The Effects of Stigma on Accessing Mental Health Care

There are many perks to living in a city like Toronto, a drive down to Young and Dundas for shopping and a movie, a few blocks up to Young and Bloor for some delicious Shawarma, or Front and Jarvis St. for some grocery shopping at St. Lawrence Market. I feel confident in saying that you can find practically anything in this city. However, living in a big multi-ethnic city may also lead to more stressors. Canada is a great country, and free healthcare is most likely due to its high life expectancy of 80- 84 (“Canada”)[1].  The mental and physical well-being of individuals is important in leading a happy life. Yet accessing health care or accessing proper treatment for healthcare becomes a barrier that many vulnerable and racialized members of society face, one can’t understand these barriers without understanding the social determinants of health.

Social Determinants of Health

Access Alliance has come out with multiple reports, research papers and literary reviews looking at the social determinants of health. Of the many barriers, the main issues can be broken down into 5 points[2]:

  1. Financial – issues surrounding housing, income, medical costs (specialists, medicines) etc.
  2. Cultural – practices of the patient or health care provider, discussion or help around sensitive health issues, traditional and religious observations, perceptions of illnesses etc.
  3. Linguistic barriers – communication barriers especially with tSocial Determinants of Healthhose who do not speak English (or French)
  4. Geographic barriers – members living in under-serviced or marginalized areas may find difficulty in gaining access to proper health care centers or transporting
  5. Discrimination- whether on the basis of gender, sexual orientation, immigration status (especially in cases of uninsured people), studies have shown that they often effect the ways in which individuals receive service.

In addition to these barriers contributing to mental health, the stigma that is attached to mental health makes it even more difficult to get help or a diagnosis.

Mental Health Stigma

A study by the Canadian Mental Health Association (CAMH) states that 1 in 5 Canadians will suffer from mental health issues in their lifetime (Canadian Mental Health Association)[3]. Whether this is depression, anxiety, post-traumatic stress disorder, bi-polar disorder, substance abuse, eating disorders or other personality disorders. Everyone is at risk, yet often time people don’t seek out help, with only 1 out of 5 children who need help receiving it (Canadian Mental Health Association)[4]. There is a stigma that individuals attach to mental illness and these stigmas lead to the mistreatment and misdiagnosis of individuals.

stigma_finger

The rhetoric surrounding mental health can be damaging, whether an individual is saying “Just eat!” to someone suffering from an eating disorder, or “Get it together, it could be worse.” to someone going through depression. It’s simple to forget the strength of words. Just recently I had a conversation with someone and they said: “This bipolar weather makes me so depressed”.  We take away the experiences of individuals – we devalue and delegitimize the actual emotional experiences of a person. Women may also face alternate barriers to getting mental health treatment, their mental health may be downplayed to be “hormones”, or worse yet “Premenstrual Syndrome (PMS)”. Now although PMS is real, it should not be used to delegitimize real emotions a woman may be feeling.

At times health care providers may be quick to lessen the mental illness stating that it is a biological issue, while other psychiatrists may be quick to diagnose an individual with a mental illness (Fink and Tasman,1)[5] . Even treatments are often stigmatized, with individuals who take medication seen as weaker than those who can cope without it. Or electroconvulsive therapy (better known as electroshock therapy) seen as an ineffective treatment of the past[6], yet it is one of the most prevalent methods used as a last resort for more severe mental health issues like depression (Wells and Zlomislic)[7].

I remember when a friend of mine was going through what I perceived as a severe bout of depression, during our conversation I told her to see a counselor or therapist who may better provide help. She told me that visiting one would lead to her getting medicated, which she felt would lead to dependency, instability and more health issues than she had prior.  She is not alone in this view.

The social stigma which is carried by individuals has led to mental illness being seen as a taboo topic in many communities. With a generalization of people with mental health issues portrayed as dangerous. The media perpetuates these stereotypes through new stories, films and movies which either trivialize mental health issues, or over dramatize them.  They portray individuals with mental illness as unstable, dangerous and often malevolent.  Similarly, they portray teenage girls in films with eating disorders as vain and vapid. The complexities and multi-dimensional layers are rarely portrayed- surely it is not all black and white.

eating-disorders
(Segal, 2014)

Eating Disorders

Being regularly bombarded by the media takes away what little solace we may already have in our day. However, the factors that contribute to the development of an eating disorder is unknown. Studies have shown links to genetic vulnerability, psychological factors as well as socio-cultural influences.  Eating disorders can develop in individuals dealing with body image issues, stress or low self-esteem. Bombarded by photo shopped images and unattainable beauty standards in the media, or perhaps triggered by stressors or experiences in their own lives.

