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'How does mental health stigma affect service users' lives?'

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Elaine’s research into stigma opened her eyes to the reality many service users’ face

'How does mental health stigma affect service users' lives?'

Elaine Francis is a mental health student nurse


I knew a little about mental health stigma when I started my nursing course. I knew it involved being marked or set apart and misinformed negative attitudes and discriminatory behaviour towards people with mental health problems. But I wanted to understand what this meant to people in real life, so I spent my transition period finding out.

What I found surprised me.

I am no stranger to research. I’ve been an academic librarian and helped people understand that there’s a world outside Google. So, naturally I developed my research questions, searched authoritative sources, and collected a stack of over 100 neatly managed references to patiently whittle and read.

This may sound a little full on and, to be honest, I’d agree. In truth, I’d retreated into a theoretical comfort zone in defence against the hard truths I was uncovering. It is lucky that I caught myself in time and could refocus to help put the person back in the stigma.

“Nine out of 10 people with mental health problems see the negative impact of stigma on their lives”

I found that stigma is complex. Stigma sends out a message of what is “us” and punishes those who are “them”. Stigma involves ignorance, prejudice and discrimination, labelling, stereotyping, status, loss and power. It can be subtle or blatant, individual or systematic, and internalised.

Time to Change has reported that the experience of stigma and discrimination can be worse than the illness itself, and that nine out of 10 people with mental health problems see the negative impact of stigma on their lives.

These are very clear statements but I still find them incomprehensible and overwhelming.

Mental health stigma can negatively affect all aspects of someone’s life. It is at the root of fear, prejudice and discrimination. It is why people may feel less entitled, less empowered and less human, have lower expectations, be more socially isolated and feel a sense of shame.

In a survey on staff attitudes, I was shocked to read a comment from a mental health service user that they felt their mental illness could be beneficial, as some professionals were kind to them. I find it hard to imagine this stigmatised world, where not being discriminated against is seen as kind, rather than a human right.

It is also difficult to understand how mental health stigma is experienced in healthcare settings: there is no typical experience. To use another statistic: in Europe and the USA, 50-74% of people with mental disorders do not receive treatment. This leads to an increased risk of premature death.

“I find it hard to imagine this stigmatised world, where not being discriminated against is seen as kind, rather than a human right”

Mental health stigma helps to explain why people with mental health problems in healthcare settings can be seen as being less competent, and why they are avoided and treated with disrespect. It is why there is less access to medical care, increased diagnostic overshadowing, delayed help-seeking and a high dropout rate.

A person’s experience of healthcare can be even worse if addiction, self-harm, or an “unpopular” mental health diagnosis are thrown into the mix – or even if you are a healthcare professional. Curiously it seems “we” professionals think that “we” should be tougher than that.

In fact, healthcare professionals are seen as more pessimistic about mental health than the general public.

That gives pause for thought.

Mental health nurses have been seen as more pessimistic about outcomes, and stigma by association can spill over and have a negative effect on the quality of interpersonal working relationships. More pause for thought.

I find it antithetical that the very people who exist to help a person’s recovery can, in practice, do the opposite.

I feel fortunate to be one of life’s optimists, albeit a rather realistic one. I appreciate my naivety and am glad to be a student with plenty of opportunities for different experiences and inspiration. The literature suggests that student nurse attitudes around mental health are more positive at first.

My research has made me look at who I am as a person, how I want to practise and uncovered some very real challenges to overcome.


Elaine Francis is a second year Mental Health Nursing student at University of Greenwich. She tweets at @eformation


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