The Effects of Self-Stigma on Occupational Engagement for Adults With Mental Illness

Abstract

Purpose: The purpose of this study is to explore the impacts of self-stigma on everyday occupations of persons with serious and persistent mental illness. Greater understanding of the impacts of self-stigma is important to development of occupation-based interventions used by occupational therapists in mental health settings. Methodology: A qualitative phenomenological approach was utilized to interview six participants between the ages of 31-58 years old with severe and persistent mental illness. High level in vivo coding was used to interpret participant responses. Results: Four themes emerged from participant interviews: 1) negative impact on self, 2) coping with negative social encounters, 3) positive contributions to one's sense of self, and 4) acceptance of diagnosis and acknowledged need for medication. Self-stigma is experienced as changes in sense of self with the greatest impact shortly after the initial diagnosis of the mental illness; with time and external supports, the individual learns to accept and cope with the diagnosis, resulting in decreased self-stigma and increased occupational engagement. Conclusion: Based on the results of the study, OTs are encouraged to provide interventions early in the course of the illness to counteract the negative impacts of self-esteem and self-efficacy associated with self-stigma on occupational engagement. Research findings could be used to develop a screening tool to determine the presence of self-stigma of clients receiving mental health OT services and guide intervention planning. 1 CHAPTER 1 THE PROBLEM Rationale Currently 61.5 million Americans have a mental illness (MI), and approximately 13.6 million have a severe MI such as schizophrenia, bipolar, or depression. The prevalence of these diagnosis cost the American government $193.2 billion in healthcare costs (National Alliance Mental Illness [NAMI], 2013). Interestingly, mood disorders rank as the third most common cause of hospitalization for adults ages 18-44. According to World Health Organization [WHO] (2001), 450 million people have a mental health diagnosis; while two-thirds of those individuals do not seek health-care services. A common barrier by individuals with MI seeking health-care services is stigma. Stigma is depicted in three forms of societal influences: structural, public and self-stigma (Corrigan, Markowitz, & Watson, 2004). Structural stigma is described as the invisible forces within institutions and policies that limit equality of opportunities for individuals with MI (Corrigan et al., 2004). Public stigma refers to groups of persons possessing stereotypical and prejudiced beliefs towards individuals with a MI which commonly results in discriminatory action (Corrigan, Kerr, & Knudsen, 2005). Lastly, self-stigma is defined as the internalized stereotypical and prejudiced beliefs held by individuals that influence self-esteem and self-efficacy (Livingston & Boyd, 2010). Persons with MI experience diminished self-esteem and self-efficacy resulting in maladaptive coping mechanisms, altere...