12, 15, 19 Compromised patient–provider relationships and early termination of treatment are also consequences. 1– 2, 12, 35 – 37 For example, anticipated stigma from healthcare providers has been identified as a factor in people’s reluctance to seek help for a mental illness. These issues create barriers through such pathways as delays in help-seeking, discontinuation of treatment, suboptimal therapeutic relationships, patient safety concerns, and poorer quality mental and physical care. 2, 14Ĭonsequences of stigma for access and quality care Burnout and compassion fatigue have been identified as exacerbating concerns. 6, 22 – 24 A Canadian qualitative study 14 articulated stigmatization among health providers to be, at least in part, related to a tendency “see the illness ahead of the person,” which can contribute to a failure to use person-first language and/or a tendency to engage in behaviours that may be experienced as dismissive or demeaning. 2, 5 – 7 Also, patients with certain disorders, such as personality disorders, tend to be particularly rejected by healthcare staff and are often felt to be difficult, manipulative, and less deserving of care. Research with healthcare providers is consistent with this idea, finding that stigmatizing attitudes and behaviours towards persons with mental illnesses exist across the spectrum of healthcare. 21), the pervasiveness with which negative interactions are reported suggests the problem is not isolated to a few insensitive providers but is more systemic in nature-that it is a problem with how healthcare culture prioritizes and perceives persons with mental illnesses. 15 – 21 While research also highlights many positive patient experiences (eg, Clark et al. 15 – 21 Key themes include feeling excluded from decisions, receiving subtle or overt threats of coercive treatment, being made to wait excessively long when seeking help, being given insufficient information about one’s condition or treatment options, being treated in a paternalistic or demeaning manner, being told they would never get well, and being spoken to or about using stigmatizing language. People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact.
These have been described as “key learning needs,” 14 acknowledging that they are specific concerns that can be changed through targeted initiatives.
Research has identified a number of issues contributing to stigmatization in healthcare, which have direct and indirect impacts on access and quality of care for persons living with mental illnesses. 11 Such an understanding is helpful for appreciating how stigmatization occurs on multiple levels throughout the healthcare sector, including structural (eg, investment of resources, quality of care standards, organizational culture), interpersonal (eg, patient–provider interactions, discriminatory behaviours, negative attitudes), and intraindividual (eg self-stigma, patient reluctance to seek care, provider reluctance to disclose a mental illness and/or seek care). 11 – 13 It is also keenly recognized that only powerful social groups can stigmatize.
11, 12 Stigmatization occurs on multiple levels simultaneously-intrapersonal (eg, self-stigma), interpersonal (eg, relations with others), and structural (eg, discriminatory and/or exclusionary policies, laws, and systems).
What are the main sources of stigma in healthcare?ĭeveloped from Goffman’s pioneering work, 10 stigma is conceptualized as a complex social process of labeling, othering, devaluation, and discrimination involving an interconnection of cognitive, emotional, and behavioural components.