Mental Health Stigma Among Filipinos: Time for a Paradigm Shift PDF

Philippine Journal of Health Research and Development Mental Health Stigma Among Filipinos: Time For A Paradigm Shift Ana Kriselda B. Rivera1* and Carl Abelardo T. Antonio2 *Corresponding author's email address: [email protected] 1 College of Public Health, Univers...

Philippine Journal of Health Research and Development Mental Health Stigma Among Filipinos: Time For A Paradigm Shift Ana Kriselda B. Rivera1* and Carl Abelardo T. Antonio2 *Corresponding author's email address: [email protected] 1 College of Public Health, University of the Philippines Manila 2 Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila S H O R T R E V I E W Abstract This paper aimed to provide a review of mental health stigma in the Philippines, its implications on policy and programs, and interventions on addressing the issue. Stigma towards people with mental illnesses in the Philippines is rampant; there seems to be lack of sensitivity in referencing mental health issues. Many forms of stigma affect people with mental illnesses. Stigmatizing attitudes and discriminatory behaviors are evident at home, school, workplace and healthcare settings. Stigma is a major barrier to the recovery of mentally ill persons. Increasing the awareness of the public on mental illnesses through health education and promotion is already an established intervention. Various strategies can also be done, such as integrating culture and arts, by providing incentives to companies which have mental health policies, and recognizing institutions and media agencies which promote positive portrayals of people with mental illnesses. Keywords: social stigma, mental health, mental disorders, Philippines Introduction continues to be the biggest barrier to the development of the mental health system in general – it affects planning and Stigmatizing attitudes date back to the 16th century organizing of mental health programs, influences the when manifestations of mental illnesses are associated allocation and prioritization of resources for mental health, with witchcraft, magic and evil doings. People with mental and impedes the delivery of mental health services. illnesses were treated harshly – they were placed in asylums far from the public, while some are even detained This paper provided a brief discussion on the perception in jails and madhouses; they were ridiculed and called of Filipinos on mental illness as influenced by stigma. This names. It was not until the 19th century when mental paper also discussed the implications of stigma on people illnesses were slowly being viewed to be of medical causes with mental illness, the general public and on public health. rather than supernatural in nature. Today, on account of Lastly, this paper enumerated possible interventions and the advancements made in psychiatric research, we now strategies that may address the issue. understand the science behind many mental illnesses, and have explanations for management and treatment. Mental health stigma among Filipinos However, despite these developments, stigma remains in our society. People with mental illnesses are still suffering Abdullah and Brown , highlighted that stigma is from the same stigmatizing attitudes and discriminatory inextricably bound to culture. Culture influences behaviors behaviors. and beliefs, and sets the standard for what is considered normal and acceptable to a society. Beliefs about mental In the Philippines, stigmatizing attitudes towards people health and illness are, therefore, also culturally bound. with mental illnesses are typically demonstrated with humor or hatred; whereas, media representations of them are For the Filipino culture, having mental illness is viewed as usually associated with harm and misconduct. Stigma exists a family's mental illness. In a study, private stigma (self- in school settings, in the workplace and even in medical stigma) is said to mediate the relationship between public institutions among healthcare practitioners. Stigma stigma and attitudes of seeking professional help; private 20 Phil J Health Res Dev April-June 2017 Vol.21 No.2, 20-24 Mental Health Stigma Among Filipinos stigma also has a negative correlation with intentions to Media plays a critical role in shaping the public's seek professional help; while another study found that loss perceptions of mental illness. Tragic news concerning of face has been found to be directly associated with people with mental illness is often sensationalized. An perceived stigma for both seeking and receiving analysis of tabloids made by Angermeyer & Schulze in psychological help among Filipinos. Germany found that news articles included very little information on the mental illness of people involved with Although mental health stigma evidently persists in the serious crimes. Meanwhile, a different analysis by Corrigan Philippines, there is very limited information on the depth of in the U.S. found that 39% of violence may be its burden among Filipinos with mental illness. The attributed to mental illnesses. Similarly, people with mental Department of Health (DOH) considers the lack of illness face stigmatizing responses from the police. A study promotional programs on mental health a reason for the showed that they are more likely to be arrested by the persistently high stigma in the country. Derogatory terms police ; meanwhile, a survey on the attitudes of police such as “abnoy” and “baliw” are easily incorporated in officers in Greece found that 60% believed that people with casual conversations. People often use mental illness insults mental illness are more dangerous than the general in describing annoying politicians ; the President himself population, 47% thought that these people should be on is not spared of these insults. Restraining of people with continuous medication, 67% thought that they should be mental illness is not something new; sometimes, their permanently hospitalized, more