Mental Illness Stigma Concepts Consequences And Initiatives To Reduce Stigma Pdf

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The Impact of Mental Illness Stigma on Psychiatric Emergencies

Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care.

Stigma has undesirable consequences in patients with mental disorders. Certain measures can reduce stigma and provide a more dignified way for patients to recover from the crisis. This article aims to discuss the causes of stigma, ways of dealing with it, and achievements that have been made in psychiatric emergency care settings.

Among the many current definitions of stigma, we can extract that stigma exists when the effect of trivializing, labels, loss of status, and segregation happen at the same time in the same situation 1. Although the quality and effectiveness of mental health treatment and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce its stigma 2. Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, has been identified as a major barrier to treatment and recovery, resulting in poorer care quality for mentally ill people 3 , 4.

Stigma also impacts the treatment-seeking behavior of health providers themselves and negatively mediates their work environment 4 , 5. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention 6 , 7. Although such emergencies can also be secondary to physical illnesses, what differs them from other emergencies is precisely the presence of severe behavioral changes.

In most cases, they represent extreme severity in mental illness, they are associated with feelings of fear, anger, prejudice, and even exclusion. Among the most prevalent psychiatric emergencies are suicidal behavior, severe depressive or manic episodes, self-mutilation, severely impaired judgment, severe self-neglect, substance intoxication or abstinence crises, and aggressive agitation 6 , 7.

Adequate management of such situations can reduce patient suffering and prevent the perpetuation of stigma. Although there are different models of care for psychiatric emergencies, we will consider situations whose general management principles are the same in different environments. This Review of the management of Psychiatric Emergencies in situations of public calamity. The strategy was used to search the following international electronic databases; Pubmed —present , Scielo —present , and Cochrane Database of Systematic Reviews —present.

The search terms comprised: psychiatric emergencies, emergencies, mental disorders, calamity, disasters, epidemic, and pandemic. We supplemented the search results with important publications. Stigma stems from several sources personal, social, or family that work synergistically and can cause several complications throughout life 2 , 8. Studies have shown that the stigma of mental illness can stem from a lack of understanding or information, as well as from the meaning of the illness itself, such as strange behavior or agitation 2 , 9.

Since no specific study has been conducted on stigma in psychiatric emergencies, we will assess some general hypotheses about mental illness stigma and apply them to emergency situations, regardless of where they are treated. Agitation without or with aggressive behavior is common in situations of psychiatric emergencies.

However, in this case, the aggressiveness or state of violence must be seen as a complication of mental illness. As expressed by one author, there is a subjective and cultural relationship between mental illness and violence, and this perception has implications for patients, with an increased sense of isolation secondary to discrimination On the other hand, a study concluded that mental illness singly does not predict violent behavior Thus, albeit a minority of patients have addiction issues, it is a mistake to generalize the possibility of aggression to any diagnosis or any potential emergency.

Psychomotor agitation may or may not be associated with aggressiveness. Agitation and bizarre behavior are stereotypes created about people with mental illness, and these intensify when a patient has a crisis. Finally, little is known about the risk and causal factors related to social and contextual issues of aggression, although literacy reports that mental patients are more often victims than perpetrators of violence People with mental illness should be protected, and in the context of psychiatric emergencies, how they are handled is of critical importance.

People can take a long time to seek treatment and hide their symptoms, or when they become apparent, the family hides them at home or sends them to a distant hospital. This reaction is very similar to that of some families who try to hide when a relative committed suicide 9.

Attempting to hide symptoms can impede treatment seeking and lead to worsening of the condition. More immediate services, such as outpatient clinics, community services, and even emergency units can make patients feel exposed and assume the presence of a disease. Parents of patients with mental illnesses have a greater sense of stigma, in particular embarrassment and shame In turn, shame in the family of people with mental illness may be greater than that of families of people with cancer One study states that the real prevalence of psychiatric emergencies may be higher than that observed, and therefore, patients may take a long time to seek care for fear of stigma and the high cost of psychiatric treatment Another recent study investigated motivating factors for seeking treatment in Lebanon and found that relatively few mentally ill patients In higher education, the highest income and the female sex were identified as positive predictors for the demand for treatment, and the recognition of than the importance and impact of mental illness 16 , 17 , especially in emergency situations.

While parts of the population are aware of mental illness, others are still unaware of some diagnoses, their causes, and their impact. Evidence suggests that factors that influence avoiding or postponing treatment include ignorance about aspects of mental illness and discrimination Many seek to learn about mental illness in the mass media, including movies and social networks.

What they see, of course, shapes the way they think about both mental illness in general and individual disorders. Since psychotic breaks, suicide, and aggravating situations can be shown in distorted or even comical ways, the severity of emergency situations involving mental illness may not be recognized. Without proper information from family members, even the patients themselves may have difficulty recognizing a worsening of their condition, and when they do, they may have difficulty deciding where to look for help.

For example, reluctance engaging suicidal people is often based on a fear of exacerbating their condition and further stimulating suicidal behavior. However, studies have shown that this fear is unfounded, and conversations about suicidal tendencies can even reduce symptoms 20 , The recognition that suicidal behavior is serious and that treatment seeking often requires help makes it easier for family members and other caregivers to bring in patients for emergency treatment before a fatality can occur.

Distorted ideas about mental illness also contribute to the perpetuation of negative and inaccurate images. People with these disorders, as well as individuals with anxiety and depression, are seen as just needing to change their habits and calm down. Such views are rarely understood as diseases, such as cancer or heart disease Emergency situations, such as severe dependence, withdrawal syndrome, delirium, and induced psychosis may fail to be correctly addressed due to stigma.

