By Ashwin, UK Correspondent
Oct 4, 2004, 16:00

A survey of psychiatric and non-psychiatric in-patients, published in the October issue of the Psychiatric Bulletin, has found that the stigma of mental illness is reflected in the secrecy surrounding disclosure of hospital admission, and the relative lack of tokens of support.

How do people with mental illness respond to stigma? There is evidence that they internalise negative beliefs, leading to feelings of shame and low self-esteem. This process of 'self-stigma' can result in reluctance to seek help, and secrecy about the illness.

This study used a structured interview-based questionnaire to measure the number of cards and gifts received by 40 people undergoing psychiatric in-patient treatment, compared with an age- and gender-matched group of medical in-patients.

Patient disclosure of admission and diagnosis to family and friends in the two groups was also assessed.

It was found that psychiatric in-patients received about half as many cards as the medical patients (60 v. 112). Gifts to the psychiatric patients were often practical in nature, such as toiletries, ordinary food and tobacco. Medical in-patients received more 'luxurious' presents, such as flowers, balloons, magazines, trivia books and luxury foods.

Disclosure of admission for mental illness was significantly lower in the psychiatric patient group compared with the medical patient group, both to family members (139 v. 193) and particularly to friends (74 v. 332).

The psychiatric patients gave varying reasons for non-disclosure, mainly relating to their experience, or fear, of stigma from others. For example:

'People are afraid... They judge you differently when they know'
'I feel embarrassed... I should be more in control'
'I'm afraid I'll be sacked'
One psychiatric patient blamed his lack of cards on 'people not knowing what to put on a card if you're mad'.

Research into methods of reducing stigma points to contact with people with mental illness as being the most reliable method of producing longstanding change in attitudes. Reduced contact with mentally ill patients has implications for society as a whole in maintaining the status quo of stigma.

The authors of the study comment that clinicians should be aware of the risk of isolation, reduction in support from patients' social network, and elements of self-stigma that prevent honesty about their illness. Recovery, compliance with medication and the risk of relapse are all likely to be affected by patients' experiences of stigma.

Bromley JS, Cunningham SJ (2004) 'You don't bring me flowers any more': an investigation into the experience of stigma by psychiatric in-patients, Psychiatric Bulletin, 28, 371-374.

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