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Stigma and Mental Illness
In Module 1 we learned that one of the four components of mental health literacy is effective and sustained reduction of stigma. In Module 2, we focus on understanding the different types of stigma related to mental illness and learn about evidence-based strategies that effectively address it and how these can be applied in the school setting.
Learning objectives
In this module, you will:
● Enhance your understanding of stigma and how that relates to mental illness; ● Learn about some evidence-based strategies that can be used to reduce stigma in the school setting.
Warming-up activities
Activity 2.1: Write down 5 words that first come to mind describing a person who has a mental illness.
Next, write down 5 words that first come to mind describing a person who is a teacher.
Review your descriptor words. How many words that you have used have negative connotations (such as crazy; sick; disturbed; unwell; stressed out; etc.), how many have positive connotations (such as: hard working, dedicated, understanding, considerate, friendly, creative, etc.) and how many have neutral connotations (such as: person, male, female, tall). If you are like most people, many of the words you wrote to describe a person who has a mental illness will tend to have negative connotations and the words you wrote to describe a person who is a teacher will have positive connotations.
Note: Mental illness affects approximately 1 in 5 people worldwide with a similar proportion in Canada. People with mental illness could be an acquaintance, a friend, a family member, a co-worker, a neighbor, a classmate, a celebrity, and so on. Indeed, statistically, approximately 1 in 5 people who are teachers in Canada will have a mental illness. However, we tend to think of people who have a mental illness differently without even realizing it. This is called stigma. Everyone has some stigma, and some people have more than others.
Activity 2.2 : Take a minute to think about where your images of people who have a mental illness come from.
- Movies?
- Television or other media?
- Books?
- Family or friends?
- Personal experience?
Question for reflection
How has your exposure to people with mental illness or knowledge about mental illness made a difference in the way you think about it? The way we perceive others, including people with mental illness, has been greatly influenced by social, cultural and other factors. Historically there was a general lack of knowledge about mental illness and today there are often negative and often false stereotypes found in mass media. This leads to portrayals such as a psychotic killer as an example of people with schizophrenia. Just think of some examples of uninformed opinions about mental illness and negative descriptions of people with mental illness we have been exposed to from mass media. Remember that this also pertains to treatments for mental illnesses. How many times have you read negative stories about treatments for mental illnesses compared to negative stories about treatments for other illnesses?
Module 2
Note: It is important to note that mental illness is not the only medical condition that has historically been stigmatized or that is now still being stigmatized. Just bring to mind the stigma against epilepsy, leprosy, HIV- AIDS and even cancer. Why do you think that there may be less stigma against those diseases now? Do you think that knowledge about what causes those illnesses and awareness of how effective treatments can be have made a difference in stigma?
Activity 2.3 : Meet Joan. She is a grade 9 student who enjoys English literature and soccer. She was a student in one of your classes for about five months prior to her hospitalization for a mental illness called Depression and you have always been on friendly terms with her. She has just returned from a two-week inpatient stay for treatment of her Depression after trying to end her life by suicide.
- What do you expect when you meet Joan?
- How do you prepare for her arrival? List 5 things that you may do.
Review your answers:
- How many of the things on your list had to do with you expecting to be a caregiver?
- How many things on your list were about you feeling or thinking that you need to make things easier for her?
- How many things on your list involved asking her what she’s good at, and what she needs to feel supported in doing?
- How many things on your list were about setting reasonable expectations for academic outputs?
- How many things on your list were about talking to school based student services providers (such as counsellors or psychologists) to discuss what you could do in the classroom?
Next, watch this video about Joan: https://www.youtube.com/watch?v=hsaZwJHgYYM&feature=youtu.be
- Now that you’ve watched the video, what was your first reaction to Joan’s story? ● What did you want to know more about? ● What are you left wondering about?
- What might have caused a teacher to tell Joan to drop out? ● What could have been done instead? ● What would you as a teacher say in this circumstance?
- Joan described two kinds of teachers she encountered at school. What were they like?
- What did Joan mean when she said that some teachers “don’t believe that mental health is an actual thing”? Did she herself show that she knew the difference between mental health and a mental illness? Why do you think people use the words mental health when they mean mental illness? Could that use of language be an example of stigma? ● Have you ever encountered a teacher who felt or thought similarly? ● What did you do or say to that person?
- What did Joan say was the best support you can give? What will you do next?
Note: The attitudes, knowledge and feelings we have about mental illness end up influencing our behaviours toward people who have mental illnesses and also impact what we say to others about mental illnesses. Teachers can play an important role in helping students and others change how people with mental illness are perceived and treated. As future teachers, you have the power to help determine the kind of environment in which students learn.
