SpringerLink - Journal Article

Organizational and Individual Level Determinants of Stigmatization in Mental Health Services

Mieke Verhaeghe¹ and Piet Bracke¹

(1)	Department of Sociology, Ghent University, Korte Meer 5, Ghent, 9000, Belgium

Received: 13 July 2005 Accepted: 5 February 2007 Published online: 23 March 2007

Abstract Despite the large amount of research on the existence and the negative consequences of stigmatization of clients of mental health services, little is known about the differences between services. Using data from 520 clients of 47 rehabilitation centers in a multilevel design, we studied organizational and individual characteristics explaining variation in social rejection and self-rejection. The results reveal that only a very small percentage of variance in stigmatization is explained by organizational features, such as size, composition of the client population and the kind of supplied activities. Client level characteristics affecting stigmatization are current mental health status, former mental hospitalization, and participation in psychotherapeutic activities.

Keywords stigmatization - mental health services - multilevel analysis

A preliminary version of this paper was presented by the first author at the 4th NSV/VVS Marktdag Sociologie in Nijmegen, on 22 May, 2003, with the title “Stigmatisering verschilt: determinanten van stigmatisering van cliënten van dagactiviteitencentra en arbeidszorgcentra” (Stigmatization differs: determinants of stigmatization of clients in day activity centers and vocational care centers).

All authors certify responsibility for the manuscript.

Mieke Verhaeghe is a researcher at the Department of Sociology, Ghent University, Ghent, Belgium.

Piet Bracke is an associate professor at the Department of Sociology, Ghent University, Ghent, Belgium.

Mieke Verhaeghe
Email: Mieke.Verhaeghe@Ugent.be

References

Angermeyer M. C., Link B. G., Majcher-Angermeyer A. (1987). Stigma perceived by patients attending modern treatment settings. Some unanticipated effects of community psychiatry reforms. Journal of Nervous and Mental Disease 175(1):4–11

Anthony W., Cohen M., Farkas M. (1990). Psychiatric rehabilitation. Boston: Boston University Press

Anthony W. A., Cohen M., Farkas M. (1982). A Psychiatric Rehabilitation Treatment Program – can i recognize one if i see one. Community Mental Health Journal 18(2):83–96

Arrindell, W. A., & Ettema, J. H. M. (1986). SCL-90. Handleiding bij een multidimensionele psychopathologie-indicator. Lisse: Swets & Zeitlinger

Bingham C. R., Valenstein M., Blow F. C., Alexander J. A. (2002). The mental health care context and patient characteristics: Implications for provider job satisfaction. Journal of Behavioral Health Services & Research 29(3):335–344

Bryk A. S., Raudenbush S. W. (1992). Hierarchical Linear Models. Applications and data analysis methods. Newbury Park: Sage

Chee C. Y. I., Ng T. P., Kua E. H. (2005). Comparing the stigma of mental illness in a general hospital with a state mental hospital – A Singapore study. Social Psychiatry and Psychiatric Epidemiology 40(8):648–653

Cnaan R. A., Blankertz L., Messinger K., Gardner J. R. (1988). Psychosocial rehabilitation: Toward a definition. Psychosocial Rehabilitation Journal 11:61–77

Colton M., Casas F., Drakeford M., Roberts S., Scholte E., Williams M. (1997a). Stigma and social welfare: An international comparative study. Aldershot: Ashgate

Colton M., Drakeford M., Roberts S., Scholte E., Casas F., Williams M. (1997b). Social workers, parents and stigma. Child and Family Social Work 2:247–257

Cormack S, Furnham A. (1998). Psychiatric labelling, sex role stereotypes and beliefs about the mentally ill. International Journal of Social Psychiatry 44:4:235–247

Corrigan P. W., Markowitz F. E., Watson A., Rowan D., Kubiak M. A. (2003). An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior 44:162–179

Corrigan P. W., Watson A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1):35–53

Crisp A. H., Gelder M. G., Rix S., Meltzer H. I., Rowlands O. J. (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry 177:4–7

Derogatis, L. R. (1993). Brief symptom inventory. Administration, scoring and procedures manual, Minneapolis: NCS Pearson Inc

Dudley J. R. (2000). Confronting stigma within the services system. Social Work 45(5):449–455

Falk G. (2001). Stigma. How we treat outsiders. New York: Prometheus Books

Fife B., Wright E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health and Social Behavior 41(1):50–67

Goffman E. (1963). Stigma. Notes on the management of spoiled identity. New York: Simon and Schuster

Gove W. R. (1970). Societal reaction as an explanation of mental illness: An evaluation. American Sociological Review 35:873–884

Gove W. R., Fain T. (1973). Stigma of mental hospitalization – Attempt to evaluate its consequences. Archives of General Psychiatry 28(4):494–500

Hox J. J. (1995). Applied multilevel analysis. Amsterdam: TT Publications

Hugo M. (2001). Mental health professionals’ attitudes towards people who have experienced a mental health disorder. Journal of Psychiatric and Mental Health Nursing 8:419–425

Huttman E. (1973). Factors leading to client degradation in welfare and public housing. Journal of Sociology and Social Welfare 1(1):83–85

Huxley P. (1993a). Location and stigma: A survey of community attitudes to mental illness: 1. Enlightenment and stigma. Journal of Mental Health 2(2):73–80

