The prejudice and discrimination suffered by mentally ill people

I know this report is heavily biased towards the UK, however I am sure in many countries the same/similar problem exist, and very similar methods can be used to tackle it.

On average, one quarter of the population of the United Kingdom suffers from mental illness at some time during one year. The term ‘mental illness’ can denote a variety of conditions, ranging from schizophrenia to bipolar disorders (manic depression) to phobias and anxiety. These individual groups all have their specific needs and problems; however one problem common to them all is the prejudice and discrimination against sufferers. These issues of what are, according to Johan Galtung’s theories, structural violence, can be addressed and tacked for all groups non-denominationally.

The nature and extent of discrimination suffered

Mentally ill people suffer from being prejudged and stigmatised within society. Friends, family, healthcare professionals, colleagues can all be sources of discrimination. The results of this can be further mental and social problems: lower self-esteem, social isolation, exclusion, depression, anxiety and so on. The UK Mental Health Foundation’s ‘Pull Yourself Together’ report states “People who experience mental health problems are heavily discriminated against and stigmatised in society, and often feel excluded”. In a survey done by the Mental Health Foundation, it was found that 47% of people surveyed had experienced physical or verbal abuse from the public. 24% had experienced hostility from neighbours and their local community. The problem of discrimination against mentally ill people is widespread. Below is an illustration of the levels of discrimination felt by the people surveyed by the Mental Health Foundation, and the sources of the discrimination:

Percentages of people who felt discrimination suffered from:


                0%                 20%                 40%                 60%                 80%                 100%
                |                   |                   |                   |                   |                   |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Family        |********************************************************  56%                                      |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Friends       |***************************************************  51%                                           |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Workplace     |***********************************************  47%                                               |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| GPs           |******************************************** 44%                                                   |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Personal      |**************************************** 40%                                                       |
| Relationships |                                                                                                   |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Finding       |*************************************  37%                                                         |
| Employment    |                                                                                                   |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
| Non-GP Health |********************************  32%                                                              |
| professionals |                                                                                                   |
+---------------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+
                |                   |                   |                   |                   |                   |
                0%                 20%                 40%                 60%                 80%                 100%

The form of discrimination depends on the source:

From friends, family and within personal relationships: The majority of people reported that the main problem with families was that the mental illness was not understood properly. Some mentally ill people are ostracised and distanced from their families, with uninformed relatives behaving as if the condition is contagious. Loss of status within families is a common complaint: inheritances deleted or reduced and responsibility taken away being the most frequent of these. Many people reported that ‘general hurtful comments’ such as ‘mental’ and ‘fruitcake’ from their families were common occurrences. Many felt their families consider their condition to be a character flaw, and that the sufferer is personally responsible for their condition.

From colleagues, bosses and prospective employers: Those who had jobs when diagnosed with mental illnesses were often pressurised into resigning, were dismissed, or were made redundant on grounds of being incapable to complete their jobs properly. Those who kept their jobs felt pressurised over sick leave: either the sufferer felt they could not take a sufficient term of sick leave, or that they were pressurised into returning too soon. Many suffered bullying and ridicule from colleagues, or were rejected of isolated. On the other hand, some mentally ill people who were surveyed found that their employers did not take their mental illness seriously, and were therefore not given the consideration required. Mentally ill people who are searching for jobs often feel they cannot disclose their condition to a prospective employer for fear of discrimination. An example of this is given by the Institute of Psychiatry: 200 job applications were sent out to personnel departments over the United Kingdom. All were identical except for half of the applications said the applicant was recovering from diabetes (I am slightly unsure as to how it was *recovering* from Diabetes, I assume that it just said that the applicant was diabetic) , and half from depression. Those that said depression had a significantly reduced chance of being asked to attend an interview. Large numbers of job applicants had their offers of employment withdrawn once they disclosed their mental health history. Others found themselves subject to extra interviewing, medicals, and personal questioning. 60% of people surveyed by the Mental Health Foundation felt they could not tell a prospective employer about their mental illness due to the risk of stigma and discrimination.

From GPs and other healthcare professionals: BBC news of Monday April 24 2000 reported that mentally ill people do not receive the healthcare they require, from GPs and others, including psychiatric staff. GPs had been reported as being unapproachable: “Nearly a fifth of people felt they could not tell their GP about their mental health problems”, or that, if they did tell their GP, mentally ill people are often misdiagnosed. GPs have been reported saying such things as ‘Snap out of it!’ ‘Pull yourself together’ and ‘I can only help if you’re suicidal’. Many other sufferers have been accused of acting, or of being “stupid or unreliable”. It has been found that often a person’s mental illness has been diagnosed as a physical condition, or, once the mental condition has been diagnosed, all physical problems have been put down to the patient’s mental illness. These result in the mentally ill person receiving inappropriate healthcare - often detrimental to their health. GPs tend to allow mental illness to be controlled only by medication, often not referring the patient to a specialist or for therapy because mentally ill people are regarded as ‘time wasters’. Many patients felt that they were patronised or “regarded as second class citizens” when it came to their GPs. Many female patients were ‘advised to have their pregnancies aborted’ and were encouraged not to think about having children due to their mental illness. There have been some incidences of mentally ill patients being stuck off their GPs register.

