Stigma in healthcare, particularly towards mental health illnesses, poses a significant barrier to quality care. It hinders access to treatment and recovery, deteriorating the physical health of those affected. It also negatively impacts the work environment for healthcare providers themselves, often discouraging them from seeking help for their psychological problems.
This article hopes to shine a light on the issue, dissecting the primary sources of stigma in healthcare, its impacts, and evidence-based solutions that can be implemented to improve patient-provider interactions and quality of care.
Table of Contents
3. Consequences of Stigma for Access and Quality Care
4. Removing Barriers to Access and Care Through Stigma Reduction
5. Stigma, Prejudice and Discrimination Against People with Mental Illness
6. Defining Stigma and Understanding its Impact
7. The Commonality of Stigma Across Health Conditions
8. Conclusion
10. References
1. Understanding the Concept of Stigma
Stigma is a complex social process involving labelling, devaluation, and discrimination. It results from an intricate interplay of cognitive, emotional, and behavioural components, creating serious barriers to access and quality care.
Stigma can occur at multiple levels concurrently--intrapersonal (self-stigma), interpersonal (relations with others), and structural (discriminatory policies, laws, and systems). It is also important to note that stigmatization can only be carried out by powerful social groups, highlighting the inherent socio-political dynamics at play.
2. Identifying Sources of Stigma in Healthcare
Several issues contribute to stigmatization in healthcare, which directly and indirectly impact the access and quality of care for persons living with mental illnesses.
2a. Negative Attitudes and Behaviours
People with mental health conditions often report feeling devalued and dehumanized by health professionals. This can lead to feelings of exclusion, receiving threats of coercive treatment, excessively long waiting times, insufficient information about their condition, and being spoken to or about using stigmatizing language.
2b. Lack of Awareness
Another contributing factor is a lack of awareness and unconscious biases. Many healthcare providers are unaware of their implicit beliefs and attitudes that may contribute to stigmatizing experiences among their patients.
2c. Therapeutic Pessimism
Healthcare providers often hold pessimistic views about the reality and likelihood of recovery, which can act as a barrier to recovery for people seeking help for mental illnesses.
2d. Lack of Skills
Inadequate skills and training can lead to stigmatization. This can result in feelings of anxiety or fear among practitioners, negatively impacting patient-provider interactions and the quality of care.
2e. Stigma in Workplace Culture
Stigma also permeates the healthcare sector as a workplace. Staff are often discouraged from talking openly or seeking help for psychological problems.
3. Consequences of Stigma for Access and Quality Care
Stigma can lead to delays in help-seeking, discontinuation of treatment, sub-optimal therapeutic relationships, patient safety concerns, and poorer quality mental and physical care.
4. Removing Barriers to Access and Care Through Stigma Reduction
The negative impacts of stigma in healthcare have led to increased calls for healthcare organisations to take leadership roles in addressing the issue.
5. Stigma, Prejudice and Discrimination Against People with Mental Illness
Discrimination against people with mental health conditions is still a major problem. Stigma and discrimination can be subtle or obvious, but regardless of the scale, they can lead to harm.
5a. Types of Stigma
There are different types of stigma:
Public stigma involves the negative or discriminatory attitudes that others have about mental illness.
Self-stigma refers to the negative attitudes that people with mental illness have about their own condition.
Institutional stigma, is more systemic, involving policies of government and private organisations that intentionally or unintentionally limit opportunities for people with mental illness.
5b. Harmful Effects of Stigma and Discrimination
Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. Some harmful effects of stigma can include reluctance to seek help or treatment, social isolation, fewer opportunities for work, school or social activities, and bullying, physical violence or harassment.
5c. Stigma in the Workplace
Stigma in the workplace is a significant issue. Many employees avoid using available Employee Assistance Programs (EAP) due to concerns about being treated differently or fears of losing their jobs.
5e. Addressing Stigma
Research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact.
6. Defining Stigma and Understanding its Impact
Stigma is a powerful social process characterised by labelling, stereotyping, and separation, leading to status loss and discrimination. Health condition-related stigma is stigma related to living with a specific disease or health condition. Such stigma may be experienced in all spheres of life; however, stigma in health facilities is particularly egregious.
7. The Commonality of Stigma Across Health Conditions
While many health conditions are subjected to stigma, the following seven were selected as the focus of this correspondence article because of their high degree of commonality in stigma drivers: HIV, tuberculosis (TB), Mental Illness (MI), substance abuse, diabetes, leprosy, and cancer.
8. Conclusion
An improved understanding of how health condition stigma is currently addressed in health facilities is needed to identify gaps and areas for investment in stigma reduction. This understanding can also help explore the possibility of concurrently addressing more than one health condition stigma with a joint intervention.
9. Acknowledgements
Joe would like to thank all those who contributed to the discussion and provided input on earlier drafts of this article.
10. References
More in-depth information on this subject can be found in the following references:
Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Soc. 2001;27(1):363–85.
United Nations Agency for International Development (UNAIDS). Protocol for identification of discrimination against people living with HIV. Geneva: UNAIDS; 2000.
Dodor EA, Kelly S, Neal K. Health professionals as stigmatizers of tuberculosis: insights from community members and patients with TB in an urban district in Ghana. Psychol Health Med. 2009;14(3):301–10.
Ross CA, Goldner EM. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. J Psychiatr Ment Health Nurs. 2009;16(6):558–67.
Strauss SM, Alfano MC, Shelley D, Fulmer T. Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008. Am J Public Health. 2012;102(2):253–5.