Huxley P. (1993b). Location and stigma: A survey of community attitudes to mental illness: 2. Community mental health facilities – anonymity or invisibility. Journal of Mental Health 2(2):157–164

Joachim G., Acorn S. (2000). Stigma of visible and invisible chronic conditions. Journal of Advanced Nursing 32(1):243–248

Kaasenbrood, A. J. A., & de Valck, B. R. (2000). Stigma. In G. Pieters & M. Van der Gaag (Eds.), Rehabilitatiestrategieën bij schizofrenie en langdurig zorgafhankelijke patiënten. Care development (pp. 135–143). Bohn Stafleu Van Loghum

Kaplan H. B., Martin S. S., Johnson R. J. (1986). Self-rejection and the explanation of deviance: Specification of the structure among latent constructs. American Journal of Sociology 92(2):384–411

Kaplan H. B., Xiaoru L. (2001). Adolescent self-rejection and adult social action: A conditional relationship. Social Science Quarterly 82(4):701–715

Kirk S. A. (1974). Impact of Labeling on Rejection of Mentally Ill – Experimental Study. Journal of Health and Social Behavior 15(2):108–117

Lamb H. R., Bachrach L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services 52(8):1039–1045

Liggins J., Hatcher S. (2005). Stigma toward the mentally ill in the general hospital: A qualitative study. General Hospital Psychiatry 27(5):359–364

Link B. G. (1982). Mental patient status, work, and income: An examination of the effects of a psychiatric label. American Sociological Review 47:202–215

Link B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review 52:96–112

Link B. G., Cullen F. T., Frank J., Wozniak J. F. (1987). The social rejection of former mental patients: Understanding why labels matter. American Journal of Sociology 92(6):1461–1500

Link B. G., Cullen F. T., Struening E., Shrout P. E., Dohrenwend B. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review 54:400–423

Link B. G., Phelan J. C. (2001). Conceptualizing stigma. Annual Review of Sociology 27:363–385

Link B. G., Struening E. L., Rahav M., Phelan J. C., Nuttbrock L. (1997). On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior 38:177–190

Littrell J., Diwan S. (1998). Attitudinal predictors of preferred policy options: Contrasting AFDC with work programs. Journal of Sociology and Social Welfare 25(2):69–99

Long E., Runck B. (1983). Combating stigma through work for the mentally restored. Hospital and Community Psychiatry 34(1):19–20

Markowitz F. E. (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior 39:335–347

Meznar M. B., Nigh D. (1995). Buffer or bridge – environmental and organizational determinants of public affairs activities in american firms. Academy of Management Journal 38(4):975–996

Mok M. (1995). Sample size requirements for 2-level designs in educational research. Multilevel Modeling Newsletter 7(7):11–15

Nieradzik K., Cochrane R. (1985). Public attitudes towards mental illness – the effects of behaviour, roles and psychiatric labels. International Journal of Social Psychiatry 31:23–33

Phelan J. C., Link B. G., Stueve A., Pescosolido B. A. (2000). 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

Phillips D. L. (1963). Rejection: A possible consequence of seeking help for mental disorders. American Sociological Review 28(6):963–972

Phillips D. L. (1964). Rejection of the mentally ill: The influence of behavior and sex. American Sociological Review 29(5):679–687

Phillips D. L. (1967). Identification of mental illness: Its consequences for rejection. Community Mental Health Journal 3(3):262–266

Prior L. (1993). The social organization of mental illness. London: Sage Publications

Raingruber B. (2002). Client and provider perspectives regarding the stigma of and nonstigmatizing interventions for depression. Archives of Psychiatric Nursing 16(5):201–207

Rosen A., Walter G., Casey D., Hocking B. (2000). Combating psychiatric stigma: An overview of contemporary initiatives. Australasian Psychiatry 8(1):19–26

Rosenfield S. (1997). Labelling mental illness: The effects of received services and perceived stigma on life satisfaction. American Sociological Review 62:660–672

Scheff, T. (1966,1999) Being mentally ill. A sociological theory (3rd ed.). New York: Aldine De Gruyter

Schulze B., Angermeyer M. C. (2003). Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science and Medicine 56:299–312

Sixma H. J., Spreeuwenberg P. M. M., van der Pasch M. A. A. 1998. Satisfaction with the general practitioner – A two-level analysis. Medical Care 36(2):212–229

Spicker P. (1984). Stigma and social welfare. London: Croom Helm

Spicker P. (2002). Stigma and social exclusion in healthcare (book review). Health and Social Care in the Community 10(3):206–207

Van Houtte M. (2006). Tracking and teacher satisfaction: The role of study culture and trust. Journal of Educational Research 99(4):247–254

Verhaeghe, M., Bracke, P. & Bruynooghe, K. (in press). Stigmatization in different mental health services: A comparison of psychiatric and general hospitals. Journal of Behavioral Health Services & Research

Williamson J. B. (1974). The stigma of public dependency: A comparison of alternative forms of public aid to the poor. Social Problems 22(2):213–228

Wright E. R., Gronfein W. P., Owens R. J. (2000). Deinstitutionalization, social rejection and the self-esteem of former mental patients. Journal of Health and Social Behavior 41:68–90