Impedance of Help-Seeking

The prejudice and discrimination that characterise the stigma of mental illness significantly contribute to the disconnect between effective treatments and care-seeking (Corrigan et al., 2014). The unwanted repercussions of mental health stigma, such as anticipated and experienced discrimination, and poor treatment both personally and professionally, have all been linked to the taboo of help-seeking for mental health problems globally (Yoshimura, Bakolis, & Henderson, 2018). Individuals who do not seek help fear the judgement and persecution of public opinion should they be found in a scenario that does not conform to socially accepted views of health and wellbeing (Corrigan & Shapiro, 2010; Lucksted & Drapalski, 2015).

Research underscores how stigma serves as a barrier to help-seeking for children (Adler & Wahl, 1998), adolescents (Chandra & Minkovitz, 2007), adults (Vogel, Wade, & Hackler, 2007), and elders (Graham et al., 2003). Stigma impacts care seeking at personal, provider, and system levels. Stigma and discrimination can impede access to care at institutional, community and individual levels in the following ways: institutional through legislation, funding, and availability of services (Corrigan et al., 2004b); community through public attitudes and behaviours (Evans-Lacko. Baum, Danis, Biddle, & Goold, 2012), and individual through self-stigmatisation and feelings of shame in seeking help (Rusch et al., 2009).

Stigma underlies the shame and secrecy associated with suffering from mental illness, and the reluctance to self-disclose which inhibits access to care as sufferers are wary of how others will view them once they disclose their disorder (Byrne, 2000; Dinos et al., 2004; Tanaka, Ogawa, Inadomi, Kikuchi & Ohta, 2003). Similarly, they attempt to avoid the unfair discrimination and loss of opportunity that comes with stigmatising labels by avoiding going to clinics or interacting with mental health providers with whom the prejudice is associated (Corrigan, 2004). Patients who are seen by non-psychiatric health workers in general health facilities are apprehensive of referral to psychiatrists or other mental health professionals (Hartley, Korsea, Bird, & Agger, 1998; Regier et al., 1993). This arises in most circumstances for reasons that include patients feeling more comfortable with non-psychiatric workers in general health facilities and the desire to avoid being labelled ‘mentally ill’.

In a study of a rural Australian community (Fuller, Edwards, Procter, & Moss, 2000), the authors report that every person they interviewed concluded that mental health problems were associated with a high degree of stigma, and many suggested that they were associated with fear. A social worker in the study reported that "... a lot of people won't come in (for treatment) because...mental health (has) got that stigma ... you know, I’m not a nut case ...” and according to a telephone counsellor in the study: “... some are shocked when you ... try to give them a referral to a mental health service. Because they may think that’s only for weirdos, people who are mad.” A mental health consumer and advocate in the study similarly declared that “... because of the stigma attached to mental illness ... the last thing you want to do is to go into the system and seek help.”

The conventional understanding of mental health problems as implying irremediable insanity leads to a fear about what happens to people who become clients within the mental healthcare system. The telephone counsellor further stated: “... [people] see mental health as like the one step on from ... [the asylum] ... like all the people in the white coats. ‘I don’t need that sort of thing.”' The implication is that, even when people do recognise their distress, they may avoid formal mental health services, not perceiving them as an appropriate source of help. Owing to stigma, some would still not seek help even when the situation has become critical. The South African Federation of Mental Health (2011) revealed that South Africans would rather die than admit to mental illness.

Stigma is a powerful inhibitive factor for help-seeking even for battle-hardened soldiers. Over 3000 military staff from the US Army or Marine Corps units that had served combat duty in Iraq or Afghanistan were

Consequences of the Stigma of Mental Illness 35 anonymously surveyed three to four months after their return. They were assessed for depression, anxiety, or post-traumatic stress disorder (PTSD). The majority of the affected soldiers (60 77%) did not seek mental healthcare mostly due to concerns about possible stigmatisation (Hoge et al., 2004).

It has also been argued that self-stigma is a much more potent stigma that may directly inhibit help-seeking since the individual perceives the act of seeking professional help for distress as a threat to their self-worth and as a weakness of character (Vogel & Wade, 2009). Families and relatives, who are stigmatised by association, could hide ill relatives and not talk about their condition, thus practically foreclosing access to care. Associative stigma could add to the burden of care which could lead to extreme measures such as child abuse, neglect or abandonment with a report alleging that some mothers of children with intellectual disabilities had considered doing away with their children in Nigeria (Abasiubong, Obembe, & Ekpo, 2006).

Thus, stigma leads to non-utilisation, underutilisation or delay in the utilisation of mental health services, living in denial of mental health problems and early termination of mental health treatment. Delay in seeking medical treatment at the onset of illness results in symptoms being aggravated as patients try to cope on their own and the family is frightened of the consequences of releasing this information (Tanaka et al., 2003). Studying Arab clients in mental health settings, Al-Krenawi and Graham (2000) noted that stigma might have a particularly gendered implication with the potential damage that mental health help-seeking could cause to present and future marital prospects of females, including the possibility of divorce or the husband taking on a second polygamous wife.

Over 70% of Arab American women reported feelings of shame associated with seeking formal social services, and almost this number, too, reported embarrassment associated with reporting their problem to people outside of their family (Al-Krenawi, Graham, Al-Bedah, Kadri, & Sehwail, 2009). On the other hand, men may associate formal helpseeking with a diminishment of their masculinity and abilities to be strong providers and family leaders (see Chapter 7, Culture of Self Reliance).

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