Activity 2. What do you think about those definitions? Do you think that stigma against mental illness extends to stigma against those professionals who treat people with mental illness? Do you think that stigma against mental illness extends to treatments for people with mental illness?
Stigma of mental illness prevails in everyday life. It may or may not be possible to eradicate all stigmas but awareness of stigma and how it can negatively impact our own beliefs and actions is a good place to start.
Note: Your students will experience and learn from your attitudes, ideas, and beliefs about mental illness by how you behave in the classroom, the school and in your community (including what you say and what you do not say). It is very important to remember that not speaking out against stigma is often understood by others to mean that you condone it.
What are the consequences of stigma of mental illness?
Stigma can lead to discrimination, and may “impede social integration, interfere with the performance of social roles, diminish quality of life, and prevent timely access to treatment, effectively creating a vicious cycle of social disadvantage and disability” (Stuart, 2005, p. S22).
Stigma Type What It Is Example
Personal Stigma Personal attitudes toward peo-
ple with mental illness
I do not think students with
mental illness should go to this
school.
Emotional Responses Feelings and emotions toward
mental illness
I fear people with psychosis; I am
embarrassed that my child has
an Anxiety Disorder.
Perceived/Public Stigma Beliefs about how others (gen-
eral public) perceive mental
illness
People think a person who is
mentally ill should not get mar-
ried or should not run for public
office or not serve on the Su-
preme Court.
Social Distance The degree to which people
are willing to accept those who
have a mental illness into their
social lives
I don’t want people with mental
illness living in my community
Self-stigma A situation in which people with
mental illness internalize social
myths and prejudices about
mental illness
I am stupid because I have
ADHD.
Stigmatizing Experiences Experiences by people with
mental illness in social life
I have difficulties finding a job
because of my Depression.
Stigma Against Treatment Ignores evidence of effective
treatment
Don’t take medicines. Psycho-
therapy is nothing but talk.
Stigma related to mental illness impedes or prevents individuals with mental illness from achieving numerous individual and social successes and can limit a person’s access to health care.
Stigma for me, the most agonizing part of my disorder. It cost friendships, career opportunities, and most importantly - my self-esteem. It wasn’t long before I began internalizing the attitudes of others, viewing myself as a lesser person (Simmie and Nunes, 2001, p.308).
I would do everything to have breast cancer over mental illness. I would do anything because I (would) not have to put up with stigma (The Standing Committee on Social Affairs, Science and Technology, 2006, p.2)
Effectively addressing stigma
Activity 2.5: Can you think of some strategies that may be effective in changing the stigma related to mental illness? What role does language have in creating or perpetuating stigma? Write down your thoughts and then continue to the end of activity 2.7. Review your notes and reconsider what you wrote.
What can we do?
So what does it take to decrease stigma? Let’s look at some of the work we could do to change our minds and change our behaviours.
Evidenced-based strategies to fight stigma
Now imagine that one of your students has just received a diagnosis of a mental illness. What does it feel like to be surrounded by images, rumours, and popular beliefs about people with mental illnesses? What happens when that student accepts those images and beliefs as the truth about their chances of success in life? It must take some serious bravery to keep going in the midst of all of the negative perspectives and assumptions about “people like that”.
But how can we make that change? Researchers have identified a number of evidence-based strategies that could be used to change someone’s attitudes and behaviours about mental illness. Remember, that given the complexities of stigma, some of these strategies may work better than others and some may work better in some unique groups or settings or at different ages (such as: young people, schools, community organizations, political parties, etc.). Some of these strategies have been fairly well studied and others have not. While much more is yet to be learned, these interventions provide us with a good place to start.
- Education, which involves correcting false information about mental illness and replacing it with information based on best available scientific knowledge about the causes and treatments of mental illnesses. There is good evidence that this approach works for teachers and for students in the school setting.
- Another strategy is known as “contact education” or “first person experience”. This includes getting to know someone who has a mental disorder and learning about mental illness through that relationship (there is a video clip related to this in activity 2.7).
- Advocacy is a strategy to encourage us as citizens to participate and be engaged in our community and increase the priority of mental health promotion and provision of rapid access to effective mental health care on agendas of decision makers (such as politicians). For example, becoming part of an advocacy group working to improve the provision of mental health care for young people or monitoring the media and responding to stigmatizing messages about mental illness or its treatment can be a good way to address stigma.
words and actions.
- Listen more than you speak. ● It might be tempting to trivialize someone’s illness when we know of someone who is going through worse times. Instead, try saying: “I’m sorry to hear that, it must be a difficult time. Is there anything you can share that might allow me to be helpful?
