MHM Magazine

Issue 6 | 2022 | MENTAL HEALTH MATTERS | 43 MHM come from the limited education, awareness, and understanding of psychiatric disorders. For this reason, individuals with severe mental illnesses are often challenged doubly: on the one hand, they struggle with the symptoms and disabilities that results from the disease and, on the other, they are challenged by the stereotypes and prejudice that results from misconception about their illness. Studies have reported that mental health is increasingly recognised as an important public health and development issue in South Africa, with mental health stigmas playing a major role in persistent suffering, disability, and economic loss associated with mental illnesses. Hence, it is crucial to work toward breaking the stigma around mental illness within our communities. MENTAL HEALTH STIGMA The modern definition of the term stigma was first described by Ervin Goffman in 1963 as the character or attribute by which a person was devalued, tainted, or considered shameful, or discredited. Seeing as mental health stigma was later defined as the disgrace, social disapproval, or social discrediting of an individual with a mental health problem, this definition could be broadened to also include the community. Such an inclusion may be important in breaking stigma, especially in South Africa or Africa, where community values and identity originate from Ubuntu. Being able to understand mental health stigma from the perspective of Ubuntu may be the start for addressing these in a more socio-culturally appropriate manner. Umuntu ngumuntu ngabanye abantu (I am because we are) speaks of how we see and relate with each other within a community. To have a broader understanding of Ubuntu within the definition of mental health stigma may be one other way that Africans may be able to understand the seriousness of mental illnesses, particularly how these stigmas violate human dignity, discriminate, marginalise, isolate, and reject individuals with mental illness. Based on Ubuntu, both the family and the community may have been impacted in similar ways by psychiatric disorders of an individual within that community. The impact and misunderstanding of mental health stigma are a problem when analysing Ubuntu and its relation to these stigmas. Ubuntu could be used as a theoretical system to addressing the four types of mental health stigma holistically. MENTAL HEALTH STIGMAS Mental health stigmas may include: 1. Self-stigma: This type of stigma refers to an individual with a mental illness who has a negative attitude towards their own mental illness, and is sometimes called internalised stigma. This negative attitude is often because of the prejudice and discrimination that these individuals may experience due to their illness, and/or may have a diminished self-esteem and efficacy due to living in a society that widely endorses stigmatising ideas. 2. Public-stigma: Refers to the negative attitude towards those with mental illness held by the public, often based on misconception, prejudice, fears and exclusion. For example, research has indicated that certain mental health discriminations can appear in the public about how to treat individuals with mental illness, with misconceptions such as the belief that people with severe mental illness are irresponsible and display childlike behaviour. 3. Professional stigma: This happens when healthcare professionals hold stigmatised attitudes towards their patients, which is often based on fear, misunderstanding of the causes and symptoms of the mental illness, or when the professionals themselves have experienced stigmatisation from the public or other healthcare professionals because of their work. These healthcare workers may be diagnosed with a mental illness themselves and stigmatise others as a result. 4. Institutional stigma: This refers to national and/or organisational policies, legal frameworks, and cultures of negative attitudes and beliefs toward stigmatised individuals. This type of stigma may also be understood to be systemic. WHAT CAN WE DO? Based on research, the burden of mental health is increasing in Africa and is estimated to be responsible for 9% of non-communicable diseases. Common mental illnesses such as depression and anxiety disorders contribute about 8% and 3%, respectively, to the years lost to disability in Africa. Currently, mental illnesses are responsible for 13.6 million disability-adjusted life years (DALYs) in the region. These statistics are truly alarming and only indicate that mental health awareness campaigns at a community level need to increase. However, stigma is strongly influenced by cultural and contextual value systems that differ over time and across contexts. Therefore, starting early, for instance by adding mental health education as a part of the curriculum and incorporating Ubuntu in the fight to break the stigmas, may assist with changing the perspective on mental illness in Africa. Since mental health stigma consists of three related issues: Ignorance – which is a problem of knowledge, Prejudice – which is a problem of attitude, and Discrimination – which is a problem of behaviour, education, awareness, and moral development may help to break the pervasiveness of mental health stigma. References available on request.