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CE Literature Review:
Introduction
Social stigma has been a big barrier for people with mental health issues for years. Stigma has
prevented people from seeking treatment, adhering to treatment, and even discussing their mental
illness whether it has been diagnosed or not. Whenever I discuss mental health, I see it as the
definition of being mentally, spiritually, and physically healthy in all facets of life. Mental illness
does not need to be a diagnosed condition it can be as little as acute depression or as big as being
schizophrenic. Many people see symptoms of their own mental illness and don’t do anything
about it due either to the stigma they are afraid they may receive or the internalized stigma they
have against themselves. Stigma has been defined as a complex social process that involves
labeling, stereotyping, separation, status loss and discrimination that happens when there is a
difference in power between two people (Ke, et al., 2015). Stigma can often make people feel
alone, ignored, or abandoned. These stigma behaviors can discourage people from being
diagnosed with mental illness and can leave a lot of confusion within these people on how they
are feeling. Mental illness is at the forefront of public health and media, right now. “Self care” is
being emphasized throughout social media and has been slowly boiled down to face masks,
skincare routines, and drinking infused water. Although this is not the extent of self care I
believe it is a crucial step to understanding the important of taking care of one’s self. For my
capstone experience I am working with NAMI North Texas which stands for the National
Alliance of Mental Illness. NAMI is a non-profit organization that offers free peer mentor and
support groups for those struggling with mental or those affected by people with mental illness.
They also have a presentation called “Break The Stigma” which discusses what stigma is, how it
affects people, and what we can do to challenge ourselves to break the stigma cycle. This
research and literature review will help me find what studies have shown about stigma
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interventions so that we can better our seminars to have a bigger impact on our community. For
this review I read 5 different research papers, which observed how stigma affects those with
mental illness as well as some reviews over certain interventions that were put in place to combat
social stigma. I will then discuss what these implications mean and how we can proceed with this
Body
Theme #1
The community that NAMI focuses on is those with mental illness or those who have been
affected by people with mental illness in Dallas, Denton, Collin, and Rockwall counties. All of
our classes are free and are welcome to any person regardless of gender, race, ethnicity, religion,
and sexual orientation. Because our classes are free our organization attracts mostly low income
families however we don’t necessarily focus on low income communities solely. All of our peer
classes and support groups are specifically 18 and up and sadly we don’t offer classes yet for
minors under 18 because that requires a lot of resources that NAMI does not have. Even though
we don’t offer classes for minors, we do reach out to schools in the north Texas area to do
presentations for students from elementary all the way to the university level. The first journal I
read was Healthy Young Minds: The Effects of a 1-hour Classroom Workshop on Mental Illness
Stigma in High School Students by Ke and this study was to test the effects of how a one hour
classroom based workshop on high school students aged 14 to 17 worked on measuring stigma
(Ke, et al., 2015). First they started with a questionnaire to measure stigma behaviors and to
evaluate how much they knew about mental illness. The course included an introduction to
mental illness and stigma, education about psychiatric disorders and treatment options for mental
illness and available community resources (Ke, et al., 2015). They then looked at the change in
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stigma scores by administering the same test to measure stigma behaviors, in which they then
saw a dramatic reduction in the stigma scores proving the seminar to be effective (Ke, et al.,
2015). One thing I enjoyed about this study was that they administered the test again to these
students 1 month later to observe if the impact was lasting throughout time which is something I
found to not be very common throughout my research. This study demonstrated how simple an
educational seminar could be to helping people understand mental illness and stigma and how
much of a long lasting impact a small intervention like this one can have.
Theme #2
For my 2nd review I read the article The Stigma Scale: A Canadian Perspective by Meier and
although this study was conducted in Canada the one thing that drew me into it was that they
researched how region have a difference in stigma. It’s not something I had ever considered and
because of that I thought it would be very important to include in my research. The study
essentially compared the UK and Canada using a survey called The Stigma Scale, which
measures stigma behaviors and helps to kind of standardize the way we measure stigma
throughout studies so we can develop a bigger picture of accurate stigma “scores” (Meier,
Csiernik, Warner, Forchuk, 2015). The study showed that the UK had significantly higher stigma
scores than Canada which showed that regions of where people live and grow up has an impact
on the stigma they feel or receive (Meier, Csiernik, Warner, Forchuk, 2015). This evidence of
region having to do with levels of stigma had never occurred to me but makes a lot of sense
considering that different cultures have very different attitudes about mental illness. This study
shows how tailoring an education intervention would be important especially when moving to
different regions. This doesn’t have to mean only different countries but also just moving
throughout different cities in a state. For example in Texas we have a big Hispanic/Latinx
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population and very specific neighborhoods where it can be nothing but. I think when my
organization would do seminars at schools in these areas it would be very important to realize the
difference in stigma within these students vs. the predominately white schools we may have
presented at.
Theme #3
Another interesting article I came about was Portraying mental illness and drug addiction as
McGinty. This was a randomized experiment where participants read 1 of 10 vignettes (short
stories) which either depicted individuals with untreated mental illness/addiction or individuals
with successful treatment of the same conditions (McGinty, Goldman, Pescosolido, Barry, 2015).
