‘Role of stigma in limiting access to care and in discouraging people from pursuing mental health treatment’
This paper will investigate the role of stigma in limiting access to care and in discouraging people from pursuing mental health treatment through a) epidemiology of mental illness, b) risk factors associated to mental illness, c) use of social constructionist perspective followed by the role of a social worker in assessing the risk and reducing the impact of stigma.
Mental health can be defined as “a state of well-being in which the individual realizes their abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to their own community” (World Health Organization, 2004, p.12). Mental Illness can be explained as “a health condition that changes a person’s thinking, feeling or behavior (or all three) and that causes the person distress and difficulty in functioning” Mental Health Foundation of Australia (https://www.mhfa.org.au/CMS/MentalHealthExplained)
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Over the period, service providers, analysts, and individuals with lived experiences in mental ailments have come together to create an evidence-based mediation that helps people accomplish life objectives.Even after the affirmation, people diagnosed with mental illness do not explore out treatment whenever they are in need or completely indulge themselves after the treatment or medication has started. Prejudice and discrimination may form the stigma and result in distinction between taking the treatment, continuing it or fully participating in taking medications
Stigma uncovers some part of the riddle why people may not want to participate in mental health treatment or leave the treatment early.
The two following obstructions identified with stigma may undermine need for seeking treatment and participate:
a) Individual level limits are the state of mind that impact wellbeing choices influenced by stigma, which may result in escaping the treatment, dropping out, poor well-being, treatment deficiency and absence of encouragement from people that underpins care seeking.
(b) System level limits comprise of the insufficiency of protection, monetaryrequirements, staff social inadequacy, and workforce constraints that are altogether influenced by stigma. (Association for Psychological Science, 2018).
Epidemiology of Mental Illness in Australia
Mental illness may have a weakening impact on the people and families, and critical driving effect on society. For those with intense conditions, it can obstruct altogether with a man’s intellectual, enthusiastic and social capacities and is much of the time related with financial weakness, joblessness or under-work, vagrancy and undermined efficiency. (Australian Institute of Health and Welfare, 2014, p.1)
‘One in five (20%) Australians aged 16-85 experiences a mental illness in any year. The most common mental illnesses are depressive, anxiety and substance use disorder’ (Australian Bureau of Statistics, 2009). The beginning of the mental disorder is frequently around mid-to-late puberty and Australian youth (18-24 years of age) have the most noteworthy pervasiveness of mental issue than some other age gathering and 54% of individuals with dysfunctional behavior don’t get to any treatment(Australian Institute of Health and Welfare, 2014).
The term ‘stigma’ characterizes a stamp or image of disfavor, and ‘to stigmatize’ intends to view a person as disgraceful. The repercussions of being viewed in such a way incorporate disgrace, debasement, exclusion, and debilitation. The weight of mental issue along these lines is considerably bigger, not simply by the immediate actualizes of stigmatization but rather by the incredible treachery in being thusly treated. It is standard to consider stigma to be basically a normal for others towards people with mental illness. Nonetheless, the procedure of self-stigmatization is a basic yet less obvious appearance of stigma that includes significant antagonistic consequences for the prosperity of the person with the psychological issue (Green, 2009).Differentiation has been made between ‘felt’ stigma and ‘enacted’ stigma (Scambler, 2005).
‘Felt’ stigma incorporates the general population having a dread of discrimination by other individuals and, ‘enacted’ stigma is the genuine articulation of segregation by other individuals towards the person.
Therefore, ‘felt’ stigma givesrise to camouflage image to create an impression one has on other people. In my opinion, this may be more hampering to people’s lives than of ‘enacted stigma.’
There has been a noteworthy change in seriousness of mental well-being sicknesses and the uniqueness of every person’s understanding of mental issue implies that help requests and utilization of administrations are likewise fluctuated.
The assessed populace treatment rate for individuals with mental scatters from the 2007 National Survey of Mental Health and Wellbeing was 35% (1.1 million individuals. 71% were asked to see general professionals (GPs), 38% counseled clinicians, and 23% counseled specialists. Eighty-six percent of those with a psychological illness who did not get emotional wellness care said that they saw no requirement for administrations, medicines, and care (“National Survey of Mental Health and Wellbeing: methods and key findings.” 2009)
Later investigation of regulatory information recommends that there has been a significant improvement on the generally low treatment rates saw in the 2007 National Survey of Mental Health and Wellbeing. The examination shows that the level of the populace with a current mental illness who got care in 2009– 10 was 46%, generously higher than the 35% gauge found by the ABS in 2007 (Australia’s health 2014, p.6). Australian government has concentrated on delivering a more extensive scope of services for those experiencing psychological battles, with a weight on helping people to remain well instead of giving help for the most part when they are in encounter. Projects like online treatment administrations for treatment of misery and nervousness, youth emotional wellness administrations, expressed based setup, and so forth are assuming an essential job in helping the people to come back to the network.
Risk Factors associated with Mental Illness
Mental wellbeing is controlled by a scope of natural, social and psychological variables like destitution and monetary impediment; separation and deficient social backings; vagrancy or insufficient lodging; physical, and profound wellbeing; availability of wellbeing administrations. In this manner, these all affect a man’s psychological well-being and their odds of creating emotional well-being issue(Zeanah, 2018).
