When combating stigma and negative attitudes towards mental illness, a commonly accepted solution is to educate the general population about mental illness and foster greater connections between the public and people who suffer from mental illness. According to the studies discussed in this paper, a “negative attitude” may include stigmatization, doubting another’s capabilities, social distancing, dehumanization, and supporting restrictions of people with mental illnesses. Such negative attitudes are countered by campaigns for equality in the workplace, school programs and speakers, advertisements on the sides of buses, and signs in doctors’ offices all of which try to educate the public and combat misconceptions about those who are struggling with a mental illness.
It is of popular opinion that the more education and experience one has with regards to mental illness, the more tolerant, positive, and supportive one will be. Following this logic, one would think it is safe to assume that perhaps the most tolerant, supportive, and positive people in the mental health realm would be mental health professionals like psychiatrists, nurses, psychologists, therapists, doctors, and social workers. And though this expected trend has been true in most situations, this attitude is no longer guaranteed. There is a disturbing concurrence among recent studies that mental health professionals can harbor just as negative an attitude towards their patients as other less-informed citizens-at-large (Arboleda-Flórez, 2012; Charles, 2013). These findings call into question the long accepted belief that the more educated a person is about mental health issues, the more knowledgeable and supportive they are as well. As this paper will explain, it is critical that this discrepancy is researched and analyzed to find out exactly what is causing such deviation, because professionals’ stigmatizing or otherwise unsupportive attitudes—called “provider stigma” (Charles, 2013)—will harm their patients’ well-being if not corrected.
It takes only a small amount of well-implemented education for a person previously unfamiliar with mental illness, or a person with a negative outlook on mental illness, to have a positive change in opinion. It makes sense that the average new student going into the mental health field would have about the same attitude towards those with mental illnesses as the average citizen does; at this point the only factor that separates them from other members of society is their declaration that they want to study mental health. But as these new students progress in their studies, a dramatic positive change in their attitudes occurs (Hamaideh, 2009; Theriot, 2012; Linden, 2012). This change is consistently documented in studies worldwide. One such study was conducted by Shaher Hamaideh, a professor at the Hashemite University in Jordan whose research centers on mental health, stressors, clinical practices, and the nursing profession. His study, which used the Opinions about Mental Illness Scale (OMI), measured the change in Jordanian nursing students’ attitudes towards mental illness after taking a psychiatric and mental health course (Hamaideh, 2009). OMI consists of five sections, each covering a different topic: Authoritarianism, Benevolence, Mental Hygiene Ideology, Social Restrictiveness, and Interpersonal Etiology (Hamaideh, 2009). A positive difference in attitude was measured in all five sections—four of them drastically so—after the students’ completed their course (Hamaideh, 2009). As previously stated, this finding is common among students and young people learning about mental illnesses in school. Upon first glance, the result provides support for the current theory that education about mental illness will result in reduced stigma and promote positive attitudes towards people who experience mental illnesses. Perhaps this theory has held true for so long because there has been such a positive change when a member of the public, like a student, initially receives mental health education. But does the theory still hold true for the next level of the mental health profession?
Increasingly, it appears that the answer is no: mental health professionals like psychiatrists, doctors, therapists, and nurses have been found to hold stigmatizing, negative, and counterproductive attitudes towards patients with metal illnesses. Lars Hansson, a researcher and professor in the Department of Health Sciences at Lund University in Sweden, published a study in 2013 in the International Journal of Social Psychiatry titled “Mental Health Professionals’ Attitudes towards People with Mental Illness: Do They Differ from Attitudes Held by People with Mental Illness?” The study was conducted among fourteen inpatient and outpatient facilities in the southwestern part of Sweden to see if there was a difference between mental health professionals’ attitudes towards people with mental illnesses and the attitudes held by those people themselves (Hansson, 2013). 140 staff members participated, as well as 141 patients from eight of the outpatient facilities that took part in the study (Hansson, 2013). The researchers used a Perceived Devaluation-Discrimination Questionnaire consisting of 12 statements, with each participant ranking to what degree they agreed with each statement (Hansson, 2013). The statements were about the negative attitudes the public has toward those with mental illnesses, such as: “Most people think less of a person who has been in a mental hospital” (Hansson, 2013, p. 51). The results of this study are disheartening, for they demonstrate a solid trend of negative responses, “with a majority [of staff] having a negative attitude in six out of the 12 items and more than one-third in all 12 items” (Hansson, 2013, p. 51). To dig a little deeper, when dividing the data into categories, Hansson saw that responses from staff working at inpatient facilities were significantly more negative in seven of the 12 statements in comparison to responses from outpatient staff members (2013). This piece of data is a direct blow to the widely accepted idea that the more education, experience and exposure one has with mental illness, the more positive one’s attitude will be. Indeed, it suggests the exact opposite for mental health professionals—the more experience they have with patients with mental illnesses, the less optimistic they tend to be.
In addition to data provided by such quantitative studies, provider stigma has been demonstrated by qualitative studies as well. In Mental Health Provider-Based Stigma: Understanding the Experience of Clients and Families, Jennifer L.K. Charles presents her research, in which she read and extracted the main ideas about provider stigma from seven books written by patients and/or their families about their experiences with the mental health services available to them (2013). One patient wrote about how the nurses would speak of them in the third person while they were present, often incorrectly so, making them feel that their opinions about their own health were not valued (Charles, 2013, p. 368). Others described how they felt discouraged by providers from doing anything, let alone trying to live like they did before their illness (Charles, 2013, p. 369). Many spoke of how they had to make decisions about treatment without full knowledge of all the options afforded to them (Charles, 2013, p. 370). From these stories, Charles was able to identify five themes of provider stigma discussed throughout the books: “blame and shame; provider disinterest, annoyance and/or irritation; degradation and dehumanization; poor prognosis/fostering dependence; and coercion and lack of ‘real’ choice” (2013, p. 365).
Though there are conclusive studies that point to the existence of negative attitudes and stigma among mental health professionals, research on provider stigma towards mental illnesses is an extremely recent concentration. In fact, seven of the nine sources referenced for this paper were published in 2012 and 2013. A possible reason for such a late scientific response to such an important issue is that it has not occurred to most Americans to think that our health care professionals could be a part of the problem. We assume that those who take care of us know how to do so effectively, that they know what issues may arise and how to deal with them, and that they are aware that the majority of people view them as part of a support system that will be helpful, not harmful. Consequently, our trust in our mental health system has obscured the fact that some of the stigmatization of mental illness comes from within.
In conclusion, it is evident that a negative shift currently occurs between when a person is a student learning about mental health and when they become a provider of mental health services. According to our accepted logic, the reverse should be happening—as students become more experienced and knowledgeable, their negative attitudes should fade—yet our providers can possess as negative an attitude towards mental illnesses as the average member of the public (Arboleda-Flórez, 2012; Charles, 2013). More attention needs to be paid to the trajectory our mental health professionals’ attitudes take along the road to professionalization in order to better understand where they turn from positive to negative. Once we understand when and why our professionals adopt these attitudes, we’ll be better equipped to change the pathway—through professional education and clinical practices—in order to fix it. We cannot expect people with mental illnesses to receive better treatment from providers unless we accept and seek to change our faulty system; therefore, we must acknowledge the urgency with which we must re-evaluate our mental health education across all levels.