Mental illness is entrenched with definite connotations that impede health-seeking behavior in a similar way that it was in the earlier centuries. Despite scientific advancement and advocacy, the remnants of these connotations are still prevalent. When individuals suffering from mental health problems elect to seek health services, most fail to adhere to the treatment regime, while others terminate the services altogether (Conner et al. 2010, 56).
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Stigma is one of the major factors behind this phenomenon. It is one of the most significant impediments to progress in mental health services and providing timely help to the patients. This paper focuses on stigma, how it affects mental health-seeking behavior and utilization among ethnic minorities.
The Definition of Stigma
It is imperative to examine the concept of stigma to understand its impact on behavior fully. There are several constructs that are related to stigma. First, stereotypes, defined as characterizations of groups that are developed from some truth, are rigid and global in nature (Murry et al. 2011, 1119). Second, prejudice, defined as attitudes and preconceived opinions, castigated against a social group without their knowledge. Third, discrimination, which refers to treating one group differently from one another by limiting benefits to one group. These constructs are cognitive (stereotypes), affective (prejudice), and behavioral (discrimination).
Stigmatization encompasses these constructs but also includes negative characterization to the ‘outer group’ ( Sue at al. 2012, 532). In conclusion, we can say that stigmatization refers to ‘marking’ an individual group as inferior by the majority of a social group. Stigma can either be public or internalized. Public stigma refers to misconceptions and attitudes ingrained into the general public that lead to stigmatization against people with mental illness. In contrast, the internalized understanding of the concept of stigmatization refers to devaluation resulting from the application of negative stereotypes on self. Stigmatization of persons with mental illness is prevalent in the US. (Lindsey, Joe and Nebbitt 2010, 35).
Stigma and Health Seeking Behavior in Patients with Mental Illness
The correlation between stigma, ethnic minorities, and health-seeking behavior can be best described using the ‘double stigmatization’ approach. Members of ethnic minority groups experience discrimination in all segments of their life. The history of the US is awash with prejudice and discrimination against people of ethnic minorities, such as Asian Americans, Hispanic Americans, African Americans, Native Indians, and Alaska natives.
Historical discrimination against minority ethnic groups has resulted in poverty and low educational levels in these populations. As such, the utilization of mental health services is low as compared to Caucasians. In addition, discrimination is rife that limits social and economic opportunities in these communities. Studies such as Tuskegee increased distrust between care providers and ethnic minorities. Low educational levels, little trust towards healthcare providers, poverty, inadequate health services, and prejudice has reduced the ability of these groups to access medical services. These factors can ‘overlap’ and exacerbate stigma in ethnic minorities (Merikangas 2011, 35).
Individuals with mental problems in these communities experience two forms of stigmatization; stigma arising from being a member of a minority group and stigma as a result of suffering from a mental condition. This problem is further exacerbated by the lack of awareness among members of an ethnic group and lack of cultural competence on the part of health care providers (Villatoro, Morales, and Mays 2014, 353).
Ethnic minorities have a higher stigma towards individuals with mental illnesses as compared to Caucasians, although these results are not consistent. Various studies point out that the level of stigma among Asian and African Americans against people with mental illnesses is higher than in Caucasians. In addition, the two groups view persons with mental illnesses as dangerous. Latinos are less likely to stigmatize individuals with mental illness as compared to Caucasians. As such, the disparity in health-seeking behavior among Caucasians and ethnic minority groups can be attributed to double stigmatization (Villatoro, Morales, and Mays 2010, 9).
Studies on the barriers that impede African Americans’ ability to seek psychotherapy help show that cultural barriers, financial barriers, lack of awareness, alternative resources, and stigma are the primary factors. The number of individuals with medical insurance among black Americans is low as a result of historical marginalization. In addition, racism in healthcare organizations is rife that limits ethnic minorities’ ability to seek for medical help (Lindsey, Joe, and Nebbitt 2010, 35).
The number of culturally competent professionals providing services for individuals with mental illnesses is low ( Keyes et al. 394). Moreover, the number of practicing individuals from these groups is low. As such, there are numerous barriers that continue to perpetuate disparities in the provision of health services in general. These factors, combined with stigma, means that a person from an ethnic minority group will experience double stigma ( Keyes et al. 394).
History of discrimination, maltreatment, and economic marginalization has resulted in the current disparities in the provision and access to general health care. Current statistics suggest that morbidity and mortality among ethnic minorities are higher than among Caucasians. Moreover, current literature points out individual life, dies, or gets sick depending on their ethnicity, age, race, and socioeconomic status. Socio-economic determinants include income levels, occupation, and educational level. American minorities belong to the lower social class, and thus they have lower educational levels, low-income, and mostly get menial jobs. As such, they are less likely to ‘afford’ proper mental care. With less education, psychiatric care is severely compromised (Andrinopoulos, 2014, 12).
A review of the literature shows that there is low empirical evidence of A review of the literature shows that there is low empirical evidence of ‘intersectionality’ between stigma and ethnic minorities. The body of literature is narrow. Current research focuses on the impact of stigma on mental health-seeking behavior. As such more research should focus on the relationship between ethnic minorities, stigma, and mental health behavior.
Despite the limitations, the research has shed light on stigma and its impact on health seeking behavior minority groups. Disparities in health-seeking behavior between ethnic minorities and Caucasians cannot be attributed to levels of stigma, but one must also consider factors such as level of income, quality of care and cultural competence (Hunt and Eisenberg, 2010, 4). The level of stigma among ethnic minority groups is a significant impediment to the access of care.
Individuals with mental illnesses in these communities experience double stigmatization, first from the members of their communities, second from Caucasians. As such, objective approaches to solving the problem of health seeking behavior of individuals of minority groups should be directed at bridging the socio-economic gaps between the Caucasian and ethnic minorities.
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