Mental Health Related Stigma as a ‘Wicked Problem’: The Need to Address Stigma and Consider the Consequences

Abstract

Recent reviews on the evidence base for mental health related stigma reduction show that under certain conditions interpersonal contact is effective in promoting more positive attitudes, reduced desire for social distance, and increased stigma related knowledge (knowledge which disconfirms beliefs based on stereotypes). Short-term interventions may have effects that are attenuated over time; longer term programmes may support sustained improvements, but research following up long-term interventions is scarce. However, the effectiveness of these interventions should not obscure the nature of stigma as a social problem. In this article we describe stigma as a ‘wicked problem’ to highlight some implications for intervening against stigma and evaluating these efforts. These include the risks of unintended consequences and the need to continually reformulate the concept of stigma, to ensure that tackling stigma at the structural, interpersonal, and intrapersonal levels become part of the core business of stakeholder organisations. We compare the main targets of anti-stigma programmes with what is known about the sources of stigma and discrimination and their impacts to identify targets for future intervention. In some cases, interventions have been directed at the interpersonal level when structural level intervention is also needed; in others, systematic reviews have not so far identified any interventions.

Effectiveness of an anti-stigma training on improving attitudes and decreasing discrimination towards people with mental disorders among care assistant workers in Guangzhou, China

“…However, there is strong evidence suggesting that the ignorance of mental illness knowledge and prejudice and discrimination against people with mental illness among the care assistant workers are significant barriers in mental health care implementation [18][19][20]. These negative attitudes and discriminatory behaviors could lead to adverse consequences, such as unwillingness to provide mental health care, feeling impatient, spending less time on them, and paying unequal attention and substandard care for their physical health complaints and sometimes even ignore their human rights [21][22][23][24]. What's worse, training programs for care assistant workers that integrate health education and stigma and discrimination reduction techniques are rarely implemented in China.…”

Assessment of the Opening Minds Scale for use with nursing students

“…The stigma attached to being labeled with mental illness remains a pervasive social problem . As illustrated in a review by Henderson and Gronholm, mental health–related stigma has far‐reaching debilitating effects on: help seeking, education, employment, housing stability and safety, social care, health care access and quality of service.…”

The Wicked Problem of Stigma for Youth Living With Anxiety

“…According to Link and Phelan (2001), stigma occurs when interrelated components converge: labeling; stereotypes; separation (us/them); status loss; and discrimination leading to unequal outcomes. Mental health stigma is a complex social problem that operates at multiple levels-interpersonal, intrapersonal, and structural (Hatzenbuehler & Link, 2014;Henderson & Gronholm, 2018;Link & Phelan, 2001).…”