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DEPARTMENT OF SOCIAL WORK

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Question Answered: How do societal attitudes, in Britain, towards those with mental health difficulties affect their lived experience of it?

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BSc Social Science

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Course Code: SW3030

How do societal attitudes, in Britain, towards those with mental health difficulties, affect their lived experience of it?

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Word Count: 9,204

Abstract

This paper examines the role of societal attitudes towards individuals with mental health difficulties in Britain, looking closely at how these beliefs impact them and their lives and therefore acting as a basis for change in these beliefs to occur. After exercising key search terms into the research data bases the collation of second-hand, Britain based, books and journal articles written about this topic were applied to a current, contemporary society. This was in order to demonstrate the prevalence of certain stigmatizing attitudes in Britain and how these are perpetrated and used against sufferers of mental health difficulties to reduce them to a lower quality of life. The subsequent content analysis of the literature led to the decipher of 3 clear themes: the societal reactions to and stereotypes of those with mental health difficulties, the impact on and the internalised stigma of victims, and the media as a perpetrator of stigma. The results concluded that stigmatising attitudes still exist in society today and usually result from a lack of education or the misinformation amongst the general public on mental health difficulties. As a result of this, the research suggests that those suffering with these difficulties are deemed as incapable to carry out usual livelihood responsibilities, such as working or living independently. This was found to have a knock-on-effect on the way they perceive themselves, developing a sense of self-stigma whereby they internalise the stereotypes about them and assume them as true, continuing a negative cycle. Furthermore, the media was found to tend to present harmful and dramatized depictions of mental health difficulties, which with people looking to these platforms as legitimate sources of information, can be impactful on the attitudes it encourages. Stigma and stereotypes about mental health can also have an impact on treatment and diagnosis of these difficulties with individuals suffering, not actively seeking help and support. These findings indicate the need for education amongst the general public, in Britain, so that society as a whole, families and individuals experiencing these difficulties themselves, might develop a less prejudiced understanding of mental health and are made aware of the credible sources to turn to for information and have access to highly marketized professional mental health care.

Table of Contents

Introduction_________________________________________________6

Methodology_________________________________________________9

Study design________________________________________________9

Procedure__________________________________________________10

Inclusion criteria & search terms_________________________________10

-Table 1. Search terms________________________________________12

Analysis___________________________________________________12

Data collection limitations/ ethical considerations___________________14

Findings___________________________________________________14

Societal reactions to and stereotypes of those with mental health difficulties__________________________________________________15

Impact on and the internalised stigma of victims____________________20

The media as a perpetrator of stigma____________________________25

Discussion_________________________________________________30

Conclusion_________________________________________________36

Bibliography________________________________________________39

Supervision Log_____________________________________________43

Introduction

Perspectives on the mentally ill date back to the Renaissance era when, through the contribution of Foucault (1961), we understand that mental illness was seen as a sinful state, a supernatural issue external from the body, the beginnings of an alienation amongst mental health sufferers. People with mental health difficulties were incarcerated to institutions, known as hospitals, but where the main objectives were not that of medical care but instead a purpose of the confinement of these groups as they were seen as needing to be separate in society, with fear of these individuals instilled in the community through strong religious beliefs. Goffman (1963) initiated the insight on these stereotypes of marginalised groups, those with mental health difficulties, from a sociological perspective, coining terms such as stigma, first investigated by Emile Durkheim (1895), to describe the impact these societal attitudes had on the individuals suffering. He defines stigma as an attribute that is deeply discrediting, that reduces someone from a whole and usual person to a tainted, discounted one (p.3) as he notes how this idea of a spoiled identity, disqualifies certain groups from full social acceptance (Goffman, 1963). Stigma can be presented towards a physical characteristic, such as a disability that can be seen (physical deformities), a more individual characteristic which in comparison is not visible (mental illness, sexuality), or a tribal factor which could be either visible or invisible (race, gender, religion) and these beliefs tend to be underpinned by stereotypes, prejudice and discrimination. Common stereotypes about those with mental health difficulties can include and range from labels that they are violent or harbour anti-social, dangerous traits, encouraging a fear of these individuals, and that they are less able and therefore less worthy of respect and the access to opportunities enabling them a more normal life (The Ontario Human Rights Commission, 1961). There are many ways in which individuals, or a collective society portray stigma towards minority groups, which are important to look at to understand the origins of these behaviours and why people hold certain reactions to mental health and how these are reinforced through institutions in our society to create these worldwide beliefs. Foucauldian theory develops our understanding on how mental health has been problematised through history with this regime of truth being configured by societal and cultural beliefs that would have been present in a particular place at a particular time, meaning that actual objective truth becomes irrelevant (Fullagar, 2017, p.39). As a result of these power-knowledge imbalances societal beliefs like stigma and stereotypes are upheld in society, and societies to come, acting as a profound impact on those with mental health difficulties.

