Indian Journal of Health and Wellbeing 2013, 4(1), 102-109

against the required 9,696. The number of clinical psychologists was

343, against the desired 13,259. Similarly, psychiatric social workers
available were only 290, against the required 19,064, while the
number of psychiatric nurses was not available, though over 4,000
such trained nurses were required then. Also, while there were about
21,000 beds for mental health patients in the government sector, the
number was just about 5,100 in the private sector (The Hindu,
2013).During the past 6 decades, there have been a wide range of
initiatives in mental healthcare. These range from humanizing
mental hospitals, moving the place of care from mental hospitals to
general hospital psychiatry units (Murthy, 2011). In the XI Five Year
Plan, the National Mental Health Programme (NMHP) has the
Manpower Development Schemes - Centers of Excellence and
Setting Up/ Strengthening Post Graduate Training Departments of
Mental Health Specialties (Psychiatry, Clinical Psychology,
Psychiatric Social Work and Psychiatric Nursing). In addition to
mental health experts, the role of family and community cannot be
ignored that is more applicable in our setting. Mental health expert
Dr. AjitAvasthi explained that unlike the West, in India, family is the
key resource in the care of patients with mental illness. Families
assume the role of primary caregivers for two reasons. First, it is
because of the Indian tradition of interdependence and concern for
near and dear ones in adversities. Due to this most Indian families
prefer to be meaningfully involved in all aspects of care of their
relatives despite it being time-consuming. Second, there is a paucity
of trained mental health professionals required to cater to the vast
majority of the population; hence, the clinicians depend on the
family (Avasthi, 2010). The safety and better treatment of the
people is of paramount importance but protecting and advocating for
the rights of persons with disabilities is also has prominent for
holistic mental health. But inadequate knowledge regarding the
mental illnesses and stigma associated with mental health problems
are making the situation more dreadful. Too often, the widespread
stigma attached to mental health problems jeopardizes the
development and implementation of mental health programs. There
are a multitude of problems that mental health professionals are
facing today, one of such problems is fighting against stigma and
discrimination that is usually considered as fighting for mental
health. The negative attitude of the general public towards mentally
ill patients is a universal phenomenon. Many people have negative
views of mental illness, including beliefs that it is incurable and
shameful. Other many persons with mental illness are confined to
their houses without any treatment, either because their family
members do not recognize the illness or else find it embarrassing to
be associated with mentally ill relatives, who are commonly called
'mad' (Janardhana, Raghunand, et al., 2011).
The fully effective prevention programs cannot stand on their own
but need to involve self-help groups, cultural and religious forces,
and non-governmental organizations. Thara et al., in 2008 concluded
that it is eminently feasible to start a wide spectrum of mental health
and related social and economic activities in a rural area. However,
such initiatives, however well-intentioned, will not be sustainable
unless the family and the community are involved with the program
right from its inception. Role of voluntary agencies should be
emphasized in the development of mental health; one such support in
achieving the goal. There are a multitude of problems that mental
health professionals are facing today, one of such problems is
fighting against stigma and discrimination that is usually considered
as fighting for mental health.

103

Stigma and Mental Health

The lives of people living with mental illness are often drastically
altered by the society's reaction to them.Social integration is
fundamental for good emotional health and social support is viewed
as a buffering mechanism; which is considered as a protective
influence against adverse event. Whereas the absence of social
support may result in an inability to form effective coping and
adaptive behaviors necessary to re-establish norms and that could
lead to emotional problems (Gupta, Nehra, et al., 2013). Experts
believe that many people with mental illness are challenged twofold.
On one hand, they struggle with the symptoms and disabilities that
result from the disease. On the other hand, they are challenged by the
stereotypes and prejudice that result from misconceptions about
mental illness (Corrigan & Watson, 2002). Researchers have
described the adverse effects of labeling someone mentally ill.
Through labeling the negative stereotype of the mentally ill, which is
still prevalent among the general public, is triggered. This, in turn,
leads to increased discrimination against those suffering from mental
disorder (Angermeyer&Matschinger, 2003). Using negative labels
leads to stamping and shame i.e. called stigma. It is well known fact
that, single most important barrier to overcome in the community is the
stigma and associated discrimination towards persons suffering from
mental and behavioral disorders (WHO, 2001).
Stigma is a social construction that defines people in terms of a
distinguishing characteristic or mark and devalues them as a
consequence (Jones et al, 1984; Crocker et al, 1998;
Biernat&Dovidio, 2000; Dovidio et al, 2000). The stereotypes and
sigma associated with mental disorders are frequently the main
obstacles preventing early and successful treatment (Jackowska,
2009). It is matter of concernbut despondently, many persons who
would benefit from treatment will never seek that help partly
because of the stigma of mental illness. The very ugly face of stigma
can be seen by the fact that mentally retarded children and adolescents
are thrown away because of their disability (Gupta, Nehra,et al., 2013).
As per Time to Change (2008) survey nearly nine out of 10 people
(87%) with mental health problems have been affected by stigma and
discrimination. In the same survey more than two-third of people with
mental health problems (71%) admitted that they stopped doing things
they wanted to do because of stigma.
Mental illness often constitutes a double jeopardy for those
affected because of stigmatization by members of the community
(Corrigan & Watson, 2002). Healthcare professionals have an
inspiring role in combating stigmatization but the irony is that their
attitudes to psychiatry (Rajagopal et al, 2004) and people with
mental health problems (Byrne, 1999; Wahl, 1999) remains quite
negative. Furthermore, medical students and doctors often regard
psychiatric patients as difficult and unrewarding to treat (Nielsen &
Eaton, 1981; Lawrie et al., 1998). There is substantial evidence that
social support improves mental health. It diminishes self-esteem
and robs people of social opportunities (Corrigan, 2004); this can
include being denied opportunities such as employment or
accommodation because of their illness (Parle, 2012). Fortunately,
an enlarging body of evidence establishes that medical students'
attitudes become more positive following training involving both
patient contact and education about the effects of stigma (Corrigan
& Penn, 1999).
During the last few decades substantial research has been directed
toward identifying factors that are contributed by stigma and