Stigma: The Attitudes, Experiences, and Coping Mechanisms of People Attending Public Mental Health Clinics

Most people with psychiatric problems live in the community. These problems impact on their lives in various ways, including the way they cope with the associated stigma. This study is the first attempt in Israel to understand the experience of stigma from the perspective of people attending mental health clinics. Stigma is likely to deter people from seeking help, contribute to social isolation, induce fear of rejection, and harm the person’s clinical condition and his or her rehabilitation. Due to this stigma, some people in need of mental health care (whether or not they have been diagnosed with a psychiatric illness) prefer not to seek help, which may lead to an unwarranted deterioration in their condition.

This is one in a series of studies conducted jointly with the Mental Health Services of the Ministry of Health to suggest directions for interventions to reduce stigma with regard to objectives, intervention methods, and target sub-populations. The study described in this report is a preliminary examination of the stigma experience as perceived by people attending mental health clinics, whether or not they are classified as psychiatric patients. Altogether, 167 people attending three mental health clinics in the Jerusalem district were interviewed, 109 of whom had been admitted to hospital for psychiatric reasons in the past. Concurrently, a preliminary study of parents of people with psychiatric illnesses and another study, which focused on the attitude of the general population and was based on a representative nationwide sample, were also conducted.

We found, inter alia, that 45% of the interviewees feared that friends would distance themselves and over a third feared rejection by members of their family. In fact, 40% had actually experienced rejection by friends and about a third had experienced it by family members. Over a third reported that others stopped treating them as “normal” people when they learned that they were having treatment. It is therefore not surprising that over half the respondents tend to hide the fact that they are in treatment, as a way of coping.

The report reviews a number of directions for intervention, while emphasizing that caution is required given that the sample is small. Many respondents said that the issue of social stigma and its implications did not come up in the treatment setting. Thus, it is important to find ways to encourage discussing these issues in the treatment setting. The study found that even those receiving treatment themselves had stigmatic views of people with mental disorders. Thus the report proposes working with these people and emphasizing their positive characteristics and strengths, as a group. The findings also reveal that the organization of groups should be encouraged, as a source of mutual emotional support. With regard to where mental health care is provided, it appears that if in the future this is to be in general clinics, there is a need for preparation, since the respondents expressed a certain preference for dedicated mental health clinics as the setting for ambulatory mental health care. This finding is in keeping with a weak trend found in the national representative study of the general public.

The study was funded with the assistance of the National Institute for Health Services and Health Policy Research.

Citations in the professional and academic literature

Sykes, I., Menashe, E., Lazerwitz, E., Vlodavsky, A., & Zaga-Shabbat, L. (2007). Reflections on an effort to develop a cross-disability consciousness inclusive of people with psychiatric disabilities. Disability Studies Quarterly27(4).

רועה, ד., טל, א., בלוש—קליינמן, ו., שרשבסקי, י., לידור, נ. ה., תלם, ע., … & Shershevski, Y. (2011). Psychiatric Rehabilitation: On the Way to Becoming a Profession/השיקום הפסיכיאטרי: בדרך לפרופסיה. ביטחון סוציאלי, 85-105.