Stigma Of Mental Illness And Attitudes Towards Seeking . - Atlantis Press
Advances in Social Science, Education and Humanities Research, volume 139Universitas Indonesia International Psychology Symposium for Undergraduate Research (UIPSUR 2017)Stigma of mental illness and attitudes towards seeking mental healthservices among undergraduates in a public university in MalaysiaHong Sing YeeUniversity of Malaya*E-mail: singyee.hong@hotmail.comAbstractMany people with mental illnesses have faced, or are facing the burdened impact the stigmahas acted on them. Needless to say, mental health stigma held by society is playing its role asa barrier that prevents many people from actively seeking professional mental help (Corrigan,2004). Researcher then sought to examine the current level of stigma. Aims: To investigatewhether the level of stigma surrounding mental illness is significant and whether it affectstheir attitude towards seeking mental help significantly. Methods: Questionnaires weredistributed to 100 participants from the age of 20 to 28 from different faculties and dataobtained was analyzed using SPSS 24.0 using mean score, percentage, frequency, andPearson correlation. Conclusions: The level of stigma towards mental illness is low andinsignificant, and participants generally hold a positive attitude towards seeking mental healthservices. There is a significant positive correlation between the level of stigma and theirattitude towards seeking mental health services.Keywords: personal stigma; public stigma; perceived public stigma; attitudes towardsprofessional mental help-seeking.1. IntroductionHaque (2005) described the ideas of mental illnessand mental health in Malaysia based on the religioustexts (as cited from Cheng et al, 2018). In Malayculture, it is seen that the strong influence ofreligion in the culture as one of the compasseswhich direct the conceptualization that mentaldisorders result from the act of deserting orneglecting Islamic values. Meanwhile, in Chineseculture, people are keen that any excessive,unbalanced, or undisciplined emotion is the cause ofillnesses. For the Chinese, filial piety is the mostprioritized value above all and one‟s self-worth isdignified by the physical and concrete achievements;things that can be seen and acknowledged that onebrings to the family (i.e., education, occupation, andmonetary gain). Then, the Christians say that truemental health is not attainable in the absence of aright relationship with God.According to American College Health Association(2015), mental health issues are common andpervasive in college campuses and universities, withapproximately 50% of adults who attend collegeshaving been diagnosed with mental disorders (Zivin,Eisenberg, Gollust, & Golberstein, 2009; as citedfrom Cheng et al, 2018). Nevertheless, it should alsobe acknowledged that the help-seeking percentageamong the students is alarmingly low. In Malaysia,The Ministry of Health Malaysia‟s statisticsrevealed a worsening state of mental healthproblems among Malaysian students, from one in 10individuals in 2011 to one in five in 2016 (NationalHealth and Morbidity Survey, 2015). Again, similarto the Americans, undergraduates are among the agegroup susceptible to the risk of developing mentalillness, and thus, it should also be given muchattention compared to other age groups and stagesof life development. Even though the treatment,effectiveness and the knowledge regarding mentalhealth have improved over the past 50 years, thereare still a substantial number of people who refuseto seek for professional mental help given their direcircumstances (Corrigan, 2004).Stigma, according to Corrigan (2004), has beenidentified as a major barrier to seeking help frommental health professionals. Aside from having todeal with public stigma, individuals who seekpsychological help must also overcome self-stigma,which may play an even more crucial and influentialrole in help-seeking behaviours (Eisenberg et al.,2009; Vogel et al., 2006). Among samples ofcolleges‟ students, racially or ethnically diversecollege students with a higher level of self-stigmaCopyright 2018, the Authors. Published by Atlantis Press.This is an open access article under the CC BY-NC license 49
