Stigma the Leading Cause of Untreated Mental Health

Three-quarters of the South Africans who suffer common mental health disorders such as depression, anxiety and post-traumatic stress (PTSD) go untreated[i] – not only due to healthcare system constraints, but also the barriers of stigma, misinformation, and fears of discrimination, job loss or social rejection.

Poor mental health is a major contributor to absenteeism, poor work performance and productivity losses, with depression rated as the leading global cause of disability and ill-health[ii], and costing the South African economy over 5% of Gross Domestic Production (GDP) annually. [iii]

Prof Renata Schoeman, head of the MBA in Healthcare Leadership programme at Stellenbosch Business School, said stigma, a major contributor to untreated mental health, involved negative labelling and stereotyping of people with mental health conditions, leading to discrimination, loss of individual identity and community status, and exclusion from social networks and work opportunities.

She said organisations and the media play a key role in breaking down the stigma surrounding mental health which prevents people in distress from seeking the help they need to participate fully in the economy and society.

“Mental health is too often surrounded by silence, stigma, and misconceptions. The way it is portrayed in the media and addressed in the workplace can profoundly impact the lives of those affected by mental health conditions.

“The impact is not only on the quality of life and ability to be productive members of society for those living with mental health conditions; the impact for organisations and the economy is also substantial,” she said.

“Stigma becomes a barrier to asking for help and seeking out mental healthcare, due to a lack of information and understanding of the causes of mental health disorders. People are told to ‘just get over it’; they fear they will be seen as weak or be overlooked for work opportunities or promotion.”

“Stigma becomes internalised, resulting in poor self-esteem, a lack of self-belief – people don’t believe they can be helped or can succeed at work or in life. All of this adds up to a barrier to people restoring their lives, participating fully in work, education and social and family life, thriving and having quality of life,” Prof Schoeman said.

Role of leaders
Leaders need to “normalise the conversation” about mental health, stress and emotions, she said, and show employees that taking care of their mental health is as important as looking after their physical health.

“Responsible leadership is about being vulnerable and authentic. As a leader, if you have struggled with your own stress and mental health, if you have undergone treatment or counselling – talk about it. It is a positive story to share, and makes it easier for others to talk about their own struggles.”

“Convey the message, through talking and action, that seeking help is a sign of strength, not weakness,” she said.

She said that while employers were legally obliged to make reasonable accommodations in the workplace, for mental health conditions as much as for physical health conditions, the conversation should also turn to resilience.

“All work has stress factors and employees also need to be encouraged to take responsibility for their own health, self-care and the stress caused by issues outside of the workplace.”

“Responsible leaders need to enable people to function optimally at work by removing the factors that cause people not to cope. They can support access to treatment, ensure that workplace health and wellness programmes provide mental health support, but they must also consider what is reasonable and not reasonable.”

How can the media contribute to breaking down stigma?
The portrayal of people with mental health conditions in the media can play either a positive or a negative role in perpetuating stigma and stereotypes, she said.

“The media can avoid perpetuating stigma by considering the use of language about mental illness and people with mental illness, for example using neutral and technically accurate terms rather than slang or stereotypes of mental health conditions.

“A key aspect for avoiding sensationalism and combatting misinformation and misconceptions, is for the media to build relationships with mental healthcare professionals who can provide factual information and comment on mental health conditions, treatments and scientific research.

“When reporting on issues surrounding mental health, a qualified, experienced mental health professional can contribute to a more balanced view based on the experiences of the many people they have treated,” Prof Schoeman said.

She also highlighted the misuse of technical, diagnostic terms in society and in the media as contributing to the stigmatization of people living with mental health conditions.

“People very easily say that they or someone else are depressed, have ADHD, are ‘on the spectrum’, or are bipolar, but this is disrespectful and hurtful to people who have actually been diagnosed, are living with the condition and receiving treatment.

“Ticking the boxes of symptoms does not add up to a diagnosis. The core element of diagnosis is whether the symptoms negatively affect the person’s ability to function emotionally, interpersonally, at work and socially.

“In that case a diagnosis and prescription of appropriate treatment – for example, counselling, medication and/or lifestyle changes – is made specifically to restore the person’s ability to function optimally in daily life,” she said.

Prof Schoeman said leaders and business in the media could contribute to reducing stigma around mental health by creating platforms for people with mental health conditions to tell their stories about their experiences and difficulties as well as their path to recovery and positive functioning.

“Conveying positive and accurate portrayals of what it is like to live with a mental illness, drawing from lived experiences, enables greater understanding, empathy and compassion, based on factual information,” she said.

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Author: Linda Christensen from Jigsaw PR on behalf of Stellenbosch Business School.