Stigma and Serious Mental Illness

BACKGROUND PAPER

June 2016

Click here for a PDF of this backgrounder complete with references

SUMMARY

Stigma is a significant problem encountered by individuals with serious mental illness. The Surgeon General in 1999 called stigma "powerful and pervasive." The Secretary of Health and Human Services said, "Fear and stigma persist, resulting in lost opportunities for individuals to seek treatment and improve or recover." Stigma is known to lower self-esteem, contribute to disrupted family relationships and adversely affect the ability to socialize, obtain housing and become employed. Despite growing awareness that psychiatric disorders are medical diseases that respond to treatment, stigma has not decreased. Recent studies indicate, to the contrary, that stigma against people with mental illness has increased over the past half century and is still increasing.

Multiple studies have also shown that the major cause of this stigma is the perception that some individuals with mental illnesses are dangerous. Given this fact, it seems self-evident that stigma will not be decreased until we decrease violent behavior committed by mentally ill persons. Only ensuring they receive timely and effective treatment will assure this. Campaigns to decrease stigma by simply trying to educate people are not sufficient. The current situation finds an average commuter riding a bus to work, facing an anti-stigma poster proclaiming that “Mentally ill persons make good neighbors,” while simultaneously reading a newspaper detailing the most recent violent act committed by a mentally ill person.

STIGMA AGAINST MENTALLY ILL PERSONS IS INCREASING

In 2016, McGinty and colleagues compared news media stories concerning mental illness for 1995 to 2004 and 2005 to 2014. Stories in which stigma or discrimination were mentioned as problems increased from 23% in 1995-2004 to 28% in 2005-2014.
In 2010, Pescosolido and colleagues assessed stigma around mental illness by comparing findings from a 2006 survey with a similar 1996 survey. They reported that stigma had increased during the 11-year period and that “significantly more respondents in the 2006 survey than the 1996 survey reported an unwillingness to have someone with schizophrenia as a neighbor. . . . Our most striking finding is that stigma among the American public appears to be surprisingly fixed, even in the face of anticipated advances in public knowledge.”
Previously, the same researchers had compared the public perception of mental illness in 1996 compared with findings from a similar survey in 1950. They reported that, despite an increased understanding of the causes of mental illness by 1996, stigma had increased. This finding was also reflected in the 1999 Surgeon General’s report on mental health: “Stigma in some ways intensified over the past 40 years even though understanding improved.”

VIOLENCE IS THE LEADING CAUSE OF THIS STIGMA

In the 2016 study by McGinty et al. (cited above), comparing news stories from 2005 to 2014 with stories from 1995 to 2004 found that more recent media reports “were more likely to mention mass shootings by people with mental illness.” Most dramatically, “the proportion of newspaper stories about interpersonal violence related to mental illness that appeared on the front page increased from 1 % in the first decade of the study period to 18% in the second decade (p< 0.0001).” The second decade was when the mass killings at Virginia Tech, Tucson, Aurora and Newtown all took place.
A 2012 national survey of 1,797 Americans assessed the effects of a news story about “a mass shooting by a person with a history of serious mental illness” on the attitude of the public. The news story significantly increased negative attitudes to and stigma against mentally ill persons. The authors concluded that such stories “appear to play a critical role in influencing negative attitudes towards persons with serious mental illness and support for gun control policies.”
A national poll of Americans taken in January 2013, one month after the Newtown massacre of schoolchildren by a mentally ill young man, reported:

• 46% of respondents believed that “people with serious mental illness are, by far, more dangerous than the general population.
• 67% were unwilling “to have a person with a serious mental illness as a neighbor”.
• 71% were unwilling “to have a person with a serious mental illness start working closely with you on a job.”
In 2008, a Harris poll reported that a majority of the public believes that violent behavior is a symptom of schizophrenia, and “roughly one in four Americans say they would feel uncomfortable around adults who have been treated for schizophrenia.”
In 1999, a man with schizophrenia killed two people in a library in Salt Lake City. According to a newspaper account, within hours Valley Mental Health began getting calls from frightened clients. “Clients were just sobbing,” said Connie Hines, public relations director for Valley Mental Health told The Deseret News. They were afraid, she said, that the public would want to retaliate against them and that whatever progress had been made in the de-stigmatization of mental health had been set back years by the shooting.
In 1999, a study reported that 61% of adults believed that an individual with schizophrenia was “very likely” (13%) or “somewhat likely” (48%) to do “something violent to others.”
In 1996, a study of American university students reported that reading a newspaper article reporting a violent crime committed by a mental patient led to increased “negative attitudes toward people with mental illness.”
In 1995, a study in Germany reported that, following two attempts on the lives of prominent politicians by mentally ill individuals in 1990, “there occurred a marked increase in social distance towards the mentally ill among the German public.” Although this social distance slowly decreased over the following two years, “it had not yet completely returned to its initial level by the end of 1992.”
A 1994 survey of Utah residents reported that 38% agreed that “people with mental illness are more dangerous than the rest of society.”
A 1993 survey reported that more than half of people agreed with the statement that “those with mental disorders are more likely to commit acts of violence.”

HOW STIGMA CAN BE DECREASED

The British since 2008 have been conducting a national campaign to reduce stigma surrounding mental illness. Called “Time to Change” the Britain Department of Health has pledged for this effort, now in its 8th year. This campaign has seen an 8.3% improvement or 3.4 million people with improved attitudes towards mental health and stigma from 2008 to 2014.
The major US effort to decrease stigma against individuals with mental illness was launched in 2009 and included public service announcements featuring film star Glenn Close and her sister, Jessie, who has severe bipolar disorder.

There is no evidence that such efforts have any effect in decreasing stigma.
Since violent behavior by individuals with untreated severe mental illness is the main cause of stigma, it is unlikely that stigma decrease until the violent episodes associated with it decrease. As early as 1981, Henry Steadman, Ph.D., remarked on this relationship with the observation: “Recent research data on contemporary populations of ex-mental patients supports these public fears [of dangerousness] to an extent rarely acknowledged by mental health professionals. . . . It is [therefore] futile and inappropriate to badger the news and entertainment medial with appeals to help destigmatize the mentally ill.”
In the intervening years, many have echoed Steadman’s sentiment. In 2012, Steven Sharfstein, MD, a former president of the American Psychiatric Association, noted that negative attitudes toward persons with serious mental illness are unlikely to decline “as long as there are untreated, delusional, disheveled, threatening homeless individuals on our streets and in high-profile media examples of violence.”

Stigma and Serious Mental Illness