Bipolar disorder and the 3 levels of stigma:

Lived experience and research perspectives

Dr. Erin Michalak (moderator) Natasha Kolida, Redefining BipolarDr. Steven Barnes, UBC Psychology

Sandra Kiume,@unsuicide

Support for this

event provided by the Laurel

Foundation:

Natasha Kolida,Redefining Bipolar

Dr. Erin Michalak, CREST.BD (Moderator)

Dr. Steven Barnes,UBC Psychology

Sandra Kiume,@unsuicide

Introducing our speakers today:

We’re tweeting from:@crest_bd@erin_michalak@unsuicide@redfinebipolar @sj_barnes

Remember #BellLetsTalk

Research Perspective: Patrick Corrigan and ColleaguesNotably: Corrigan & Watson (2002)

“The Paradox of Self-Stigma and Mental Illness”

Self-stigma defined

Self-stigma happens when a person with lived experience endorses negative stereotypes about

mental illness, which can cause behavioural, cognitive, and emotional changes in that person.

Self-Stigma 1 2 3

1. Sadness 2. Anger 3. Neutrality

My BD and Self-Stigma• Immediately after diagnosis,

I became depressed.– I internalized the stigma.

• Not long after I also became angry.– Like, really angry.– Angry enough to become an

activist.• Being a mood disorder, why

no support after diagnosis for this issue?

Managing Self-Stigma• Self-stigma manifests

uniquely.• Education is key.

– “Know thyself.”• Holistic approach to

approaching the self.– BD Wellness– Quality of Life

• It’s okay to not be okay.– It’s also okay not being

okay with the above.

The Light In The Tunnel• No matter where you’re at in your life, there’s hope.

• Self-stigma is kind of like the monster underneath the bed.

Structural Stigma Defined

Structural stigma is the rules, policies and procedures of social institutions that restrict the rights of and opportunities for people with mental illnesses.

Corrigan et al. (2011). Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates. John Wiley & Sons.

Structural Stigma Realms:Health Care

• Underfunding• Coercive philosophy of care• Unprofessional behaviour of clinicians

Positive change: all nurses in Canada will receive continuing education about mental health and stigma

Structural Stigma Realms:Employment & Income

• Employer refusal to hire • Criminal record checks reveal mental health

interventions by police• Failure to accommodate at work• Disincentive to work

Positive change: MHCC’s National Standard for Psychological Health and Safety in the Workplace development and implementation

Structural Stigma Realms: Housing

• Landlord discrimination/refusal to rent• Lack of affordable housing• Lack of/underfunded supportive and long term

mental health housing in community • Barriers or unacceptable qualifiers to access mental

health housing (eg. required to be sober or take medications, sharing overcrowded rooms)

Structural Stigma Realms:Education

• Barriers to education• Failure to accommodate at school• Discriminatory policies

(e.g., suicide attempt survivor not allowed to return to school)

• Questioning gaps in history due to treatment

Structural Stigma Realms:Criminal Justice

• People with lived experience of mental health issues over-represented in criminal justice system

• Stereotypes of violence reinforce structural stigma

• Poor quality of mental health care contributes to lack of parole, inappropriate use of solitary confinement

Structural Stigma Realms:Privacy

• Health history not allowed same privacy as physical conditions

• Police reveal mental health contacts with citizens in criminal record checks and to other agencies (eg. RCMP to FBI)

Positive change: courts in some Canadian provinces have ruled that police can no longer reveal mental health contacts in criminal record checks

Structural Stigma Realms:Public Participation

• In many countries people are prevented from voting in elections, serving as jurors, or holding political office

• Canada allowed people with mental illness to vote in federal elections in 1990. Only 1 of 4 countries to permit voting, of 63 surveyed in 2001

Structural Stigma Realms:Travel & Immigration

• Travel restrictions and visa qualifications from many countries

• If any history of police involvement in mental health emergency, may be denied entry to US

• Immigration denial to Canada if deemed a danger to safety or requiring an “excessive demand on health or social services”

Structural Stigma Realms:Media

• Representations and stereotypes of people with mental health conditions

Positive change: Mindset – Reporting on Mental Health guidelines for Canadian journalists. Similar in Australia and UK

Structural Stigma Realms:Reproductive Rights & Parenting

• History of sterilization• Discouraged from parenting, denied adoption or in

vitro fertilization• Restriction of parental rights, children removed from

custody • Assumption that a mental illness makes a person a

bad parent

Structural Stigma

• Studies of people with lived experience reveal most prefer legal litigation or mediation as a way to fight stigma, wanting institutional reform instead of public awareness campaigns.

• Self-stigma and social stigma are barriers to people with lived experience fighting structural stigma (e.g., Not wanting to launch a court challenge for fear of identification)

Fighting Structural Stigma

• Legal challenges• Political advocacy• Social and health care inclusion• Health care reform (recovery-oriented)• Education targeting professional groups, landlords

and employers• Research into the most effective methods of fighting

stigma