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PubMed1992

Psychiatry and the homeless mentally ill: a reply to Dr. Lamb.

Homeless mentally ill persons are highly visible subjects of ongoing public discussion and potent symbols of a host of contemporary social problems. They present psychiatry with a scientific challenge that calls for further elucidation of the sources of their mental illness and for fashioning possible solutions to their problems. They also present a moral challenge that requires psychiatrists to acknowledge the cultural, political, legal, and economic context of the mental problems of the homeless in the course of deciding what should be done to help them. H. Richard Lamb has proposed a program of aggressive outreach and psychiatric hospitalization for the homeless mentally ill. The authors believe that his proposal misconstrues the problems and needs of homeless mentally ill individuals; it would also needlessly infringe upon their freedom, further stigmatize them, and probably not help them. The authors offer an alternative understanding of the plight of the homeless mentally ill which places their problems within a larger context of social trends and domestic issues that society has been reluctant to confront. Psychiatrists can help the homeless mentally ill by championing their liberty rights and by focusing public discourse on the broad national need for improved access to medical and psychiatric care.

Attitude of Health Personnel↗
PubMed1993

Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council.

This report was produced in response to a request by the Senate Committee on Appropriations that the National Advisory Mental Health Council prepare and submit a report on the cost of insurance coverage of medical treatment for severe mental illness commensurate with the coverage of other illnesses and an assessment of the efficacy of treatment of severe mental disorders. About 5 million Americans (2.8% of the adult population) experience severe mental disorders in a 1-year period. Treating these disorders now costs the nation an estimated $20 billion a year (with an additional $7 billion a year in nursing home costs). These costs represent 4% of total U.S. direct health care costs. When the social costs are also included, severe mental disorders exact an annual financial toll of $74 billion. This total accounts for the dollar costs of shortened lives and lost productivity, as well as the costs incurred in the criminal justice and social service systems. However, it cannot begin to account in human terms for the enormous emotional cost and pain borne by Americans with severe mental illness and by their families. Many myths and misunderstandings contribute to the stigmatization of persons with mental illness and to their often limited access to needed services. For example, millions of Americans and many policy makers are unaware that the efficacy of an extensive array of treatments for specific mental disorders has been systematically tested in controlled clinical trials; these studies demonstrate that mental disorders can now be diagnosed and treated as precisely and effectively as are other disorders in medicine. The existence of effective treatments is only relevant to those who can obtain them. Far too many Americans with severe mental illness and their families find that appropriate treatment is inaccessible because they lack any insurance coverage or the coverage they have for mental illness is inequitable and inadequate. For example, private health insurance coverage for mental disorders is often limited to 30-60 inpatient days per year, compared with 120 days or unlimited days for physical illnesses. Similarly, the Medicare program requires 50% copayment for outpatient care of mental disorders, compared with 20% copayment for other medical outpatient treatment. These inequities in both the public and private sectors can and should be overcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Depressive distress among homosexually active African American men and women.

OBJECTIVE: Although early surveys of psychological adjustment among gay men and lesbians suggest only minor and not clinically relevant differences from heterosexual populations, concerns about psychiatric morbidity associated with HIV infection have renewed interest in the prevalence of psychological distress in this population, particularly among gay men. These later studies have focused primarily on white men. However, research indicates higher crude prevalence rates of psychological distress in community-drawn samples of African American subjects than in white subjects and also higher rates in women than in men. The authors examined rates of depressive distress and suicidal thoughts among homosexually active African American men and women who might be especially at risk for psychiatric morbidity due to multiple stigmatized social statuses. METHOD: Two nationally recruited groups of homosexually active African Americans (829 men and 603 women) completed self-administered questionnaires, including the Center for Epidemiologic Studies Depression Scale. RESULTS: Homosexually active black women were as distressed as HIV-infected gay black men. Men with symptomatic HIV disease were significantly more distressed than men who were HIV infected but asymptomatic, HIV-antibody negative, or whose HIV status was unknown. Both men and women reported distress levels in excess of those previously reported in studies of blacks or primarily white gay men. CONCLUSIONS: Further research is needed to identify specific predictors of life stressors and lack of social support among homosexually active African Americans who appear to be at higher risk for depressive distress.

Adolescent↗
PubMed2005

Strong inverse association between height and suicide in a large cohort of Swedish men: evidence of early life origins of suicidal behavior?