Advances in Social Science, Education and Humanities Research, volume 139are less likely to seek mental help fromprofessionals (Nam et al., 2013; Vogel, Wade, &Hackler, 2007; as cited from Cheng et al, 2018).Also, researchers have identified that collegestudents who associate the act of seeking help withtheir self-stigma are more likely to experienceanxiety and depression when they think of seekinghelp (Cheng, McDermott, & Lopez, 2015; as citedfrom Cheng et al, 2018).Public stigma is one of the vital contributors thataffect largely on people‟s attitudes toward seekingpsychological help especially among those fromAsian cultural backgrounds (Sue, 1994; Ting &Hwang, 2009; as cited in Nam, & Lee, 2015).Students seemed to be fearful of the stigma thatrelated to mental health problems and worried that itwould be perceived as a sign of shortcoming anddeficiency, while also affecting their future careerprospects if a mental health diagnosis were toappear on their medical descriptions (Quinn, Wilson,MacIntyre, & Tinklin, 2009).The existence of stigma towards mental illness isunavoidable in most cultures. However, it is evenmore notable in Asians and Asians Americans ascompared to White Europeans and Americans(Kleinman, 2004; Fogel & Ford, 2005; Yang et al.,2007; Hsu et al, 2008). The term „stigma‟ is definedby several different uses. „Public stigma‟ is knownas the negative stereotypes and prejudices thatgeneral community and public held about mentalillness and individuals diagnosed with mental illness(Corrigan, 2004). „Personal stigma‟ is how anindividual, by themselves, would see and treatothers who may or may not be stigmatized(Pedersen & Paves, 2014). „Perceived publicstigma' is the beliefs of members of a society aboutothers' perceptions and attitudes toward people witha certain stigmatized group (Reavley & Jorm, 2011).This stigma towards mental illness has been puttingon a prominent barrier against seeking mental healthservices from professionals and thus, neglecting thetreatment beneficial to the patients (Sartorius, 2007;Schomerus & Angermeyer, 2008).In a study done by Ilic et al. (2013), they found thatsome participants reported how they felt as thoughthey were evaluated and judged through the lens andinterpretation as someone “mentally ill”.Participants also reported experiences of being thetopic of gossips, having their friends or datingpartners withdrawing and distancing themselves as areaction to what has been shared about their mentalissues, hurtful remarks, and bad jokes about mentalillness or psychiatric treatment. The majority ofrespondents claimed that they experienced thewithdrawal from friends, neighbors, and evenrelatives. Many people with mental health issuesnever seem to pursue treatment, while with thosewho did go for professional mental help did notadhere to the course or completing the wholetreatment (Corrigan, 2004). According to previousresearch, this is due to the stigma that is attached tomental illness and people who tried to seek help fortheir mental issues.This research examines both personal stigma andperceived public stigma of the participants ratherthan self-stigma since both the stigma applies toeveryone, with or without the participants havingmental health problem (Eisenberg et al., 2009) andwhether these two stigmas would significantlyaffect their attitudes towards professional mentalhelp-seeking (one‟s inclination to reach out forprofessional mental help if one is having personalcrisis or extended mental and psychological distress)(Soorkia, Snelgar, & Swami, 2011). Positiveattitudes towards professional mental help-seekingmean they are more inclined to seek psychologicalaids from professionals while negative attitudestowards professional mental help-seeking are whena person is unlikely to reach out for psychologicalhelp even in the midst of having psychologicalissues or discomfort (Soorkia, Snelgar, & Swami,2011).There may be other different factors that are haltingthe people from pursuing mental health services. Asyet, few researchers have taken the initiative toinvestigate the current perceived stigma ofundergraduates towards mental illness, theiracceptance towards people with mental illness or ahistory of mental illness, and their attitudes towardsseeking mental health services. Also, most of theprevious researches that were done focused onbarriers to mental health care in Western countriesand it is not yet seen on research in Malaysia, andthus, it is not