Stigma, Discrimination And The Concept Of Social Exclusion The WritePass Journal

Stigma, Discrimination And The Concept Of Social Exclusion Abstract Stigma, Discrimination And The Concept Of Social Exclusion ). As noted by Goffman (1963), stigmatized individuals may accept the negative labels placed on them resulting in self-stigma which manifests in many ways including shame, self-hatred and self-isolation. Similarly, HIV/AIDs related stigma is reported to have severe implications on the stigmatized person. The onset of HIV and AIDS during the early 1980s triggered responses of stigma, fear, denial and discrimination which have, up-to date, been targeted at individuals perceived to be infected (UNESCO 2002). Such individuals become rejected not only by the community but also by their beloved ones. These individuals are also reported as having been denied access to health and education services on several instances. Research also shows that such individuals receive unfair treatment in the workplace. The root causes of stigma related to HIV/AIDS are fear and moral judgement (UNESCO 2002). HIV/AIDS pandemic is associated with fear of causal transmission of virus, fear of living with the virus, fear of loss of productivity, and imminent death (UNESCO 2002). Moral judgment is also considered as the root cause of the stigma. People infected with the disease are often seen as self-blaming, since the transmission of the pandemic is linked to stigmatized behaviour. HIV/AIDS-related stigma remains a barrier to effectively managing this epidemic. The fear of shame and discrimination prevents such infected individuals from seeking the much needed help and support, thereby making prevention and management extremely difficult. The feelings of shame, guilt and the fear of discrimination impedes an individuals willingness and ability to adopt preventive behaviours. This results in delayed help-seeking behaviours. Stigma still appears to be a major issue facing many employers and employees. There is increasing evidence of people being turned down for a job simply because they are infected with stigmatized illnesses. Others have also reported as having stopped looking for employment because they expect to be discriminated against. For example, a study led by Graham Thornicroft found over a third (34%) of the participants as having been shunned by people due to their mental illnesses (Thornicroft et.al, 2007). The study also found nearly a quarter (25%) of the participants as having stopped applying for work because they anticipated discrimination, and another 37% who were afraid of initiating close personal relationship due to fears of being discriminated against (Thornicroft et al., 2007). However, it was found that for those who anticipated discrimination, their experiences did not necessarily confirm this. Nearly half (47%) of those who had stopped looking for work and 45% of those that were afraid of initiating personal relationships because they anticipated discrimination did not in the actual sense experience this (Thornicroft et al., 2007). The study also found that 71% of the participants wished to conceal their illness, raising concerns about delayed help seeking behaviours due to fears of discrimination once their condition is disclosed (Thornicroft et al., 2007). Similarly, a recent survey on 500 leading employers in the UK conducted by SHAW Trust, showed that one in three employers thought that persons with mental illness were less reliable than the rest of the workforce (Thomas 2012). The survey also found that negative attitudes held by employees towards the mentally ill were a major barrier to employing individuals with mental illness. This indicates that stigma is still a major concern in the employment. Implications on policy and practice: There is a current policy spotlight on providing stigmatized individuals with greater employment support. This is largely due to emerging evidence of discrimination of stigmatized individuals in employment. It should be noted that some societies may increase the level of stigmatization through their laws, rules and policies. Legislations such as limitations on international travel and migration and those that include compulsory screening and testing tend to increase stigmatization and create a false sense of security concerns among individuals who may not necessarily be dangerous (EU report 2010). There is, however, a range of standards and policy initiatives which have been formulated to help address problems of stigmatization. The National Service Framework for Mental Health, for example, has incorporated standard services which must be adhered to including guidance on social inclusion, tackling stigma, and ensuring health promotion among those with mental illness (DFID 2007). There is also the Disability Discrimination Act (DDA) 1995 which prohibits discrimination of disabled individuals in terms of employment, union membership and access to housing, health and education services (DFID 2007). The definition of disability is extended by the DDA 2005 to include people diagnosed with HIV. This implies that people with traits or attributes considered stigmatized are protected against discrimination in recruitment, training, promotion and from unfair dismissal. Such individuals are also protected against