Understanding and addressing the stigma of mental illness with ethnic minority communities

Higher income societies have moved from institutional to community-based care for people experiencing mental illness. However, stigma and discrimination persists and undermines help-seeking, recovery and life chances. Mental illness prevalence is higher amongst communities that face multiple prejudices and disadvantages within society, including Black and minority ethnic communities who may experience migration trauma, racism, acculturation and adverse social circumstances. This study examines beliefs, stigma and the effectiveness of existing national mental health campaigns with Pakistani, Indian and Chinese heritage communities in Scotland, UK, using community based participatory research. Community organisers were trained and supported to co-facilitate focus groups with 87 people using a range of languages. Whilst diversity within and between communities was apparent, important trends emerged. People with mental illness experience high levels of stigma from communities. Families experience significant associated stigma. This shame combines with culturally inappropriate services to reduce help-seeking from mental health services, friends and families. Existing anti-stigma campaigns have failed to reach or engage with communities due to a combination of practical issues such as the use of inappropriate language, imagery and media, but also due to assuming western medical concepts of illness. Participants suggested a new model for national campaigns placing greater emphasis upon community development, cultural events, positive contact and dialogue with families, faith leaders and youth groups. National anti-stigma programmes must develop more effective partnerships with communities or risk magnifying existing inequalities. Despite a range of national programmes to address stigma towards people with mental illness, it remains as the major barrier to social inclusion for people with mental illness living in communities. Stigma is particularly severe if people have a mental illness and are also economically disadvantaged or face multiple stigmas. By adopting community based participatory research (CBPR) approaches with three Black and ethnic minority communities in Scotland, this study makes the case that stigma can only be understood and effectively addressed with reference to its socio-cultural context.