The Stigma of Mental Illness

Almost half of all Australians will experience a mental health disorder within their lifetime, and one in five Australians aged 16-85 years have experienced mental disorders within the last 12 months. Episodes may come and go throughout a person’s life; whereas others may be transient and thus those patients can fully recover. Only 35% of mental health sufferers seek treatment, which is thought to be half the proportion of the population who seek treatment for physical disorders.

Despite the availability of mental health care for Australians, many tend to avoid treatment for a myriad of reasons. Barriers such as attitude, financial concerns and perception, whether self-perceived or society’s stigma, lead to avoidance of treatment. Beyond mental health, this lack of treatment may also result in deterioration of physical health and relationships with family, friends and work.

Stigma is defined as “a mark of disgrace associated with a particular circumstance, quality or person”. In the context of mental health, stigma refers to the community’s misconceptions of mental illness.

Misconceptions can include beliefs that those who suffer from mental illness are dangerous, that sufferers are “all the same”, or that they are unfit to work. Inaccurate ideas regarding mental health can be perpetuated throughout the community and reinforced by the media.

A multitude of consequences may occur; sufferers may feel socially alienated, others feel discouraged from seeking health care, and some may face discrimination within their community or workplace, further hindering recovery.

Stigma is of particular importance to those who are in adolescence and early adulthood. There is a high occurrence of mental health issues associated with these age groups; with young people less likely to seek professional help. The stigmatising attitudes surveyed in the 2011 National Survey of Mental Health Literacy and Stigma Report showed little change from attitudes in the 2003-4 survey. This trend was also demonstrated in a 2007 study which explored the barriers to mental health treatments in rural Australia. The adolescents who participated in this study described the extent and effect of social stigma in their community, resulting from the “gossip networks” which contributed to social exclusion and ostracism. A resultant fear of social stigma negatively influenced their desire to seek help as well as compounding the impact of the illness. In the case of Aboriginal families, the study found fear and mistrust of potentially unwarranted government interventions (e.g. a child being removed from the family) added to the stigma.

The NSW Consumer Advisory Group (supported by the NSW Department of Health) is lobbying to implement a program similar to one introduced in New Zealand which includes a broad advertising campaign featuring people with mental illness educating the public, the ongoing education of journalists about the effects of discriminatory reporting of mental health, and also monitoring journalist reports.

The role of health care professionals is vital to provide effective treatment to patients. The medical paradigm for treatment has shifted from an authoritative relationship to one of collaboration between client and practitioner, and it is this concordance that is vital to optimise patient outcomes. Patients should be offered respect, empathy, compassion, help to seek support when needed, and a sense of hope, as one of the most disabling aspects of mental illness is the perception of exclusion from ordinary activities and treatment by the community as a whole.

Specifically, pharmacists can offer measures to improve patient education and behavioural prompts, as well as monitoring medication use. Patient education involves dispelling misconceptions of mental illness, providing personalised counselling along with written communications (such as consumer medicine information leaflets) and explaining the details regarding the impact of particular medicines. In addition, pharmacists may suggest prompts to manage medicines; whether by incorporating dosing schedules into the daily routine (e.g. taking the medication after breakfast), suggesting dose administration aids such as blister packs or self-monitoring aids, or positively acknowledging and reinforcing concordance. It is vital to actively ask the patient about the adverse effects of medicines and to explore potential solutions around these effects. For example a day time dose that may be shifted to an evening dose in response to a patient’s sedation.

Patients should be directed to useful resources and support organisations such as: beyondblue, SANE Australia, the Black Dog Institute, Mind Australia, and Lifeline. Focussing on public health, beyondblue tailor information for specific population groups to provide easily accessible education, health services and online tools. The Black Dog Institute is pioneering diagnosis, treatment and prevention of mood disorders. It also partners with universities, health services and community groups to focus on access to, and running of, education programs. Some organisations also have trained mental health professionals to offer personalised and confidential support through a variety of mediums.

It is important for society to recognise the impact that social stigma has on sufferers. By changing society’s perception of mental illness, mental health treatment outcomes can be improved.