In 2020 television presenter Caroline Flack ended her own life after an onslaught of obstructive media attention regarding occurrences in her personal life. The hounding of a mentally vulnerable woman by newspapers, particularly tabloids saw mocking messages surrounding the stars personal struggles and sentencing her before her trial. This encouraged the public to develop a prejudiced opinion, and in some cases act on this scrutiny, resulting in the presenter to lose her job, thus having a knock-on effect on Flacks mental health at the time and ultimately resulting in her premature death. Cases such as this act as evidence for negative societal attitudes towards those with mental health difficulties, particularly how this is upheld by a major institution in our society, the media, and how this influence can have a domino effect on an individuals life, how it can be lived in terms of what they are restricted to do, and what they choose to do with it. The prevalence of these attitudes still in our society, as seen amongst the treatment of Caroline Flack, amidst the unknowingly last few months of her life, is why this acts as an important motivation behind this research into how societal attitudes in Britain, towards those experiencing mental health difficulties affect their lived experience of it. In our society we are quick to dissociate people from our reality when they offer an indifference to what we perceive as the norm, an assumption that can be harmful to the other and how they experience the world, which is why this research aims to look at the reasons behind these common assumptions, how they are withstood in society, looking more specifically at the media, and achieve an understanding of the impact they can have on those experiencing mental health difficulties day-to-day.

This study aims to synthesise the literature on societal attitudes towards mental health in Britain and to see how these attitudes effect the lived experience of those with mental health difficulties. But also try to develop an understanding as to why certain views are held in society. Once the methodology has been laid out, the configuration of a literature review will follow before a subsequent content analysis and the coding of three main themes, the second-hand sources were interpreted for their wider meaning, and lastly conclusions were made about the importance of this research and suggestions for future developments.

Methodology

Study Design

In order to achieve the aforementioned aims of how societal attitudes towards those suffering with mental health problems effect their lived experience, this study adopted a qualitative approach. This type of method is useful for gathering non-numerical data and providing a rich description when exploring attitudes and behaviour. Therefore, the qualitative route was chosen as mental health is a complex phenomenon and in order to gain a better understanding over this topic and make clear ties and conclusions in this research, methods needed to be employed that would gain the most in-depth information. In this way this research has taken an interpretivist approach, as a way of giving meaning and interpretations to actions in order to realise a humanistic, empathetic understanding. In addition, interpretivism tends to assume that reality is subjective and socially constructed by which an action is based on the beliefs, norms and values of a culture or society. This research philosophy approach supports the aims of this research to see how beliefs and stereotypes can shape someones reality, namely in this case those suffering with their mental health. Taking a critical social research approach when studying something such as mental health and society is important as we intend to uncover imbalances in power structures in our society which can be oppressive over certain groups and to critique these social structures and underlying assumptions that are resulting in those suffering with mental health difficulties to have a different life experience.

Procedure

I used different research databases including Social Care Online, PsycInfo, and Google Scholar in order to collate a series of second-hand journal articles and books as well as reference harvesting to develop my understanding and knowledge of the topic and begin to observe recurring themes and concepts within the texts. Some of these databases were logged through the Royal Holloway Library Search to narrow the resources to those relevant to the Social Science academic database.

Inclusion Criteria and Search Terms

In order to guarantee the most efficient results out of the search engines I developed some search terms (see Table 1.) to see how many secondary sources there already is on the topic and where my research would fit into it. In terms of exclusion criteria, whilst it had been thought that sources from over 10 years would be excluded ago due to a risk of lack of validity in these aged documents, many of the resources that appeared after the search terms were generated, were written over 10 years ago and I did not want to exclude these valuable sources. This is where a gap was noticed in the literature of research conducted in the past 10 years that would be more valuable and reliable to people researching today and so it was decided this is where the research would slot in and fill gaps. In addition, it had been indicated that definitions of mental illness and societal reactions to this have broadened with negative stereotypes being on the decline and people knowing more about psychiatric disorders, and so this research is important as it enables comparisons to be made over time and draw firm conclusions on these changes. Sources and research were limited to to that of Britain rather than making this an international study as a way of in ensuring that my research is valid and relevant to the society in which I live in and that of which the research is being created. The research question is group specific in terms of looking at those who suffer from mental health difficulties but societal views and attitudes that have been looked at, have not been limited to that of a specific group such as older or younger people, but instead society at a whole and how these attitudes are influenced throughout and between generations. Not being limited to group specific research leaves room for comparisons to be made between certain groups. Mental health is such a broad topic, with many conditions and diagnosis falling into this category, however, instead of looking at specific types of disorders under this definition the term mental health difficulties will be based on the characterization of a clinically significant disturbance in an individuals cognition, emotional regulation or behaviour (World Health Organization, 2022).