known if the results can be generalizedto Malaysia. It is crucial for the level ofstigmatization among undergraduates to be clarifiedbecause the stigmatization reflects the innerthoughts of themselves on mental illness and alsofor the people around them. In knowing the currentlevel of stigmatization among the students, themental health professionals would be able toimprovise on what should be done and what hadimprovedthisstigmatizationphenomenon.Therefore, this current study sought to answer thefollowing questions:a) Is the level of stigma towards mental illnesssignificant among the participants?b) What is their attitude (negative/positive) towardsseeking mental health services?c) Do they accept the people with mental illness as250
Advances in Social Science, Education and Humanities Research, volume 139normal functioning members of society?d) Is there a significant correlation between thelevel of stigma towards mental illness and theirattitudes towards seeking mental health services?2. MethodsParticipants. This research is done in the form ofdescriptive study. The subjects for the studyconsisted of a number of 100 undergraduates from apublic university in Malaysia from the age of 20 to28 years old. The subjects were picked randomlyfrom different faculties and were given a briefinstruction on how to complete the questionnaires.All of the respondents (n 100, response rate 100%) completed the questionnaires independentlyand the questionnaires were returned to theresearcher. Each of the questionnaires consists ofthree parts and the data obtained was analyzed usingSPSS version 24.0.Measures. Part A: Demography. Part A in thequestionnaires includes the items related to thebackground of the respondents: their age, gender,ethnicity, and faculty of their studies. There are fouroptions related to age: (1) 17 – 20 years old, (2) 21 –24 years old, (3) 25 – 28 years old, and (4) 29 yearsold and above. Next, there are four optionsregarding their ethnicity: (a) Malay, (b) Chinese, (c)Indian, and (d) others. Meanwhile, there are nooptions of the faculty of studies given since therespondents are to fill it on their own accord.Part B: The Perceived Stigma Questionnaire(PSQ). In this study, only the modified version ofthe Discrimination- Devaluation (D-D) Scalecontaining 12 questions statement from the originalPSQ developed by Link in 1989 was used. Only thedevaluation-discrimination scale is used since thisresearch is principally concentrated on assessing theattitudes and perceptions of participants towardpeople who had and are receiving mental healthservices. In the modified version, the items wererewritten to inquire the participants‟ thoughts andopinions on what they themselves would do asopposed to what most people out there would do.To measure people‟s personal stigma, which is theirown stigmatizing attitudes about seeking mentalhealth treatment from professionals, 10 items with“Most people” are replaced with “I.” For instance,the original item „Most people would willinglyaccept a mental health consumer as a close friend‟was changed to „I would willingly accept a personwho receives mental health services as a closefriend‟. Also, to measure the participants‟ perceivedpublic stigma, 2 items that start with “Most peoplethink . . .”, and then followed by a stereotype or aform of discrimination, or a kind of acceptingperception or attitude towards people with mentalillness diagnosis) were asked.Participants are asked the extent to which they agreewith statements about individuals with mentalillness, rated on a six-point Likert scale: stronglydisagree 1, disagree 2, somewhat disagree 3,somewhat agree 4, agree 5, and strongly agree 6.Some of the items are reverse scored (i.e. 5, 6, 7, 9,11, 12), and scores for all the items are added toobtain a total score ranging from 12 to 72. Lowerscores on the scale indicate more devaluationdiscrimination toward the mentally ill.Table 1Reliability and validity of efficients0.78 – 0.87Part C: The Inventory of Attitudes toward SeekingMental Health Services (IASMHS). IASMHS wasfirst developed by Mackenzie, Knox, Gekoski, andMacaulay in 2004. The 24-item scale is created todetermine the attitudinal factors that influence theact of seeking mental health services. This scale wasdeveloped based on Fisher and Turner‟s cal Help Scale. Results showed that the24-item scale