Proceso de la Serigrafía 1 Espacio

Stigma represents a kind of death – a social death. Nonstigmatised people, through avoidance and social rejection, often treat stigmatised people as if they were invisible, nonexistent, or dead.192

188

Mental Health Act 1996 s 15(2).

189

Ibid s 16(1)(a).

190 _{Ibid s 72B(1).} 191

Jurisdictions differ in the precise statutory processes regarding review procedures, length of time between reviews, etc. In Tasmania, the Mental Health Tribunal reviews involuntary hospitalizations 6 monthly (s 29 (1)); as an informal process (s.56(2)), without regard to technicalities or legal forms (s.56 (1)(a)); is not bound by Rules of Evidence (s.58(1)); does not guarantee representation for patients; is not compelled to produce hearing transcripts or Statement of Reasons; and the Act is silent on the right of appeal. One tribunal member can hear the proceedings (s.49 (2)) and there is no requirement that that person is a lawyer.

192

Lerita Coleman Brown, ‘Stigma: An enigma demystified’ in Lennard J Davis (ed), The Disability Studies Reader (Routledge, 1997) 216, 226.

The consequence of stereotypes, prejudice and discrimination is the imposition of interactional/social distance with the amount of distance imposed measured by the level of intimacy required.193 The concept of social distance is conceptualised in a number of different ways including affective social distance which determines the levels of social distance through feelings such as sympathy, fear, loathing, anger and pity which one group expresses toward another group.194 Normative social distance refers to the distinctions between ‘them’ and ‘us’ and is expressed through the norms of social acceptability. The primary question in this concept is who is different and therefore, outside the normal majority.195

Researchers use the construct of social distance to assess expected discriminatory behaviour toward adults with mental illness based on the opinion that it can provide valuable insight into factors that influence mental illness stigma. In 2006,

Angermeyer et al. undertook a literature review of 33 national and 29 local and regional population studies of public beliefs about, and attitudes toward, people experiencing mental illness.196 Angermeyer found that while the public majority considered that they were in need of help, a substantial proportion perceived them with unease, uncertainty and fear. There is a tendency to increase social distance when 54-85% of respondents thought that people with schizophrenia were

unpredictable while 18-71% thought them to be dangerous.197 Pescosolido reported that 71.8% of their study’s respondents indicated that they would socially distance themselves from people who were drug dependent; 55.7% reported wanting to avoid interactions with people who were alcohol dependent (Angermeyer reported 65-71%); 48.4% said they would shun a person diagnosed with schizophrenia; and 37.4% said they would be unwilling to associate with a person diagnosed with a major depression.198

These results were in line with results of other studies that found that the most socially isolated individuals were identified as those experiencing schizophrenia,

193

Jack K Martin, Bernice A Pescosolido and Steven A Tuch, ‘Of Fear and Loathing: The Role of 'Disturbing Behavior,' Labels, and Causal Attributions in Shaping Public Attitudes toward People with Mental Illness’ (2000) 4 Journal of Health and Social Behavior 208.

194 _{Jo C Phelan, ‘Geneticization of Deviant Behavior and Consequences for Stigma: The Case of Mental Illness’}

(2005) 46 Journal of Health and Social Behavior 307.

195

Nedim Karakayali, ‘Social Distance and Affective Orientations’ (2009) 24 Sociological Forum 538.

196

Matthias C Angermeyer and S Deitrich, ‘Public beliefs about and attitudes towards people with mental illness: a review of population studies’ (2006) 113 Acta Psychiatrica Scandinavica 163.

197

Ibid, 170.

198

alcoholism, or who were drug abusers, and that there was greater public tolerance for people who have a serious mental illness than people who have alcohol or drug dependencies. In light of the recent trend worldwide in mental health services infrastructures, policies and programs towards creating a more homogenous service approach to mental illness/alcohol/drug dependency via the concepts of co-

morbidity, co-occurrence and dual diagnosis,199 people experiencing a mental illness may become even more stigmatised, and rejected, in future.