Risk factors can be defined as contributing factors to an individual’s vulnerability to relapse, they occur through, factors, like – loneliness or isolation, difficulty communicating, chronic or severe mental illness, low self-esteem, anxiety, lack of family support, limited social network, lack of social identity, death of someone dear, divorce or family break up, unemployment, violence, cultural shock, stigma and discrimination, lack of support services, social and environmental barriers.
All domains of life can be a source of a risk factor to some or the other. However, it cannot be predicted to which extent any particular risk factor can contribute to an episode of mental illness.
However, by highlighting stigma as a potential risk factor could have an impact on individual and in result he/she could delay treatment seeking or continuing treatment which could further lead to a worse outcome, risk of relapse and increase in isolation.
The absence of mindfulness alone isn’t in charge of people to seek for treatment but the dread of being named as ‘rationally debilitated.’ Families being the emotionally supportive network realize that mental illness is a disease, yet tragically, assumption and disgrace meddles in looking for consideration as well as proceeding with it.
Without a doubt, stigma remains a potential risk factor for mental disorder and an obstruction in looking for consideration and proceeding with treatment.
Social constructionist perspective
The social constructionist view talks about the worries to mental disorder based on understanding the particular methodology an individual develops their reality to other people. Constructionism contends that something exists since society assembled it, made it or required it for its improvement or intrigue (Galbin, “An Introduction To Social Constructionism “, 2014, pp. 82 -92)
From this statement, it can be said that symptoms of mental illness can be seen as what society defines as ‘mental illness’ in a particular culture. Therefore, the social constructionist perspective could depend upon individual beliefs every society holds on what is normal or acceptable behavior as per the norm. For example, suicide in Indian society depicts ‘weak personality’ ‘mentally not strong’ while, in Japanese culture, suicide is an approach to make up for your transgressions. The indications of mental illness appear to be the essential focal point for enhancing personal satisfaction. As a glaring difference, the individual experience of stigma is unfavorable to the personal satisfaction, is once in a while given priority in the consideration and treatment by either the general public or mental health experts.
Stigma animates and expands social disengagement, averts treatment chasing by the individuals who require it. At times patients, carers and mental health professionals/ psychological experts express there individual occurrences of stigma, sometimes it is challenging to come to a conclusion whether the occasions are the proposed consequence of negative perspectives or discriminatory act has occurred (Carr & Halpin, “A Bulletin of the Low Prevalence Disorders Study”, 2002, p. 3)
Media additionally assumes an imperative job and is regularly condemned for the creation and broadcasting of stigmatizing demeanors on mental illness, and the facts demonstrate that people who have psychological sickness are depicted as ‘unsafe’ or ‘erratic’ by general society. In the British publication house, it isn’t surprising to peruse the labels like, ‘insane people,’ ‘psychos,’ ‘schizos’ in the daily papers (Carr & Halpin, “A Bulletin of the Low Prevalence Disorders Study”, 2002, p. 5)
The Commonwealth Government has undertaken a project to study inclusion of mental issue through the Media Monitoring Project.
Role of Social worker
Social workers are educated to recognize and determine that the mental disorders encountered by people, families, groups, and societies are not generated or influenced by a particular factor. Personal, educational, health, economic, employment or other societal factors can contribute and create hindrances to individuals. These factors are the central focus for social workers in supporting people with mental illness and helping them achieve positive wellbeing.
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Social workers focus on investigating whether the change has to be made at an individualistic level or other spheres. Their practice in mental health across the spectrum holds different roles like a clinical social worker, case manager, therapist, family support worker, and rehabilitation worker. Social workers make use assessments to understand their client’s situation, problem, and strengths. They make use of professional knowledge to identify and assess relevant indicators to reduce risk for the client and others. Use of risk assessment and Mental State Exam are vital assessments in determining the risk. It includes a risk of self-harming behavior, vulnerability to violence, and other safety questions in the home and environment and level of the potentiality of their client to harm others and to analyze the requirement for psychiatry follow-up.
Social workers are the mediators, they can help in reducing the impact of stigma and bridge the gap between mental health professionals and individuals through stigma management. Through Mental Health Literacy Campaigns, social workers can use the educational strategy and encourage individuals and families to seek services.
Lastly, the strength-based approach can play a significant role in mental health recovery. Individuals have strengths within them, which can contribute to improvement. Helping clients in cultivating their interest, identify and build their strengths to achieve their goals could be a way to help them recover.
Personal and interpersonal stigma plays an important role in discouraging people from seeking and continuing mental health treatment. Addition to that, there are various risk factors associated with mental illness and stigma is highlighted as a significant risk. Through social constructionist perspective, it was observed that different cultures have a different perception about mental health and there’s a required need for awareness amongst mental health professionals for understanding the stigma and gaps in utilizing the services.
Use of risk assessment and MSE by the social worker is vital in identifying risk and catering to the needs of their client. Making use of literacy programs and strength-based approach could help in reducing the impact of stigma and encourage individuals in seeking and continuing care.
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