Stigma by Professionals

1
Stigma by Professionals

• Doc. Dr. Sci. Sladana trkalj Ivezic
• Psyciatric Hospital Vrapce
• Croatia

2
Stigma

• Public opinion of mentally ill persons
• dangerous, irresponsible, not capable for life
  decisions, hard to talk to, responsible for
  causing the mental illness, non curable
  (schizophrenia), weakness of the character
  (anxiety disorder and depression)
• Public reaction lack of empaty
• desire for social distance and rejection

3
Stigma is universal phenomenon

• Stereotyped negative attitudes toward mentally
  ill are universal phenomenon (public,
  professionals, patients)
• Self-stigmatization means accepting the negative
  stereotype of mental illness

4
Stigma and hospitalization/treatment

• Psychiatric Hospital is used to isolate
  dangerous people
• Psychiatric hospital used repressive methods
• The medical treatment doesnt cure but drugs
  people

5
Why to talk about Stigma among Professionals ?

• Experience of mental illness causing low
  self-esteem and shame
• Switch from hospital to community treatment did
  not influence the self-perception of stigma by
  the patient
• Patient therapist relation is healing relation
  and should be free of stigma

6
Why to talk about Stigma by Professionals in
Mental Health?

• Stigma of mental illness is obstacle in the
  treatment of mentally ill persons and negatively
  influence the outcome
• Stigma increase risk for depression and suicid
• Influence of stigma on persons life is not
  assesed regulary so it is not consider in
  treatment plan
• Treatmen plan for diminishing negative
  consequences of stigma is nedeed for patients as
  well as professionals

7
Circulus Viciosus of Stigma

• Stigmatizing attitude are mostly coming from
  unconsciousness what is every important to know
  for people treating these patients (
  countertransference )
• People easely project fear of madness or
  weakness into mentally ill stereotype
  (shizofrenia, anxiety, depression)

8
Pilot researchPatients and their Experience with
Stigma

• Disrespect, ignorance, gossiping, calling names
  like lunatic, madcap, crazy
• Incapable for job and employment, avoided,
  isolated from the community, thrown away as
  waist, controlled more than necessary for their
  benefit, considered dangerous, environment felt
  pity for them
• With no reason they were treated with doubt,
  they experienced lack of understanding for their
  problem in their environment, there was lack of
  empathy for them , they were treated as non
  curable and lost cases

9
From whom they experienced inappropriate
reactions?

• Family, friends, neighbors, at the working place,
  physicians, psychiatrists, nurses and paramedics
  staff
• Psychiatrists were not taking them serious, there
  was a lack of communication with psychiatrists
  who were imposing to the patients their own
  personal values as proper ones and havent give
  them enough information on their illness. 

10
Ethic Guidelines Madrid Declaration

• Patient is a partner in treatment 
• support autonomy , trust, respect, agreement,
  right to be informed, to have confidential
  relation and privacy,
• Enforces self-efficiency and targeting own goals
  of treatment
• Implements biological, psychological and social
  methods of treatment

11
Stigma and Diagnosis

• Many patients do not know their diagnosis. They
  read it in the medical documentation, they talked
  between themselves, they are told that they have
  psychosis or endogen psychosis without
  explanation what is it.
• Professionals have fear that diagnoze will
  stigmatize patients
• Giving diagnosis to early is unnecessary
  stigmatization
•  

12
Stigma and research data

• Recovery form psychiatric disorder is
  possible, date (outcome and treatment) are more
  optimistic than pesimist
• DSM IV schizoprenia as cronic disorder
• How come that we used the more pesimsitic
  data?

13
Stigma of non-curability of mental illness and
its chronic character

• Dispite the optimistic date from the research,
  too often the patient doesnt experience
  optimism and hope from therapist regarding the
  prognosis of their illness
• Relaps of illness is conected with stoping
  the medications and not as an interaction of
  biological, psychological and social factors.

14
Stigma/ Education about Illness

• Patient has a right to have stigma free
  information about the illness
• Free of personal standpoints of professions
  which are in collision with the researches

15
Supporting Stigma

• If we are not openly talking about the diagnosis
  or if we talk in stigmatizing way, spreading
  myths and not facts ( Expl. Schizoprenia is
  genetic disorder) , than we support the myth
  about the horrible and incurable decease.
• Patient has a need for normalization of his
  experiences in order to continue with his life

16
Symptoms of Illness and Terminology

• Psychotic symptoms should be described in the
  same manner as somatic symptoms
• Mad house, lunatic, crazy-nut these are terms
  that will survive in social environment
• If professional is using these terms she/he is
  expressing stigma and lack of respect for the
  patient

17
Unnecessary Paternalism incapacity-stigma

• It is considered that the patient will not
  understand what is in his/her best interest, so
  professionals is taking over responsibility for
  the patient and knows whats the best for
  her/him.
• Not giving the information on diagnosis,
  treatment and planning of treatment in agreement
  with patient right on the choice of treatment is
  often conected with stigma on incapacity.

18
Paternalism and incapacity-Stigma

• Unnecessary paternalism contributes the most to
  violation of privacy, confidentiality and
  repression
• From the ethic point of view one person gives
  herself/himself right or abuses his/her position
  to bring decisions for another person.

19
Guardianship, Stigma and Human Right

• Guardianship as supstitute for treatment
• Incapacity stigma
• Deprivation of legal capacity and independent
  decision-making
• Based on stigma related to incapacity and
  inability of recovery
• To much guardianship is stigma relating

20
Stigma of danger

• Professionalss will asses a psychotic patient as
  dangerous and disabled due to stigma
• Admited patient could be placed to the closed
  ward even when there are no reasons for doing so
• He/She should give the evedence that he is not
  dangerous before he/she will be placed at open
  ward

21
Restriction of Freedom and Stigma of Being
Dangerous

• Restriction of the freedom of movement and using
  restrains could be conected with danger-stigma
  and disability-stigma and not the outcome of the
  real necessity for doing so.
• the precise guidelines are needed regarding the
  restriction of movement and usage of restrains.
• Individual assesment of risk

22
Mistrust and Stigma

• Patient often finds him/herself in a situation
  that they have to prove that he/she can be
  trusted and that he has to earn credits for
  privileges such as freedom of movement, right
  to keep with him personal belongings,
  communication with outer world, over-controlling
  of the regular intake of medicines.
• Neglect of rights can be conected with stigma

23
Stigma of Hospitalization

• Persons treated in psychiatric hospital are
  observed as more messed-up and are more
  stigmatized.
• Unnecessary hospitalization may burden a patient
  with stigma

24
Anti-stigma Programs for professionals and
antistigma treatment plan

• Stigma is often included in diagnostic procedure
  and treatment of psychiatric illness and
  represents an obstacle in the treatment
• Interventions of profesionals could be guided
  by stigma and they should be more aware about it.
• Stigma operate on uncounsousses level
  (countertransference)
• Strategies for minimizing the effects of stigma
  shoul be the part of treatmen plan

25
Patients experience successful cooping with
stigma

• There are good medications for the treatment
  of madness but there are not medications yet for
  human stupidity