Complaints from People with Mental Illnesses.. The Role of Stigma Dorothy Cotton, Ph.D., C. Psych. CACOLE June, 2009.

Complaints from People Complaints from People with Mental Illnesses..with Mental Illnesses..

The Role of StigmaThe Role of Stigma

Dorothy Cotton, Ph.D., C. Dorothy Cotton, Ph.D., C. Psych.Psych.

CACOLE June, 2009CACOLE June, 2009

Why complaints from PMI?Why complaints from PMI?

20% of the population will experience 20% of the population will experience a mental illness at some point in their a mental illness at some point in their liveslives

Estimates suggest that 5-10% of police Estimates suggest that 5-10% of police calls will involved a PMIcalls will involved a PMI

That means 3.2 MILLION such calls a That means 3.2 MILLION such calls a yearyear

What kinds of occurrences?What kinds of occurrences?

Apprehensions under the MHAApprehensions under the MHA Offenses--Primarily minorOffenses--Primarily minor At least as likely to be victims as At least as likely to be victims as

perpetratorsperpetrators ““other??” including social support other??” including social support

contactscontacts Often co-occurring substance problems Often co-occurring substance problems

and homelessnessand homelessness Often well known to policeOften well known to police

Why talk about stigma?Why talk about stigma?

Perceived as being as debilitating as Perceived as being as debilitating as mental illnesses themselvesmental illnesses themselves

Priority of the Mental Health Priority of the Mental Health Commission of CanadaCommission of Canada

What is stigma ?What is stigma ?(the MHCC definition)(the MHCC definition)

A social process, experienced or A social process, experienced or anticipated, characterized by anticipated, characterized by exclusion, rejection, blame or exclusion, rejection, blame or devaluation that results from devaluation that results from

experience or reasonable experience or reasonable anticipation of an adverse social anticipation of an adverse social

judgment about a person or a groupjudgment about a person or a group

The dictionary definition…The dictionary definition…

A mark of shame, a strain on person’s A mark of shame, a strain on person’s good reputationgood reputation

Syns: reproach, taint, tarnish, disgrace, Syns: reproach, taint, tarnish, disgrace, infamy, disreputeinfamy, disrepute

Global devaluation of a person on the Global devaluation of a person on the basis of some characteristic they basis of some characteristic they possesspossess

Origin: stigmata (brand) designed to Origin: stigmata (brand) designed to expose something unusual and bad expose something unusual and bad about the moral status of the signifierabout the moral status of the signifier

Stigma’s component partsStigma’s component parts

StereotypesStereotypes

PrejudicePrejudice

DiscriminationDiscrimination

Stereotypes…Stereotypes…

……beliefs about a social group made beliefs about a social group made in an all or none fashion, in an all or none fashion, characterizing the group as a whole characterizing the group as a whole while dismissing individual while dismissing individual differences or unique characteristicsdifferences or unique characteristics

May be based of an iota of truth—or May be based of an iota of truth—or may be blatantly wrongmay be blatantly wrong

PrejudicePrejudice

……unreasoning, unjustified, over- unreasoning, unjustified, over- generalized and negatively tinged generalized and negatively tinged attitudes related to their group attitudes related to their group membershipmembership

……prejudgmentprejudgment

Discrimination…Discrimination…

Unfair treatment of others or harmful Unfair treatment of others or harmful actions toward them based on actions toward them based on membership in a certain groupmembership in a certain group

Discriminatory practices may be Discriminatory practices may be unofficial or officially sanctioned by unofficial or officially sanctioned by law or policylaw or policy

For example…womenFor example…women Stereotype:Stereotype:

Women are shorter than menWomen are shorter than men Women are not as good as men at machinery Women are not as good as men at machinery

and technical stuffand technical stuff Women are moody and unpredictableWomen are moody and unpredictable

PrejudicePrejudice Women are bad drivers—watch out!Women are bad drivers—watch out!

