Stigma and discrimination can have a huge impact on the lives of people affected by depression and, for many, they are the single biggest barrier to recovery.
Stigma is experienced by people affected by depression when negative judgements are made about them based on the condition, usually as a result of stereotypes, misconceptions or fear. Stigma can take many forms. It may be someone making an unpleasant remark or ignoring you; or assumptions being made about the kind of person you are or your abilities. Discrimination is the active part of stigma, when someone is not only judged because of the condition they experience but is actually treated differently.
It may seem that understanding and awareness of mental health problems is
improving but many studies have shown that stigma is still widespread. Consider the following statistics:
- The most common mental illnesses are anxiety and depression (22% of the
- population) but when asked to describe mental illness 63% of people said it was ‘someone with schizophrenia’ (which affects just 1% of the population). This figure has increased from 56% ten years ago. (Department of Health 2007)
- The number of people who believe that someone with a mental illness is ‘someone who has to be kept in a psychiatric or mental hospital’ has also increased over the past decade, from 47% to 59%. (Department of Health 2007)
- Belief in the link between mental illness and violence has similarly risen, from 29% to 36%. (Department of Health 2007)
- A fifth of employers say that they would not employ someone who had been in
- receipt of Incapacity Benefit. (Chartered Institute for Personnel Development May 2006)
- 18% of employers said that they would not employ someone who has experienced mental ill health compared to 10% who wouldn’t employ someone with a physical disability. (Chartered Institute for Personnel Development May 2006)
Institutionalised discrimination
Stigma and discrimination start at the top, creating a climate within which employers routinely exclude people with mental health problems from work and other organisations feel empowered to discriminate too. The state discriminates by:
- Having legislation that allows internment on the grounds of a person’s medical condition (as opposed to whether someone is dangerous)
- Giving less weight to witness evidence from people who have had mental illness
- Barring people who have had mental illness from public service – for example, not allowing them to sit on juries
- Barring people who have had mental illness from holding public office
- The Royal College of Psychiatrists has recently drawn attention to a range of health professions whose entry criteria exclude people who have had mental health problems.
- Even where people with mental health problems are not openly excluded, informal discrimination makes it hard for them to pursue a career in professions such as law, medicine and politics – a recent report by the All-Party Parliamentary Group on Mental Health found that 1 in 5 Members of Parliament has had mental health problems, but most felt they could not disclose this publicly.
Insurance companies may deny health, personal and holiday insurance to people who have had mental health problems, and can refuse to pay a claim where an applicant failed to disclose their history, even where this has no bearing on the claim.
Employers regularly exclude people with mental health problems from work –seeking to sack those who develop problems while refusing to employ those with a history of mental illness.
Self-exclusion
Another manifestation of discrimination is a process of self-exclusion in which people behave as if discrimination will always happen. For example, while someone with depression is right to fear that they might be discriminated against in employment, they would be wrong to believe this will always be the case. If, however, they avoid seeking employment, and fail to take advantage of the help available because of this fear, it becomes a self-fulfilling prophecy.
Stigma in the media
The media regularly link mental illness with violence and homicide even though the number of homicides by people with a mental illness has fallen significantly over the last 50 years (during which time, the number of homicides has increased by more than 500%).
Elsewhere, the media regularly use stigmatising language on a par with some of the language used to describe ethnic minorities back in the 1970s.
While challenges can be made against television and radio coverage of mental illness through the regulator Ofcom, the Press Complaints Commission only considers complaints where an individual is directly affected by press coverage. So, for example, only Frank Bruno could complain about the “Bonkers Bruno” headline – those of us who feel it is inappropriate to use the term “bonkers” to describe someone with a mental illness have no right of redress. This said, we all have the choice not to buy newspapers and not to subscribe to TV stations that discriminate in this way.
Over-estimating severity
The majority of people with a history of mental illness choose not to disclose their condition publicly – or to be very selective about who they disclose to.
One problem that arises from this is that those people who are “out” about their mental illness are often those who have little choice in the matter – those with the most severe and enduring conditions; those in long-term contact with specialist services; those who have been in contact with the criminal justice system; those who have been excluded from employment; those in poor housing; those who lack social networks and intimate relationships.
This leads politicians, health and social care professionals, journalists, voluntary organisations, and user/survivor groups themselves to stigmatise the majority of people with mental illness as being much needier, much more dependent and much less self-resilient than is actually the case, by applying the characteristics of the 10% with the most severe and enduring illness to the 90% with common mental illness.
Many people with depression find it highly stigmatising to be legally categorised as “vulnerable” or as “disabled”, when most, for most of the time, are fully able to work and to function in society.
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