5.2.1 Comorbidity

Recent national public health rationalisation processes have included support and implementation of comorbidity policies200 and service delivery201 that has resulted in alcoholism and drug abuse/dependency becoming extrinsically linked to mental illness. Recent Australian research shows that the comorbid population is far from a homogenous group and that the co-occurrence of mental health issues and alcohol and other drugs (AOD) dependencies has failed to produce consistency in

ideologies, frameworks, terminology, treatment approaches and professional knowledge. Consequently, a person may have their mental illness go undetected or untreated in the AOD setting; be labelled as difficult to treat; be denied services because of the complexity of their presentation; be ineligible for cross-referral; or be denied service altogether because they do not meet the treatment criteria because of their co-occurring disorders and complex needs.202

Co-morbidity has little advantage to the person experiencing a mental illness but it does afford them great disadvantage through further stigmatisation. When

199

Queensland Health, ‘Service delivery for people with dual diagnosis (co-occurring mental health and alcohol and other drug problems)’ (Policy Paper, Queensland Government, 2008)

<http://www.comorbidity.org.au/sites/default/files/Qld%20DD%20policy%20Oct%2008_0.pdf>.Maree Teesson and Lucy Burns (eds), ‘National Comorbidity Project’ (Research Paper, National Drug and Alcohol Research Centre, 2001) <http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth- publicat-document-metadata-comorbidity.htm>.

200

Mental health policy implementation guide: dual diagnosis good practice guide; 2002. Department of Health (U.K.)

<http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistic s/Publications/PublicationsPolicyAndGuidance/DH_4009058>. See also National comorbidity initiative: a review of data collections relating to people with coexisting substance use and mental health disorders. Cat. No. PHE 60. (Drug Statistics Series No. 14). Canberra: Australian Institute of Health and Welfare; 2005,

<http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459660>.

201

Gavin Andrews, Scott Henderson and Wayne Hall, ‘Prevalence, co-morbidity, disability and service utilisation, Overview of the Australian National Mental Health Survey’ (2001) 178 British Journal of Psychiatry 145, 153.

202 _{Rachel Canaway and Monika Merkes, ‘Barriers to comorbidity service delivery: the complexities of dual}

diagnosis and the need to agree on terminology and conceptual frameworks’ (2010) 34 Australian Health Review 262.

addressing a conference on mental health and homelessness in 2010, Michael Kirby, the then Chair of the Canadian Mental Health Commission, and former Australian High Court Justice stated that there is:

... a huge lack of compassion on the part of Canadians toward individuals who suffer from mental illness, who are homeless, or who suffer as a result of substance abuse … If you have all three, the discrimination is colossal.203

Stigma is compounding and comorbidity attracts its own stigma because of the impact it has on the person’s ability or capacity to deal effectively with their conditions204 and yet, despite the fact that the limited available evidence does not support co-morbid psychotherapeutic treatment, 205 mental health agencies have adopted an integrated services approach. Clinical care and treatment services are delivered to people experiencing mental health problems such as substance abuse together with behavioural syndromes associated with permanent physiological disturbances and physical factors.206 Inappropriate behaviours arising from cerebral vascular accidents207 or a neurological disorder caused by alcoholism 208 are being inextricably associated with mental illness and the label, ‘mentally ill’.

5.2.2 Hierarchy of acceptance

The term hierarchy of acceptance refers to a structure of public preference toward marginalised groups with the level of acceptance of each group’s distinct difference determining the group’s ranking. In 1970, John Tringo modified the Bogardus scale209 to measure social distance between respondents and 21 disability groups. The study established that a hierarchy existed in which mental illness placed at the bottom of rankings indicating the greatest amount of social distance. Tringo’s results were mirrored by later studies that also rank mental illness at the bottom, or

203

Monte Paulsen, ‘Canada short changes mental health care: Kirby’, The Tyee (online), 22 June 2010 <http://thetyee.ca/Blogs/TheHook/Health/2010/06/22/Canada-short-changes-mental-health/>.