Table 1. Search terms

___________________________________________________________________

Search Term

Database Hits

Societal attitudes AND mental health

Social Care Online 4

Lived experience AND mental health

Social Care Online 413

stereotypes AND mental health

Social Care Online 117

(Mental health or mental illness or mental disorder or psychiatric illness) AND societal attitudes

PsycInfo243

stigma or discrimination AND mental illness or mental health or mental disorder

PsycInfo26.662

(Stigma or discrimination) AND (experience AND mental illness)

PsycInfo2,269

(Society and media) AND mental health

PsycInfo962

Mental health AND experience AND mental health Social Care Online 5408

Analysis

Once the data was collected, the method used to help analyse the data was content analysis. Content analysis is a research technique for the objective, systematic and quantitative description of the manifest content of communication (Berelson, 1952). In this way, content analysis will be used to reveal attitudinal and behavioural responses to certain groups, namely those with mental health difficulties as a way of investigating this issue in society. Content analysis is a useful resource for determining patterns, themes and concepts within the qualitative data and as a way of quantifying and analysing the meanings and relationships of certain themes, concepts or words. This type of analysis is most productive when studying my research topic regarding societal attitudes to those with mental health difficulties and how this effects the lived experience of it as it allowed similar ideas and attitudes towards mental health to be collected and coded from these sources in a quantitative way, but also enables the investigation into any underlying meanings and relationships. The contrast of quantitative and qualitative research methods alongside one another results in a more rigorous analysis. In order to conduct the content analysis of the research, firstly the approach that would be taken in order to develop the research question and aims was decided. The approach the content analysis has taken is a relational content analysis stance. This means that rather than looking at the frequency a concept occurs in the set of data, instead the relationship between the concepts in the context of which they appear is investigated. Once the research question and aims were identified, I began to bracket my own pre-conceptions on the topic in order to not have these be reflected in the research and avoid any signs of bias. Next, categories were created within the data by grouping similar concepts together and certain re-occurring words and patterns in order to discover their meaning and operationalise the variables, these categories consist of and will be ordered thematically by societal reactions to and stereotypes towards those with mental illness, the impact on and internalised stigma of victims and the media as a perpetrator of this stigma. When assessing the data, it will also be important to code the relationships between the concepts and their meanings, following a relational content analysis structure, this will make it easier to sum up and analyse the data.

Data Collection Limitations/ Ethical Considerations

Data collected only represents a small part of the whole, with exclusion data being precise. While this provides strong external validity for the topic matter, a further replication of the study of a wider population might increase validity for a larger population. If quantitative methods had been used, data may have been coded easier and contextualised in a thematic way, but qualitative methods meant data was richer. Other data collection methods such as interview or questionnaires may have gained more of an insight into personal experience and beliefs regarding mental health difficulties, however, in the light of ethical considerations for this sensitive topic, analysing second-hand literature ensured a more reliable and representative response whilst remaining ethical.

Findings

The systematic literature review and subsequent content analysis resulted in three main themes. The themes are societal reactions to and stereotypes of those with mental health difficulties; impact on and internalised stigma of victims; and the media as a perpetrator of stigma, which will formulate the thematic structure of this findings chapter.

Societal reactions to and stereotypes of those with mental health difficulties

Those living with mental health difficulties might often find themselves battling day-to-day for a place in their society. Whilst potentially coping with symptoms of their mental health difficulties, for example anxiety, hallucinations etc, that may debilitate their ability to live life independently or to its fullest quality, these groups also must face the derogatory reactions from the public, which are fuelled by a lack of education of these difficulties and could result in discrimination. Goffmans participant observation at St Elizabeths Hospital, a federal psychiatric hospital in Washington, DC (Pescosolido, 2013, p.2), enabled him to draw the conclusion that after being an inmate at one of these asylum institutions the individuals social position will never be again what it was prior to entrance because the total institution bestows an unfavourable status (Goffman, 1961, p.72). This statement connotes the idea that those with mental health difficulties are disadvantaged by societys reaction being based on assumptions and misunderstandings resulting in stigmatizing attitudes. Whilst there is no concrete definition of stereotypes within the literature, it can be understood as a belief about a group of individuals (Shunsuke, 2006, p.306), emphasising the issue that these predispositions are merely based on belief, rather than facts or knowledge. However, even though there is emphasis here that stereotypes are predicated on beliefs, the Foucauldian theory tells us that this does not make it any less true within a society.

