Stigmas Faced by the Psychiatric Population: Inside and Outside of the Hospital

As part of PRMS’ ongoing commitment to behavioral health, we invited Dr. Sahil Kapoor, Member of the Indo-American Psychiatric Association (IAPA) and second year psychiatry resident at the University of Arkansas for Medical Sciences’ Baptist Health residency training program, to be featured as a guest blogger this month. Dr. Kapoor shares more about his research on the stigma individuals with mental health disorders face and provides tips on how society can help change it.

"What mental health truly needs is more sunlight, more honesty, and more unapologetic conversation," said actress, Glenn Close, whose words remain highly relevant today. This quote highlights the essential objectives and direction needed in the realm of mental health. Unfortunately, vulnerable populations continue to confront significant inequalities and stigma in various environments. The existence of such stigmas in society can be attributed to multiple factors, including a lack of understanding of mental health issues, stereotypical portrayals in the media, and specific cultural influences. There could also be cultural and societal norms playing into the role of past experiences, such as institutionalization and mistreatment – and sometimes social, economic, and political factors can contribute to stigma.

Stigmas within Healthcare Institutions

In healthcare environments, biases among providers can perpetuate stigma, often stemming from inadequate training that leads to labeling individuals with mental health disorders. This focus on symptom management, rather than adopting a holistic approach, further reinforces stigma. Additionally, institutional barriers, such as hospital policies, management practices, and the surrounding environment, can contribute to this issue.¹ Furthermore, the lack of proper physician-to-physician interaction and handoffs can also contribute to the stigma within the hospital setting.

I remember on my first day as an intern, that the Medicine team, before treating a patient for medical issues, had the notion of their psychiatric history. Consciously or subconsciously, we all go through similar things within or around us that should not be avoided, but rather worked upon. How would you feel if a loved one faced stigma for their treatment options because of their mental health?

Stigmas are a chain of thoughts, like a communicable disease, that spreads from individual to individual, and those resistant remain unaffected. Some with healthy genetics (unbiased and having their own opinion) are also unaffected.  Famous people have shared many well-known quotes on the subject that can help reduce stigma. As Naomi Osaka said, "It's O.K. to not be O.K., and it's O.K. to talk about it," – we should teach the world to follow it, even if subconsciously, people may keep their mental health diagnoses in mind. Bill Clinton also said, "Mental illness is nothing to be ashamed of, but stigma and bias shame us all" – and it takes a nonjudgmental approach to treat patients.

Negative Impact of Stigma on Mental Health

Outside the hospital, people with psychiatric illnesses often face social exclusion and isolation, sometimes affecting their education and employment due to societal stigmas. The media has also played a role, and there is a need to change public attitudes and enact proper laws and policies that decrease the existence of mental health stigmas in society.² Self-stigma comes from within an individual; they may think they are flawed, thus preventing them from seeking help. Stigma discourages help-seeking behaviors from the population suffering from any mental health disorder. It's a cycle that further leads to delayed treatment, exacerbation of symptoms, social isolation, worsening mental health, low self-esteem due to internalized stigma, low self-worth, and thus negative treatment outcomes and recovery.³

Stigmas also negatively impact the people who take care of family or friends suffering from any kind of mental health disorder.⁴ Individuals fear that they will be judged for not providing proper care, in turn leading to social isolation, reluctance to seek mental health care, and also limited efforts to take responsibility for anyone suffering from a mental health disorder. This leads to further propagation of these disorders with increased severity in society. 

As adults we are possibly equally responsible for perpetuating the stigma by using psychiatric symptoms as insults. This is the time we ought to be more discreet and sensitive with words and actions and help engender empathy and understanding in people with mental health disabilities. Stigmas revolve around us; we often hear certain words such as “mental,” “psychotic,” “bipolar,” and “borderline” when people label an individual, even if we never know what an individual is truly going through or what their mental health condition is.

Stigmas within the Asian-Indian community

The roots of psychiatry can be traced back to times mentioned in Indian mythology, but to date, mental health stigmas in Asian-Indian communities have been prevalent, like the soul within a body. Though there has been more acceptance and awareness, the roots can often be too deep for someone to seek help in times of need. I still remember the echoes of my neighbor’s daughter, who was tied inside the house as she suffered from Schizophrenia – society’s pressure for acceptance, and to prevail in that same society, prevented the parents from seeking help. Our cultural factors play a role, too; myths that prevail, like mental disorders, are due to supernatural power.⁵

The Asian Indians are one of the largest communities in the United States,⁶ yet despite that, there are very few studies on their mental health or utilization of mental health support.⁷ There are many stressors, including but not limited to language barriers, culture, nuances of gender roles, family structure, and intergenerational tensions.⁸ The National Latino and Asian American Study reported that while 18% of the general U.S. population sought mental health services and resources, only 8.6% of Asian Americans did so. Asian Americans fear being thought of as weak or “crazy” for having a psychological disorder – perhaps more than any other group. Shame and embarrassment force many to struggle in silence and never seek help.⁹ Overall, Asian Americans are 50% less likely to seek mental health services.¹⁰ To bridge that gap, we must start at the roots of acceptance among ourselves and understand that mental health is as important as physical health. What we see can be treated easily, so raises the importance of effectively treating less visible mental health disorders. Though this is about the Asian community, understanding any community, their beliefs, reservations, and hindrances to seeking any help must be highlighted, explored, and acted upon with empathy and better understanding.

Public Health Education and the Role of the Psychiatrist

The stigmas we try to end begin within ourselves. Even though direct personal exposure to people with mental health conditions has been shown to dispel negative stereotypes and decrease stigma, treating a patient as a patient, despite their medical or mental history, should be our primary aim.² As we know, brain development occurs at the initial stages of life, and there should be a defined curriculum at schools to ensure that mental health is taken as a priority. Education must be imparted as early as possible to avoid bullying and trauma in young minds. We need to provide accurate information and stories that spread awareness and education throughout the world. We should enforce positive interaction with those facing mental health issues to reduce the stigma faced within themselves, as well as advocacy for inclusive policies and laws that can help reduce stigma and provide proper training to healthcare providers for non-biased and holistic care. Treating individuals with mental health disorders in these ways can help address the condition with understanding, empathy, and acceptance so individuals do not feel compelled to hide their condition. 

References:

1. Norms CotSoCBHS, Board on Behavioral Cg, and Sensory Sciences, Education DoBaSSa, National Academies of Sciences Eg, and Medicine. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. 2016. https://pubmed.ncbi.nlm.nih.gov/27631043/
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4. Vaishnav M, Javed A, Gupta S, et al. Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications. Indian J Psychiatry. Oct 2023;65(10):995-1011. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_667_23
5. Definition of STIGMA. Accessed Dec, 2024. https://www.merriam-webster.com/dictionary/stigma
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7. Rastogi M, Wadhwa S. Substance abuse1 among Asian Indians in the United States: a consideration of cultural factors in etiology and treatment. Subst Use Misuse. 2006;41(9):1239-49. https://doi.org/10.1080/10826080600754470
8. Diwan S. Limited English proficiency, social network characteristics, and depressive symptoms among older immigrants. J Gerontol B Psychol Sci Soc Sci. May 2008;63(3):S184-91. https://doi.org/10.1093/geronb/63.3.s184
9. Why Asian Americans Don’t Seek Help for Mental Illness. Accessed December, 2024. https://www.mcleanhospital.org/essential/why-asian-americans-dont-seek-help-mental-illness
10. Confronting mental health barriers in the Asian American and Pacific Islander community. Accessed Dec, 2024. https://www.uclahealth.org/news/article/confronting-mental-health-barriers-asian-american-and-2