than 60% believed that family members are even the ones who detain and keep they are rarely or never able to work, and 75% believed that them far from the public. The Filipinos' knowledge on they are rarely capable of building a family and living mental illness appears to be simplistic, the opinions can be independently. quite unforgiving, and the stigmatizing behaviors seem to be uninhibited. Moreover, self-stigma presents as a danger to self- esteem. Because of their condition, people with mental Implications of stigma illness may believe that they are less appreciated and less respected by others. These negative feelings may lead to Stigma towards people with mental illness is conceived demoralization and decreased self-worth and self-efficacy not only by the public, but by those with mental illness as. Those who disclosed their mental illness to a greater well, towards themselves. Public stigma is the negative extent have been found to experience significantly higher attitudes and discriminatory response of the people damaging effects on their self-esteem. Social interactions towards people with mental illness. Self-stigma results are also affected by self-stigma. People with mental illness when people with mental illness internalize the stigmatizing tend to have negative expectations from other people and notions of the public towards them. so they are likely to act defensively when interacting but appears to have less self-assurance. Stigmatizing attitudes have been found to increase over time. Stigma entails a great deal of negative outcomes to Stigma affects the willingness of people with mental individuals suffering from mental illness. Public stigma illness to seek help. A study in the the U.S. by Alvidrez et presents as danger to social opportunities. Results of a study al. found that 32% of its participants did not initially in the U.S. revealed that 56% of Americans are reluctant to recognize the need to seek help for their mental problems spend an evening socializing with people who have mental because of stigma. Furthermore, Cooper et al. stated illness, 58% are reluctant to work closely with them, and that stigma influences people in considering other 68% would not allow them to marry into their family. alternatives of help seeking, such as informal sources. Despite their willingness to work, employment Similarly, the effects of stigma persist not only in initiating opportunities of people with mental illnesses are also help seeking but as well as when treatment has already compromised. It is evident from the limited data available, started. Studies by Sirey, et al. found that stigma affects that people with mental health problems, particularly those antidepressant medication noncompliance and premature with psychotic disorders, have very low rates of treatment discontinuation, particularly among older employment. Furthermore, a study found that more clients. Underutilization of mental health services is than 50% of its sample population have deliberately influenced by stigmatization even in countries where concealed their condition (schizophrenia) from co-workers services are offered free of charge. Family shame also and friends out of fear of being stigmatized. serves as a significant predictor of treatment avoidance. Phil J Health Res Dev April-June 2017 Vol.21 No.2, 20-24 21  Mental Health Stigma Among Filipinos Stigma presents as a barrier in all the levels of prevention targets depression and anxiety , and the Open the Doors of public health. It serves as an obstacle to acquiring campaign, an international movement started by the World information about mental health problems. Current data Psychiatric Association (WPA) focused on reducing stigma is needed in order to address the persisting mental health among schizophrenia patients. An awareness campaign issues in the country. However, there is definitely a lack of in Australia was conducted to improve mental health accurate and relevant information that will assist the literacy and help-seeking attitudes among young people. government in formulating comprehensive mental health The campaign had a significant impact on self-identified policies (primordial level of prevention). Moreover, stigma depression, increased awareness of suicide risks, improved can affect the willingness of policy makers in investing in help-seeking behaviors, and reduced perceived barriers to mental health. In turn, it leads to lower prioritization in the help-seeking. allocation of government funds for mental health and subsequently resulting to poor delivery of services. According to Lauber , targeted interventions may be Furthermore, stigma may affect the eagerness of the public more effective because the objectives and messages are to participate in awareness and promotional campaigns more specific. Targeted groups can be workplaces, schools, (primary prevention) about mental health which are police as well as mental health professionals. The labor designed to minimize the onset of mental health illness in agency of the government must work with the human rights the public. Likewise, when there are already mental illness commission in assuring that the rights of mentally ill persons cases involved, stigma serves as a barrier to the utilization of are lawfully maintained. Employers can offer possible programs that aim early case detection and management working arrangements with mentally ill employees like (secondary prevention), as well as to the continued working from home or giving additional time to finish their participation in treatments to lessen severity of illness tasks. Meanwhile, increasing awareness in the school (tertiary prevention). setting can be done through educational workshops and watching video interviews, documentaries or movies about Interventions addressing stigma mental illness. Interventions among police officers may include training seminars on dealing with mentally ill Byrne points out that the starting point for