Mental Illness Stigma in the Workplace

This study looks into the effects of education on the stigma associated with those who have mental diseases. Two hundred students and recruits will complete the Social Distance Scale and the Affect Scale to determine their level of stigma toward people with mental illnesses. The independent variable is education, which is assessed as the number of years spent in formal school. The dependent variable is the level of stigma based on the scale scores. Other variables in the study include the respondent’s age, gender, and ethnicity. The fundamental idea is that the more years a person has in school, the less stigma he or she has on those with mental illnesses. Data generated will be coded and used to generate a statistical analysis for the study. Discussion of the results will refer to the related literature for this study,

Research Proposal: Mental Illness Stigma in the Workplace

Mental illness affects others’ perception about a person. In the workplace, an employee does not immediately open up to a co-worker about his or her mental condition. In many instances, such condition is even kept from public knowledge for fear of discrimination. Employers are not usually informed about this health condition during recruitment and hiring as applicants fear that such condition will prevent them from being hired. However, mental illness is a condition that is prevalent in contemporary society. In the US, about 1 in every 5 adults experiences mental illness at a given year. The most prevalent is anxiety disorder affecting 42 million Americans (NAMI, nd.).

There are numerous strategies to reduce stigma on people with mental illness. Corbiere et al. (2012) identified education, contact, and protest as among these strategies. Education programs are launched to address the lack of factual knowledge about these conditions. The main criticism on these programs is that literacy is increased but behavior towards the affected group does not always change. Contact means exposure to persons with mental illness and engaging in activities where there is a one- on- one contact. Such activity may facilitate the feeling of being on equal status with the other. However, contact strategies are time-consuming and can also be very expensive. These may not be cost-efficient in the long run. The third strategy critiqued by Corbiere et al. (2012) is protest which refers to patient report resulting from advocacy activities and patient empowerment. Such an activity may reduce the negative perceptions; however, it is not always assured that these would result in positive attitudes towards persons with mental illness.

Studies on education and stigma look at the effects of education activities in the reduction of stigma. Wei et al. (2015) conducted a study on mental health literacy to identify available resources about this education activity. They identified four domains in mental health literacy which includes understanding accessing and sustaining healthy mental condition, understanding mental disorders and how these are treated, reducing the stigma associated with a mental disorder and improving the health-seeking efficacy. They added further that such literacy would address the concepts of knowledge, attitudes, and help-seeking efficacy.

Changing the attitudes through education has often been the theme of many stigma-reducing initiatives. Taghva et al. (2017) assessed stigma-reducing strategies in Iran from the perspectives of stakeholders. The results of the study showed the role education has on reducing stigma. A strategy identified was to generate a change in the attitudes of medical students by making them visit psychiatric wards. Such contact with mental health patients can effect a change in their attitudes. Pharmacists and other health-care providers are also said to be in need of changing their attitudes towards the mentally-ill so that they can contribute to the success of the latter’s treatment.

One important insight from such study was modifying the attitudes of health care providers. They have discovered from their study that medical students get most of their information about the mentally ill from sources that are not scientific, like movies. Since movies are entertainment vehicles, messages about mental conditions may not be delivered in a factual manner. Thus, it would be more effective for medical students to have regular presence in the psychiatric wards so that they acquire factual information about the different psychiatric cases. Such visits need to be with supervision so that they are given proper guidance.

Public education was also identified by Taghva et al. (2017) as a necessary step towards reducing stigma. The authors mentioned that children from an early age need to be guided so that they will not develop prejudice against persons with mental disorders. Providing awareness about these issues at an early age and increasing social awareness are strategies that can contribute to the reduction of stigma against the mentally ill. Corrigan (2016) looked at the two common strategies that are used to address stigma: education and contact. He raises the issue that a lot of studies have said “that education has little impact on the prejudice and discrimination that limit a person’s rightful opportunities” (p.68). He enumerated long-term studies on stigma and emphasized that the numbers on stigma did not change even though the numbers of persons informed or provided educational input increased.

The present study investigates whether a person’s education has an effect on how he/she regards others, particularly those with mental illness. Since education provides knowledge to students about various topics. It likewise develops an individual’s understanding about the world. The proxy for education is the number of years that a person has spent in a formal school setup. Therefore, it is expected that the more educated the person is, the more capable he/she is of understanding the various conditions that affects the health of a person, physical or mental.

