Stigma and discrimination

Question 1

Define stigma

Answer 1

A sign of shame, disgrace or disapproval
To shun or reject
The word stigma comes from an old Greek word, meaning to brand or tattoo.

A combination of:
Ignorance – Problem of knowledge
Prejudice – Problem of attitude
Discrimination – Problem of behaviour

Question 2

Define discrimination

Answer 2

is the systematic, unfair treatment of people, because they are different

Discrimination is a behaviour that says to people with mental illness or addiction issues that,
“we don’t want you here”,
“you’re not as good as us”,
“you’re not one of us”
“you are not important, and you don’t belong”.

Question 3

What can discrimination impact?

Answer 3

Affects:
Discrimination of Families/ Whanau
Lack of information
Often Blamed for illness
Discrimination within Families/ Whanau
Lack of tolerance and understanding
Guilt and Shame
Frustration
That they can’t “fix it”
That services can’t “fix it” Exclusion of family/ whanau

Mental Health Services:
Not being involved in clinical decisions
Lack of consultation
Exclusive treatment of individuals
Assumption of ignorance
Blamed for problem – Child and adolescent

Community:
Social avoidance and exclusion
Lack of tolerance and knowledge from public services (school, church, general hospitals, police)
Reputations being inherited.
Migrant populations

Discrimination within Families:
Lack of education = Inaccuracy in knowledge = possibility of unhelpful/ abusive responses
Feeling responsible, ashamed of the reputation = less likely to ask for help
More likely to wait to long before accessing services
Feeling helpless to fix their loved one and frustrated that MH services can’t either

Self discrimination:
Discrimination of Families/ Whanau
Often Blamed for illness
Lack of tolerance and understanding
Guilt and Shame
Frustration
That they can’t “fix it”
That services can’t “fix it”
Exclusion of family/ whanau

Discrimination within Families:
Lack of education = Inaccuracy in knowledge = possibility of unhelpful/ abusive responses
Feeling responsible, ashamed of the reputation = less likely to ask for help
More likely to wait to long before accessing services
Feeling helpless to fix their loved one and frustrated that MH services can’t either

Community:
Social avoidance and exclusion
Lack of tolerance and knowledge from public services (school, church, general hospitals, police)
Reputations being inherited.
Migrant populations

Mental Health Services:
Not being involved in clinical decisions
Lack of consultation
Exclusive treatment of individuals
Assumption of ignorance
Blamed for problem – Child and adolescent

Question 4

What are the principles of recovery

Answer 4

Is borne of hope

Is a journey defined by the individual

Needs a supportive environment to thrive

Involves individuals redefining who they are in the presence of a psychiatric label.

Is an active and ongoing process

Is a non-linear journey

Recovery skills can be learnt

Involves a person educating themselves about their illness

Learning to manage both internalised and external stigma and discrimination

Question 5

What is trauma informed care?

Answer 5

A framework for human service delivery that is based on knowledge and understanding of how trauma effects the peoples lives

Question 6

What is a trauma-informed approach?

Answer 6

A trauma-informed approach is a strengths-based model of care delivery which focuses on the persons strengths and competencies.

Question 7

What are the trauma informed cares key features?

Answer 7

Valuing the individual in all aspects of care

Neutral, objective and supportive language

Individually flexible plans and approaches

Avoid shaming or humiliation at all times
Focusing on what happened to you ? Instead of what is wrong with you ?

Asking questions about current abuse
Addressing the current risk and developing a safety plan for discharge

One person sensitively asking the questions

Noting that people who are psychotic and delusional can respond reliably to trauma assessments if questions are asked appropriately

Question 8

Impacts of stigma individuals

Answer 8

contributes to negative feelings such as shame, unworthiness, rejection, and loneliness.
some people who experience mental illness or addiction issues do not seek help for fear of it being a mark of social disgrace or attracting stigmatisation

Question 9

Impact of self-discrimination

Answer 9

• discrimination of families/ whanau
• often blamed for the illness
• lack of tolerance and understanding
• guilt and shame
• frustration
• that they cant “fix it”
• those services can’t “fix it”
  exclusion of family and whanau

Question 10

impact of discrimination with families

Answer 10

lack of education= inaccuracy in knowledge= possibility of unhelpful/abusive responses
- feeling responsible, ashamed of the reputation = less likely to ask for help
- more likely to wait to long before accessing services
- feeling helpless to fix their loved ones and frustrated that MH services can’t either

Question 11

impact on community

Answer 11

• social avoidance and exclusion- lack of tolerance and knowledge from public services (school, church, general hospital, police)
• reputation being inherited
• assumption of ignorance
• blamed for problem

Question 12

guidelines for use of language in reducing stigma

Answer 12

• refer to people as people first and add specific characteristics only as required
• avoid referring to people as their illness
• avoid extending the nature of the persons illness with terms such as chronic, persistent or severe

Question 13

Essentials of recovery oriented practice

Answer 13

• creating relationships of safety
• encouraging the person to have some sense of control
• engaging with curiosity
• attending to language and meaning
• tapping into the person’s own capacity for self-knowing
• facilitating self-help and personal responsibility
• trauma informed service delivery

Question 14

Strengths model: principles

Answer 14

1. people with mental illness can recover, reclaim and transform their lives
2. focus is on the individuals strengths rather than deficits
3. the community is viewed as an oasis of resources
   4.the client is the director of the helping process
4. the nurse- client relationship os primary and essential
5. the primary setting for our work is the community

Question 15

Trauma

Answer 15

is the lasting adverse effects on a person’s or collective’s functioning and mental, physical, social, emotional or spiritual well-being, cause by events, circumstances or intergenerational historical traumatic experiences.

Question 16

Trauma based approach

Answer 16

• the primaily views the individual as having been harmed by something or someone. thus connecting the person and the socio-political environments
• this framework expects individuals to learn about the nature of their injuries and to take responsibility in their won recovery

Question 17

Trauma based approach key features

Answer 17

• integrates philosophies of quality care that guide assessment and all clinical interventions
• is based on current literature

Question 18

Trauma informed care and practice

Answer 18

• involves not only changing assumptions about how we organise and provide services, but creates organisational cultures that are personal, holistic, creative, open and therapeutic
• it is a practice that can be utilised to support service providers in moving from a caretaker to a collaborator role using models of recovery orientated approach