could be explained and understood interms of three correlated factors, which makes upfor 43% of variance (8 items for each subscale): (a)Psychological openness (PO), (b) Help-seekingpropensity (HSP), and (c) Indifference to stigma(IS).Firstly, psychological openness (PO) refers to thedegree to which an individual is open toacknowledging the presence of a psychologicalproblem and to seek professional care for such aproblem. Question 1, 4, 7, 9, 12, 14, 18, and 21belongs to this subscale. Next, the help-seekingpropensity (HSP) subscale reflects one‟s willingnessand perceived ability to seek help for psychologicalproblems and comprises question 2, 5, 8, 10, 13, 15,19, and 22. Meanwhile, another 8 questions: 3, 11,16, 17, 20, 23, and 24 belongs to the subscaleindifference to stigma (IS), where this subscalerefers to how concerned an individual would feel ifsignificant others were to discover that they werereceiving psychological care (Hyland et al., 2015).Each factor is proposed to be measured via 8 itemsand each item is measured using a five-point Likertscale ranging from 0 (“disagree”) to 4 (“agree”).The following items are reverse scored: 1, 3, 4, 6, 7,9, 11, 12, 14, 16, 17, 18, 20, 21, 23, and 24.251
Advances in Social Science, Education and Humanities Research, volume 139Table 2Table 3Reliability and validity of IASMHSSubscalesCronbach’s alphasPerceptions of respondents towards people withmental illness (percentage, frequency, means andstandard deviation)Item SomeAgree (%) Strong- Means SDwhatly agreeagree(%)(%)1 37(37%) 34(34%)17(17%) 4.540.9682 25(25%) 30(30%)14(14%) 4.181.2093 33(33%) 28(28%)1(1%)4.131.1434 38(38%) 29(29%)9(9%)4.081.2035 11(11%) 8(8%)2(2%)4.461.2986 22(22%) 19(19%)9(9%)3.431.3947 32(32%) 8(8%)5(5%)3.831.3498 42(42%) 24(24%)10(10%) 4.091.1299 27(27%) 13(13%)1(1%)3.761.14710 34(34%) 12(12%)8(8%)3.571.27311 30(30%) 19(19%)10(10%) 3.161.2122 22(22%) 6HSP0.760.64IS0.790.91PO Psychological openness, HSP Help-seekingpropensity, IS Indifference to stigma3. ResultsParticipants’ demographic characteristicsAmong 100 respondents involved in this study,more than half of the sample is made up of femalerespondents (70%, n 70), while male respondentsconsist of 30 of them (30%, n 30). Age wise,respondents aged 21 to 24 makes up the largestnumber of the sample, which is 81 (81%), then 17 to20, which is 10 of them (10%), and 9% participantsfrom ages 25 to 28. Then, regarding the ethnicity, amajority of the respondents is made up of Malayundergraduates, which is 44 of them (44%),followed by Chinese with 36 of them (36%), thesecond least number of respondents are the Indiansrespondents, 17 of them (17%), and the leastnumber of the respondents are in the „others‟, where2 of them are from Brunei while another femalerespondent does not specify her ethnicity in thequestionnaire.Level of stigma towards mental illness among theparticipants12 questions from Part B of the questionnaires wereanalyzed using SPSS 24.0 by utilizing the meansscore, frequency, and percentage.From the percentage and means obtained, it can beseen that for the respondents, the level of the stigmatowards mental illness and also towards the peoplewho have the mental illness is low and notsignificant. Besides, it is also seen that theparticipants generally hold a positive and nonstigmatizing attitude towards people with mentalillness, and those who had, or are receiving mentalhealth services. Also, it shows that most of theparticipants are generally inclined towardsacceptance of the people with mental illness asnormal functioning members of society. Perceivedpublic stigma seems to hold a higher percentage andgreater level of stigmatizing attitudes as comparedto personal stigma. This means that the participantsmay have overestimated the negativity of the stigmathat they perceive the public may hold againstpeople with mental illness diagnosis as compared totheir own personal stigma attitudes.1 Accept one as close friend; 2 One is as intelligent asaverage person; 3 One is as trustworthy as average person; 4 Accept one as teacher for young children in public school; 5 Entering mental hospital is a personal failure; 6 Refusal ofallowing one to take care of their children even if he/she hasbeen well; 7 Being in a mental hospital makes one lesser thanan average person; 8 Acceptance of hiring one to work ifqualified; 9 