Summary: Yes, we can reduce stigma around minority mental health by recognizing the specific, nuanced, differences among various cultural ethnic groups that affect current attitudes towards mental health in the U.S.
Key Points:
- Minority Mental Health Awareness Month (MMHAM) occurs annually during July, with events running throughout the year.
- People from minority groups in the U.S. receive mental health treatment at lower rates than people in the majority.
- A recent theme for reducing stigma around minority health was Turn Awareness Into Action.
- Awareness refers to learning and understanding basic facts about mental health and mental health treatment, like the one we share above about treatment rates
- Taking action refers to steps individuals, families, and organizations can take to reduce stigma around minority mental health like sharing basic facts you learn about mental health
Stigma and Mental Health in Minority Communities
During Minority Mental Health Awareness Month (MMHAM), we spend a significant time addressing stigma and discrimination related to the Black American community. That’s logical, because the founder of MMHAM, Bebe Moore Campbell, was a Black woman whose primary mission was increasing awareness about mental health in her community.
However, she was keenly aware that all minority communities in the U.S. share a similar experience:
The presence of varying levels of stigma, derived from traditional cultures, which have a negative impact on treatment seeking and engagement.
To address this shared phenomenon, we’ll zoom out and take a broad look at stigma among different cultural groups in the U.S. We’ll discuss the impact of the following cultural traditions on mental health stigma: Asian, African, Arab, and Latin American. For comparison, we’ll also share mental health stigma associated with traditional Western European cultures.
The paper “Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review” offers a perfect reference for understanding the effect of traditional culture on contemporary mental health stigma.
The research team identifies a simple reason for examining cultural stigma around mental health in order to reduce it:
“Addressing the stigma surrounding mental health can significantly enhance the effectiveness of psychiatric care.”
In mental health – according to the study authors – the word stigma describes attitudes toward people with mental health disorders defined by:
- Negative stereotypes
- Prejudice
- Discrimination
- Judgment
Negative consequences of stigma lead to significant barriers to effective mental health care, including but not limited to:
- Delayed diagnosis
- Delayed treatment
- Diminished quality of life
- Increased morbidity/illness
If you’ve never experienced stigma or discrimination, it may not be easy to understand how it feels, or the impact it might have on the way individuals think and feel about themselves.
What’s It Like to Experience Stigma?
To illuminate some of the details around the subjective experience of stigma, we’ll share the contents of the Internalized Stigma of Mental Illness (ISMI) Scale, an evidence-based metric endorsed by mental health professionals around the world.
The ISMI includes five subscales. Explaining what these scales measures can help people who never experience stigma glimpse the impact of stigma on an internal level:
- Alienation: feeling less than a full member of society because of personal mental health disorder
-
- Here’s a question/statement from that section: “I feel out of place in the world because I have a mental illness.”
- Stereotype Endorsement: extent of individual agreement with common negative stereotypes about people who have a mental health disorder
-
- Here’s a question/statement from that section: “Mentally ill people tend to be violent.”
- Discrimination Experience: individual instances of exclusion/rejection because of mental health status
-
- Here’s a question/statement from that section: “People ignore me or take me less seriously just because I have a mental illness”
- Social Withdrawal: frequency with which an individual avoids social situations out of fear of stigma
-
- Here’s a question/statement from that section: “People can tell that I have a mental illness by the way I look.”
- Stigma Resistance: personal capacity to resist stigma, and resolve the internal conflicts associated with stigma
-
- Here’s a question/statement from that section: “In general, I am able to live my life the way I want to.”
Now, imagine living with some of those thoughts in your head. Not just sometimes, but frequently: that’s a glimpse into the subjective experience of stigma associated with mental health. Reading those subscales and the statements on the scale are informative, and highlight the deep impact stigma can have on the way a person thinks, feels, and behaves.
Now let’s look at the way different cultural traditions impact stigma among people in the U.S. today.
Culture and Tradition: Stigma Appears in Various Forms
The research team collected and analyzed scholarship on mental health stigma related to various cultures around the world, collated the dominant tropes for each tradition, summarized their effect on the individual, and described how that stigma might drive behavior related to mental health and mental health treatment.
Here’s what they found.
Common Effects of Stigma, By Cultural Group
Asian:
- Perception of mental illness: viewed as a sign of weakness or personal failure, inability to control self
- Impact: brings shame on family, self
- Outcome: moderate stigma reduces treatment seeking, reduces treatment engagement
Source: Seeking professional help: Etiology beliefs about mental illness across cultures
African
- Perception of mental illness: often attributed to spiritual or supernatural causes
- Impact: personal shame, embarrassment, concern for effect on family
- Outcome: extreme stigma severely reduces treatment seeking and engagement
Arab
- Perception of mental illness: may be viewed as divine punishment
- Impact: personal self-doubt, shame, worry about effect on family
- Outcome: significant stigma often delays or prevents treatment
Source: Lifetime Prevalence of Mental Disorders In Lebanon: First Onset, Treatment, and Exposure to War
Latin American
- Perception of mental illness: often viewed as personal failing/weakness/lack of willpower
- Impact: degrades self-esteem, increases shame/embarrassment
- Outcome: moderate stigma delays, prevents, or results is subpar care
Western
Perception of mental illness: misinformation/poor information about danger, unpredictability, and volatility about people with mental illness
- Impact: degrades self-esteem, increases shame/embarrassment
- Outcome: moderate stigma results in social exclusion/discrimination, delays, reduces or prevents treatment seeking
Source: The Stigma of Psychiatric Disorders and The Gender, Ethnicity, and Education of the Perceiver
It’s important to understand that although stigma almost always has the same result – delayed or no treatment, with attendant negative consequences – the factors that drive stigma, i.e. the etiology of stigma, is different for each culture, and within each culture, varies by family and by individual.
How to Reduce Stigma: Minority Mental Health Awareness Month
Based on an analysis of the types of strategies that can effectively reduce stigma around minority mental health, the study authors identified the five with the greatest impact:
- Campaigns to Increase Public Awareness. Public awareness months like Minority Mental Health Month (MMHAM) are effective in recruiting new people, sharing new information, and raising the mental health IQ of the general public
- Training Mental Health Professionals in Cultural Awareness/Cultural Competency. Mental health providers – if they want to serve all patients who need support – should receive specific, targeted training that helps them recognize both the benefits and drawbacks of traditional cultural approaches to mental health.
- Peer Support Programs. When a person from a minority group has direct contact with a person with a shared cultural heritage who also has a mental health disorder, they’re more likely to engage, listen, and learn about the benefits of evidence-based treatment for mental health disorders.
- Community-Based Mental Health Services. If we want to help minority communities the best way we can, we have to go to minority communities: it’s that simple. More than that, we need to create the infrastructure needed in minority communities to provide ongoing, long-term mental health support.
- Evidence-Based Stigma Reduction. Research shows that two types of direct contact with people in minority cultures can reduce stigma. First, contact involving basic education can address core misconceptions about mental health and mental health treatment. Second, person-to-person contact with someone from their culture with a mental health disorder who has engaged in and benefitted treatment can reduce skepticism, reduce reluctance, and normalize seeking and participating in mental health treatment.
When we take those five steps, we can reduce stigma around mental health and improve minority mental health around the country. To learn more about MMHAM, follow this link:
Gianna Melendez
Jodie Dahl, CpHT