|Year : 2016 | Volume
| Issue : 2 | Page : 81-82
Stigma toward psychiatric disorders: What can we do about it?
Siddharth Sarkar1, Varghese P Punnoose2
1 Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
2 Department of Psychiatry, Government Medical College, Kottayam, Kerala, India
|Date of Web Publication||25-Apr-2016|
Dr. Siddharth Sarkar
Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, Room No. 4096, Teaching Block, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarkar S, Punnoose VP. Stigma toward psychiatric disorders: What can we do about it?. Indian J Soc Psychiatry 2016;32:81-2
Stigma is an important consideration while discussing the rights of patients with psychiatric disorders. Stigma affects the prospects of tangible opportunities, dents the self-esteem, and influences the service provision for patients with mental illnesses. The experience of stigma leads to nondisclosure of psychiatric illnesses, and shying away from treatment facilities; thus potentially leading to poorer outcomes in patients with psychiatric disorders. Label of a psychiatric disorder may also lead to discrimination, withering of social relationships, and social exclusion. Thus, stigma can be construed as an impediment to recovery among patients with psychiatric disorders. This thematic issue of Indian Journal for Social Psychiatry carries forth several articles related to stigma among patients with psychiatric disorders and substance use disorders.
The subsequent question that arises is that if stigma toward psychiatric disorders is associated with sinister implications, then can (and should) we do something about it? Several interventions have been suggested for dealing with stigma among patients with mental illnesses. These have been, for the sake of convenience, divided into protest-based approaches, education-based approaches, and contact-based approaches. The protest-based approaches gather attention and action against stigmatizing public statements, media reports, and advertisements. The education-based approaches attempt to counteract stigma by debunking myths and offering correct information. The contact-based approach attempts to modify the attitudes by bringing people into contact with an individual with mental illness and diminishing the stereotypes.
Who should be the recipient of stigma-related interventions is the next question to answer. Interventions have targeted a range of audience: general public, medical students, health-care professionals, personnel from law enforcement agencies, family members of patients with mental illnesses, and patients themselves. Health-care providers are important recipients of such interventions as the stigmatizing attitudes and beliefs of health-care personnel determine whether the patients with psychiatric disorders feel at ease while seeking care. Furthermore, patients with psychiatric disorders and substance use disorders often get into contact with police and judicial system. The law enforcement agencies thus need to be sensitized to psychiatric illnesses, so that stigmatizing attitudes arising out of misconceptions and stereotypes can be corrected.
Synthesis of published literature does suggest that stigma-related interventions do work, and result in reduction of the stigma toward psychiatric disorders. The comparative efficacy of the above-mentioned stigma reduction interventions has been evaluated in systematic reviews and meta-analyses., It has been suggested that the outcome of contact-based interventions are better than that of education-based ones. The type of disorders being addressed also makes a difference in the efficacy of the intervention. It has been observed that the efficacy of intervention may be better for those targeting depression, than those aimed at schizophrenia. The efficacy of interventions for stigma against substance use disorders is particularly low. Thus, some psychiatric disorders are easily amenable to stigma reduction measures while others are not. Whether the effect of interventions last for an adequate duration is another consideration, it has been suggested that the effect of education-based stigma reduction interventions usually last for a small period, and the impact wears off over a period.
The overall efficacy of stigma reduction interventions studied to date typically has small to moderate effect sizes., This means in controlled design, the interventions aimed at curtailing stigma do work, but not impressively. This coupled with the limited duration of efficacy of stigma-related interventions conveys the need for repeated and intense interventions targeting stigma. Given, the constraints in the generation of funds for mental health issues, policy makers are likely to be diffident in the allocation of ample resources for addressing stigma. However, since stigma affects individuals with mental health issues in a variety of ways, carving out enough resources to comprehensively tackle stigma would be something which would yield dividends in the long-term.
Challenging stigma in the Indian scenario would have several roadblocks unique to the country. Although the nation probably has the second largest population of individuals with mental health issues, considering the sheer population, the constraints on the health care resources are also immense. Less than 4% of the gross domestic product is spent on healthcare in India as compared to about 17% in the USA and about 5% in China. Furthermore, the funds allocated to mental health issues are a fraction of the total health budget in India. Thus, with limited health resources, scaling-up stigma-related interventions would be a challenge in the Indian milieu.
Another issue would pertain to the sociocultural milieu of the India. There are disparate views about the causation of mental illnesses in the Indian society. Beliefs about supernatural causation of mental illnesses are ingrained, and treatment from faith healers is common before the patients are brought into the fold of formal health-care seeking. This is more pronounced in rural areas, but families from urban areas also seek such methods of treatment. Thus, knowledge of the symptoms and causation of mental disorders needs to be imparted to the general public, before formal mental health-care seeking gets community acceptance.
Furthermore, implementation of contact-based interventions and protest-based interventions at this juncture would be an onerous task. Community sensitization about the needs of mentally ill is yet to occur on a broad scale. Contact-based interventions may still be attempted for among the health-care providers, but would be difficult to implement for the community. The individuals with mental illnesses and their caregivers need to be united more effectively before implementation of the protest-based measures.
Thus, several challenges lay ahead for dealing with stigma in the Indian scenario. Yet, concerted and collaborative efforts may help in addressing this challenge. Greater cognizance is required from the policymakers for the need to counter stigma toward psychiatric illnesses. Efforts need to be multi-pronged targeting several audience groups. Health-care professionals would be one of the most important groups, who would refer and provide care for psychiatrically ill subsequently. Hence, greater emphasis needs to be placed in the teaching among medical, nursing and other health professionals, with attempts at incorporating training that involves interaction with patients with psychiatric disorders. With increased awareness and acceptance of psychiatric disorders, probably the stigma associated with it can fade away.
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