Global Health Blogs with Professor Swahn

 

One in four people around the world will suffer from mental illness at some point during their life. Mental health problems have been stigmatized by society since the beginning of civilization; and though there have been improvements against such stigmas due to increased mental health and scientific knowledge, it is still highly prevalent amongst all global populations. Stigma has been defined as “stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.”

The three levels normally associated with mental health stigma are public or societal stigma, self-stigma, and health professional stigma.

Public stigma refers to stigmas that are shared by the general public and are often structural, embedded in a society’s framework creating barriers for mental health treatment.

Self-stigma refers to the internalization of societal stigmas, negatively affecting one’s perception of themselves and their value. Self-stigma also includes the fear of being labeled.

Health professional stigma, though it seems inherently wrong that a health professional would hold stigmas toward mental health, has been shown to exist and may lead to Individuals with mental illness not receiving the same care once the professional becomes aware of their mental illness. Heath professional stigma is normally based off the professional’s already believed stigmas but can also be due to the high rates of “burnout,” and mental illness amongst themselves, having less willingness and energy to deal with mentally ill patients.

The fear of being stigmatized can have serious consequences if it keeps someone from seeking treatment.        

How Culture Influences Mental Health Care:  

Though there are similarities of basic stigmas associated with mental illness across global populations, culture can have an influence on many aspects of how mental illness is viewed and treated. Four ways culture can impact mental health care:

1. Cultural stigmas: how a culture regards people with mental illness. If a culture considers people with mental illness inferior, those people may hide their health issues and struggle to ask for help.
2. Understanding symptoms: culture can influence how someone expresses their symptoms, possibly only discussing physical symptoms rather than emotional ones, or vice versa.
3. Community support: depending on the culture and mental health stigmas, this can affect how or if a person gets support from their community.
4. Resources: it can be difficult to find resources and treatments that consider one’s specific cultural factors and needs.

Stigmas Around the Globe:

There are common stigmas shared by most, if not all, global populations in terms of mental health, but certain countries, regions, and/or cultures also shows differences in their stigma beliefs and degree. In general, people in Eastern countries report more stigma with mental illness across all levels of society than in Western countries. The stigma towards depression is significantly more pronounced in Eastern countries. While Western countries stigmatize mental illness in minorities more, Eastern countries show more stigma towards majority group members. Studies have revealed that “global attitudes towards seeking mental health treatment vary by sociodemographic characteristics and past exposure to mental health treatments.”

Here are some specific findings of mental health stigmas in the U.S. and other global regions:

The United States:

In the past decade stigmas have seemed to stabilize, not increasing, or decreasing in the United States, and in general, Americans hold positive attitudes towards seeking help for mental health issues. That being said, this review highlights specific stigmatizations still occurring. American adults were not only found to view children with depression and ADHD as more dangerous to themselves and others, but also viewed children with depression as lazy. Also, in the U.S., age and political views were associated with blaming and punishing someone with mental illness, with young conservatives being more likely to hold such beliefs. “Social distance,” the exclusion of those with mental illness from social gatherings, working relationships, marriages, etc. was found to be widespread across U.S. populations. According to research published by The Commonwealth Fund, minorities in the U.S. are less likely to get mental health treatment or will wait until symptoms are severe before seeking help.

Europe:

One review found that amongst 5 European countries studied, 56.4% of the respondents said they were not okay with a person with depression or schizophrenia to marry into their family, but reported less rejection within the work force, with only 23.5% saying someone should not be hired if they have a mental health problem. Like many regions globally, schizophrenia results in significantly more rejection than depression in European countries. In general, within Europe, post-communist, and less developed countries, showed more stigmatization than more economically advanced ones.

Africa:

                African countries hold similar stigmas as mentioned above, but also hold very specific beliefs behind the stigmatization of mental health religious and cultural factors. Similar to other regions, mentally ill people are assumed to be violent and destructive, even within the health care system. In many cases people with outwardly obvious mental illness in rural African communities are thought to be possessed by spirits or involved in witchcraft, with an estimated 90% of people with such mental illnesses being taken to spiritual leaders first. The accusation of witchcraft can lead to exclusion from the community. In Zimbabwe many believe mental illness to be a punishment from the gods, leading to family and community members not associating with a person as to not bring the punishment on themselves. experience the wrath of god themselves. Many African countries are not willing to provide mental health services, but rather direct those with mental illness to “prayer camps.”

Asia:

                While Asian countries also have stigmas of danger associated with mental illness, as well as supernatural and religious stigmas, they show significant differences in family stigmas. According to this study, in China 56% of those with a mental illness kept it secret from their family for fear of discrimination, with 75% believing such discrimination would cause significant stress on their family. Though Japan as shown great improvement in their stigmatization of illnesses like schizophrenia, stigmatization of illnesses like bipolar disorder have increased. In Korea, people with alcohol dependence are 4 times less likely to seek treatment than those in the U.S. because of increased stigmas associated with substance abuse. There was also a significant negative portrayal of people with mental illness in the media. In general, Asian countries have a high belief that depression is due to a weak personality. Read more about these stigmas in specific Asian countries and their current mental health programs here.

Global Health, How Can We Combat Mental Health Stigmas:

The most pronounced stigma across the globe is the portrayal and belief that people with mental illness are dangerous and should feel ashamed. Stigmatization decreased across populations with increased education, younger generations, lower socio-economic people, and more developed nations. Stigma itself can worsen mental health due to the discrimination, reduced self-esteem, increased psychological burden, ultimately interfering with the seeking of services and treatment. The fear of rejection by society can lead to avoidance in acknowledging mental health problems and missed life opportunities.

The assistant director of The Carter Center Mental Health Program suggests 3 key ways we can combat stigma: the media portraying stories about recovery and how prevalent mental illness actually is,  policy changes to increase mental health support and services, and by people who have experienced mental health speaking out and telling their stories. One initiative in Australia, Stop Mental Illness Stigma Charter, defines 7 commitments aimed at reducing the impacts of stigmas which could be used in a global context.

“The Global Burden of Disease Study showed that by 2020 depression is going to be the second leading cause of morbidity across the globe. And yet it receives nowhere near the societal attention, funding, research money that either cancer or cardiac disease do.”

With 41% of developing nations having no mental health policy and no treatment facilities for severe mental disorders, global health officials need to address the barriers in specific countries when it comes to mental health treatment and cultural stigmatizations to adequately develop appropriate mental health interventions and preventative measures. Researchers need to conduct more studies to better understand the impacts of “different cultural traditions, attitudes, values, and beliefs on stigma.”