Social Distance Theory

According to Bogardus (1959 as cited in Wilson & Scior, 2015) the willingness of a person to” engage with a member of another group in situations of varying degrees of intimacy” is referred to as social distance. The concept of social distance has been utilized by researchers to assess stigma towards vulnerable groups including those with intellectual disabilities (Ouellette-Kuntz, 2010). Wilson & Scior (2015) noted that previous studies on emotional reactions are mostly involved with caregivers and their challenging wards, thus, they carried out a study on the interactions between emotions, implicit attitudes and explicit attitudes. They generated correlations which indicated a negative relationship between explicit attitudes and social distance. This means that participants with more positive explicit attitudes have less desire for social distance. In the current study, the measures for stigma are the participants’ reactions to a person manifesting common signs of mental illness. When faced with someone who appears to have mental illness will the participant be willing to engage that person in a conversation? Will the participant even acknowledge the presence of that person?

Emotions can influence how a person react towards a person with mental illness. A person’s initial reaction towards any situation is often based on his/her emotions. Angermeyer et al. (2010) note that ”emotional reactions have a substantial effect on the desire for social distance” (Abstract). Their results indicate that fear and anger are among these reactions. Since emotions affect how people react to those with mental illness Angermayer et al. (2010) suggested interventions to reduce stigma of mental illness should focus more on the aspect of emotions. The questionnaire used in the current study includes two questions on emotions. The aim for such inclusion is to verify whether fear and anger are still common responses.

Method

Design

This is a quantitative study. Information will be collected from questionnaires distributed to the identified respondents. Data will be coded and statistical analysis will be conducted to process the data. Results of the statistical analysis will be used to infer relationships between the independent and dependent variables

Research Question

The focus of this study is to determine whether education has an effect on his/her perception about persons with mental illness. The primary question to be answered is Does education reduce stigma over persons with mental illness?

Hypothesis 1: The more educated a person is the less stigma he/she would have on someone with mental illness

Hypothesis 2: Education has no effect on a person’s stigma on persons with mental illness

Independent variable: Education. This is measured by the number of years in formal school. This means 12 years basic education + no of years in vocational, college or university.

Dependent variable: Level of stigma. The figures will be taken from the results of the measures.

Other variables: age, gender, ethnicity, and occupation

Participants

Observations shall be done in several venues in order to get a diverse sample as much as possible. The first site is the university, the second a train station, and the third site is at the mall. Target participants are university students, commuters, and shoppers. The aim is to observe the behavior of 100 participants.

Materials

The two main things that are needed for the experiment are an actor and a questionnaire. The actor will pretend to be a person talking to himself will be walking around campus, train station, shopping mall. He will be dressed like a regular student carrying a bag and a book. The short questionnaire contains the profile of the research participant and four (4) questions. Below are some items included in the copy of the questionnaire.

Participant # _______ Date: ________ Venue: _____________

PROFILE

Age: ______ Gender: Male Female LGBT

Ethnic group: African-American Asian Hispanic White

No. of years in Grade school: ____ High School: ____ College: ____ Graduate: ____

Occupation: _____________________________________________________________

REACTIONS

How does participant react when mentally-ill person approached him/her the FIRST time?

ignore him look at him shoo him away other:__________

How does participant react when mentally-ill person approached him/her the SECOND time?

ignore him look at him shoo him away other:__________

PERCEPTIONS

What did you feel when the man was talking to himself?

nothing curious scared other:__________

What did you feel when he was asking you a question?

nothing curious scared other:__________

REFERENCE TO MENTAL ILLNESS:________________________________________

Figure 1. Questionnaire on Education and Stigma

Procedures

Contact is considered by several studies ( ) to be the most effective in reducing stigma among the different strategies. In this experiment, the researcher shall instruct one person to act like someone with a mental disorder. This person shall pretend to be a mentally ill individual and will walk around the campus, train station, and shopping mall and shall maintain a loud, animated conversation with an imaginary companion. The researcher will then observe the reactions of the people around him. It is expected that the participants will either (a) stay and ignore the mentally ill person; or (b) walk away from the mentally ill person. Behaviors A and B are the measures of social distance that this experiment seeks to observe.

Identifying research participants

Researcher shall visit the proposed venues several times to identify the most appropriate places to hold the experiment. It should be a place where many students stay for some time. For example, for a period of one week, what day would have the most number of students? It may be the quadrangle of the school or a waiting area. It should not be the school cafeteria since part of the experiment is for the participants to hear the person’s conversation and the cafeteria would be too noisy for that. Once the venue is identified, the researcher makes an initial study of potential participants. It is a common practice for students to be with the same persons when they are waiting for their next classes or relaxing after their classes. Thus, researcher would be able to make an initial assessment of the potential participants. This initial inspection of the venue and target participants provides important information for the execution of the experiment. Target participants are students and staff. Age range is 18-60 and gender distribution is 50 percent women. Ethnic groups (Asian, African-American, Hispanic) should also be represented.