harassment and discrimination by colleagues in the workplace. However, despite these policy initiatives, it is apparent that stigma and discrimination is still an issue. For example, in the UK and the US, elaw and licensing practices are making it increasingly difficult for stigmatized individuals to be employed (Gonzalez 2012). Under the American with Disabilities Act, disabled persons can be denied a license especially where such a person poses a threat to others that cannot be reasonably eliminated (Gonzalez 2012). Also, a study by the HIV Law project on professional licensing practices in the US reported over 20 states with requirements that prohibit granting or renewal of license for persons with communicable or infectious diseases including HIV (Gonzalez 2012). Adding to this discriminatory licensing criterion, the study found that science based data was largely ignored, thereby promoting stigma and denying stigmatized individuals employment opportunities. A similar trend was evident in the UK especially when reforms were made to the job and benefit system with the aim of encouraging stigmatized individuals to re-enter the workforce (Gonzalez 2012). According to Laura Dunkeyson, a policy officer at the National AIDS trust, job applicants were often asked about their health status prior to the extension of an offer, which resulted in the exclusion of a number of persons from the workforce (Gonzalez 2012). Moreover, it was reported that, on application of a job by non-disabled and disabled individuals, the non-disabled persons were twice as likely to be invited for the interview as the disabled. Clearly, stigma still exists. However, popular views about mental illness and HIV/AIDS appear to be improving in term of less social rejection. According to a newly released research by Aviva (2012), over 28% of employees in the UK believe that the stigma associated with mental health problems has dropped. This is attributed to the increased awareness and public understanding of mental health issues. This shows that interventions that aim at improve public knowledge can effectively reduce the level of stigmatization. With improvement in public knowledge, people are more likely to recognize features of illnesses and become more supportive for those with such illnesses. Interventions to reduce stigma Efforts to reduce stigma have often been inhibited by the lack of public awareness and knowledge on issues contributing to the stigmatization of persons. Efforts to address stigma have also been inhibited by the lack of incentives/benefits for taking action (DFID 2007). Adding to this, stigma has been perceived as culturally specific and complicated to address (DFID 2007). The following are some important steps that might be taken to address the issue of stigmatization in employment: Stigmatized individuals could be provided with employment initiatives such as individual placement and support interventions (IPS) which is more effective than the traditional rehabilitation schemes (Pinfold 2003). Promote awareness of anti-discrimination legislation in the public (Grove 2012). Promote social inclusion through strengthening efforts to overcoming administrative, legal and societal barriers that prevent stigmatized individuals from enjoying equal and full participation (EU report 2010). Education also plays a major role in addressing stigma and discrimination in the society. It plays a key role of lessening the stigma and can affect change where the law has failed such as changing societal attitudes (Knifton 2010). Supporting meaningful participation of stigmatized individuals in national planning and policy making as well as in other processes (DFID 2012). The government also has a key role to play alongside law reform and national human rights commissions. They may condemn stigma and discrimination both in employment and in the community Ensure promotion and protection of human rights in institutional settings Challenge/address discrimination at workplaces Ensure policy dialogue and policy reform where necessary Increase interaction with stigmatized individuals to help build their confidence and increase their self-esteem Ensure strengthening and building capacity of individuals with stigmatized illnesses through skill building, training and counseling, network building, and income generation (DFID 2012). Ensure interactive and participatory education. This is highly effective as it fosters greater understanding of stigma and allows people to reflect on their attitudes and actions, thereby catalyzing individual change around stigma (DFID 2012). Advocate for policies that promote and facilitate effective rights based approach to addressing stigma related issues. There is also the need to stop mandatory testing except for limited purposes such as blood donations, court orders and epidemiological research. In addition, there is need for the government to emphasize on the rights of privacy of test results, given the recent changes in law in UK which allows insurance companies the right to know test results. Conclusion Stigmatization remains a major issue facing both the employers and employees. People can be stigmatized based on their race, beliefs, obesity, AIDs and even based on their mental health. Stigma has a dramatic, though under recognized effect on the