Table of Contents
Results: Hypothesis 1, 2 & 3
Results: Hypothesis 4
Attributions of dangerousness
Attribution of avoidance
Results: Hypothesis 5
Research showed that the majority of the people have negative stereotypical views with regards to severe mental illness (Byrne, 2001; Angermeyer, Holzinger & Carta, 2011). Studies indicate individuals with SMI are aware of the social stigma attached with the psychiatric illness. Hence, to avoid labeled and ridiculed by the society, they often keep their illness a secret (Angermeyer & Matschinger, 2003). Goffman (1963. as cited in Corrigan,Markowitz &Watson , 2004) defined stigma is an endorsement of discredit or disgrace which allows social isolation. Corrigan (2000) posited that the stigma of severe mental illness (SMI) is a socio–cognitive process which interprets and discredits salient invalid cues through stereotypic thoughts. Unfortunately, stigma is not an attribute that remains internalized within a person, but it translates into discriminatory behaviour. Individuals with SMI not only suffer silently but also endure prejudice, isolation and social injustice. Numerous studies suggest that knowingly or unknowingly the general community including employers and corporate leaders practice or have discriminatory policies that stigmatized people with SMI (Corrigan, Watson, Warpinski & Gracia, 2004). However, because the stigma is a social interaction process, contact familiarity (Angermeyer, Matschinger &Corrigan,2004 ; Corrigan, 2005) and knowledge about SMI (Corrigan et al., 2004) greatly affect attitude change and social distance (Corrigan et al., 2001). Tacking public stigma of SMI is important because researchers can identify social inequalities and introduce humanistic practices that address the rights of individuals with SMI. Social research on public stigma of SMI has serious implications on public health educators, healthcare system and politically motivated laws.
According to The National Alliance on Mental Illness (NAMI, 2013) one in four people experience mental illness at some point of time and worldwide 450 million people are living with mental health conditions. The health and social costs of not including individuals with mental health disabilities from taking active social roles leads to high productivity losses in human potential and remain vital health issues as well as a personal burden to the stigmatised (Cyhlarova, McCulloch, McGuffin & Wykes, 2010). The biogenetics causal models of psychiatric disorders posited that schizophrenia, bipolar disorders and other significant depressive illnesses are the consequences of genetics and neurobiological factors (Rusch, Todd, Bodenhausen & Corrigan, 2010). The recovery models of SMI postulated psychopharmacological drugs alone are insufficient for holistic recovery but requires an integrated biopsychosocial approach that maximises the lives of the persons with SMI (Killaspy et al., 2013). The researchers suggested that the social inclusion of SMI not only allows better control over their lives but also reduce social inequalities (Killaspy et al., 2013). However, qualitative studies on service users experience revealed that accesses to social resources and meaningful employment opportunities are few and not common among people with SMI (Tew, 2005; Lewis, 2009).
A survey report by the National Institute for Health Resources (NHS) in UK on public stigma of SMI revealed only 20,000 of the 500,000 people with SMI have secure employment of job (NHS, 2013). In addition, seventy one percent of people with SMI indicated public stigma has left them vulnerable to abuse, violence and victimization (National Mental Health, 2013). For individuals with SMI, the most common barrier which prevents access to treatment, social and economic opportunities is public stigmas associated with the view of fear and dangerousness (Penn, Kommana, Mansfield & Link, 1999; Corrigan et al., 2002). The biomedical models, DSM classification and the clinical risk management models of mental health practices has vastly contributed to the understanding, diagnosis and risk factors of SMI. However, the fact that these models encouraged public distance and understanding that psychiatric disorders are dangerous cannot be denied (Read, Haslam, Sayce & Davies, 2006). Systematic population review of thirty-three research pertaining to biogenetic explanations on public attitude, beliefs and social acceptance of mental illness indicated that the general public associated mental disorders with stereotypes of unpredictability and dangerousness (Angermeyer et al., 2011). Similarly, Link and colleague’s (1999) summarised report on General Social Survey in UK found that people associated DSM labels of schizophrenia and other major depressive disorders with strong views of the danger and less desire for social integration. The study found that vignettes depicted Schizophrenia (88%), major depressions (61%), alcohol (49%) and drug (44%) abuse with mental illnesses received much greater understanding of dangerousness than depiction of the other types of troubled individuals (17%). The above findings suggest that the public perception of dangerousness of SMI is not in proportion to reality.
