People with schizophrenia put up with a lot more than their illness. Stigma, from both the community and from health professionals, contributes yet another major stress they can well do without. Many people with schizophrenia say that the stigma and prejudice associated with their illness is as distressing as the symptoms themselves. In a survey people with mental illness and their families said ?less stigma? was the number one thing that would make their lives better. They wanted healthcare workers who ?treated them with more respect?, who ?would appreciate just how far a little kindness goes?, and a community that ?would understand that we are not lazy or weak? and that recovery is not simply a matter of ?pulling yourself together?.
Stigma contributes to loneliness, distress and discrimination against people with a mental illness and their families. Indeed, more than 40 negative consequences of stigma have been identified,2 including discrimination in housing, education and employment and increased feelings of hopelessness. The end result is that many people are reluctant to seek help, less likely to cooperate with treatment, and slower to recover self-esteem and confidence. Tragically, this leads many to suicidal behavior. It is important, therefore, for
clinicians and other healthcare workers to appreciate that stigma and its associated prejudice form a very real barrier to recovery and may even be fatal.
What can health professionals do?
As health professionals we have a responsibility to put our own house in order first, to look at ways to improve the attitudes and behavior of many healthcare workers. Norman Sartorious has coined the phrase ?iatrogenic stigma?. The aims of the Open the Doors program are to :
Sartorious believes that medical professionals, especially psychiatrists, contribute to stigma through both the careless use of diagnostic labels and through treatments that produce significant side effects (such as extra pyramidal signs), which mark the person as having a mental illness more so than the original symptoms. Discriminatory behavior by doctors in general can also be implicated in the excessive premature death rate among people with mental illness (particularly from cardiovascular disease 5 ) there is a tendency to
ignore these patients? general health problems or discount them as being delusional. Early diagnosis of physical illness in people with schizophrenia must also be followed up effectively to ensure true equity in healthcare. Longer-consultation fees and new mental-health item numbers (available from 1 July 2002) are being accessed by general practitioners with the required training, and should make this a more realistic possibility. The challenge is also to develop strategies to bring about systemic change so that the rights of people with mental illnesses are respected. They and their families need to be consulted and treated with respect and kindness within the healthcare system. My own view is that overworked, under-resourced healthcare workers are at particular risk of stigmatizing people with mental illness.