Cultural considerations
In today’s increasingly diverse classrooms, it is essential that teachers are aware of and practice within a framework that respects that diversity. Not all students come from backgrounds that share the same understanding of or types of stigma against mental illness. Furthermore, students may have different understanding and different levels or types of stigma than their parents or cultural communities about mental illness. These differences may impact on how you as a teacher can best support your student if they have a mental illness. Recognition of this reality is important.
Activity 2.5 (again): Please return to the notes you made in Activity 2.5. Is there anything you would add? Is there anything you would re-consider?
Conclusion
Back to Joan: She is a person who has strengths and weaknesses. She has emotions, thinks about many things and has a wide repertoire of behaviours. She has good days and bad days. She’s had positive and negative experiences at school, and is proud of her achievements and her success at overcoming obstacles. She also happens to have a mental illness – it’s called Depression. As a result of that illness she may need some additional assistance from you. Most importantly to you as an educator right now, Joan recognizes the significant role that teachers can play in her life. If you focus on Joan’s strengths while you assist her with her challenges, you may help her better walk the road of a productive and fulfilling life. Over the course of your teaching career, you will meet many young people, with unique hopes, dreams, interests, and personalities. When you get to know your students, you can get to know how best to help them.
As a teacher, get to know yourself too, so that you know how to build on your strengths and address your weaknesses. We would like to conclude this module with the following quote. Who has to change first: the students or the teacher?
The reframing changed my negative, critical attitude toward April’s behaviour to a positive, supportive outlook. As a result, the exercises and movement no longer upset or distracted me. Once I became comfortable with the reframing, April’s behaviour really improved. (p. 3, Weiner, 2006)
Culturally responsive teaching
In Canada, our communities and classrooms are experiencing increased diversities in many different domains, including but not limited to: class, race, ethnicity, religion, sexual orientation, first language or others.
Culturally responsive teaching is, according to Willis and Lewis (1998), about allowing students to be who they are, and having a socio-political consciousness that allows teachers to not only have a greater sense of community, but also be in a position to critique their own education. This self-reflection must also include self-consideration about privilege and taken-for-granted experiences such as having a stable home life and adults who care(d) for us (Herman, 2004), healthy relationships (Jordan, 2009), and freedom (Sen, 1992). In other words, cultural awareness is central to culturally responsive teaching.
Cultural competency is one way to approach this – the knowledge, behaviours and values that are congruent with leading a classroom or school that is inclusive of all cultures.
Given the complexity of multiculturalism, it has been suggested that cultural humility should be a core value in the educational context.
Cultural humility is not a set of knowledge or skills, but rather a way of operating. It is defined as the ability to maintain an approach that is open to others in relation to the aspects of cultural identity that are most important to the person (Hook, Davis, Owen, Worthington & Utsey, 2013). In other words, it is not about us, but about the other.
There are three features of cultural humility that we can adopt and enact:
- A lifelong commitment to self-evaluation and self-critique. We need to be brave enough to look critically at ourselves, our beliefs and behaviours, curious enough to learn, and patient enough to understand that we will never be ‘finished’ with learning.
- A desire to fix power imbalances where none ought to exist. Teachers and learners come to the classroom with strengths, capabilities and vulnerabilities. We can seek to listen, understand, and advocate for change within the relationships we have with students, families, peers and communities, but we must also work for change within the larger, structural institutions. Cultural humility is larger that our individual selves – we must work to change the systems.
- Develop partnerships with people and groups who advocate for others. Even though individuals – such as Malala, who has raised the awareness of the struggle and rights for girls’ education worldwide – can create positive change, the sustainability comes when we work together across sectors, schools, classrooms and relationships. As we develop capacity for change, we share those skills with those who need them. As we are met with barriers to change, we reach out to those who may be able to help us successfully negotiate them.
Supplementary Materials
British Journal of Psychiatry: Evidence for effective interventions to reduce mental health related stigma in the medium and long term: systematic review www.bjb.rcpsych.org/content/207/5/
Cancer and Stigma: A Brief History http://ncbi.nlm.nih.gov/books/NBK12903/
HIV Stigma and Discrimination Persist, Even in Healthcare http://journalofethics.ama-assn.org/2009/12/oped1-0912.html
You may also want to check out this video: TEDx Youth – Kevin Breed: Confessions of a depressed comic https://www.youtube.com/watch?v=-Qe8cR4Jl
Interested in Human Rights and stigma? Check these out.
World Health Organization. WHO Resource Book on Mental Health: Human Rights and Legislation. Geneva, World Health Organization. 2005
Mfoafo-M’carthy M. and Huls S. Human Rights Violations and Mental Illness: Implications for Engagement and Adherence.
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