life opportunities of stigmatized individuals including employment opportunities, access to education, health and housing. Efforts to reducing stigma have often been inhibited by the lack of public awareness and knowledge, lack of incentives/benefits for taking action, and the widely held view that stigma is complex to address. However, a few of initiatives appear to be reducing the level of stigmatization. According to a newly released research, popular views about mental illness and HIV/AIDS appear to be improving in term of less social rejection. This has been attributed to the increased awareness and public understanding of mental health issues While there is a voluminous literature exploring the publics perception of stigma, there is need for further research to explore these peoples experiences, the impact on their lives, and ways to addressing these issues. This could help shape interventions and policies for improved legislation. Reference Berzins K.M., Petch A. Atkinson J.M., 2003. â€Å"Prevalence and experience of harassment of people with mental health problems living in the community†. British Journal of Psychiatry 183 (12) 526–533. Briggs, E., 2007. Reducing HIV stigma within the workplace. Brockington I., Hall P., Levings J. Murphy C., 1993. â€Å"The community’s tolerance of the mentally ill†. British Journal of Psychiatry 162 (1) 93–99. Brohan, E. and G. Thornicroft, 2010. â€Å"Stigma and discrimination of mental health problems: workplace implications†. Occupational medicine, vol.60 (6, pp. 414-415 Chevannes B., 1998. Rastafari and other African-Caribbean Worldviews. Rutgers University Press; New Jersey. Crisp A., Gelder M., Rix S., Meltzer H. Rowlands O., 2000. â€Å"Stigmatisation of people with mental illnesses†. British Journal of Psychiatry 177 (7) 4–7. Department for International Development (DFID), 2007. Taking action against HIV stigma and discrimination. DFID EU report, 2010. Promoting social inclusion and combating stigma for better mental health and well-being. European Communities Gale E., Seymour L., Crepaz-Keay D., Gibbons M., Farmer P. Pinfold V., 2004. Scoping Review on Mental Health Anti-stigma and Discrimination – Current activities and what works. Leeds: National Institute for Mental Health in England. Goffman, E., 1963. Stigma: Notes on the management of spoiled identity. New York: Simon Schuster Inc. Gonzalez, C., 2012. HIV employment discrimination still an issue in US, UK. AIDSMEDS [viewed on 27th December 2012] available from aidsmeds.com/articles/hiv_employment_discrimination_1667_22733.shtml Grove, B., 2012. Overcoming stigma and discrimination in the workplace what does the evidence tell us? Centre for Mental Health Knifton, L., 2010. â€Å"Workplace interventions can reduce stigma. In: Mental health, training, education and practice†. Journal of public mental health, vol.7 (4). Brighton Ltd. Link B.G. Phelan J.C., 2001. â€Å"Conceptualising Stigma†. American Sociological Review 27 363–385. MacLean, L., Edwards, N., Gerrard, M., Sims-Jones, N., Clinton, K. and L. Ashley, 2009. Obesity, stigma and public health planning. Health Promotion International Parle, S., 2012. â€Å"How does discrimination affect people with mental illness?† Nursing Times; 108: 28, 12-14 Phelan, J. and Link, B., 2006. Stigma and its public health implications. Mailman School of Public Health, New York. Phelan J.C., Link B.G., Stueve A., Pescosolido B., 2000. â€Å"Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared.† Journal of Health and Social Behavior 41:188-207. Pinfold, V., 2003. Reducing stigma and discrimination: what works? Showcasing examples of best practices of anti-discrimination projects in mental health. Read, J. Baker, S., 1996. Not just Sticks and Stones: A survey of stigma, taboos and discrimination experienced by people with mental health problems. London: Mind. Stafford, M.C., Scott, R.R., 1986. â€Å"Stigma deviance and social control: Some conceptual issues.† in The Dilemma of Difference, edited by S. C. Ainlay, G. Becker, and L. M. Coleman. New York: Plenum Thomas, O., 2012. Depression stigma stops people getting and keeping a job. [viewed on 27th December 2012] available from wsandb.co.uk/wsb/news/2218175/depression-stigma-stops-people-getting-and-keeping-a-job Thornicroft, G., Szmukler, G., and K. T. Mueser (Eds.), 2011. Oxford textbook of community mental health. Oxford University Press, USA. Thornicroft, G., Rose, D., and A. Kassam, 2007. â€Å"Stigma: ignorance, prejudice or discrimination†. The British Journal of Psychiatry, 190: 192-193 Thornicroft, G., 2006. Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press. UNAIDS, 2000, HIV-related stigma, discrimination and human rights violations. UNAIDS UNESCO, 2002. HIV/AIDS stigma and discrimination: an anthropological approach. UNESCO/UNAIDS research project. Weiss, M.G., and Ramakrishna, J., 2004. Health-related stigma: rethinking concepts and interventions. Amsterdam Whitley, R., 2005. Stigma and the social dynamics of exclusion. Research and practice in social sciences, vol.1 (1), pp.90-95 Wood, k. and P. Aggleton, 2010. Stigma, discrimination and human rights. Thomas Coram Research Unit Institute of Education, University of London. World Health Organization, 2001. The World Health Report 2001 – Mental health: New understanding, new hope. Geneva: WHO.