OBJECTIVE: Previous studies have found associations between poor fetal and infant growth and the risk of suicide. The authors' goal was to investigate the association between height--a measure of childhood growth--and suicide risk. METHOD: The authors conducted a record linkage study of the birth, conscription, mortality, family, and census register data of 1,299,177 Swedish men followed from age 18 to a maximum of age 49. RESULTS: There were 3,075 suicides over an average follow-up period of 15 years. There was a strong inverse association between height and suicide risk. In fully adjusted models, a 5-cm increase in height was associated with a 9% decrease in suicide risk. CONCLUSIONS: The strong inverse association between height and suicide may signify the importance of childhood exposure in the etiology of adult mental disorder or reflect stigmatization or discrimination encountered by short men in their adult lives.

Adolescent↗
PubMed2001

Familiarity with and social distance from people who have serious mental illness.

OBJECTIVES: This study examined the effects of familiarity with and social distance from persons who have serious mental illness on stigmatizing attitudes about mental illness. METHODS: A total of 208 community college students completed three written measures about familiarity, perception of dangerousness, fear, and social distance. Path analysis with manifest-variable structural modeling techniques was used to test a version of a model in which familiarity influences the perception of dangerousness, which in turn influences fear, which influences social distance from persons with serious mental illness. RESULTS: Most of the participants reported experience with mental illness. Scores on the three written measures largely supported the path model. Correlations between the perception of dangerousness and fear as well as between fear and social distance were particularly strong. CONCLUSIONS: Approaches to social change that increase the public's familiarity with serious mental illness will decrease stigma. Further studies are warranted that focus on how contact between members of the general public and persons who have serious mental illness may be facilitated.

Adult↗
PubMed2003

Use of schizophrenia as a metaphor in US newspapers.

Research has identified misleading and stigmatizing popular beliefs about schizophrenia, but little is known about media images corresponding to these beliefs. Building on Susan Sontag's exploration of cancer in the 1978 book Illness as Metaphor, the authors hypothesize that "schizophrenia" is now more commonly misused. A total of 1740 newspaper articles from 1996 or 1997 that mentioned schizophrenia or cancer were randomly selected and then coded for contextual and metaphorical use. Only 1 percent of articles that mentioned cancer used that illness in a metaphorical way, compared with 28 percent of the articles that mentioned schizophrenia. Results differed by newspaper but not by region. The authors suggest that these inaccurate metaphors in the media contribute to the ongoing stigma and misunderstandings of psychotic illnesses.

Humans↗
PubMed2004

Community pharmacists' attitudes toward and professional interactions with users of psychiatric medication.

Consumers of psychiatric medications or services may be stigmatized by health care providers. The authors surveyed community pharmacists (N=283) in the greater Toronto area to determine their attitudes toward and professional interactions with patients who used psychiatric medications and those who used cardiovascular medications. Despite generally positive attitudes, pharmacists reported feeling more uncomfortable discussing symptoms and medications with patients who have mental illness than with patients who have cardiovascular problems. Patients with mental illness appeared to receive fewer pharmacy services than patients with cardiovascular disorders. Barriers to receipt of counseling included a lack of privacy and inadequate training. Adequate training in mental health may be key in improving the professional interactions of community pharmacists toward patients who use psychiatric medication.

Adult↗
PubMed2004

Survey of stress reactions among health care workers involved with the SARS outbreak.

The outbreak of severe acute respiratory syndrome (SARS) was unique because it was highly concentrated in health care settings and a large number of health care workers were infected. This study investigated stress reactions among 338 staff members in a hospital in East Taiwan that discontinued emergency and outpatient services to prevent possible nosocomial outbreak. Seventeen staff members (5 percent) suffered from an acute stress disorder; stepwise multiple logistic regression analysis determined that quarantine was the most related factor. Sixty-six staff members (20 percent) felt stigmatized and rejected in their neighborhood because of their hospital work, and 20 of 218 health care workers (9 percent) reported reluctance to work or had considered resignation.

Adult↗
PubMed2005

Newspaper stories as measures of structural stigma.