The three main eating disorders are (“Eating Disorders – Canadian Mental Health Association.”)[8]:

  1. Anorexia nervosa – often driven by a strong desire to be thin, measures such as not eating, over exercising or puking.
  2. Bulimia nervosa – over eating then puking or using laxatives.
  3. Binge-eating disorder- impulsive over eating, often as a way of dealing with emotions – to cope or find comfort.

If eating Disorders are not dealt with, many health issues can develop. That is why getting help is crucial.

 

Take Care of your Mental Health and the Mental Health of Others

My father used to say “Your mind is all you have”, and I can only imagine the personal struggles one may feel, let alone being trapped, afraid or alienated in your mind – the one place that you should find solace.

Mental Illness not only effects individuals, but it effects the people around them- whether family, friends or significant others. They may feel they caused it, or that they can’t help; the inability to provide support or cope with what they perceive as instability may lead to break ups or families seeing less of each other. There needs to be a broader understanding and de-stigmatization of all forms of mental health. From a personal level – of understanding, acknowledging and accepting it, to a community level of acceptance and understanding. Once communities begin having an open dialogue, the stigmas will easily disappear and people will no longer feel as though they are alone in their minds.

It’s great to see projects like “Bell Let’s Talk”, training of public workers (from police, social workers, doctors, teachers etc.), and new organizations forming focusing on the improvement of mental health issues. There is still a lot of work to be done! Knowledge is power and speaking against negative stereotypes will lead to the de-stigmatization of mental illnesses. There needs to be better representation of people with mental illness in the media, I know fighting these stigmas is the first step in creating better health, diagnosis’ and outcomes for all people.

 

Other resources

Title Banner is “Stamp Out Stigma” campaign by Oxford & Buckinghamshire NHS to confront stigma of mental health.

Romahno, John. Prevention Psychology: Enhancing Personal and Social Well-being. Washington, D.C: American Psychological Association, 2015. Print.

“Eating Disorders Risk Factors.” What Causes an Eating Disorder? Risk Factors. Web. 29 Jan. 2016. < http://www.nedc.com.au/risk-factors>

“Eating Disorders – Canadian Mental Health Association.” Canadian Mental Health Association. 2015. Web. 29 Feb. 2016. <https://www.cmha.ca/mental_health/facts-about-eating-disorders/#.VqrdABz8ca8>

“National Centre for Eating Disorders – Facts About Eating Disorders.” National Centre for Eating Disorders. 2012. Web. 29 Jan. 2016. < http://eating-disorders.org.uk/information/facts-about-eating-disorders/>

[1] “Canada.” World Health Organization. Web, 29 Jan. 2016

[2]  Access Alliance. “Racialised Groups and Health Status: A Literature Review Exploring Poverty, Housing, Race-Based Discrimination and Access to Health Care as Determinants of Health for Racialised Groups”. 2005. PDF file. http://accessalliance.ca/wp-content/uploads/2015/03/Racialised_Groups_Health_Status_Literature_Review.pdf

[3] “Fast Facts about Mental Illness – Canadian Mental Health Association.” Canadian Mental Health Association. Web. 29 Jan. 2016.

[4] “Fast Facts about Mental Illness – Canadian Mental Health Association.” Canadian Mental Health Association. Web. 29 Jan. 2016.

[5] Fink, Paul Jay. and Allan Tasman. Stigma and Mental Illness. Washington, DC: American Psychiatric, 1992. Print.

[6] I am also guilty of this assumption

Segal, Molly. “Eating Disorder One-on-one Support Thanks to New Funding.” CBC. 4 Dec. 2014. Web. 23 Feb. 2016. <http://www.cbc.ca/news/canada/nova-scotia/eating-disorder-one-on-one-support-thanks-to-new-funding-1.2859819&gt;.

[7] Wells, Jennifer, and Diana Zlomislic. “Electroshock Therapy More Prevalent in Ontario, but Guidelines Are Minimal.” Toronto Star. 13 Dec. 2012. Web. 29 Jan. 2016. <http://www.thestar.com/news/gta/2012/12/13/electroshock_therapy_more_prevalent_in_ontario_but_guidelines_are_minimal.html&gt;.

[8] “Eating Disorders – Canadian Mental Health Association.” Canadian Mental Health Association. Web. 29 Jan. 2016.

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