Mental health stigma is a key factor preventing people from accessing the care they need, according to new research from King's College London.
The new study, published today in Psychological Medicine, brings together data from 144 studies, including over 90,000 participants worldwide.
Approximately 1 in 4 people have a mental health problem, yet in Europe and the US, up to 75 percent of people with mental health disorders do not receive treatment. For many disorders such as psychosis, bipolar disorder, major depression and anxiety disorders, delaying or avoiding care is associated with worse outcomes.
Professor Graham Thornicroft, from the Institute of Psychiatry (IoP) at King's College London and senior author of the paper, says: "We now have clear evidence that stigma has a toxic effect by preventing people seeking help for mental health problems. The profound reluctance to be "a mental health patient" means people will put off seeing a doctor for months, years, or even at all, which in turn delays their recovery."
The study, which was funded by the National Institute for Health Research (NIHR) as a part of the SAPPHIRE Programme, looked at the effect of stigma on how individuals with mental health problems accessed and engaged with formal services, including GPs, specialist mental health services and talking therapies.
Stigma was the fourth highest ranked barrier out of ten. The main types of stigma preventing people from accessing care were 'treatment stigma' (the stigma associated with using mental health services or receiving mental health treatment) and 'internalised stigma' (shame, embarrassment). Other important barriers preventing people seeking help were fear of disclosing a mental health condition; concerns about confidentiality; wanting to handle the problem on one's own; and not believing they needed help.
The study also identified certain groups for whom stigma had an even stronger effect on preventing people seeking help. These included young people, men, people from minority ethnic groups, those in the military and health professions.
Dr Sarah Clement, from the IoP at King's and lead author of the paper, says: "Our study clearly demonstrates that mental health stigma plays an important role in preventing people from accessing treatment. We found that the fear of disclosing a mental health condition was a particularly common barrier. Supporting people to talk about their mental health problems, for example through anti-stigma campaigns, may mean they are more likely to seek help."
Notes to editors:
For an embargoed copy of the paper or interviews with the author(s), please contact Seil Collins, Press Officer, Institute of Psychiatry, King's College London / seil.collins@kcl.ac.uk / (+44) 0207 848 5377 / (+44) 07718 697 176
Paper reference: Clement, S. et al. 'What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies' is published in Psychological Medicine
Funding: The research was funded by the NIHR under its Programme Grants for Applied Research (PGfAR) Programme (Improving Mental Health Outcomes by Reducing Stigma and Discrimination: RP-PG-0606-1053). Additional funding was provided by Comic Relief, the UK Government Department of Health, European Commission and the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London.
About SAPPHIRE:
SAPPHIRE is a five year research programme on mental health-related stigma and discrimination, funded by the National Institute for Health Research. It focuses mainly on three areas: access to mental healthcare, how physical health care is provided, and employment. The research will lead to the production of: best available evidence on population education regarding stigma and discrimination; legal requirements on disclosing psychiatric history; a decision-aid on job applications; DVDs for training courses; and four standardised scales to assess the impact of discrimination and associated financial costs. http://www.sapphire.iop.kcl.ac.uk
About the National Institute for Health Research:
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.
About King's College London:
King's College London is one of the top 20 universities in the world (2013/14 QS World University Rankings) and the fourth oldest in England. It is The Sunday Times 'Best University for Graduate Employment 2012/13'. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £554 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: http://www.kingshealthpartners.org.
The College is in the midst of a five-year, £500 million fundraising campaign – World questions|King's answers – created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health. More information about the campaign is available at http://www.kcl.ac.uk/kingsanswers.
Journal
Psychological Medicine