the family and the broader society.
We’re all impacted
Maybe you’ve met someone like Ben, and it may be you even have a person in your family who has not received the help they need because of mental health stigma. Even if you don’t personally know someone who has been harmed by stigma, the ripple effects of stigma are felt widely across communities, provinces and our nation and no doubt impact you.
According to the Mental Health Commission of Canada, about one in five people experience a mental health problem or illness each year. By age 40, 50 percent of Canadians will have had a mental health concern. That’s twice as many as those who live with type two diabetes or heart disease.
Despite its prevalence, mental health and mental illness are still not well understood or accepted in our society. In fact, the Mental Health Commission of Canada says that stigma surrounding mental health is still so daunting, about 40 percent of parents say they wouldn’t disclose if their child had mental health problems even to the family doctor; six out of 10 people with a mental health concern say they wouldn’t seek help for fear of the label “mentally ill.”
In the workplace, people who take time off for mental health often feel the need to hide the reason for their leave. Mental health stigma also extends to individuals living with countless other conditions related to the brain – and brain functioning – such as autism, ADHD and Down Syndrome.
Vicious cycle
Stigma is harmful on many levels. On the individual level, stigma prevents people from seeking needed treatment and care. “Delays in seeking care can exacerbate mental health conditions leading to worse outcomes and reduced quality of life,” according to psychiatric health researchers Ahmed A. Ahad, Marcos Sanchez-Gonzalez and Patricia Junquera.” Without needed treatment and care, mental health conditions can deteriorate quickly, leading to further harms and impacting one’s ability to maintain social connections, family relationships, employment, physical health and housing. Loss of these personal protective factors then further exacerbates mental illness. Stigma causes a vicious cycle of shame and harm that ripples out across all aspects of one’s life.
Ahad and his team go on to say that stigma extends to families and caregivers of those living with mental illness. “For families, the stigma can lead to shame and isolation, making seeking necessary support and resources more difficult.” Over time, families may “burn out” and give up, feeling hopeless about their loved one’s ability to get well.Oftentimes relationships break down entirely.
Structural stigma
Stigma can also occur on a structural level within systems such as workplaces, schools and hospitals. For instance, stigma can affect an individual’s ability to access healthcare when they need it. A team of international researchers from nine countries who looked at 42 studies found that “stigma in health facilities is particularly egregious, negatively affecting people seeking health services at a time when they are at their most vulnerable.”
The article goes on to explain that stigma in healthcare facilities can manifest as: “outright denial of care, provision of sub-standard care, physical and verbal abuse, to more subtle forms, such as making certain people wait longer or passing their care off to junior colleagues.” Healthcare stigma also presents when healthcare providers focus only on the most stigmatized illness, making it hard for people with addictions to get help for a co-occurring mental health issue, or for people with mental health issues to get treatment for a corresponding physical illness. The article concludes, “Within the health system, stigma towards a person living with a specific disease undermines access to diagnosis, treatment, and successful health outcomes.”
It’s in everyone’s best interest to ensure that people aren’t ashamed or afraid of seeking help for a mental illness; that families are able to access information and support to effectively care for their loved ones; that services are funded appropriately and equitably and available when and where they are needed; that research is underway to help find effective treatments; and that institutions such as healthcare facilities, schools, universities and workplaces strive to educate and inform their employees and stakeholders to reduce the impact of structural stigma. Let’s normalize seeking help for mental health concerns and support easy access to needed treatments and care.
Here are some ways you can help
to reduce mental health stigma:
1. Look at mental illness and other brain-related conditions (including addictions) through the same lens you use for physical illness.
2. Don’t stigmatize the use of medication to treat mental illness and addiction. At times, we perpetuate stigma by expecting people to be able to manage their condition on their own, or with counseling only, or to end an addiction through abstinence. Medications are an important part of many treatments for mental illness and addiction when used as prescribed.
3. If you or someone you care about has been diagnosed with a mental illness or addiction, learn about the diagnosis, treatments available and how you can be an effective caregiver or support person. Search out reliable information through organizations like the Mental Health Commission of Canada, the Centre for Addiction and Mental Health or the Canadian Centre for Substance Abuse.
4. Get certified in Mental Health First Aid to increase your understanding of mental illness and how to help.
5. In your workplace, encourage your organization to adopt training programs like The Working Mind.
6. Use your influence to advocate for appropriate and equitable funding for mental health programs, facilities, treatments, services and research.
7. Support charities and foundations that do anti-stigma work and that fund research into effective treatments for mental illnesses.