all target persons, on being cautious and more careful in interacting groups at every level of intervention is education. He said with them. that education in the form of research helps the public, particularly the professionals, in understanding the Mental health professionals are encouraged to go complexities of stigma. It also provokes discussions among beyond educating within the confines of their clinics to scientific communities which, in turn, results to even more participating in programs of public education. According to investigations on the subject matter. Studies on the Byrne, every intervention must convey the importance of interaction of varying aspects of self-stigma and care stigma and discrimination, challenge the stereotypes within seeking can be done, as well as conducting regular surveys ourselves, and continue to explain the nature of prejudice on the public attitudes to mental health, mental well-being. In the U.S., the National Alliance of the Mentally Ill and mental illnesses which may serve as baseline (NAMI) has pushed for better legal protection in terms of information to other studies and as reference for future housing and working conditions for people with mental policies. Interactions with people having mental illness illness through education. The group has also been further supplement educational approaches [17,18]. successful in pointing out negative representations of Contact may be direct, face-to-face interaction, or indirect, mentally ill people in the media. through watching video interviews. The media serves as a highly influential instrument in Anti-stigma campaigns have already been introduced reframing public perception of mental illnesses. Hostile and from around the world, mostly from developed countries. violent representations of people with mental illness should Some campaigns target mental health stigma and be discontinued. Instead, media should focus on reporting discrimination in general for all groups like the See Me accurate descriptions and explanations of mental illnesses. campaign of Scotland , the Time to Change of U.K. , In addition, the media should not only focus on the illness and Elephant in the Room of Canada ; while other itself but also on ways of coping with the illness and assisting campaigns are more directed to a particular mental support groups. Guidelines on reporting mental disorder like the Beyond Blue campaign of Australia which illnesses can be developed to ensure responsible journalism 22 Phil J Health Res Dev April-June 2017 Vol.21 No.2, 20-24 Mental Health Stigma Among Filipinos among news agencies. Media prizes and awards may be Conclusion given to media outlets showing positive and innovative representations of people with mental health problems The mere avoidance of people in engaging in discussions. on mental illnesses has a lot to say about how it is perceived by the public. There is undeniably high stigma associated Culture and arts can also be incorporated in anti-stigma with mental illnesses in the country. These stigmatizing views awareness campaigns. Concerts, theater performances and are translated in the way the public uses offensive labels in art exhibits focusing on mental illnesses are organized in describing mentally ill persons, as well as in equating them different parts of the world, all with the same goal of with people, particularly politicians, who the public diminishing stigma and discrimination. The World Health considers dishonorable and undesirable. Moreover, media Organization (WHO) compiled these efforts in a report on reports of people with mental illness who are involved in global advocacy campaigns to end mental health stigma. crimes are almost always overemphasized and lacking in the Some of the activities mentioned in the report were the Indian information needed that will, at the least, attempt to explain theater play entitled, Mind Matters, which portrayed a the rationale for their conduct. As a result, people with journey through a person's mind, and The Hidden Artist art mental illnesses are faced with enduring stigmatizing exhibition which showcased the paintings of persons with attitudes and responses from the public which may further mental illness from Israel. Events like these were included in exacerbate their mental well-being and compromise their mental health festivals or fairs, wherein free diagnosis and physical conditions and social relations. consultation services were also provided. In the Philippines, a free art exhibit organized by the nonprofit Interventions which aim to reduce stigma can be organization, NoBox Transitions Foundation, Inc., entitled Still integrated in the community, school, workplace and other Life, featured the works of local artists with drug use and settings. Promotion and education strategies are considered addiction as the subject. effective and efficient means of increasing awareness of the public on mental health problems. Targeted interventions Other strategies done in the Philippines were mostly are believed to be more successful due to their spearheaded by private individuals and non-government responsiveness to individual needs. Creating events which organizations. Students of the University of the Philippines incorporate culture and arts is a more enjoyable and Manila College of Nursing initiated a fundraising event for interactive way of increasing awareness on mental illnesses. their psychiatric patients at the National Center for Mental Health (NCMH); this event later prompted the students in References organizing other activities such as a symposium on mental health awareness and a socializing event for the patients of NCMH. According to a report by Corrales , the 1. Abdullah T, Brown T. Mental illness stigma and Janssen Pharmaceutical Companies of Johnson & Johnson ethnocultural beliefs, values, and norms: An has collaborated with the National Institutes of Health, integrative review. 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