Refusal of consideration the application of oneand prefer another applicant; 10 Most people treat personwho receives mental health services as anyone else; 11 Reluctance of young people to date one; 12 One’s opinionwill be taken less seriously.Attitude (negative/positive)mental health servicestowardsseeking24 questions from Part C of the questionnaires wereanalyzed using SPSS 24.0 by utilizing the meansscore, frequency, and percentage.Table 4Mean and Standard Deviation for subscale HelpSeeking Propensity (HSP)ItemMeanSDSequences among 9456Total21.57.632 Knowing of what to do and talk if decided to seek help forpsychological problems; 5 Would recommend good friendsto seek mental services if they ask; 8 Is confident to findrelief in psychotherapy; 10 Could get professional help ifwanted to; 13 It is easy to find the time to see professionalfor mental services; 15 Would want to get professional helpif were worried or upset for some time; 19 Inclined to getprofessional attention if having mental breakdown; 22 Willingly confide intimate matters to person if one might help252
Advances in Social Science, Education and Humanities Research, volume 139From Table 4 above, it can be seen that the totalmean for the subscale of Help-Seeking Propensity is21.5 over the total mean for three subscales, 51.03.(Psychological openness (PO) 12.84; Indifferenceto stigma (IS) 16.69). This shows that therespondents have a positive attitude towards seekingmental health services since the help-seekingpropensity (HSP) subscale reflects one‟s willingnessand perceived ability to seek help for psychologicalproblems.Table 5Overall Mean Score and Standard Deviation for threesubscales of 9.213Total51.0326.103PO Psychological openness, HSP Help-seekingpropensity, IS Indifference to stigmaCorrelation between the Level of StigmaTowards Mental Illness and Attitudes TowardsSeeking Mental Health ServicesTo analyze the relationship between the level ofstigma towards mental illness and their attitudestowards seeking mental health services, Pearson Rcorrelation is used.Table 6Correlation between the Level of Stigma TowardsMental Illness and Attitudes Towards Seeking MentalHealth ServicesLevelof lnessHealthServicesLevel ofPearson10.419StigmaCorrelationTowardsSig sSeekingMentalHealthServicesPearsonCorrelationSig (2-tailed)N0.41910.000100100The correlation between perceived stigmatizationtowards mental illness and attitudes towards seekingmental health services is r 0.419 (p 0.05). It isconcluded that there is a significant positivecorrelation between perceived stigmatizationtowards mental illness and attitudes towards seekingmental health services among the participants.Hence, the hypothesis is accepted.4. Discussion and ConclusionThe present study revealed that the level of stigma islow among the participants and it significantlyaffects their positive attitudes towards seekingmental health services. Contrary to expectation andcomparison with previous research, the finding inthis study shows that the respondents are showing apositive attitude towards seeking mental healthservices (one‟s willingness and perceived ability toseek help for psychological problems). However, itis similar to a study done by Chen and Chang (2016)on the staffs in a psychiatric hospital in Taiwanwhich shows that they do have a positive attitudetowards people with mental illness in generalsituation. Besides, in a study done by Gateshill,Kucharska-Pietura, and Wattis in 2010, they foundthat the attitudes of both mental health professionalsand non-mental health professionals towards peoplewith eating disorders were deemed positive, inwhich also reported them feeling sympathy towardsindividuals with eating disorders.Nevertheless, there are also limitations to the study.First, the researcher examined the participants'personal stigma by obtaining the data fromquestionnaires on how one would hypotheticallytreat or view someone with mental illness diagnosis.The researcher has no means of knowing if theparticipants would actually react in such a way thatis being examined in the questionnaires when theymeet individuals with mental illness diagnosis.While this option gives participants the freedom toexpress an option where they may not have a firmopinion, it somewhat limits our understanding ofhow individuals would genuinely and realisticallyview others (or perceive