We’ve finally started to talk about mental illness - in the past, we have been remarkably silent about something that affects around 20% of the population. While I’m glad the topic is finally getting some attention, I have noticed the conversation doesn’t seem to be going far enough, and the focus seems to put a lot of responsibility on the shoulders of the person with mental illness. Fault being placed on people living with mental illness in this way is reflected in our use of the word ‘stigma’, when what we are really talking about is discrimination.
Media, government, policy-makers and institutions all seem to have a focus on the word stigma. However, mental illness is captured under the definition of ‘disability’ in the Disability Discrimination Act 1992 (Cth), as well as state and territory equivalents. That legislation protects people with mental illness from being treated less favourably because of their illness. It is debatable whether the Act has been as effective for people with mental illness as it has for those with other disabilities. I believe our conceptualisation of ‘stigma’ rather than discrimination has played a role in this. This is not to say that stigma is not a useful concept in identifying negative attitudes – however, we need to be more precise in our identification and not use it to shoulder the blame of illegal discriminatory behaviour.
Speaking in terms of stigma creates a divide between mental illness and other characteristics for which a person may face discrimination. Stigma implies that the problem is societal, shifting the responsibility for combatting it away from policy makers and giving them no guidance on how to combat it. This is especially important in cases where the tools of the state can be used to oppress and harm, such as community treatment orders. It implies the barriers faced by people with mental illness are not as severe or systemic. It is also disempowering – stigma as a concept is less focused on enabling people to know their rights and take action when they are treated unfairly. When a person is discriminated against, they make take action under the various anti-discrimination statutes. Stigma is an attitude or societal problem, something that is much less difficult to identify and combat.
Stigma implies that it is the person with the illness that is wrong, while discrimination focuses on the action of others, and shines a light on societal norms and practices that actually impact the everyday lives of those living with mental ill-health. Campaigns around stigma imply that the fault lies with the individual, and in their internalised shame that prevents them from help-seeking. In reality, this shame cannot be separated from the discriminatory behaviours of others that create and reinforce it. Stigma terminology has also affected research into the topic, with surveys and reports focusing on the attitudes of others towards those with mental illness, instead of asking people with mental illness what they have actually experienced. This has arguably contributed to the lack of effective interventions for improving the situation.
The way we speak about mental illness needs to change if we are to combat the entrenched, structural discrimination that people living with a mental illness face in their everyday lives and enable them to take action when it occurs – this includes housing, employment, education, healthcare (both physical and mental), interactions with the law and consumer experiences.
Those with mental illness are 2.5 – 3.8 times more likely to be unemployed than the general population, depending on diagnosis. However, this is not due to them not wanting to work, as the majority of people with mental illness want to work and consider it important to their recovery. The workforce actively discriminates against people with mental illness, often refusing to hire or promote them. Over half of those that participated in one survey reported not being hired because of their mental illness. That kind of behaviour is discrimination, and it’s illegal, yet resources and news reports fail to mention this or provide any guidance on what a person can do about it. Discrimination against people with mental illness is ‘rife’ in the private rental industry. Insurance companies often refuse to insure people with mental illness or charge them extra premiums, despite the fact they are not entitled to do so. People with mental illness are treated differently in health care, by the people that are supposed to help them – healthcare staff have reported negative attitudes towards mental illness, and there is evidence that people with mental illness receive inferior levels of care for physical conditions. Mental illness accounts for around 12% of the burden of disease yet attracts only 7.7% of national health spending, with the result that many people are unable to access the healthcare that they need and have a right to expect. People with mental illness often have lower levels of education, in part due to inflexibility in educational institutions.
As a person with a mental illness, my life expectancy is 20 years shorter than my peers. I have felt the impacts of this entrenched discrimination in my own life, and seen it impact the lives of others around me. Instead of placing the burden back on the shoulders of people like me by using ‘stigma’ as a universal term, as a society we need to reflect on our own behaviours and attitudes and identify discrimination when it occurs to enable individuals to take action and implement change on a broader scale.
References
‘Mental health in Australia: a quick guide’
Parliament of Australia (2019)
‘Mental Health Services: In brief 2018’
Australian Institute of Health and Welfare (2018)
‘Discrimination in health care against people with mental illness’
Graham Thornicroft, Diana Rose & Aliya Kassam, International Review of Psychiatry (2007)
‘Stigma, discrimination and social exclusion: What's in a word?’
Liz Sayce, Journal of Mental Health, (1998)
‘Inquiry into Workforce Participation by People with Mental Illness’
Parliament of Victoria Family and Community Development Committee (2012)
Ingram v QBE Insurance (Australia) Ltd [2015] VCAT 1936
‘Research Report: Access to the Private Rental Market: Industry Practices and Perceptions’
Tenants Union of Victoria (2008)
‘Findings - Review of the Disability Discrimination Act 1992’
Productivity Commission (2004)