Public stigma refers to reactions of the general public towards a group based on stigma about that group (Rusch, 2020, p. 530) whereby individuals that possess traits of indifference to the wider society, are labelled in ways that often suggest a separation from the norm, and othering them. Angermeyer and colleagues (2003) investigation into the extent to which the public desires social distance from people with schizophrenia, revealed that the assumptions that claimed schizophrenics were unpredictable and dangerous (p.663) inadvertently caused strong feelings amongst the public to want to socially distance from these individuals, with results suggesting this was more predominant if a negative prognosis was anticipated, thus supporting the labelling theory (Scheff,1996). These findings also correlated with the idea that the general public seems to disapprove more of persons with mental health difficulties than physical illness, with common belief that society is more likely to place blame on an individual with mental health difficulties for their current mental state (p.666), further emphasising a lack of education of these difficulties amongst the general public. Whilst a lack of education on mental health difficulties can cause these stigmatizing attitudes, it can also be a result of them, with the stigma attached to these mental health difficulties often leading to underestimation, underdiagnoses and undertreatment as there is a wide lack of knowledge regarding causes, symptoms and treatment options (Baumann, 2007, p.131). Similarly, to these findings Pescolido (2013, p.8) found that, through surveys about public stigma, there was a significant difference in the percentage of respondents expressing rejection towards a troubled person, such as a child with asthma, compared to someone with needs of a psychiatric category. These results rejected the assumption that stigma was becoming a dissipated ideology as it was clear that amongst the participants, the public can make differentiations between the person with daily troubles and those with mental health difficulties. In addition, the survey answers revealed that for both children and adult respondents, a stigmatizing reaction was more evident dependent on the social venue and the extent of the individuals problem. For example, amongst adults, they were more likely to endorse stigmatizing attitudes towards those with alcohol or drug dependence problems, reinforcing the idea that a big factor of stigma is blame (Pescolido, 2013, p.8). In terms of social venue, intimacy in a setting between the respondent and the individual with mental health difficulties reported higher levels of rejection, particularly in a workplace or if the individual in question were to marry into their family (p.9). Phelan et al (2000) revealed evidence of increased mention of danger and violence in response to what is mental illness? between 1950 and 1996, and findings from Pescolidos surveys correlate that this is still a prominent response. Ironically, notes that sufferers of mental health difficulties can be a danger to themselves, and others, initially was a statement of protection for these individuals and the wider community, however in recent times, this language reflects a negative stereotype and a cause for fear and distance amongst these groups (Link et al, 2008).

As previously mentioned, being or becoming a relative of someone with mental health difficulties can emphasise problems and beliefs in stigma. Family members ultimately only have the same amount of knowledge assumed of the general public including an unclear understanding and prejudiced disinformation, therefore it is hard for them to empathise or understand what a family member may be going through when experiencing mental health difficulties (Thornicroft, 2006, p.3). This lack of education can cause family members to keep silent when it comes to addressing their relatives mental health as they may feel they do not know what to say from a perspective of not being able to relate to the direct experience and, also, not having the tools of knowledge and understanding to give constructive advice or help. The idea that family members tend to initially go through the phase of asking why questions and considering where the blame lies for this occurrence in their own and their relatives life is known as the attribution theory (p.4), suggesting a concern with how events occur. This theory connotes the idea that if an individual is perceived as to blame for their mental health difficulties at the time, then family members are less likely to be attentive to their needs, particularly if this person is seen as unable to recover, compared to a physical illness where relatives can show support in well wishes to get better soon. Thornicroft (2006) also discusses the idea of stigma by association which refers to the impact that stigma towards those with mental health difficulties has on their close relatives (p.7). However, whilst these stereotypes and stigma in society concerning mental health can affect those experiencing these difficulties directly, it also can occur as a more passive problem. Individuals with mental health difficulties live in these societies where these cultural beliefs are held, so while they do not always have to be on the receiving end of stigma, due to the same lack of understanding that families experience, those experiencing the problem may not know much either. As a result of this they may be less likely to seek help and support or talk about it, not necessarily as they believe it is a reason to be ashamed but just because of how society is programmed.

With people who experience mental health difficulties sometimes facing struggles in gaining their families full support and understanding amongst their experiences, it is concerning how wider societal institutions are supposed to deal with these individuals in a better manner. The police are often the frontline professionals who deal with mentally ill people when they are in a crisis, this comes from their duty to protect the safety and welfare of a community whilst also enforcing care for persons who cannot care for themselves. Based on these principles it can be assumed that the police may be more likely to use force over arrestees deemed as having mental health difficulties (Jun et al, 2002, p.81), particularly if an encounter is posed as a threat or there is an element of resistance (Mulvey & White, 2014, p. 407). However, looking at the literature, whilst there is not a lot of research into police and those with a mental health difficulties encounter, notably the existing studies point towards the extensive training, discretion and coordination between the police and mental health professionals dealt with by police in the exercise of their duty. In fact, Mulvey and Whites (2014) study into whether police use of force and suspect resistance are more likely to occur in arrest encounters involving suspects with mental health difficulties, determined that there is a non-significant relationship between arrestee mental health and use of force. This suggests that, despite a strong predictor of resistance against police by those with mental health difficulties, the training gone through by police is important in adequately equipping them with the knowledge of how to deal with people in this category and enables them to be able to assess the situation appropriately, proceeding based on whether this person knew what they were doing or could have acted differently.

These findings suggest that negative societal reactions to and stereotypes of those with mental health difficulties are still prevalent in our society, with many of these views resulting from a lack of education and knowledge over these difficulties and non-direct contact with sufferers, leaving the public without the understanding and quick to base their prejudices on out-dated beliefs.

