Eliminating social stigma towards mental illness
“Your illness does not define you; it is not your identity!”
This has been universal in the practice of medicine throughout the ages. In associating an individual with their illness, the latter becomes an inevitable part of their lives. More so if it is a mental illness because why not—“It’s all in the mind.” Or at least that’s how society has perceived mental health conditions for years.
Based on the National Mental Health Survey (2015–2016) in India, nearly 85% of individuals do not receive the healthcare they need for their mental illnesses, while one in five Indians suffer from a mental health condition.
Social stigma towards people having a mental illness is all-pervasive. A study by Shivani Mathur Gaiha and colleagues published in BMC Psychiatry in 2020 looked at all published research articles on the stigma among young Indians towards mental health issues. One-third of people had negative attitudes towards individuals with mental illness and had limited awareness about treatment options. Signs of mental illness often go unrecognised, and many young people believe it is incurable. Misconceptions, myths and misinformation about mental illness add to the stigma.
Labelling an individual with schizophrenia as “schizophrenic” or someone with dementia as “demented” equates the person with the “illness”, depriving a person of their individual attributes. These terms are quite common in public discourse and media, depicting the ongoing approach towards mental health issues. In our daily practice, such instances occur when the family is glad to continue medicines for high blood sugar or high blood pressure but frowns when medicines for depression or anxiety disorders are included. Mental health conditions like depression, anxiety, dementia, schizophrenia, obsessive compulsive disorder, etc., are non-communicable disorders just like diabetes, hypertension and osteoarthritis, and need long-term treatment as well as lifestyle modifications and counselling.
Stigma towards an individual suffering from mental illness leads to negative experiences such as discrimination, social rejection and isolation. People do not seek help, hide their symptoms, and refrain from taking help from their family members for fear of shame, losing jobs, or being targeted by the community. There are still places where an odd thought or behaviour (like what happens in schizophrenia) is considered as the effect of a curse, witchcraft, black magic and other paranormal phenomena—and the possibility of a mental illness is never even considered! Much later, when the person is finally brought to us, symptoms have progressed, and they take time to recover. Delay in seeking help, especially for depression and trauma disorders (like PTSD) leads to an increase in deaths by suicide. The suicide rate in India is on the rise, with most occurring in the younger age group. Untreated and unrecognised depression and anxiety disorders form most of these deaths.
Stigma can be of several types: Public stigma (discriminatory attitudes towards others), self-stigma (internalised shame, guilt and negative attitudes that people with mental illness have towards themselves), and institutional stigma (systemic policies that overtly or covertly promote and maintain social stigma towards mental illness).
Let’s take a few examples. Public stigma makes someone wrongly believe that people with mental illness are violent.
Self-stigma can delay treatment for someone who may think it’s a crime to be depressed and thus carry social shame: “What if someone else knows about it?”
Finally, fewer mental health services or reduced healthcare opportunities for people with mental illness may reflect institutional stigma.
This stigma has several adverse consequences: Reduced self-confidence, increase in depression and anxiety, isolation, problems with work and relationships, reluctance about treatment, lack of social support, misinformation, physical violence, bullying and negative stereotypes.
Stigma can also be a major factor in the workplace, based on a national poll conducted by the American Psychiatric Association in 2019. More than half of the workers did not want to divulge their mental health issues, while one in three believed that revealing their problems may lead to them getting fired. Only one in five workers was comfortable sharing their emotional issues.
Research shows that stigma must be dealt with at personal and policy levels. Connecting with someone who has a mental illness and exchanging narratives of lived experiences is one of the best ways to reduce stigma.
Several celebrities and prominent social figures have come forward to share their own stories of struggle and eventual triumph over mental illness, and they can serve as examples. Sensitive reporting on deaths by suicide, sensitisation to mental illness (and not sensationalising the issue), reporting recovery stories, and busting myths/misinformation about mental disorders—can be achieved through media. Community awareness programs conducted by several national and state-level institutes are needed to snowball mental health education and eliminate stigma.
Mental and physical illness must be considered equal in services, policy and funding—only then can the gap be bridged. Although still nascent, insurance coverage for mental health issues is vital to promote help-seeking. Several such moves have been targeted in the Mental Healthcare Act, 2017, but much remains to be implemented.
At a personal level, we can all be compassionate, informed and empathetic towards individuals with mental illness. We must also be conscious of our ‘language’ and attempt to empower them to live a meaningful life in society. Essentially, a nationwide commitment is necessary to end the stigma.
Dr Debanjan Banerjee
Consultant Neuropsychiatrist, APOLLO Multispecialty Hospitals, Kolkata