To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Large efforts have been made to erase the stigma of mental illness, but it is unclear whether they have succeeded on a population level. We examine how attitudes toward people with depression or schizophrenia have evolved in Germany since 1990, and whether there are different developments for both disorders.
Using data from the three decades, four wave repeated cross-sectional representative population study in the “old” (western) states in Germany with surveys in 1990 (n = 2,044), 2001 (n = 4,005), 2011 (n = 1,984), and 2020 (n = 2,449), we calculate time-trends for social distance and emotional reactions toward someone with major depression or acute schizophrenia.
Social distance worsened in six out of seven situations for schizophrenia, whereas improving in two out of seven situations for depression. Emotions related to fear and uneasiness increased for schizophrenia, whereas tending to decrease for depression. Pro-social reactions like the desire to help increased for depression, but decreased for schizophrenia. Initially observed differences, favoring depression over schizophrenia, widened over the 30-year study period. For schizophrenia, the biggest negative changes occurred between 1990 and 2001, whereas some improvements with regard to depression occurred more recently.
Contrary to expectations, stigma has become more severe regarding acute schizophrenia in Germany over the last 30 years, whereas only slightly improving for depression. The apparent normalization of mental health problems seems not to directly translate into improving attitudes toward people with severe mental illness. Re-focusing of anti-stigma efforts on people with severe mental illness seems necessary.
Public attitudes toward mental illness create a cultural reality, defining what it means to deal with mental illness in a given place at a particular time. Time-trend studies show how the cultural conception of mental illness is changing, guiding our efforts to reduce the stigma of mental illness. Over the past decades, similar trends have emerged in several countries: Whereas professional treatment has become more and more popular for all mental disorders, attitudes toward persons with mental disorders have not generally improved. Looking at depression and schizophrenia, there are indications for a dissimilar development: Although someone with depression is met with increasing empathy and tolerance, and funding for depression treatment enjoys growing support among the public, people with schizophrenia face growing fear and rejection. Support for coercion like involuntary hospital admission also has increased. Attitudes toward people with substance use disorders have generally not changed and are particularly problematic. Whereas an overall broadening conception of mental health problems among the public seems to have improved attitudes toward people with common mental disorders, it is unclear whether this has had any positive effect on attitudes toward people with severe mental illness. The apparent divide in attitudes toward common versus severe mental illness poses a new challenge to future anti-stigma efforts.
Help seeking for mental health problems is a multifaceted and dynamic process involving both formal and informal networks that has many associated barriers. One of the prominent barriers is help-seeking stigma, which is stigma associated with asking for or receiving help. This stigma can emerge even during very early stages of the development of a mental health problem, leading to delays in receiving any care or support. The aim of help-seeking interventions is to mitigate the barriers associated with help seeking. Much of the research surrounding help-seeking interventions focuses on increasing mental health literacy, and developing cognitive techniques surrounding help seeking for improving mental health and reducing stigma by applying strategies including: psychoeducation, contact, and resource sharing. Systematic reviews show that the majority of interventions target formal help seeking. Research that is more recent has highlighted the potential benefits of online help-seeking interventions due to its accessibility and cost-effectiveness. This chapter reviews the current challenges of help-seeking interventions and future direction of research.
Substance use disorders (SUD) are among the most stigmatized mental health conditions. We explore the social function of SUD stigma, to demarcate the boundaries of acceptable behavior, and summarize how public stigma, self-stigma, and structural stigma increase harm due to SUD by delaying help-seeking, impairing treatment, criminalizing substance users, and reducing the life chances of people with SUD. We identify a continuum model of SUD, and a balanced view of social and individual responsibility, as potential areas where conceptual changes could decrease stigma. Contact-based interventions, education, and protest are strategies to overcome the stigma of SUD. Addressing the stigma of SUD will help to create a culture of hope, empowerment, and compassion, as well as high quality, stigma-free care for people with SUD.
Although health care is generally designed to help people, it has the potential to effectively impede recovery for people using substances by obvious and subtle discrimination. Stigmatizing attitudes among health professionals are common, regularly expected by people who use substances and potentially reduce quality of delivered clinical care. The power gradient that drives stigma and discriminatory behavior is particularly palpable in the healthcare setting and prevalent within different clinical situations like emergency medicine, primary care, and the psychiatric ward as within language. Comprising the current evidence of interventions, specific clinical settings and language regarding substance use stigma, we suggest recommendations for changes in clinical practice. Professionals need to avoid inflicting very real harm by increasing shame and reducing self-worth through stigmatizing settings, language, and concepts. Reducing substance use stigma is an integral and profoundly important part of caring for people who use substances and should be considered as such.