Impact on and Internalised stigma of victims

The misrepresentation in society of severe mental health difficult resulting in those suffering becoming victims of stigma and discrimination, can have more of an impact on their quality of life than their mental health difficulties do (Corrigan, 1998, p.201). The impact on these individuals of negative stereotypes about them and their mental health difficulties can include having fewer opportunities in their lives, such as in the workplace, housing, health care, relationships with family and friends, but particularly their relationships with themselves. Internalised stigma, also known as self-stigma, refers to the reactions of individuals who belong to a stigmatized group and turning the stigmatizing attitudes against themselves (Rusch et al, 2005, p.531), explaining how a person with mental health difficulties begins to endorse negative messages and stereotypes about their mental health and comes to believe them, applying them to him/herself and making it their reality which can result in discouragement, hurt, anger and lowered self-esteem.

Corrigan (1998) uses the analogy of Mr Goodman to explain how the differing reactions to mental health difficulties as opposed to physical illness from health care professionals, family and friends can impact how an individual is enabled to carry out their lives. Mr Goodman led a regular life. He lived alone, went to work, attended church and took part in activities with friends but following an episode of his schizophrenia, he was denied the right to continue with these basic human rights, having to live in an institution, leave his job and lose out on his friendships. This occurrence is then compared to a diabetes patient who may, from time to time, be hospitalised due to their illness but will not have their life taken away from them or necessarily be deemed as unable to look after themselves so quickly. Corrigan expresses that societys reaction to the disease seems to have an equally harmful impact on the persons abilities to successfully achieve life goals (p.202) as there are so many prejudices and misconceptions about their abilities and needs. In fact, Wahl (1999, p.476) reveals that mental health caregivers were severely implicated, in his surveys and follow up interviews, as contributors to stigma through their discouraging advice, disparaging remarks and rejecting behaviour, which can often be more discouraging for consumers as it is coming from someone who is meant to provide help to them and know best of their situation. Evans and Repper (2020) draw on these stereotypes based on the capability of those suffering with their mental health to assess the clear link between unemployment and mental health difficulties. Their journal states that in the UK, only 15% of people with serious mental health problems are employed (p.15), despite research based on personal accounts suggesting that these individuals do want to work and data proving that employment can improve quality of life, mental health, social networks and social inclusion. People with mental health difficulties or additional needs are not expected to work as they are seen as unfit for the job; however, this type of exclusion continues the cycle of these beliefs being perpetrated in society amongst the general public, who do work, and therefore those with mental health difficulties are excluded from big opportunistic positions in life, which further prevents them from having a certain community presence or gaining status from colleagues or friends. Denying those with mental health difficulties the right to social inclusion, an income, status and social contacts can add to the pessimistic self-perception and view of the future experienced by these individuals as they may not feel like they have a sense of purpose or belonging without an opportunity to contribute and receive recognition in the society of which they live. For example, 32% of mental health consumers who responded to a nationwide survey regarding their experience of stigma and discrimination revealed that they had not been accepted to a job, despite being qualified for the role, once their mental health status was revealed, whilst if they were accepted there was high reports of an unfriendly environment amongst their co-workers (Wahl, 1999, p.471). As a result of these reactions to an individuals mental health difficulties, they reported on feeling obliged to avoid disclosing their mental health difficulties particularly on job applications, but also licences and housing forms and even a resistance to use health services or undergo treatment to avoid discrimination (p.471).

The idea that those with mental health difficulties may want to conceal their illness when looking at housing can be down to a lack of choice over where they get to live. It may result in them being under the provision of temporary accommodation, or they may feel that they receive low quality provision because of their mental health difficulties. In addition, these individuals may not be deemed as able to live independently, (Thornicroft, 2006, p.12) with many people having to stay under the care, and in the home, of their parents or family for much longer than expected following their diagnosis. A key factor in discrimination towards mentally ill people regarding housing is the not in my back yard phenomenon which emphasises the wishes of the general public to not house facilities for the mentally ill in their neighbourhood (Wahl, 2003, p. 1596), further endorsing the idea of social distance from these groups.

Many people with mental health difficulties know the stereotypes about their groups such as the belief that they are incompetent (Rusch et al, 2005, p.531). Based on stereotypes, discrimination and prejudice, this can result in the suffering people internalising stereotypes about them thus making them true. This also links to the idea of a self-fulfilling prophecy, whereby stereotypes and impressions, even if mistaken ones, become real as an individual conforms to the wider expectations of their behaviour making it part of their own self-concept (Sibicky & Dovidio, 1986, p.148). For example, if an individual starts to believe that they lack the competence to work, or take care of themselves, then they may stop actively looking for job opportunities as they absorb the negative beliefs that they are not meant to work and as a consequence of the preconception that they will be rejected in many areas of their lives anyway. Therefore, causing them to fail to reach this goal and reinforcing the stigmatizing attitudes and enabling a negative relationship between internalised stigma and psychosocial variables such as high hopes, self-esteem and empowerment but leaving the individual with potential symptom severity and negative attributes about themselves (Livingston & Boyd, 2010, p.2150). Corrigan and colleagues (2005, p.533) discuss why individuals may react differently to stigma, suggesting that when a person with a stigmatizing condition, such as serious mental health difficulties, identify with the negatively stigmatized group then they are more likely to allow the prejudices and discrimination to define them, in a process of self-concurrence as they give them a certain extent of perceived legitimacy, they believe they are true facts about themselves. However, if an individual does not identify with the group, then they are indifferent to the attitudes against them as they do not think these beliefs are fair to be placed upon them and may react with righteous anger, leaving them feeling more empowered than the prior group. This may be a result of varying levels of the severity of the individuals mental health difficulties, with more serious cases such as those that result in hospitalization, leading to the internalized belief that they are something to be feared or rejected in society (Link et al, 2001, p.1621).

