Prejudice and Realities in Stigma

The negative attitudes toward mental illness can be based not only on ignorance and intolerance but also on such real factors as dangerousness, unpredictability, disability, and the burden the psychiatric patient represents for the community, particularly for members of the family and professionals who experience the stress that results from caring for them. A lack of access to health services can be due to discrimination or social stigma, such as in the case of chronic mental patients. However, other patients—anxious, shy, fearful, avoidant, obsessional, schizoid and other—whose behavioral difficulties also remain frequently undetected as the public can find it very difficult to overcome the barriers that society poses to obtain some services, privileges, and compensations. They are, in fact, indirectly discriminated. Questions concerning the relation between mental health and human rights are summarily addressed in some documents of international organizations, particularly, the UN Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care. However, many situations of inequity in relation to psychiatric care are detected in contemporary systems of managed care, but solutions are not easy to implement. If we treat disabled people as equal in dignity and right, differences in physical or mental capability among people should be accommodated without discrimination. This equal treatment requires a combination of psychological approaches such as modifications in public attitudes toward disabled people and social efforts to confront the concrete realities of disability and legal measures (including positive discrimination) when the previous steps are not sufficient.