DiscriminationDiscrimination women should not have drivers licenses or be women should not have drivers licenses or be

admitted into certain trades and professionsadmitted into certain trades and professions

The three core problemsThe three core problems

The problem of knowledge (ignorance)The problem of knowledge (ignorance) Things we do not know or think we know Things we do not know or think we know

about the target groupabout the target group The problem of attitudes (prejudice)The problem of attitudes (prejudice)

Conclusions we draw and things we thinkConclusions we draw and things we think The problem of behaviour The problem of behaviour

(discrimination)(discrimination) actions we take and rules we make based actions we take and rules we make based

on the aboveon the above

..what we don’t know…what we ..what we don’t know…what we think we know…think we know…

Schizophrenia=split personalitySchizophrenia=split personality Depression is not a MIDepression is not a MI <10% of people will experience a MI<10% of people will experience a MI Mentally ill = dangerousMentally ill = dangerous Mentally ill = irresponsible, Mentally ill = irresponsible,

incapableincapable MI is a moral/character flawMI is a moral/character flaw

The problem of attitude..The problem of attitude..

Concern about social distanceConcern about social distance Visceral and emotional reactions to Visceral and emotional reactions to

PMIPMI Need for social controlNeed for social control Attribution of responsibilityAttribution of responsibility Justification for discriminatory Justification for discriminatory

behaviourbehaviour

The problem of The problem of behaviour/discriminationbehaviour/discrimination

Conceptualizing stigma as Conceptualizing stigma as discrimination moved concern from discrimination moved concern from

attitudes to behaviourattitudes to behaviour

What do we actually DO to people with What do we actually DO to people with mental illnesses?mental illnesses?

The Effects of Stigma..The Effects of Stigma..

Generally speaking..Generally speaking..

Social isolation and withdrawalSocial isolation and withdrawalLack of access to servicesLack of access to services

Housing problemsHousing problemsEmployment problemsEmployment problems

Self-stigmaSelf-stigmaDecreased optimism and moraleDecreased optimism and moraleIncreased levels of depressionIncreased levels of depression

Decreased participation in therapyDecreased participation in therapyFamily conflictFamily conflict

..and what does this have to do ..and what does this have to do with the complaints process???with the complaints process???

Before they ever get to you..Before they ever get to you..

On the one hand…On the one hand…

Stigma may be the reason they were Stigma may be the reason they were involved with the police to start withinvolved with the police to start with

On the other hand..On the other hand..

PMI may avoid making a complaint for PMI may avoid making a complaint for fear of discrimination (“they won’t fear of discrimination (“they won’t

believe me anyhow”)believe me anyhow”)

When they get to you..When they get to you..

Likelihood of denial of mental illness Likelihood of denial of mental illness or failure to discloseor failure to disclose

Reacting from previous experienceReacting from previous experience Anticipation of rejectionAnticipation of rejection Failure to follow through because of Failure to follow through because of

lack of expectationslack of expectations The effects of self stigmaThe effects of self stigma

What assumptions do we bring to What assumptions do we bring to the interaction?the interaction?

Mental illness=dangerousMental illness=dangerous Mental illness=unreliable reportingMental illness=unreliable reporting Mental illness=limited intellectMental illness=limited intellect Mental illness=always, everythingMental illness=always, everything Mental Illness=misperceptionsMental Illness=misperceptions

As an aside….As an aside….

Most police have received training in Most police have received training in regard to interactions with PMI..regard to interactions with PMI..

Don’t assume lack of knowledge/skill Don’t assume lack of knowledge/skill on their parton their part

But…But…

Aside from MHA apprehensions, few Aside from MHA apprehensions, few police services have specific police services have specific

guidelines or policies around how to guidelines or policies around how to deal with situations involving PMI, deal with situations involving PMI,

which makes adjudication of which makes adjudication of complaints difficultcomplaints difficult

How do these affect our How do these affect our interactions?interactions?

Social distance (how do I get this guy Social distance (how do I get this guy out of here as quickly as possible???)out of here as quickly as possible???)

Second guessing (did you really Second guessing (did you really mean that? Are you sure?)mean that? Are you sure?)

Bias: are you sure there was nothing Bias: are you sure there was nothing you did to….you did to….

To do..To do..

Education for intake staff re mental Education for intake staff re mental illnessillness

User friendly processesUser friendly processes Utilizing support personsUtilizing support persons Positive role models and leadershipPositive role models and leadership ?Dedicated staff?Dedicated staff

““Mental illness is nothing to be Mental illness is nothing to be ashamed of, but stigma and bias ashamed of, but stigma and bias

shame us all”shame us all”

Bill ClintonBill Clinton

For more information…For more information…

About the Mental Health Commission About the Mental Health Commission and its work on stigma…and its work on stigma…

www.mentalhealthcommission.ca

About interactions between police About interactions between police and people with mental illnesses…and people with mental illnesses…

www.pmhl.cawww.pmhl.ca