The findings from the literature regarding this sub-topic suggest that stigmatizing attitudes and negative societal beliefs around mental health difficulties lead to victims of this treatment having less opportunities within society, such as being able to work; providing for society and themselves, living independently in their personal accommodation or having access to adequate treatment and health care professional advice, as a result of the views that they are incapable and incompetent to be entitled to these rights. This irrational prejudice that leads to discrimination and involves viewing people who are deemed as having mental health difficulties as inferior is known as sanism (Poole, 2012, p.20). Being stripped of these rights makes mental health sufferers lack status in society, as they do not have a place in it, they do not feel represented by their community and so they may begin to internalise these values attributed to them by the general public and assume them as true and legitimate means for them not having the same access in society as others. This can result in psychosocial emotional reactions such as low self-esteem which, in turn, could become depression such as suicidal thoughts, emphasising that they do not feel worthy enough as they anticipate rejection throughout their lives. This impact on the self-esteem of those with mental health difficulties should act as an initiative to challenge stigmatizing attitudes due to their detrimental effects.

The media as a perpetrator of stigma

Looking at the common stereotypes and stigmatizing reactions to mental health and its sufferers amongst the general public, it is also important to consider the driving forces behind these widespread beliefs being upheld in society. The extent to which us as individuals interact with mental health has been largely impacted and shaped by the media and our exposure to easily accessed information which is often deemed as a credible source. Brian Smith (2015) explores the media as one of the primary causes for stigma towards mental health difficulties, suggesting that all prime-time television, childrens programming and news media are guilty of creating negative perceptions of both those with mental health difficulties and the people who help treat them, namely health care professionals (p.1). Smith (2015) notes a review conducted by The National Mental Health Association (1997) that examined which media sources the public used the most often to inform themselves on mental health difficulties and reported that television (70%), newspapers (58%), television news (51%), news magazines (34%) and the internet (25%) were the main sources, however depictions of the mentally ill within these outlets consisted of false, damaging and often extremely negative images, promoting stereotypes that fuel a connection between the mentally ill and violence (p.2). This theme was consistent in main characters of television shows that presented mental health difficulties, who tended to end up killing people, negative headlines in reference to mental health and depictions of mentally ill characters in childrens movies; such as Maurice from Beauty and the Beast (p.4) who is seen to be taken away in a lunacy wagon falsely depicting to children that the mentally ill need to be separate from society which amongst many others is a stigmatizing view that may shape the attitudes of children and be carried into later life. These findings are supported by the work of Morris (2006) whose book determines that some media outlets use mental health difficulties as a source of commercialisation, providing readers or watchers with an overdramatic mental health storyline that exaggerates the protagonist to keep consumers hooked and more interested due to the claim that madness sells (p. 14). However, he also relays that some platforms do not take this profit-making route but instead use their large exposure to promote education of the public regarding these topics and as a way of raising awareness to the issues regarding mental health difficulties by providing excellent demonstrations of the lived experience of mental health difficulties for its sufferers, as it should be. For example, the childrens animated film, Inside Out which by depicting emotions; joy, sadness, disgust, fear and anger as anthropomorphic characters, shows us how the emotions inside each of us act as voices to guide us through our lives (Bryant, 2016). The personification of main character, Rileys, emotions go on to normalise sadness, rather than trying to push past this emotion with joy, which is usually coming from a false sense of happiness that is less effective and in turn enables Riley to be able to communicate healthily once she addresses the sadness she feels and expresses it. These sorts of examples show that not everyone or everything is always a perpetrator of stereotyping or stigma, and exemplifies those wide-reaching institutions, like the media, can use these platforms for good.