In addition, the perception that patients will be treated negatively can cause them or even family members to avoid seeking treatment. Among other distorted views are the idea that mental health problems are not common, that people affected are unlikely to recover and that treatment does not bring results It is dangerous to think that mental illness treatment is ineffective, since it can lead people to ignore emergency situations and fail to seek help for them.

Another result of stigma is social distancing from individuals with mental illness. Social distance regarding individuals with mental illness has been measured in some situations at work, among neighbors, and in marriage Distancing can lead to difficulties in recognizing emergencies, as well as in offering support, especially for patients who cannot understand their own situation. This problem can be even more serious when social distancing occurs within the family itself.

Finally, a situation may be even more serious: structural discrimination. Where, for example, setting up treatment sites for mental illness in distant areas, many of which are difficult to access, can give the feeling that the problem is not in your region. Another consequence of the distance is being able to transmit the idea of being in poor places in the city, full of crimes and dangerous, which can produce even more false beliefs and negative reactions 1.

As a consequence, people with mental illness are much more likely to be victimized. Patients may associate treatment for mental illness, whether on an outpatient basis, in hospital wards or in intensive care, with fear, distorted beliefs and even negative memories from prior experience. When patients are referred for emergency treatment, they may arrive voluntarily or involuntarily.

Regardless of whether the symptoms are in remission by the end of treatment, the entire process may be remembered with sadness, resentment, and shame.

Patients may be placed in an environment with unknown people including professionals and may not be treated according to their wishes often with injectable medications. However, even with voluntary admission, patients can be treated in a place they are ashamed of or have contact with other patients with similar or worse conditions.

Psychotropic medications can also be seen as stigmatizing, and in an emergency environment, patients are forced to use them, often at higher doses and frequencies than in outpatient treatment. Some medications can cause unpleasant side effects and give patients the feeling that they are no longer in control of their life.

Physical restraint, which is also associated with emergency psychiatric treatment, worsens the stigma for patients and consequently influences adherence to medical treatment 30 , Training the healthcare teams to use restraint correctly and only as a last resort is essential, although not all teams are prepared for this. Research has point some issues out that contribute to stigma in healthcare, either directly or indirectly impacting access to care and care quality for people with mental illnesses 4.

Since emergency cases require immediate assistance, healthcare professionals must be prepared to deal with aggravated mental illness and any related stigma 4. In Brazil, psychiatrists also presented negative ideas about people with schizophrenia.

Negative stereotypes were present along with the belief that tolerance to side effects of psychotropic medications.

Already, being older was related to less prejudice Lauber et al. In another study carried out with mental health professionals in hospitals, the same authors observed that some maintain more social distance from individuals with schizophrenia than other people 32 , Rettenbacher et al.

This type of attitude can exacerbate emergencies, bearing in mind that many patients require involuntary intervention and are given higher doses and frequencies of medication over a few hours or days. The attitudes of professionals and the culture of the workplace can help to sustain stereotypes and hinder care. The nature of contact in healthcare environments, especially the in the emergency room and the psychiatric emergency unit, it makes professionals keep in touch with people who have severe and chronic symptoms.

This could, paradoxically, perpetuate rather than dispel stereotypical beliefs 3. However, the undesirable effects of contact seem to decrease among professionals with greater experience and age, again demonstrating that experience is a factor that can reduce stigma and inexperience a factor of perpetuation 3 , Rossler 39 reported several variables of the work environment that restrict care quality and can eventually lead to professional burnout, counting non-supportive environments, unsupported locations, restricted means, insufficient facilities, and stigma towards the mental health team.

Health professionals reported that these unfavorable conditions impaired the quality of care provided 40 , For instance, nurses reported that poor availability of resources and infrastructure hampered security locations that handle psychiatric emergencies must provide adequate protection for patients and staff , which exacerbates the insecurity of caring for patients with mental illness and may delay or to keep away from care 41 , On the other hand, professionals who care for people with substance use disorders, who have better support in their services, showed more positive attitudes towards patients Experience and age were also related to lower burnout 3 , while younger psychiatrists are prone to work-related stress and burnout symptoms Other causes of stress include a lack of positive feedback, poor pay, and an unpleasant workplace.

Stigma can also affect health professionals, which could exacerbate public stigma as well as influence postures toward look up treatment.

In a review of the topic, Sartorius et al. Public opinion often has the idea that psychiatry does not produce results and can even be harmful, and that psychiatrists are low-status doctors who use too many psychotropic medications. The media presents psychiatry as a specialty without training, representing psychiatrists as madmen, healers, or even charlatans. Medical students and other medical fields view psychiatry in a low light, which discourages many students from pursuing a career in mental health 42 ,

Mental illness stigma: concepts, consequences, and initiatives to reduce stigma

Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders.


This review aims to clarify the concept of mental illness stigma and discuss Finally, we discuss three main strategies to reduce stigma - protest, education, and Well-designed anti-stigma initiatives will help to diminish negative consequences of mental Article Download PDFView Record in ScopusGoogle Scholar. [7].


The Impact of Mental Illness Stigma on Psychiatric Emergencies

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4 Response
  1. Olina B.

    Review. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Nicolas Rüsch a,*, Matthias C. Angermeyer b, Patrick W. Corrigan c.

  2. Monika J.

    Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. Dec;20(8) doi: /alfabia.org

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