204

Netzach Goren and Jane Mallick ‘Prevention and early intervention of coexisting mental health and substance use issues, Drug Info Clearing House, Issues Paper 3, November 2007 <

http://www.druginfo.adf.org.au/attachments/347_PRQ03Nov07_final.pdf>.

205 _{Laurie Barclay, ‘Integrated Treatment of Substance Use Disorders and Comorbid Conditions - A Literature}

Review’, Medscape (online), 27 April 2009 <http://www.medscape.com/viewarticle/701725>.

206 _{Australian Institute of Health and Welfare (AIHW) 2005. Mental health services in Australia 2003–04.}

AIHW cat no. HSE 40. Canberra: AIHW (Mental Health Series no. 8). (Up to 4% of all mental health services provided by government services and agencies; 3% of private hospital services; 16% by General Practitioners)

207

Stroke

208 _{Korsakoff's syndrome} 209

The sociologist E. S. Bogardus developed the ‘Bogardus social distance scale’ in 1925. The scale was used to measure the social-psychological distance between different ethnic and racial groups.

close to bottom in varying order with alcoholism and drug addiction.210 Motivated by the liberalisation of public opinion, and the legislative rights changes that had occurred in the three decades since Tringo’s study, Thomas211

tested whether the hierarchy still existed, and if so, how stable it was in what had generally become, more informed and more tolerant communities. He found that the ‘hierarchy of preference of disabilities proposed by Tringo over 30 years ago remains firmly entrenched’.212

6.

DISCRIMINATION

Discrimination is a multifaceted phenomenon that exists explicitly in norms, values and institutions. It is not necessarily the deliberate, prejudicial treatment of a person, or a group of people who, on the basis of having a negatively valued difference, are considered to have less social worth. Discriminated people are subject to exclusions and restrictions that deny them the same opportunities of the social majority to participate fully in economic, social and political life.213

Individual discrimination is the behaviour of individual members belonging to one group that is intended to have a differential and/or harmful effect on the members of another group.214

Structural discrimination, sometimes called institutional or systemic discrimination, is entrenched in the structure and institutional patterns of behaviour and actions of organisational culture. It relates primarily to the ways in which norms, behaviour and rules intentionally, or unintentionally affect, and obscure, discriminatory and/or harmful effects on a stigmatised group, either because of prejudice, or because of a failure to take into account the particular needs of different social identities.215 However, the idea of structural discrimination is that it represents an attempt to

210

Stefan J Harasymiw, ‘A longitudinal study of disability group acceptance’ (1976) 37 Rehabilitation Literature 98. See also Gary L Albrecht, Vivian G Walker and Judith A Levy, ‘Social distance from the stigmatised’ (1982) 16 Social Science and Medicine 1319. Also David R Austin, ‘Attitudes toward old age: a hierarchical study’ (1985) 25 The Gerontologist 431.

211 _{Adrian Thomas, ‘Stability of Tringo's Hierarchy of Preference Toward Disability Groups: 30 Years Later’}

(2000) 86 Psychological Report 1155.

212 _Ibid. 213

Craig Morgan et al., ‘Social exclusion and mental health: Conceptual and methodological review’ (2007) 191 The British Journal of Psychiatry 477.

214

Fred L Pincus, ‘Discrimination comes in many forms: Individual, institutional, and structural’ (1996) 40 The American Behavioral Scientist 186.

215

Patrick W Corrigan, Fred E. Markowitz and Amy C. Watson, ‘Structural levels of mental illness stigma and discrimination’ (2004) 30 Schizophrenia Bulletin 481, 481.

capture a social wrong distinct from a direct discrimination. Pincus observed that ‘[t]he key element in structural discrimination is not the intent but the effect of keeping minority groups in a subordinate position’.216