This discrimination and prejudice against people with mental illnesses has a long term effect on the health of the sufferer, even beyond the duration of their illness. In a Health Education Authority survey of psychiatric workers, it was found that 60% of the people they’d worked with now have long term emotional problems as a result of the discrimination they’d suffered. 99% of psychiatric workers believed discrimination to have long term detrimental effects of the health of a patient.

Causes and attitudes of prejudice towards mentally ill people

The attitudes, and therefore prejudiced behaviour, towards mentally ill people, stem from several roots. According to Baron and Byrne (1991), “prejudice is an attitude toward the member of some group, based solely on their membership in that group”, and as prejudice is what causes the discrimination towards mentally ill people, it is the development of the attitude which needs to be investigated.

Much of the intolerance of mentally ill people is due to general ignorance of the condition. ‘Fear of the unknown’, reinforced by minimal contact with mentally ill people, can often lead to the development of stereotypes and stigma - almost definite antecedents to conative (active) discrimination. This is a clear demonstration of Rosenberg and Hovland’s ‘Three Component Model’ of attitude and discrimination. The Minority Rights Group report ‘The Rights of the Mentally Ill’ says that the fear and ignorance of mental illness leads to segregation, therefore “ritual of myth is frequently established to deal with the unknown”. This will create a social taboo of associating with mentally ill people, one of the causes of ignorance of their conditions through limited contact. The segregation of mentally ill people automatically makes them a group. The alignment of all mentally ill people into one mass group dehumanises and depersonalises them, exacerbated by the use of their condition to describe them: ‘the mentally ill’. The connotations this label holds is that of a condition which is “wholly and incurably debilitating”, which allows human actions towards the group of mentally ill people to be rationalised and justified.

Vivian and Brown (1995) describe prejudice as a “special case of inter-group conflict”: the conflict is between the group of mentally ill people, and the group of not mentally ill people – ‘everybody else’. According to Tajfel et al (1979) the mere existence of another group will create tension and conflict: just knowledge of the existence of that group is enough to produce ‘pro-ingroup’ and ‘anti-outgroup’ attitudes, and the act of categorisation of an individual automatically creates conflict. This is known as the ‘Minimal Group Theory’. In the case of mentally ill people, this means that they are routinely categorised as part of an ‘enemy’ group, therefore are discriminated against. Inter-group discrimination is also caused by the need of the discriminator to increase their own self esteem, therefore make others look bad (Tajfel and Turner’s Social Identity Theory). Other members of the discriminating group will conform to this in order keep with prevailing social norms. The need to conform will often override the desire to be fair. Reich and Adcock (1976) described this: “ill treatment of minorities is best seen as reflecting a prejudice which already exists and which is maintained and legitimised by conformity”.

The media intensifies the problems of discrimination against mentally ill people. The animalistic portrayal of mentally ill people as violent and dangerous, aside from being, on the whole, false, can be the only experience some people have of mental illness. This reinforces stereotypes and gives opportunity to confirm the prior beliefs held through stereotypes as true – ‘biased perception’. Two-thirds of media reports portray mentally ill people as violent despite this being proven incorrect by the National Confidential Inquiry into Suicide and Homicide by people with Mental Illness. 40% of daily tabloid articles and 45% of Sunday tabloid articles about mental health contained stigmatising words like ‘nutter’ and ‘loony’. This sort of tactless reporting can not only be upsetting and detrimental to a mentally ill person’s health, but it leads others to believe that this is and normal, therefore socially acceptable. The government, through lack of concrete anti-discriminatory laws and procedure, also promotes this idea of discrimination being socially acceptable, which in turn justifies prejudiced behaviour.

Ways to reduce discrimination

91% of people surveyed by the mental health foundation said they thought it was possible to reduce discrimination against people with mental illness, with the right action taken. There is, as of yet, little legislation covering discrimination against mentally ill people: the Mental Health Act 1983 is currently under reform, but this covers merely the grounds under which a mentally ill person can be detained or treated. Campaign groups such as the Mental Health Foundation and Mind are driving for more detailed and appropriate rulings regarding discrimination.

