S T I G M A. APNA 26th Annual Conference Thursday, November 8, Schwindt 1 OBJECTIVES CONCEPT ANALYSIS

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1 S T I G M A Rhonda Schwindt, MSN, RN, PMHAPN-BC The presenter has no conflict of interest THE CONUNDRUM OF MENTAL HEALTH CARE: A CONCEPT ANALYSIS OBJECTIVES Examine the essential components of stigma. Explore the relationship between stigma & serious mental illness. Discuss the impact of stigma on those affected by a serious mental illness. Identify strategies to decrease the negative consequences of stigma. CONCEPT ANALYSIS Conceptual clarity promotes understanding Understanding guides actions Targeted Actions promote individualized care Schwindt 1

2 SIGNFICANCE of STIGMA Most formidable obstacle to effective mental health care (SAMSHA, 2006). 450 million people worldwide with a diagnosable mental illness (World Health Organization [WHO], 2010). Less than half seek treatment (Bathje & Pryor, 2011; Andrews, Issakidis, & Carter, 2001). Most do not receive adequate care (Hauenstein et al., 2007; McAlpine & Mechanic, 2000). STIGMA: What We Know Complex & universal concept Substantial amount of literature Powerful phenomenon Devalues & marginalizes Huge disparities in definition & application CONCEPT EVOLUTION Marks left on Jesus after Crucifixion(Stigmata)(Stigma, n.d.a.) 33 A.D. Mark made by a pointed instrument (Stigma, n.d.a.). 15th Century Mark of disgrace; tainted individual (Goffman, 1963) s A stain or reproach on one s reputation (Stigma, n.d.b.). Present Day Schwindt 2

3 CURRENT DEFINITIONS Byproduct of deviant social conditions (Elliot et al., 1992). Psychological variable located within the individual (Jones et al., 1984). Problem of knowledge, attitudes, and behavior (Thornicroft, Rose, Kassam, & Satorius, 2007). CURRENT DEFINITIONS Devalued social identity (Crocker, Major, & Steele, 1998). Socially shared cognitive representations (Ottati, Bodenhausen, & Newman, 2005). Interrelated co-occurring components (Link & Phelan, 2001). Moral & existential experience (Yang, Kleinman, Link, Phelan, Lee, & Good, 2007). RELATED TERMS Discrimination Consequence or outcome of stigmatization (Corrigan & Shapiro, 2010; Macinnes & Lewis, 2008). Prejudice Attitude, opinion or emotional response (Phelan, Link, & Dovidio, 2008). Schwindt 3

4 ANTECEDENTS Identification Human differences are identified Labeling Differences deemed acceptable or unacceptable Attachment Labels linked to individuals &/or groups of individuals Separation Divided into in-groups & out-groups (Link & Phelan, 2001) ATTRIBUTES Social Processes (Weiss, Ramakrishna, & Somma, 2006). Cultural influences (Abdullah, T., & Brown, T. L., 2011). Power (Link & Phelan, 2001). CONSEQUENCES Discrimination Social status loss Coping behavior (stigma management) Self-stigma Decreased quality of life Exacerbation of illness Schwindt 4

5 CASE STUDIES Model Case Contains all the identifying attributes (Walker & Avant, 2011). Contrary Case Does not contain any of the identifying attributes (Walker & Avant, 2011). ANTI-STIGMA STRATEGIES Personal contact (Mann & Himelein, 2008). Realistic portrayals (Bathje & Pryor, 2011). De-emphasizing biological and genetic causes (Mann & Himelein, 2008). Stigma counseling (Bathje & Pryor, 2011). Group identity (Watson, Corrigan, & Larson, 2007). Schwindt 5