The results of the study showed that people who read the stories about individuals with untreated
conditions heightened the negative attitudes people had related to these conditions (McGinty,
Goldman, Pescosolido, Barry, 2015). However the people who read the vignettes regarding
people with successful treatment for these conditions had a greater belief in the effectiveness of
treatment and less willingness to discriminate against persons with these conditions (McGinty,
Goldman, Pescosolido, Barry, 2015). This shows that the portrayal of those with mental illness
has a big impact on stigma behaviors and can influence a person’s belief on whether or not
treatment is possible. This would be a great addition to our peer to peer classes. We have a
specific class that focuses on the families affected by those with mental illness so that they may
better cope and understand what their loved one is going through. This would be a great addition
to our classes to include stories or portrayals of people living and managing their mental illness
so that family members who may still have some stigma/discriminatory behaviors or thoughts
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can see that it is possible to improve and that mental illness does not have to be something so
Theme #4
Another article that was researched was Toward understanding mental illness stigma and help-
seeking: A social identity perspective by Klik. This is one that discusses the help-seeking
behaviors that people express specifically when searching for mental health help and how stigma
affects these help-seeking behaviors. This study showed that those experienced more stigma and
discrimination were less likely to seek treatment for their mental health issues (Klik, Williams,
Reynolds, 2018). The study also showed that those who experienced higher levels of
discrimination and stigma had a lower social and self-identity meaning they had a hard time
feeling they “belonged” in the groups and communities they were a part of (Klik, Williams,
Reynolds, 2018). This shows how hard it can be for a person to feel accepted and open about
their mental illness when stigma plays a factor because they can often feel very alone and
isolated.
Theme #5
For the education aspect of research the article used was Challenging the Stigma of Mental
Illness Among College Students by Kosyluk. This study was designed to answer the question of
whether stigma education intervention was more effective with a contact-based condition or an
education-based intervention (Kosyluk, et el., 2015). The contact-based condition meant that the
intervention consisted of a student with a diagnosed mental illness willing to tell his/her personal
story and journey with their diagnosis to students (Kosyluk, et el., 2015). The education-based
intervention had a PowerPoint that defined mental illness/stigma as well as went over common
myths and facts surrounding mental illness specific to the college population (Kosyluk, et el.,
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2015). The study found that there was a significant reduction in personal stigma after the
interventions (Kosyluk, et el., 2015). There was no significant difference between the contact-
based condition and education-based intervention meaning that both interventions were effective
in reducing stigma (Kosyluk, et el., 2015). For NAMI all of the education seminars we offer, like
peer-to-peer and family-to-family, are taught by people who have either been diagnosed with a
mental illness or the family member of someone with mental illness. We feel that having
personal connection and hearing first hand stories can have a bigger impact on participants’
response to the education. However since this study shows there is not a significant difference
between these two kinds of interventions, this can be used to formulate more education
presentations even with presenters who may not have that diagnosis or that personal family
Conclusion
Stigma has a big impact on many different behaviors for people with mental health issues. We
have seen that it can affect people’s ability and motivation to find help, the way someone can be
diagnosed, and how everyone can experience stigma in different ways. Stigma has been a big
barrier on mental health for years and can be prevented. Education will always be the key to
unlocking everyone’s ultimate potential and I believe that stigma comes from a place of
ignorance. It can be very hard to understand what someone is going through mentally however it
is possible to learn and understand so that we can eradicate stigma throughout our communities.
Throughout this research I have shown how important stigma correcting interventions and
education programs are for people so that they may have a bigger understanding of the people
around them with mental illness. This research will be used to make a bigger impact on the
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community that NAMI serves so that we may continue to educate and bring a difference to the
References
Ke, S., Lai, J., Sun, T., Yang, M. M., H., Wang, J. C., . . . Austin, J. (2015). Healthy young
minds: The effects of a 1-hour classroom workshop on mental illness stigma in high
school students. Community Mental Health Journal, 51(3), 329-337.
doi:http://dx.doi.org.ezproxy.uta.edu/10.1007/s10597-014-9763-2
Klik, K., Williams, S., & Reynolds, K. (2018). Toward understanding mental illness stigma and
help-seeking: A social identity perspective. Social Science & Medicine., 222.
Kosyluk, K. A., Al-Khouja, M., Bink, A., Buchholz, B., Ellefson, S., Fokuo, K., . . . Corrigan, P.
W. (2016). Challenging the Stigma of Mental Illness Among College Students. Journal
of Adolescent Health, 59(3), 325-331. https://doi.org/10.1016/j.jadohealth.2016.05.005
McGinty, E. E., Goldman, H. H., Pescosolido, B., Barry, C. L. (2015).Portraying mental illness
and drug addiction as treatable health conditions: Effects of a randomized experiment on
stigma and discrimination. Social Science & Medicine, 126, 73-85.
https://doi.org/10.1016/j.socscimed.2014.12.010\
Meier, A., Csiernik, R., Warner, L., & Forchuk, C. (2015). The stigma scale: a Canadian
perspective. Social Work Research, 39(4).