Reducing stigma in health-care settings.

JANUARY 2014 VOLUME 110 NUMBER 1 I n a lecture she gave last June, Heather Stuart spoke about a colleague who had breast cancer treatment and woke up in a hospital room filled with flowers and cards and visitors, thrilled with the support. Sometime later, this woman was hospitalized for depression. She woke up sad and alone in an empty room. “This is what stigma is and what stigma does,” said Stuart, the Bell Canada mental health and anti-stigma research chair at Queen’s University and senior consultant to the Mental Health Commission of Canada (MHCC). “The most disturbing part is that my colleague is a psychiatrist and works in a mental health facility. You would think that mental health professionals would be more understanding.” Health-care providers may be aware that they should not perpetuate stigma, yet people who seek help for mental health concerns report that some of the most deeply felt stigma they experience comes from front-line health-care professionals. The desire to avoid stigma is one of the key reasons people who meet the criteria for mental illness may not seek care. Stuart, who is also a professor in the public health sciences department at Queen’s, is co-author of a paper that provides an overview of the nature of stigma associated with mental illnesses, with a focus on the stigma demonstrated by health-care providers. The authors cited a review of general nursing literature, which revealed that some emergency department and intensive care unit nurses behaved in openly unsympathetic and demeaning ways toward people with mental health issues. These nurses felt that dealing with such issues was not their job, and they viewed people who had selfharmed as wasting resources meant for saving lives. Many health-care providers do not realize that their own language and behaviours are harmful, says Stuart. “Every one of us is part of the problem, because we’ve all grown up in a society that has taught us to stigmatize mental illness. Even though we don’t want to admit it, we all do it. It’s unconscious and can come up particularly when we’re Stigma, according to the MHCC, is a complex social process that marginalizes and disenfranchises people who have a mental illness and their family members. Prejudicial attitudes and discriminatory behaviours fuel inaccurate notions that people with mental illness are violent, unpredictable and can never recover. There are three kinds of stigma: self-stigma, public stigma and structural stigma, which occurs at the level of institutions, policies and laws and results in inequitable or unfair treatment. Stigma defi ned