Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals

Abstract

The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.

Ethical Dilemmas of Participation of Service Users with Serious Mental Illness: A Thematic Synthesis

“…They also report a retrospective desire for professionals to go against their wishes so that they can (still) receive the care they need (Skorpen, Rehnsfeldt, & Thorsen, 2015). Lastly, some service users say they are frustrated by being expected to be assertive, reflexive and express themselves while feeling that they lack the skills to do so (Sercu & Bracke, 2016 (Lindwall, Boussaid, Kulzer, & Wigerblad, 2012). They describe situations in which they forgo their own suggestions and follow service users' wishes related to support and treatment (Topor et al, 2006) even when they disagree (Lakeman, 2010).…”

“…Open dialogue also helps service users to convey their preferences and concerns to professionals and that enables professionals to consider what matters to the users (B€ ack-Pettersson et al, 2014;Skorpen et al, 2015). For service users, the important aspects of dialogue include professionals taking the time to listen and be responsive to their ideas, opinions and feelings (B€ ack-Pettersson et al, 2014;Blegen et al, 2016;Coatsworth-Puspoky et al, 2006;Eriksen et al, 2012;Happell, 2008;Schr€ oder et al, 2006;Schroeder, 2013;Sercu & Bracke, 2016;Shattell et al, 2006;Skorpen et al, 2015;Topor et al, 2006). Even when service users are incoherent or angry and reveal negative views of their treatment or professional relationships, they prefer professionals to stay calm, act respectfully, and take them seriously (Coatsworth-Puspoky et al, 2006;Lindwall et al, 2012;Schr€ oder et al, 2006;Shattell et al, 2006).…”

“…Professional behavior that promotes the professional's control and authority over the service user leads to unsatisfactory relationships in the perception of service users. This includes situations in which service users are not being heard or talked down to (Coatsworth-Puspoky et al, 2006;Eriksen et al, 2012;Gaillard, Shattell, & Thomas, 2009;Lindwall et al, 2012;Skorpen et al, 2015) or defined by their diagnostic label (Blegen et al, 2016;Coatsworth-Puspoky et al, 2006;Gaillard et al, 2009;Lilja & Hellz en, 2008;Schroeder, 2013;Sercu & Bracke, 2016;Shattell et al, 2006).…”

“It’s When the Trees Blossom”: Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana

“…Ultimately, outcomes may be improved if clinicians seek to understand patients' causal beliefs and integrate these views with their biomedical treatment to enhance therapeutic alliances and treatment engagement (Dixon, Holoshitz, & Nossel, 2016). Stigma in care settings has been found to be mitigated when treatment aligns with explanatory beliefs (Sercu & Bracke, 2017). Peer support and traditional healers could be utilized to facilitate treatment engagement.…”

Psychosoziale Beratung in einem gemeindepsychiatrischen Zentrum – eine qualitative Studie über die Erfahrungen der Nutzer

“…Dennoch scheint das GPZ eine wichtige Rolle als Anlaufstelle für Personen mit psychischen Störungen zu spielen, die nicht stationär behandelt werden möchten. Internationale Studien belegen, dass Nutzer eine Krankenhausbehandlung v. a. dann ablehnen, wenn sie negative Vorerfahrungen im Krankenhaus gemacht haben, oder sich vor "Psychiatrisierung" und Stigmatisierung fürchten [14,20]. Die Beratungsstelle des GPZ könnte möglicherweise dabei behilflich sein, einen Zugang zu dieser Gruppe von Patienten anzubahnen.…”