The second venue is the train station. The things that will be considered here in identifying the participants is the time of day where there is a substantial number of commuters are present. The experiment will not take place during the rush hour where there is a huge volume of commuters. It will be difficult to observe the reactions when so many people are rushing towards many directions.

The third venue is the shopping mall. Here, the best area would be the food court. Even though, this place would also be a noisy area, the diners here are more relaxed unlike the university cafeteria where students are mostly in a rush to eat and go to the next class. In the shopping mall food court, the diners tend to be eating in a leisurely manner and would most likely be observant of the people around them. This is also a good chance to get members of different ethnic groups from varying age ranges and occupations.

In all the three venues, the participants will be approached before the mentally ill person will appear. They will be briefed about the experiment and their consent secured. They will not be informed beforehand about the scenario because their spontaneous reaction is the data that the research is collecting. However, they will be informed that they will be participating in an experiment. Participant will then be asked to answer a short questionnaire that collects information of their age, gender, ethnicity, number of years in formal school, civil status, current occupation, and home state.

Conducting the experiment

Researcher assembles the research team and prepares all necessary materials such as short questionnaire. The actor that will play the part of the mentally ill person is also briefed about how to execute the experiment. Days before the experiment, a dry run of the entire experiment is carried out to identify potential problems. The team makes the necessary adjustments to ensure the success of the experiment. On the day of the experiment, the following processes shall take place.

Identify participants. The participants are identified at random. This means every fifth person that goes into the quadrangle (for the university subjects) will be approached by a member of the research team and invited to participate. He/she is briefed about the experiment and will be asked to sign the consent form. When he/she agrees, the short questionnaire will be administered and he/she will be informed that the experiment will take place in a little while. Several participants will be approached at the same time to be able to gather more data. At least 10 participants will be observed by the research team each time the mentally ill person performs.

Observe participants. The actor pretending to be a mentally ill person enters the area talking loudly to an invisible companion. He would intentionally pass through the participants two times. The first time, he will just be telling his imaginary companion certain things. The tone is conversational and soft. He will be looking straight ahead and nods a few time while explaining in a gentle manner. On the sheet bearing the participants’ profile, check the box that answer this question. How does participant respond to the first time the subject approached him/her? The participant (a) ignore him, (b) look at him, (c) shoo him away, and (d) other.

The second time he passes through the participants, he will be asking questions and his voice will be angry or agitated. He will stop at each participant, faces him/her and asks one question in a loud voice looking straight at the eyes of the participant. When he asks his question, he will raise his hand on the third work and drops these angrily at chest level. He pauses for about 3 seconds as if waiting for a reply then continues to walk towards the next participant. On the sheet bearing the participants’ profile, check the box that answer this question. How does participant respond to the second time the subject approached him/her? The participant (a) ignore him, (b) look at him, (c) shoo him away, and (d) other. The reaction ”other” means any kind of reaction that does not fall under items a,b, or c.

De-brief the participants. Once the mentally ill person leaves the area, the research team members, approaches the participants to de-brief them and thank them for participating. They will be asked two questions. (1) What did you feel when the man was talking to himself and (2) What did you feel when he was asking a question? The research team will not mention any term referring to mental health or mental condition.

Processing data gathered

After the experiments, the research team will collate all the information. For each participant, the research team has collected his/her profile, his/her actual reaction, and his/her perception towards the incident. The researcher anticipates four kinds of reaction from the participants towards the mentally ill person. These are (a) ignore him, (b) look at him, (c) shoo him away, and (d) other. Each of these reactions will be assigned their own codes, just like the profile variables. The response to the last two questions will also be coded. It is expected that the participant would feel (a) nothing, (b) curious, (c) scared, (d) other emotion when the mentally ill person talks in a soft voice and when he talks in a loud, angry tone. A participants’ mention of any term associated with mental illness will likewise be noted.

Results

This researcher anticipates age, gender, ethnicity, and occupation to have a linear relationship with stigma. Age may have a negative linear relationship with stigma. A middle-aged person is expected to have less stigma towards a mentally ill person than a young adult. Women may opt to shoo away a person with mental disorder especially if women have children with them at the time of the experiment. A person’s ethnic background is not expected to affect his/her reaction towards a person with mental disorder.

The levels of stigma have two measures in the experiment. In the observed reaction by the researchers, reaction C represents the highest level. In the reaction based on the participants’ feelings toward the incident, reaction C also represents the highest stigma level. It is expected that the more years in school a person has, the lesser the stigma he/she would have on persons with mental disorders.