OBJECTIVES: Structural stigma and discrimination occur when an institution like a newspaper, rather than an individual, promulgates stigmatizing messages about mental illness. This study examined current trends in the news media on reporting topics of mental illness. METHODS: All relevant stories (N=3,353) in large U.S. newspapers were identified and coded during six weeklong periods in 2002. Stories were coded by themes that fit into four categories: dangerousness, blame, treatment and recovery, and advocacy action (that is, calls for public policy and action that increase the quality of care or opportunities for those with mental illness). RESULTS: Thirty-nine percent of all stories focused on dangerousness and violence; these stories most often ended up in the front section. Few stories promulgated the idea that either the person or the family was responsible for mental illness (2 percent). Instead, stories about genetic or biological or environmental causation (for example, stress and trauma) were more common (15 percent). There were equal numbers of stories about biological and psychosocial treatments (13 and 14 percent, respectively). Four percent of all treatment-related stories addressed recovery. Twenty percent of stories contained themes that fell into the broad category of advocacy action. These stories addressed the shortage of resources in the public mental health arena, the need for better care, the absence of good-quality housing, and the goal of insurance parity. CONCLUSIONS: Data on how mental illness is represented in newspapers yield a useful perspective on structural stigma and the policies and standards that are applied by the news media. These findings have implications for influencing the press.

Humans↗
PubMed2005

Structural stigma in state legislation.

OBJECTIVE: This article discusses examples of structural stigma that results from state governments' enactment of laws that diminish the opportunities of people with mental illness. METHODS: To examine current trends in structural stigma, the authors identified and coded all relevant bills introduced in 2002 in the 50 states. Bills were categorized in terms of their effect on liberties, protection from discrimination, and privacy. The terms used to describe the targets of bills were examined: persons with "mental illness" or persons who are "incompetent" or "disabled" because of mental illness. RESULTS: About one-quarter of the state bills reviewed for this survey related to protection from discrimination. Within that category, half the bills reduced protections for the targeted individuals, such as restriction of firearms for people with current or past mental illness and reduced parental rights among persons with a history of mental illness. Half the bills seemed to expand protections, such as those that required mental health funding at the same levels provided for other medical conditions and those that disallowed use of mental health status in child custody cases. Legislation frequently confuses "incompetence" with "mental illness." CONCLUSIONS: Examples of structural stigma uncovered by surveys such as this one can inform advocates for persons with mental illness as to where an individual state stands in relation to the number of bills that affect persons with mental illness and whether these bills expand or contract the liberties of this stigmatized group.

Human Rights↗
PubMed2006

Self-stigma, empowerment, and perceived legitimacy of discrimination among women with mental illness.

OBJECTIVE: The study sought to better understand why some people with mental illness self-stigmatize and develop low self-esteem while others remain indifferent to stigma or respond with a sense of empowerment. The authors hypothesized that a high level of perceived discrimination, little sense of identification with the group of people with mental illness, and a high level of perceived legitimacy of discrimination lead to self-stigma. METHODS: Sixty women with borderline personality disorder and 30 women with social phobia, who were recruited at three centers in Germany and Switzerland, completed stigma-related questionnaires. RESULTS: After depression and index diagnosis were controlled for, a low level of perceived discrimination and of the legitimacy of discrimination predicted high self-esteem and high empowerment. Identification with the group of people with mental illness did not predict self-esteem or empowerment. CONCLUSIONS: Perceived legitimacy of discrimination may be a crucial determinant of a person's response to stigma.

Adult↗
PubMedDate not supplied

The occupational and psychosocial impact of SARS on academic physicians in three affected hospitals.

A cross-sectional anonymous survey was administered to all directory-listed physicians within a network of three large teaching hospitals that provided care to SARS patients in Toronto. One hundred ninety-three physicians participated, 23% of whom provided direct care to SARS patients. A significantly higher rate of psychological distress was seen among physicians providing direct care to SARS patients (45.7%) than among those not providing direct care (17.7%), and physicians providing direct care reported feeling more stigmatized. Several physicians (10.9%) reported entering the hospital despite experiencing identified SARS symptoms. The most frequent SARS concerns were about the care of non-SARS patients following suspension of nonessential services and loss of physician income.

Adult↗
PubMed2006

Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia.