to be viewed by others).The participants may consciously or unconsciouslyunderstate their explicit and implicit levels ofpersonal stigma because they were more inclined toshow a pleasant and socially favorable attitudetowards individuals with mental illness diagnosis.Secondly, since there are only 100 participants inthis study, and not to mention that they have asimilar educational background, which in thiscontext means they are pursuing tertiary educationin a public university in Malaysia, the findingsobtained from this study may not adequatelygeneralize the result to other sociodemographicgroups. Therefore, a comparison between previousstudies from other countries, populations, andsociodemographic factors may not be sufficientlydiscussed.253
Advances in Social Science, Education and Humanities Research, volume 139AcknowledgementsFirst and foremost, I am utmost thankful to mysupervisor, Dr. Noor Aishah binti Rosli for guidingme throughout the process of completing my thesisand giving her time discussing the progress despiteof her busy schedule. My parents, Hong Tek Yongand Wong Siew Kee for offering a great support andencouragement during the period of completing mythesis, and definitely, in the past, present and thefuture to come. Finally, to the friends who havebeen sharing their advice and opinions on how toprogress with my thesis: Wan Jing Mun, FarhanaNabila binti Fakarrudin, Chong Pei Ying, JenniferUng, and Hoi Kah Mun. I am deeply thankful andwords are never enough.ReferencesAli, K., Farrer, L., Fassnacht, D. B., Gulliver, A., Bauer, S., &Griffiths, K. M. (2017). Perceived barriers and facilitatorstowards help-seeking for eating disorders: A systematicreview. 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: The level of stigma towards mental illness is low and . insignificant, and participants generally hold a positive attitude towards seeking mental health services. There is a significant positive correlation between the level of stigma and their attitude towards seeking mental health services. Keywords:
addiction-related stigma, this chapter provides a brief overview of addiction-related stigma. This chapter includes a discussion of four broad types of addiction-related stigma, ways to understand stigma, and definitions of stigma. It reviews several ways in which stigma is sustained, the effects of stigma, an exercise to consider whether
1.3 This Guide 6 2. Understanding mental illness 7 2.1 About mental illness 7 2.2 Facts about mental illness 7 3. Managing mental illness in the workplace 9 3.1 Effective communication strategies 9 3.2 Reasonable adjustments 11 3.3 Examples of reasonable adjustments to address the effects of a worker's mental illness in the workplace 13
people living with mental illness say the stigma they face is often worse than the illness itself.” In the context of these lessons, the US Substance Abuse and Mental Health Services Agency (SAMHSA) deines stigma as “a cluster of negative attitudes . Senior and Junior High Lesson Plan: Stigma
THE STIGMA OF SEVERE MENTAL ILLNESS: SOME POTENTIAL SOLUTIONS FO R A RECALCITRANT PROBLEM David L. Penn, Ph.D., and James Martin, B.A. Despite recent advances in the treatment of individuals with severe mental illness (SMI), their full integration into society
specific use for dually-diagnosed persons with mental illness and substance abuse (Link et. al, 1997), the most comprehensive measure of discrimination and stigma faced by people with mental illness is the “Discrimination and Stigma Scale (DISC)”. The DISC is a 36-item scale that
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
the roots of stigma and how it affects PLHAs, families, children and communities and develop strategies and skills to confront stigma and discrimination. How was the Toolkit Developed? The toolkit developed out of a three country research project on HIV stigma.* At the start of the research project, workshops were organized for research .
Jeffery was a good introduction to scoping. In appropriate order different bureaucratic levels were tackled, always sensitive to the pressures in each place. The many discussions with Roger proved useful during the field work later. For example, we confronted the problem of finding very large sample sites which were suitable on other parameters. So we discussed how this should be tackled .
