Stigma and discrimination

1. Stigma is the set of negative attitudes, beliefs and stereotypes people hold about mental health problems.
2. Discrimination is the unfair treatment that follows once those attitudes turn into behaviour.
3. Both can reach a person before diagnosis and after diagnosis.
4. The two feed each other, because unfair treatment confirms the stereotype and the stereotype licenses more unfair treatment.

Stigma before diagnosis

1. Expecting to be judged stops a person seeking help, so a problem that could be treated early is left to grow.
2. Many people turn the stereotype on themselves, which is called self-stigma, and feel ashamed or weak before anyone has assessed them.
3. Self-stigma lowers self-esteem, and low self-esteem is itself a symptom that makes depression harder to shift.
4. Some people conceal symptoms from family, friends and teachers, and so lose the support that would help them cope.
5. Concealment also means the people around them read the changes as rudeness or laziness.
6. Delay pushes diagnosis later, and a longer untreated period usually means a longer recovery and more time lost from school or work.

Stigma after diagnosis

1. Once a diagnosis is known, people may respond to the label instead of the person, so it overshadows everything else about them.
2. Public myths about mental illness shape how people respond to a diagnosis.
   1. People with a severe mental illness are more likely to experience violence than the general population is.
   2. Schizophrenia is a condition involving hallucinations and delusions, and it has nothing to do with having two personalities.
3. Being seen through the label lowers confidence and expectations, so a person steps back from work, education and friendships.
4. Self-stigma continues after diagnosis, and a person may decide for themselves that they will never work or study again.
5. Stigma can spread to the family too, so parents and partners are asked what they did wrong.
6. That withdrawal isolates the person further and makes the condition harder to manage.

Discrimination before diagnosis

1. Unfair treatment can begin long before any diagnosis, because other people react to the changes they have noticed.
2. At school or at work a person who misses lessons or shifts is left out, teased, or written off as unreliable.
3. Without a diagnosis there is no formal support and no reasonable adjustment in place, so the treatment goes unchallenged.
4. There is no legal protection either, since the Equality Act works from a recognised long-term condition.
5. Being treated this way makes a person even less willing to come forward, so the delay caused by stigma gets longer.

Discrimination after diagnosis

1. A known diagnosis can mean being turned down for a job, passed over for promotion, or managed out of a role.
2. In healthcare, physical symptoms are sometimes put down to the mental health problem, which is called diagnostic overshadowing.
   1. Chest pain read as anxiety means a heart problem gets missed, and this is one reason people with a severe mental illness die younger on average.
3. Losing work means losing income, and losing income puts secure housing at risk.
4. Friends drift away and relationships come under strain, so a person loses the practical support that helps recovery.
5. Under the Equality Act 2010 a long-term mental health condition counts as a disability, so this treatment can be unlawful and adjustments such as changed hours can be requested.

Reducing stigma and discrimination

1. Attitudes shift most when people meet someone with lived experience, which is why Time to Change was built around social contact between the public and people with a diagnosis.
2. Teaching about mental health in schools replaces the myths with the ICD characteristics, so a diagnosis carries accurate information.
3. Media guidelines on how mental illness and suicide are reported cut the number of stories that link a diagnosis with violence.
4. Employers who advertise adjustments make it safer to disclose a diagnosis and keep a job at the same time.
5. Recovery is a realistic outcome, and with treatment and support many people diagnosed with a significant mental health problem go back to work, study and ordinary family life.

Turning this into marks

1. When two effects are asked for, make them genuinely separate rather than one effect rephrased.
2. Say whether the effect is stigma or discrimination and whether it falls before or after diagnosis, because an answer that could apply to any of the four does not secure the knowledge mark.
3. Ground each effect in one specific consequence, such as a lost job or a missed appointment.
4. The mark most often lost is describing an effect on the person when the question asked for an effect on society.