Substance use disorders (SUD) often occur in companion to other stigmatized characteristics, e.g., lower socioeconomic status, employment status, criminal record, race, gender, sexual orientation, or comorbid physical condition. Isolating each of these conditions when addressing stigma might miss the complexity of injustice and discrimination in our society. The concept of intersectional stigma addresses the effect of combined disadvantageous positions. This chapter provides an overview of findings on SUD stigma at intersectionality’s classical focal points: the intersections of race, gender, sexual orientation, and socioeconomic status. We then discuss the following questions: does intersectional analysis of SUD stigma need to include additional attributes to fully capture the multifaceted nature of SUD stigma, and how can they be identified? Are there common denominators of SUD stigma that can be addressed with broader benefit? Finally, we present how intersectional analysis can result in practical interventions that might help people with SUD become more resilient to stigmatization.
Stigma and discrimination of people with substance use disorders (SUD) contribute massively to the harm done by their condition: stigma has negative effects on service engagement, life opportunities, and personal shame, both for those who struggle with substance abuse and their families. Overcoming the stigma of substance use disorders is essential to aid recovery in those with SUD. This book provides an in-depth understanding of the stigma of SUD, and proposes ways to overcome it in different settings from the criminal justice system to healthcare. Combining a multitude of viewpoints within a consistent theoretical framework, this book both summarizes the latest evidence and gives hands-on advice and future directions on how to combat the stigma of SUD. People with lived experience of SUD, advocates, family members, policy makers, providers and researchers in the field of addiction stigma will greatly benefit from reading this book.
What people know and how they think about drug use, consumption practices, and addiction is considerably influenced by the way the topic is talked about and framed in the media. Problems associated with the stigma of substance use disorders (SUDs) point to the need to identify factors that contribute to stigmatization and the urgency to outline courses of action to combat the stigma of addiction and other SUDs. The chapter first lays out the role the media take regarding the stigmatization of people with SUDs and refers to theoretical approaches in communication science. Findings on the coverage of people with SUDs in the media and mechanisms that lead to stigmatizing portrayals are delineated. In a second step, media guidelines as a possible means to strengthen the destigmatizing role of the media are described and discussed. Against this background, the media’s role in reporting for substance use stigma is discussed.
Using insights from previous chapters we consider three issues going forward. First, we unpack varied goals of stigma change and corresponding agendas to achieve them. Second, we describe who is the best advocate for stigma change. Third, we reflect how the experience of SUD stigma is colored by national perspectives. We end viewing the status quo, on one hand, with optimism -- SUD stigma is an injustice to be erased – but nonetheless with the sobering realization that bigotry in general (not just SUD but racism, sexism, and homophobia) are stubborn enemies to beat. Still, as in other civil rights movements, we believe that grassroot anti-stigma programs led by people with lived experience are the best approach for change in the near term.
The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.
This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.
1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].
The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.
Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. This systematic review and meta-analysis examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma.
Following a pre-defined protocol (PROSPERO: CRD42019123606), we searched three electronic databases (PubMed, Web of Science, and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness, and stigma. Of these, 13 studies were included in meta-analysis.
Continuum beliefs are consistently associated with lower stigma. Interventions were effective at manipulating continuum beliefs but differ in their effects on stigmatising attitudes.
We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of ‘us’ and a process of identification with the person with mental illness. We discuss implications for the design of future interventions.
– It is commonly assumed that reforms in the sector of psychiatric care have contributed to reducing the stigma attached to mental illness. In order to examine whether a relation between the psychiatric care set-up and stigmatisation of the patients exists we compared public attitudes towards mental patients in three countries at differing stages of progress in psychiatric reform.
– Population surveys on public attitudes towards mental patients were conducted in Novosibirsk (Russia) and Bratislava (Slovakia). The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys the same sampling procedure and fully structured interview were used. Public attitude towards mental patients was elicited using a perceived devaluation-discrimination measure.
– Psychiatric patients face considerable rejection in all three locations in question. Overall, the degree of perceived devaluation and discrimination was similar in all countries with a significant, but marginal tendency towards stronger devaluation of mental patients in Germany.
– Our results do not support a strong relationship between psychiatric reform and mental illness stigma.
To examine the evolution of the perception of the stigma attached to mental illness in Germany since 1990 up to the present.
Subjects and methods
Population surveys were conducted in the old German States (former Federal Republic of Germany) in 1990, 2001, and 2011. The perception of stigma attached to people with mental illness was assessed with the help of Link's perceived discrimination and devaluation scale.
In the 2011 survey, less mental illness stigma was perceived by respondents than in the previous surveys. In the eyes of the German public, the devaluation and rejection of people with mental illness has substantially decreased since 1990.
The perception of a decline of the stigmatization is in contrast to the development of the German public's attitudes towards persons with mental disorders, which remained unchanged or even worsened.
Perceived and personal attitudes towards persons with mental illness have developed differently, and it remains to be seen whether perceptions of less public stigma will ultimately be followed by improved personal attitudes.
To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care.
Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied.
The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02–1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97–5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12–3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03–1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist.
The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.