Background for National Statistics, 2016). These statistics prove

Background and
Introduction

Around 1 in 4 people in the UK experience a mental health
issue each year (McManus, Meltzer,
Brugha, Bebbington, & Jenkins, 2009). A study in 2015 also found
that 13% of adults aged 16 or over living in Wales were reported to have
received treatment for a mental health condition which was a 1% increase from
the previous year (Welsh Health Survey, 2015).  Mental health can be diagnosed in many
different forms, the most commonly diagnosed being depression, anxiety, bipolar
disorder, phobias, psychotic disorders, obsessive compulsive disorder (OCD),
post-traumatic stress disorder (PTSD), personality disorders and panic
disorders (Mcmanus, Bebbington, Jenkins, & Brugha, 2016)., Mental health
problems caused 18,220 people in the UK to commit suicide between 2003 and
2013(University of Manchester, 2015) and 75% of suicides in 2016 were male
(Office for National Statistics, 2016). These statistics prove how major the
problem of mental illness is and show that successful initiatives are needed to
help people cope with their mental illness.

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The Time to Change initiative was created in 2009 and was
the largest ever programme in the UK to reduce stigma against people with
mental health problems and was funded with £18 million from the Big Lottery
Fund and Comic Relief (Henderson & Thornicroft, 2009). Time to change works
with workplaces, communities, schools, local hubs and uses social marketing
techniques to improve the public’s attitudes toward people with mental health
problems and encourage people to take action against the stigma associated with
mental illness. This initiative was chosen because of its main aim to reduce
stigma and it’s more recent aim to target men, whose attitudes seem to have
shifted significantly slower than women’s.

This essay will firstly discuss the stigma that comes with
mental illness. Then the social isolation which mental health can cause will be
discussed followed by how effective an initiative is in changing people’s
outlook on mental health and reducing its stigma and resultant social isolation.

Stigma

Mental health problems are second to HIV/AIDS in regards to
discrimination (Roeloffs et al, 2003). This discrimination is a result of
stigma, which can be defined ‘as a brand, a mark of shame or discredit, a
stain, and an identifying mark or characteristic’ (Morrell, 2002, p21). Stigmatizing
beliefs may stem from media portrayal which has made people more intolerant of
people who suffer from mental illness (Granello, Pauley & Carmichael,
1999). For example, Hyler, Gabbard & Schneider (2006) suggest TV and movies
cause radical stigmatizations of the mental patient which include homicidal
maniac, narcissistic parasite or a rebellious free spirit. This is a great contributor
as to why Opinion Research Services (2016) found that 1 in 2 people thought
people with mental health problems are unpredictable.

These stigmatization are a large barrier which can stop
people from seeking help. Stigma can cause two types of harm that can
discourage treatment participation; it shrinks self-esteem and robs people of
social opportunities (Corrigan, 2004). The reason people’s self-esteem can be
reduced is because self-stigma can also occur due to people perceiving stigma
to be legitimate and identifying themselves in a ‘mentally ill group’ (Watson,
Corrigan, Larson & Sells, 2007). It has been suggested that self-stigma
only occurs when perceived public stigma is present (Eisenberg, Downs,
Golberstein & Zivin, 2009) which indicates that stigma can make people feel
ashamed of themselves even if these beliefs are radical and untrue.

Social opportunities such as likelihood to find a job are
also reduced when labelled with a mental health problem when compared to
similar people who are not labelled (Link, 1982). This can cause people to
conceal their mental illness when applying for jobs which can cause legal
struggles and further psychological implications (Wheat, Brohan, Henderson
& Thornicroft, 2010), which can work to make symptoms of a mental illness
worse . There is also evidence to suggest that having a job can help distract
people from symptoms (Van Dongen, 1996), meaning that if stigma was reduced and
people could find jobs more people would cope better with their mental illness
and there is little no evidence proving that mental health can be negatively
affected by employment (Marrone & Golowka, 1999).  These implications of stigma can all lead to a
person not seeking help, out of fear that they may suffer financially and
socially. It has also been widely proven that mental health professionals also
subscribe to mental illness stereotypes ranging from medical students (Keane,
1990) to qualified professionals (Mirabi, Weinman, Magnetti & Keppler,
1985). Again, if even health professionals are legitimizing the stigmatizations
people are going to be more wary about seeking help. Not seeking help may
result in self-harm or suicide which could have been prevented. Reducing this
stigmatization could therefore have a large effect on suicide rates in the UK
as well as recovery rates of mental illness sufferers.

Not all mental illness sufferers react to stigma negatively.
There are cases when self-stigma occurs and self-esteem and confidence in ones
future suffers. There are cases when people seem unaffected by stigma and there
are cases where people’s sense of self is harmed and they feel energized by it.
The latter people may then forcefully react to the injustice (Corrigan, 2000). This
could be a reason one study found that perceived stigma was not significantly
associated with the utilization of health care services (Golberstein, Eisenberg
& Gollust, 2008). This study used participants who generally had a higher
socio-economic status than the general population and included many students
seeking higher education. This population does not therefore accurately
represent the average population which is why this results may have been
gathered.  It is therefore important that
an initiative such as Time to Change works to help challenge stigma, to assist
people whose self-esteem and confidence would be affected. The people who react
to this stigma positively or angrily can be useful to initiatives such as Time
to Change because they can help to challenge stigma by providing their stories
and proving that these stigmatising beliefs are incorrect and damaging.