Another way in which the media has an impact on its consumers when reporting on mental health is investigated by Gunnell and Biddle (2020) as they draw on the death by suicide of television presenter Caroline Flack and actor Robin Williams, and the news coverage following these events to express how detail, sensationalism and accounts of the methods used regarding suicide are unnecessary and harmful (p.1). Their research investigates the statistics regarding people who die by suicide each year and compare this to the increase of these numbers, following a death of a celebrity by suicide that has been heavily reported on by the media. Both factors, it is argued, can be dependent on the popularity of said celebrity as this may encourage more news coverage but also increase the emotional impact consumers have when learning of the death of an idolised celebrity. The wide reporting of these sorts of deaths, even when they are not amongst celebrities, can be harmful as it makes public knowledge of the specific methods used in the suicide, in fact the authors found that reporting the methods of suicide used by a celebrity was associated with a 30% increase in deaths by the same method (p.1), which suggests that media reports can be influencing over peoples method choices as they make them cognitively available within their easily accessible news reports which can be followed up by other information sites where individuals can further educate themselves on the use of these methods. Whilst responsible reporting on suicide and the battles that can be dealt with by people with mental health difficulties can lead to a general better understanding and further education over these taboo topics, it must be argued whether this is in the interest of the public and population health. On the other hand, some evidence does suggest that there is no relationship between the reporting or naming of suicide and the increased risk of suicide amongst consumers. For example, without dismissing certain types of reporting that can be harmful to the likelihood of suicide, Niederkrothenthaler and colleagues (2020) concluded that general reporting of suicide did not appear to be associated with suicide, however, the authors advise that the intervention of guidelines for responsible reporting should be more widely implemented and promoted when reporting on deaths of celebrities by suicide to ensure that these account are responsible for the prevention of imitation.

Furthermore, as previously mentioned, a key motivation behind this research paper was the last lived moments of Caroline Flack, before her death in 2020. Matthews (2020) research paper draws on the media coverage of Caroline Flacks arrest, in December 2019, and aims to investigate how the widespread one-sided, unbalanced or predominantly negative, sensationalised or speculative news coverage of this case resulted in a trial by media (p.548), whereby Flack was subdued to news stories that portrayed a negative version of her character and dramatized real events of her life; sensationalising the apparent crimes involved, which could be argued to have been a result of her mental health difficulties which were ignored by the media, and ultimately contributed to her subsequent suicide. Caroline Flacks death connotes ideas suggested by Livingston and Boyd (2010) regarding the impact not being able to work has on those suffering with mental health difficulties, as Flack lost a big television presenting job over certain claims about her being responsible enough to carry out her job, resulting in further harmful impact on her mental health and suicide.

The literature consistently exemplifies how the trust the public has in the media and its varying outlets, alongside its widespread exposure and easy access, can have an impact on public belief and the uphold and spreading of negative views and stereotypes towards mental illness when these are being promoted within the media. Whilst ignoring mental health difficulties can be harmful, focussing on them too much in the wrong way can also lead to further problems. Instead of upholding these beliefs and making them readily available to the publics discretion, these platforms should be used for the collaboration of media and mental health professionals or charities to educate and spread awareness on these topics as a better understanding may generate a better reaction and a step back from stigmatizing attitudes towards those with mental health difficulties.

Discussion

The aim of this research was to look at the reasons behind common assumptions about people with mental health difficulties, how these beliefs are withstood in society, in Britain, looking more specifically at the media, and achieve an understanding of the impact they can have on those suffering with their mental health day-to-day.

The findings of the study highlighted three major and interrelated themes- societal reactions to and stereotypes of those with mental health difficulties, impact on and internalised stigma of victims and the media as a perpetrator of stigma. Research into the first theme of societal attitudes towards those with mental health difficulties exemplifies that negative stereotypes and stigmatizing attitudes towards people with mental health difficulties are still prevalent in our contemporary society. The out-dated beliefs about mental health and its victims stem from a wide lack of education and desired social distance from the minority, regarding these difficulties. These beliefs have instilled the idea that mental health is something to be feared, it is misunderstood and discriminated amongst the general public as it serves as a mark of indifference that the individuals who suffer with it possess, creating an unwritten rule for separation amongst the groups. Such notions are backed up by studies such as that of Angermeyer and colleagues (2003), which similarly found that common assumptions of mental health amongst the general public included connotations of violence and unpredictable danger which resonates with stereotypes explored and the want for social distance from these groups.

The clinical utility of the findings around this topic is that they exemplify the commonality of certain beliefs and prejudices in contemporary society and where they have originated from and why, whilst also providing the basis for the need to challenge these attitudes and intervention into the psychoeducation of groups in society that lack the understanding and knowledge of mental health difficulties to act adequately towards people experiencing them. This is particularly important when looking at families of those with mental health difficulties as they need to be equipped with the knowledge and skills to understand and deal with what their relative is going through in a supportive way. With the literature stating that people with mental health difficulties are likely to be blamed for their psychiatric state (Pescolido, 2013, p.8) and are quick to be diagnosed under the prognosis that there is little chance of recovery (Bauman, 2007, p.131), room for improvement amongst our health care services and the public is evident. As Thornicroft (2006) noted, there is only the information for people to base their attitudes on as is available to them, therefore in order to change these easily adapted stigmatizing attitudes, intervention is important. In this way it enables the the common perceptions of the general public to be changed, giving them essential understanding and insight into the experience of mental health difficulties to reduce the stigma around it. This in turn will also help those with mental health difficulties to generate a better understanding of what they are going through rather than seeing it as something to be concealed and ashamed of, whilst also giving them the resources to seek help and treatment in places that should be made widely accessible to them and be fuelled by psychiatric professionals who are going to strive for the best possible outcome of their patient. Settling for less amongst these groups when it comes to diagnosis, treatment, and support is not enough, it would not be allowed for the likes of physical illness.