Reducing prejudice and changing attitudes, especially with regards to stereotypes, is a “reduction process” rather than a single event, and the best way to go about this process, according to Devine and Zuwerink (1994) is to “inhibit automatic reactions and realise that prejudice is an inappropriate way of relating to others”. Propositions for reducing prejudice and discrimination against mentally ill people are:

•The government should review anti-discriminatory laws to include specific criteria for people with mental illnesses. This would provide a ‘benchmark’ of social boundaries, which would eventually bring about a change in attitude towards people with mental illness. It would also prevent some of the more outright acts of discrimination going unnoticed.

•Legislation should be introduced to modify the way in which the media portrays mentally ill people. Negative stereotypes and tabloid dramatizations should be removed, and positive accounts should replace them. The media should encourage the inclusion rather than exclusion of mentally ill people. This will, like government action, lead where the public will follow. As already mentioned above, Reich and Adcock (1976)’s definition of active discrimination with regards to conformity, then changing the norms to conform to should therefore eventually alter the attitude.

•The new Disability Rights Commission launch a campaign to raise awareness of the problems of, and discrimination suffered by, mentally ill people: what their problems are, what the causes are and the impact of these problems on someone’s life. This should include more ‘equal status contact’, with mentally ill people in order to reduce the effect of the ‘Minimal Group’, and also to reduce the idea of a stereotype through ‘attribute driven processing’ i.e. focussing on the individual rather than their group.

•Concurring with a campaign to raise awareness of mental illnesses, the government should introduce compulsory training for healthcare professionals on mental health issues in order to prevent unintentional (or otherwise) discrimination within the National Health Service. There should be stricter specifications of who can care for mentally ill people, so as to prevent workers, who perhaps don’t understand the condition of the mentally ill patient, from neglecting or wrongly treating the patient.

•An education programme regarding mental health should be integrated into the school Personal Social Education curriculum, so as to educated the next generation of the problems faced by mentally ill people. As said by Hogg and Vaughan (1995): “Prejudice is mindless: if we teach people, especially children, to be mindful of others, to think of them as complex, whole individuals, stereotypic reactions could be reduced”. An example of how children of a younger age are more open-minded to new ideas is the famous Blue eye / Brown Eye experiment conducted by US teacher Jane Elliott to teach her class about racial discrimination. The same theory can be applied to mental illness.

The idea of the public having more contact with mentally ill people is to put into practice Allport’s (1954) ‘Contact Hypothesis’. As an individual has more contact with a mentally ill person, they will realise that the stereotype is not true. They will see similarities between themselves and the mentally ill person, therefore develop a greater liking. Eventually, after having met an ample number of mentally ill people, the image of stereotype will have been sufficiently eroded for it to no longer exist – greatly reducing discrimination. Allport summarised this by saying “Prejudice may be reduced by equal status contact between majority and minority groups in the pursuit of common goals. The effect is greatly enhanced if this contact is sanctioned by institutional supports”.

The idea of a common goal is also important. Shown by Aronson et al’s 1978 experiment of the ‘jigsaw learning technique’, where children worked together so they could all learn, a common goal is a very important aspect in reducing perceived differences, therefore discrimination.

One single proposition alone cannot alter the misperceptions and fear of mentally ill people. However, with time and active campaigning, the stereotypes, stigma and negative attitudes can eventually be reduced, achieving greater ‘peace’ for mentally ill people and the people who surround them.

The broad range of conditions described as ‘mental illness’ affect a large proportion of the UK population, whether it be directly suffering, caring for, living with or knowing a mentally ill person; yet the awareness and understanding within the general population is low. Ignorance prevails, and because of this people suffer unnecessarily. This can be amended through educating the public and producing legislation to prevent active discrimination to slowly erode the unnecessary and false stereotypes. The government can be instrumental in this, and can lead the way for a better system, where people of either ‘side’ need not live in fear or unhappiness.

Sources

Baker, S. and MacPherson, J. Report: Counting the Cost: Mental Health in the Media. Great Britain (2000) Baker, S. and Read, J. Report: Not Just Sticks and Stones: A Survey of Discrimination Experienced by People with Mental Health Problems. Great Britain (1996) Gross, R. Psychology: The Science of Mind and Behaviour. Hodder and Stoughton, London (1996) Health Education Authority Press Release: Discrimination Hurts. Health Education Authority, London (Oct 1998) Heginbotham, C. The Rights of Mentally Ill People. Minority Rights Group, London (1987) Mental Health Foundation UK website: www.mentalhealth.org.uk (2001) Mental Health Foundation US website: www.mentalhealth.org (2001) ‘Mind’ website: www.mind.org.uk (2001) ‘Sane’ website: www.sane.org.uk (2001) Storr, A. The Integrity of the Personality. Pelican, Great Britain (1960) Thompson, J Sociology. Heinemann, London (1982) Whitaker, B (edited by) Teaching About Prejudice. Minority Rights Group, London (1983)

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