Corrigan , Edwards, Green , Diwan and Peen(2001) developed the Attribution Model of Public Discrimination towards Persons with Mental Illness and the AQ-27 attribution questionnaire based on the theoretical study by Reisenzein (1986) and Weiner (1995). Meanwhile, Corrigan, Green, Lundin, Kubiak and Penn (2001) modelled The Level of Familiarity (LOF) questionnaire based on Holmes and colleagues (1999) Level of Contact. The Attribution model works on the theory that familiarities with SMI influence attitude and approach-avoidance behaviour. Change in attitude is also achievable through mediation of factual knowledge or education about SMI. Meta analysis of seventy two research findings from fourteen countries indicated large effect sizes, suggesting a linear relationship between the perception of dangerousness, avoidance, education and contact (Corrigan et al., 2012). Numerous studies have supported the reliability of the AQ-27 questionnaire and allow various examinations of stereotypes and discriminatory behaviour towards persons with SMI among the adult population samples (Rusch et al., 2010; Kanter, Laura, Rusch & Brondino, 2008). The AQ-27 questionnaire measures nine stereotypes, Blame, Anger, Pity, Help, Dangerousness, Fear, Avoidance, Segregation and Coercion. The Level of Familiarity (LOF) examines eleven scenarios of varying degree of contact that involve people with SMI. The lowest ranked level of intimacy indicates less social tolerance and the highest ranked scores indicates less desire for social acceptance of people with SMI.
Corrigan and colleagues (2002) examined the theoretical relationship between the perception of dangerousness and self-responsibility on pity, anger and fear and their intention to help or avoid from persons with SMI. Two hundred thirteen community college students participated in one of the five anti-stigma conditions; influence of education on dangerousness or personal responsibility, personal responsibility or dangerousness on contact with persons with SMI and a control condition with no difference. Participants completed Attribution Questionnaire at pre-test, post-test and after one week. The findings indicated that the personal contact was a significant predictor of attitude change than education. The results also revealed that dangerousness model yielded much stronger expressions of a desire for avoidance than personal responsibility (Corrigan et al., 2002). Corrigan, Green, Lundin, Kubiak & Penn (2001) also tested the path model linking stigma of dangerousness, fear, avoidance and familiarity with SMI and the application of AQ-27 and LOF questionnaire on 208 community college students (Corrigan, Green, Lundin, Kubiak & Penn, 2001). The study found ninety percent of the respondents were familiar with SMI through movies, more than a quarter of the respondents reported having worked with individuals diagnosed with SMI, and a third reported having a friend of relatives with SMI (Corrigan et al., 2001). The results indicated a significant correlation between familiarity and stigma of dangerousness, such that increased familiarity associated with reduced dangerous beliefs about SMI and less desire to avoid.
Rusch, Kanter and Brondino’s (2009) comparative study on clinical and non clinical undergraduates revealed a linear relationship between the attribution and the biomedical models of stigma, such that clinical students’ perception of people with severe depression associated with biomedical explanation of the illness. Chikaodiri (2010) examined social avoidance towards adults with SMI among mental health professionals. The findings revealed more than three in five participants acknowledged high level of familiarity through experience of watching movies on mental illnesses. However, almost all participants indicated a desire to stay away from people with SMI, such that increased level of familiarity with the movie associated with negative social attributes of dangerousness, fear and responsibility factors. These findings appear to support Corrigan and colleague’s (2001) view that familiarity with mass media contributes to stigma of SMI. Balhara, Majumder and Lal’s (2011) comparative study examined the attitudes of tertiary level nurses, nursing staff and trainee doctors towards patients with SMI. The findings indicated heightened level of stigma in all nine attributes among the medical professionals. However, caution must be advised that all three studies (Rusch, Kanter & Brondino, 2009; Chikaodiri, 2010; Balhara, Majumder & Lal, 2011) have examined the impact of education, contact and social distance on the stigma of SMI independently and not simultaneously.
Numerous journal articles on the stigma of SMI have also found differences in stigmatizing characteristis and social distance based on the demographics of the study participants (Ciftci & Jones & Corrigan, 2013). Research on gender differences found significant main effect for gender, such that women tended to endorse vignettes with SMI as more dangerous than men (Corrigan & Watson, 2007). However, findings with regards to gender bias in the stigma of SMI have not been consistent. Several studies have found that women more than men are willing to have a close relationship with a person diagnosed with SMI ((Marie & Miles, 2008; Phelan & Basow, 2007). Ferrer and colleagues (2008) analysis of an epidemiological study conducted between 2003-2004 in Australia found influence of age on stigmatizing attributes and avoidance, such that older adults demonstrated higher mental health literacy about schizophrenia and severe depression than young adults (Farrer et al., 2008).