Discussion

The generated coefficients will be the basis of the discussion. Information from related studies will be used to infer the reasons for the generated statistics. The relationships between the variables will likewise be discussed in detail in this portion. The primary variable tested here is education, thus the first research site is the university. Proxy for education is the number of years in formal school. Education, therefore, would have a negative linear relationship with stigma. The more years in school a person have, the less stigma he/she would have on a person with mental illness. The reason for this may be the additional knowledge that a student acquires as he/she goes up the academic ladder. He/she becomes exposed to information about how the brain works and the conditions that affect a person’s health, including mental health. From the profile of participants, the study may be able to see that a participant who completed a Bachelors degree has less stigma towards a mentally- ill individual compared to someone who has just completed basic education.

Age has a negative linear relationship with stigma. It is expected that an older the person is the less stigma he/she would have on a person with mental illness. From the study’s participants, this researcher anticipates younger persons would tend to shoo away the mentally-ill person compared with the older persons who are expected to just ignore the mentally ill-person. The reason for this is the maturity that comes with age. Older persons are more tolerant because they have more experience compared with young adults. Younger persons are likewise expected to choose the third reaction (fear) when asked about how they felt when the mentally-ill person asked a question angrily. In the experiment, the actor was instructed to raise his arms while asking the question to present a threatening stance. Fear of persons with mental disorders is one of the factors that contribute to stigma. The fear comes from the notion that this condition is closely associated with violence. This experiment also wants to see whether such belief is carried by the participants as well.

There are many different factors contributing to stigma towards persons with mental disorder. Apart from a person’s individual characteristic, this experiment intends to look at the venue as an additional contributory factor towards feelings of stigma. Among the three venues, it is expected that the university would have the least stigma towards the person with mental disorder. Since the mentally-ill person is dressed as a student, the participants would immediately feel a sense of having something in common with the subject. He would be considered as one of them. Talking aloud alone, while walking around the school, may just be explained as preparing for a test or memorizing some facts. Such a behavior may even be considered normal within the university context. However, when such behavior is transferred to train station or a shopping mall, it becomes out of the ordinary. Unlike the university which is populated mostly by students, the shopping mall and train station accommodate individuals from different backgrounds. The age ranges are wider, occupations are numerous, and ethnic backgrounds are very diverse.

It is expected that the shopping mall and train station sites will provide participants who come from different age ranges, occupations, and ethnicities. Such diversity is expected to present research data that will prove the study’s hypotheses and generate significant results. The participants’ report of their feelings towards the mentally-ill person will deliver more insights about the factors that contribute to public stigma over mental disorders. The researcher anticipates to see common themes from the answers to the two questions in the debriefing stage. Fear would be one of these themes. It is also expected that participants from these two other venues will indicate annoyance and indifference as their reaction. The commuters are in a hurry to reach their destination so they would be annoyed if someone would disturb them. They may also be familiar with seeing some people acting like this, thus they could be indifferent. For the shoppers, a likely reaction could be fear especially if there are children with them, and perhaps interest too since the shoppers at the food court have some time to relax for a while and observe the activities around them. All these varied expectations will all contribute to an overall picture that will show the relationship of personal characteristics to stigma.

References

Angermeyer, M.C., Holzingr, A. & Matschinger, H. (2010). Emotional reactions to people with mental illness. Epidemiologia e Psichiatria Sociale, 19 (1): 26-32.

Corbiere et al. (2012)

Corrigan (2016)

(NAMI, nd.).

Ouellette-Kuntz, H., Burge, P,, Brown, H.K. & Arsenault, E. (2010). Public attitudes towards individuals with intellectual disabilities as measured by the concept of social distance. Journal of Intellectual Disability Research, 23(2): 132–142.

Taghva et al. (2017)

Wei, Y., McGrath, P., Hayden, J. & Kutcher, S. (2015). Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review. BMC Psychiatry,15: 291. doi. 10.1186/s12888-015-0681-9.

Wilson, M.C. & Scior, K. (2015). Implicit Attitudes towards People with Intellectual Disabilities: Their Relationship with Explicit Attitudes, Social Distance, Emotions and Contact. PLoS ONE 10(9): e0137902. doi:10.1371/journal.pone.0137902.

Yang, L. & Link, B.G. (2015). ”Measurement of attitudes, beliefs and behaviors of mental health and mental illness.” Retrieved from http://sites.nationalacademies.org/cs/groups/dbassesite/documents/webpage/dbasse_170048.pdf.