OBJECTIVE: Crisis intervention team (CIT) training provides police officers with knowledge and skills to improve their responses to individuals with mental illnesses. This study determined changes in knowledge, attitudes, and social distance related to schizophrenia among police officers after CIT training. METHODS: A survey was administered to 159 officers immediately before and after a 40-hour CIT training program in Georgia. Pre- and posttest data were gathered from surveys taken between December 2004 and July 2005. RESULTS: After the training, officers reported improved attitudes regarding aggressiveness among individuals with schizophrenia, became more supportive of treatment programs for schizophrenia, evidenced greater knowledge about schizophrenia, and reported less social distance toward individuals with schizophrenia. CONCLUSIONS: This study supports the hypothesis that an educational program for law enforcement officers may reduce stigmatizing attitudes toward persons with schizophrenia.

Adult↗
PubMed1975

Factors determining effective psychiatric outpatient treatment for Mexican-Americans.

A mental health center offering outpatient services to Mexican-Americans should be centrally located in the Mexican-American community, should have a bicultural and bilingual staff, and should have an informal atmosphere with a minimum number of bureaucratic procedures. The center's services must be publicized in a way that minimizes the stigmatization of mental illness, promotes preventive care, and indicates that staff understand Mexican-Americans' problems. La Frontera, a mental health outpatient clinic serving the Tucson area, operates under those guidelines. Clinic records in March 1973 showed that Mexican-Americans accounted for 61 per cent of the active cases.

Adult↗
PubMed1986

Neuropsychiatric manifestations of AIDS-spectrum disorders.

Psychiatric symptoms among patients with acquired immune deficiency syndrome (AIDS) may be functional reactions to contracting a fatal and stigmatizing disease or may be secondary to malignancies and opportunistic infections in the central nervous system (CNS). More recent evidence indicates that HTLV-III, the virus that causes AIDS, directly infects the CNS and may cause psychiatric symptoms before signs of immunodeficiency, cognitive impairment, or neurological abnormalities emerge. AIDS-related organic mental syndromes may mimic functional disorders such as chronic mild depression and acute psychosis. Both of these common presentations are illustrated with detailed case reports, and diagnostic and management guidelines are provided.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Perspectives on effective advocacy for homeless mentally ill persons.

To make appropriate treatment and public policy recommendations to address the problems of homeless mentally ill persons, it is important to differentiate the homeless mentally ill population from the homeless population in general. Effective advocacy for homeless mentally ill persons should have realistic goals that address the specific needs of that population rather than attempt to change the basic problems of society. The effective advocacy that has secured services for developmentally disabled persons can serve as a model. Mental health professionals' limited response to the problems of homeless mentally ill persons has further stigmatized mentally ill persons in general; one of the most powerful actions mental health professionals could take to fight stigma would be to help provide treatment and residential alternatives for homeless mentally ill persons. The recommendations of both the first and the second American Psychiatric Association task forces on the homeless mentally ill are discussed.

Chronic Disease↗
PubMed1994

Inspirational recruitment and the Maryland Plan: overcoming the stigma of public psychiatry.

University-trained psychiatrists frequently avoid public-sector employment because they do not wish to be associated with stigmatized institutions. Inspirational recruitment--the elevation of poorly paid and unpleasant work to a noble cause--is one way of temporarily destigmatizing state psychiatry. The authors describe the impact of one such effort, the Maryland Plan, on recruitment of graduates of the University of Maryland psychiatric residency program into the state's psychiatric system. Significantly more graduates entered state psychiatry in the 15 years after the plan was implemented in 1978 (78 of 164 graduates, or 47.6 percent) than in the eight years before (seven of 57 graduates, or 12.3 percent). Data indicate that low salaries did not hurt recruitment, nor did doubling the stipends prevent the majority of recruits from leaving the public sector after a few years of service.

Adult↗
PubMed1994

Psychotherapeutic management techniques in the treatment of outpatients with schizophrenia.

Successful outpatient treatment of schizophrenic disorders largely depends on the patient's ability to form a treatment alliance with mental health professionals. However, even in the context of competent pharmacotherapy, symptoms of schizophrenia often persist under this alliance. The authors review five common syndromes occurring during the course of treatment of patients with schizophrenia that interfere with the therapeutic alliance: paranoia, denial of illness, stigma, demoralization, and terror from awareness of having psychotic symptoms. Mental health clinicians can use specific psychotherapeutic management techniques for these symptoms. Examples of these techniques include "sharing mistrust" for paranoid patients, providing patients who deny their illness with alternate points of view, making admiring and approving statements to demoralized patients, and normalizing experiences of stigmatized patients. The techniques do not require advanced psychotherapy training and can be used, with ongoing supervision, by bachelor's-level mental health workers.

Adult↗