Gary (2009) suggests that being a member of an ethnic
minority group combined with stigmatisation can further discourage seeking treatment
and results in poorer well-being which again creates preventable deaths. This
could be due to socio-economic status or environmental factors not just stigma within
these ethnic minority groups. Mental health problems are more prevalent in
poorer and more disadvantaged populations (Patel et al, 2010). This partly contributed
to by people who have mental illness not being able to find a job, or being
paid less due to stigma. Huxley & Thornicroft (2003) state that in the UK, only
one in ten people  in psychiatric care
has a job and only earn two thirds of the average national hourly rate. This
statistic can scare people away from wanting to be diagnosed which may cause
them to blame themselves due to not knowing what is wrong with them. Also, lack
of money due to stigma can decrease people’s ability to get the help they may
want. For example, paying for travel to a see specialists, or having private
psychologists who can help them cope may not be an option, due to the financial
struggles of a mental illness sufferer.

Predominantly, stigma causes catastrophic negative effects
which means the need for the Time to Change initiative is obvious. If this
initiative is successful in decreasing stigma it will have a positive knock on
effect on rates of suicide or self-harm, self-stigma and help seeking. Reducing
stigma can also even out inequalities such as ability to find a job and
therefore these people can afford the best healthcare which they may need to
improve and possibly overcome their mental illness.

 

Social Isolation
& Social Ties

Another possible implication of stigma can be social
isolation (Crisp, Gelder, Rix, Meltzer & Rowlands, 2000). This can be
through a public stigma that people with mental illness should be feared and
avoided (Brockington, Hall, Levings & Murphy, 1993) or self-stigma that
they are less valued and their self-esteem is decreased (Corrigan & Watson,
2002), causing people to avoid social interaction and isolate themselves by
choice. This causes the person to have inadequate social ties and social
support which has been linked to symptoms of depression (Barnett & Gotlib,
1988). These symptoms may be caused by the psychological stress created by
losing important social ties that may have been present before diagnosis
(Seeman, 1996). Another cause may be the increased difficulty at coping with
mental illness, when there is nobody to assist in recovery. For instance, being
reminded to take medication, having emotional support or having

Social isolation can be defined as a situation in which an
individual has less social interaction than they would like, and that reduces
their quality of life (Suen, Gendron & Gough, 2017). This includes a
person’s occupational life which is severely affected by stigma meaning that a
lack of employment can result in social isolation. Although this might suggest
that older, retired individuals are more likely to perceive social isolation a
study in Southern Australia suggested that younger adults had the highest
proportion of social isolation (Hawthorne, 2007). However, this finding is
different to other studies relating social isolation to old age (Lowenthal,
1964: Victor, Scrambler, Bond & Bowling, 2000). This may be because adults
who are seriously ill and people in supported accommodation such as nursing
homes were excluded from Hawthorne’s study so it may be misrepresenting the old
age population, especially since the seriously ill are more likely to be
socially isolated due to stigma.

Hare (1956) hypothesized that social isolation was a causal factor
of schizophrenia and the belief that social isolation can cause mental issues
is also supported by other studies. (Lowenthal, 1964; Hare Duke & Hare
Duke, 2017). This indicates that social isolation at any time in life can have
a negative effect on mental health whether a problem already exists or not.
This also shows that not only can metal illness cause social isolation but
social isolation can also cause mental illness. Additionally to stigma, another
way in which social isolation is caused by having mental illness is that some
mental illnesses can affect somebodies ability to drive. For example,
medication side effects or effects of an illness itself, such as
hallucinations. This loss of a driving license has also been associated with an
increased social distance (Lauber, Nordt, Falcato & R 2004). This is the case primarily in rural
areas, due to poor transport links and inability to find social contact without
relying on somebody else. Transport links cannot always be afforded because of
the difficulty to find jobs when suffering with mental illness, which causes
people to be stuck in their homes or in their scarcely populated area leading
to a person’s social isolation and development of mental illness symptoms.

Although social isolation is negative,
having social ties which are stressful can also be undesirable. It is reported
that women have higher rates of psychological stress than men due to their
social ties (Kawachi & Berkman, 2001). Belle (1987) proposes that this is
due to women having more intimate relationships and provide more frequent
social support to others than men. This can cause them more stress due to being
emotionally invested in other people’s lives. Consequently, it is important
that a person with mental illness had not only prevent social isolation, but
also adds as little stress to their lives as possible. It is also important to
be surrounded by the right people. If the relationships that someone has are
unsatisfactory then this can also be linked with depression (Coyne &
Delongis, 1986). Examples of instances where a relationship can be
unsatisfactory and lead to depressive symptoms are, unsupportive, demanding,
intrusive or conflicting relationships (Burg & Seeman, 1994).

The ‘Time to Change’ initiative does not
have any features which look to directly tackle the problem of social
isolation, which they may need to look into in future due to the mental illness
problems that it can cause. However, since stigma is a big factor that causes
social isolation in mentally ill populations, having an effective initiative
which reduces stigma can have a positive knock on effect by reducing social
isolation. A future suggestion for the ‘Time to Change’ initiative is to
initiate social support classes for people with mental health conditions in
order for them to get advice and support off others in a similar situation. It
also feels supportive to know that there are others going through the same
struggles as yourself (Cassano, Nagel & O’Mara, 2008). These classes may
also decrease the feelings of loneliness, although transport problems and
financial issues may still be a problem with attending these classes.