Mental Illness and Structural Stigma in Canadian Health-Care Settings

Results of a Focus Group Study

This report has been prepared as part of a larger structural stigma project undertaken by the Mental Health Commission of Canada (MHCC) to better understand how health-care structures create and maintain stigma toward persons living with mental health problems and illnesses and/or with lived and living experience of substance use. In this report, structural stigma refers to the accumulated activities of social structures and organizations that deliberately or inadvertently create and maintain social inequalities for people with lived experience.

The health-care system has been consistently identified as a contributor to mental health- and substance use-related structural stigma, as is manifest in

• insufficient funding for mental health services and research
• fragmentation and underservice
• use (some would say overuse) of coercive care
• health-care providers’ poor knowledge of mental illnesses and possibilities for recovery
• diagnostic overshadowing where physical needs aren’t adequately addressed.

Structural stigma in the health-care system contributes to poor quality of care and to disability and premature death.1 However, its pervasiveness in Canada is difficult to understand without there being any coordinated attempts to document its scope and magnitude. Studies have examined how the Canadian news media negatively portrays people with lived experience. But no systematic efforts to learn how structural stigma plays out in the health-care system (and other sectors) have been undertaken. To begin addressing this knowledge gap, this study explored the personal experience of structural stigma by the people who are most affected. Its objectives were to

• gain a better understanding of the potential role of organizational practices in creating and maintaining structural stigma
• identify constructs that could inform the development of a generic framework to depict the nature of structural stigma
• inform the development of an audit tool that could be used to assess and monitor the occurrence of structural stigma.

The findings from this study will expand our understanding of the ways health-care organizations (and those working in them) may inadvertently stigmatize persons with lived experience. Given the existing gaps in our knowledge, this information will be useful to governments and health-system decision makers as they move to create non-stigmatizing health-care environments of the highest quality. In addition, information from this study will help developers create a conceptual framework of structural stigma in these settings, as well as an audit tool that can identify and monitor structural stigma in an effort to ameliorate it.