6 STIGMA: What We Learned Powerful, pervasive & persistent Social phenomenon involving interrelated components Targets vulnerable populations Multiple consequences Evolving concept Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review, 31, doi: /j.cpr Andrews, G., Issakidis, C., Carter, G. (2001). Shortfall in mental health service utilisation. British Journal of Psychiatry, 179, doi: /bjp Bathje, G.J., & Pryor, J. B. (2011). The relationships of public and self-stigma to seeking mental health services. Journal of Mental Health Counseling, 33(2), Corrigan, P., & Shapiro, J. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30, Crocker, J., Major, B., & Steele, C. (1998). Social stigma. In D. T. Gilbert, S. T. Fiske, & G. Lindzey (Eds.), The handbook of social psychology (4th ed., Vol. 2, pp ). Boston: McGraw Hill. Department of Health and Human Services: U.S. Public Health Service (HHS) (1999). Mental Health: A Report of the Surgeon General. Retrieved from Department of Health and Human Services: Substance Abuse and Mental Health Services Administration Center for Mental Health Services (SAMSHA), Mental Health is part of all of our lives: Developing a stigma reduction initiative Retrieved from Elliot, G. C., Ziegler, H. L., Altman, B. M., & Scott, D. R. (1982). Understanding stigma: Dimensions of deviance and coping. Deviant Behavior, 3, Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall. Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review Sociology, 27, 363. Hauenstein, E., Petterson, S., Rovnyak, R., Merwin, E., Heise, B. & Wagner, D. (2007). Rurality and mental health treatment. Administration Policy in Mental Health & Mental Health Service, 34, doi: /s Jones, E., Farina, A., Hastorf, A., Miller, D. T., & Scott, R. (1984). Social Stigma: The Psychology of Marked Relationships. New York: Freeman. Schwindt 6

7 Illness. (n.d.a.). In Etymology Online Dictionary. Retrieved September 29, 2011, from Illness (n.d.b.). Dictionary.comUnabridged. Retrieved September 29, 2011, from Dictionary.com website: Jones, E., Farina, A., Hastorf, A., Miller, D. T., & Scott, R. (1984). Social Stigma: The Psychology Conceptualizing Stigma. Annual Review Sociology, 27, McAlpine D. D., & Mechanic, D. (2000). Utilization of specialty health care among persons with severe mental illness: The role of demographics, need, insurance, and risk. Health Services Research, 35, (1 Pt 2) Macinnes, D. L., & Lewis, M. (2008). The evaluation of a short group programme to reduce self-stigma in people with serious and enduring mental health problems. Journal of Psychiatric and Mental Health Nursing, 15, Mann, C. E., & Himelein, M. J. (2008). Putting the person back into psychopathology: An intervention to to reduce mental illness stigma in the classroom. Social Psychiatry Epidemiology, 43, doi: /s Ottati, V., Bodenhausen, G. V., & Newman, L. S. (2005). Social Psychological Models of Mental Illness Stigma. In P. W. Corrigan (Ed), On the stigma of mental illness: Practical strategies for research and social change (pp ). Washington, DC, US: American Psychological Association. Phelan, J.C., Link, B., & Dovidio, J. (2008). Stigma and prejudice: One animal or two? Social Science & Medicine, 67, doi: /j.socscimed Thornicroft, G., Rose, D., Kassam, A., & Satorius, N. (2007). Stigma: Ignorance, prejudice or discrimination? British Journal of Psychiatry,190, doi: /bjp.bp Stigma. (n.d.a.). In Etymology Online Dictionary. Retrieved September 29, 2011, From ode=none Stigma. (n.d.b.). Dictionary.com Unabridged. Random House, Inc. Retrieved September 29, 2011, from Walker, L. O., & Avant, K. C. (2011). Strategies for Theory Construction in Nursing, (5 th ed). Upper Saddle River, NJ: Pearson Prentice Hall. Watson, A. C., Corrigan, P. W., & Larson, J. E.(2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33, Weiss, Ramakrishna, & Somma (2006). Health-related stigma: Rethinking concepts and interventions. Psychology, Health & Medicine, 11(3), doi: / World Health Organization (WHO) (2010). Mental Health: Strengthening our Response. Retrieved from Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. (2007). Culture and stigma: Adding moral experience to stigma theory. Social Science & Medicine, 64, doi: /j.socscimed Clipart was used extensively in this presentation. Schwindt 7