“37-year-old Kofi Mensah lives in a compound house with his wife and 2 children. One night he was heard shouting on top of his voice, banging on doors, praying and commanding things to happen and even began stripping himself naked. Some neighbours rushed around and helped his wife convey him to the psychiatric hospital. A month and a half later he was discharged home. However, other tenants started looking down on him and his family; they would not allow their children to play with his, would not return his greetings and they quickly rushed into their rooms when he is seen from afar.”
Similar stories can be told of people who have suffered such discrimination and stigmatisation either at work or home through no fault of theirs
Stigma: Greek origin , refers to bodily sign or mark which signals something unusual or bad about a person (cuts/burns). It indicates that a person is a slave, traitor or a criminal and is to be avoided especially in public places.
Goffman E. (Stigma. 1963) – stigma occurs when an individual is disqualified from full social acceptance because of possession of an attribute that is deeply discrediting.
To discriminate according to the Cambridge advanced learner’s dictionary is to treat a person or particular group of people differently, especially in a worse way from the way in which you treat other people, because of their skin colour, sex, religion etc. (in this case because of their health status)
Stigma is the biggest obstacle to recovery, treatment and societal acceptance for people living with mental illness. Stigma and discrimination against those living with mental illness is widespread and reaches into our educational institutions, workplaces, homes, health care centres, in the media and even in the churches /mosques. It causes shame, prejudice, apathy, and hopelessness and prevents over half of those living with mental illness from seeking treatment.
Discrimination at work or school, bullying, physical violence or harassments, low self-esteem, tagging or labelling as “abodam, seke”, madman”, health insurance not adequately covering mental illness are ways by which people are stigmatized. Stigma does not stop at the persons who are suffering from a stigmatized illness. Their immediate and even remote families often experience significant social disadvantages and if care is not taken apathy sets in and the family leaves the patient to his own fate bringing about institutionalization. On some wards visited at the Accra Psychiatric Hospital a few patients had been abandoned by their families after their discharge from the hospital possibly due to fear of stigmatisation by society against such individuals and families. Repatriation by the social welfare department then becomes the only alternative. People are stigmatised and discriminated because;
- It is believed that the patient or family has been cursed and is being tormented by a “spirit or a witch”
- It is believed that if you have a mental illness you may be aggressive, a killer, or even a sex offender.
- It is also believed that most mentally ill people are criminals.
- About 70 % of the television characters with a mental illness are often portrayed as hostile, dangerous, unpredictable and violent.
- It is believed they have poor interactive and social skills.
- Another myth is that mental illness is contagious and incurable.
Need I say that people commit horrendous crimes and may not necessarily be suffering from one mental illness or the other, neither has it been scientifically proven that mental illness is contagious.
It is high time we take strategic steps to minimise or reduce stigmatisation and discrimination of people suffering from mental illness. These include;
- Creating awareness through massive public education: This is to give insight into mental illness, treatment modalities, recovery and prevention. The need for society to realise and be willing to learn that mental illness has nothing to do with witchcraft and that it’s rather a medical condition, neither does one choose it when times are tough nor is it a respecter of persons.Educating people about attitudinal change especially towards people living with mental illness and to desist from using language or words that are derogatory such as (abodam ,“crazy” ,”lunatic”,) but being friendly as a society and using less hurtful words. Getting precise facts and information will also help dispel myths and stereotypes which may help change society’s ideas and actions. Dr. Sammy Ohene, consultant psychiatrist and lecturer at the Department of Psychiatry, University of Ghana Medical School on his part believes that a major step in reducing stigma is the proper integration of mental health into primary health care and vigorous public education about the nature of mental illness. Furthermore promoting education, understanding and respect will help break down barriers of ignorance, prejudice, or unfair discrimination meted out to people living with mental illness.
- Advocacy/support groups: These groups can be formed on local and national levels to offer and organise programmes to inform the public by taking the campaign message of stigma reduction to their doorsteps. If education and awareness creation is intensified the stigma against persons with mental illness will gradually be a thing of the past, and families will not be forced to abandon their relatives in prayer camps or mental institutions. In other parts of the world, some state, federal and programs agencies such as Vocational Rehabilitation and Veterans
Affairs (V.A ) also offer support for people who have mental health conditions. Worthy of note is the fact that discrimination against students because of a mental health condition is against the law, and educators at primary, secondary and tertiary levels are required to accommodate students as best as they can. Parents or guardians can talk to teachers if their child has a mental illness that affects learning, and find out what plans, programs and resources are available to help their wards. A good example is the New Horizon Special School, a day school in Accra geared to serve children and adults who are intellectually disabled.
- Promotion of mental health and stigma reduction project: a major step by government in promotion of mental health and stigma reduction is the passage of the mental health bill in May 2012 and its subsequent enactment into law in Dec, 2012. Act 846 of 2012 which is currently applicable and states that (i). it is unlawful to discriminate against or stigmatize the mentally ill (ii).PWMD are entitled to the same fundamental rights as a fellow citizen, and therefore shall not be subjected to discrimination (54).Government in conjunction with mental health institutions and non-governmental organisations can further embark on projects across the nation aimed at reducing stigma and discrimination to the barest minimum. The anti-stigma and discrimination project should ultimately seek to eliminate the barriers to achieving full inclusion in society and increase access to mental health resources to support individuals and families. Establishing a mental health fund to provide funding for partnerships to assess the effectiveness of existing stigma reduction programs and approaches, including media-oriented approaches such as public service announcements; developing innovative programs such as displaying of posters and distribution of leaflets, as well as organizing radio and television programs and examining the role of the media in perpetuating and changing mental illness, stigma and discrimination will go a long way to curb this menace. Government can also provide guides for employers that detail the benefits of hiring people who have mental illness, providing suggestions for recruiting and training them, outlining action plans for educating employees about mental health and related issues to create a “conducive and a friendly environment”.
- Behavioural therapy: Professor David Roe, chair of the department of community mental health at the University of Haifa, in his earlier studies showed that one of the central obstacles is the negative stigma attached to mental illness by society at large, which is much more powerful than the labels attached to people with other disabilities. This stigma may lead to social exclusion. Another obstacle that may result from stigma is “self-stigma,” whereby people with a mental illness adopt and internalize the social stigma and experience loss of self-esteem and self-efficacy. “People with a mental illness with elevated self-stigma report low self-esteem and low self-image, and as a result they refrain from taking an active role in various areas of life, such as employment, housing and social life,” Roe explains. In an attempt to address this problem, Prof. Philip Yanos of City University of New York, Roe and Prof. Paul Lysaker of Indiana University School of Medicine developed what they term “Narrative Enhancement Cognitive Behavioural Therapy” (NECT).The intervention is aimed at giving people with a mental illness the necessary tools to cope with the “invisible” barrier to social inclusion – self-stigma. A pilot project was carried out on about 22 patients and at the end of the therapy it showed that those who participated in the intervention exhibited a reduced self-stigma and, in parallel, an increase in quality of life and self-esteem. A similar therapy can be employed as a strategy in reducing stigma and discrimination in Ghana.
Let us as a nation help fight stigma and discrimination against mental illness.
By: Alberta Puplampu
The Writer, Alberta Puplampu, is a Nursing Officer