In addition, literature regarding the police and their experience when dealing with those with mental health difficulties, was revealed unexpectedly, such as that of Mulvey and White (2014), as I was not aware that these encounters would be so technical, however it proves as important towards the conclusions of the study. What is to be taken from this is that better marketing is needed for the crisis teams and home treatment teams that are available to individuals with mental health difficulties when it gets to this degree of the need for intervention. In this way it should be mental health support teams or psychiatric nurses with the dedicated experience that are the ones to help them rather than the GP or police in order to remove the stigma around seeking treatment and the intervention of police which can sometimes be seen as negative or associated with criminal activity.

Furthermore, the impact these prejudiced beliefs have on those with mental health difficulties is that they are not fully accepted into the society of which they live and do not share the same rights as others; they may not be able to work, live alone, or receive adequate care and treatment from health care professionals and their personal relationships may be affected by this. As Corrigan (1998) suggests, the attack of stigma and stereotypes onto these marginalised groups have more detrimental effects than their mental health difficulties might (p.201). In turn this can result in the internalised stigma of these groups as they begin to believe the negative connotations around their difficulties and apply them to themselves.

What can be learnt from the findings regarding the experience of stigma and the subsequent findings is again, that the public should be equipped with better understanding on the occurrence of certain mental health difficulties, as well as symptoms experienced and factual resources on the control individuals have over these, as well as the removal of boundaries that stem from stigma on these marginalised groups. It may be found that if people with mental health difficulties are granted the same rights as their counterparts in society, such as being allowed to work, and live independently where their mental health allows them, their mental health may be seen to improve as a result. Evans and Reppers (2020) study into unemployment amongst those with mental health difficulties suggested that people in these groups did want to go to work and also being able to go to work and may enable them to feel as if they have a clear social status, they are helping their community and can form relationships in society may reduce internalised stigma amongst these groups, whilst also breaking the cycle of the individual conforming to stereotypes about them and their mental health difficulties, allowing them to be reinforced.

Looking at the media as a perpetrator of stigma surrounding mental health revealed that people look to the media as a credible source of information, particularly when looking at mental health (Smith, 2015). Therefore, when these platforms present negative images of mental health difficulties and provide misinformation, the public is left with a false depiction of these groups, which may influence their views in the real world. Using the example of Caroline Flack when looking at this theme, enabled the literature to be tied into contemporary society, as a way of showing how this is relative whilst reinforcing how powerful the media and popular culture can be.

Whilst some sources do not use their wide-reaching audience to claim the popularity of these sorts of depictions of mental health, instead using their media as a useful source of real experiences and educating material, moving forward we should be encouraging more appropriate sources for the public to educate themselves by. Again, better marketing for legitimate sources of information and also guidance for those who are suffering, should be made readily available for the public so they actively seek them out (e.g., the NHS website, MIND charity, Samaritans, The National Institute of Mental Health) instead of the media, which often proves to put out mixed messages and there are no guidelines for responsible reporting.

Whilst this study was overall useful and impactful in answering my research question, how do societal attitudes towards those suffering with mental health difficulties affect their lived experience of it?, it did come with its limitations. Throughout my research design and methodology came many big decisions of what would suit my objectives best, for example, first and foremost, I had to decide whether I would use qualitative methods or quantitative in order to source and analyse my research. Whilst I chose qualitative as a way of getting in depth data on the topic if I had chosen quantitative it may have been easier to create codes and group the themes and patterns in a quantitative way to visualise the data better, however, I did not think this would suit my style as much. I chose to gather my data and information from second hand sources such as news and journal articles instead of conducting my own research in the form of questionnaires, interviews or formulating surveys because I thought with a somewhat intrusive and taboo topic of those suffering with mental health and peoples opinions and beliefs about that I did not think it would be ethical to ask people questions and feared I would not receive reliable and representative data when trying to ask people about their potentially harmful beliefs and opinions. In addition, in the future it would be interesting to look more closely at news articles published by the British media and how these portray beliefs and societal attitudes about mental health, whilst looking into how influential these sources can be on the wider publics beliefs. But I do believe that analysing second-hand sources suited my study better as I was aiming to look at society and these sorts of sources which feed into our society, particularly that of the media, can have a big impact on what people take from them. Furthermore, using an unobtrusive analysis type, such a content analysis, leads to less ethical issues than others as it connotes the idea of using sources previously produced. This also means that there are less issues with replicability and this research will be more possible to recreate under the same conditions if coded correctly and analysed transparently.

To summarise, the findings from this research project provide an important piece to the existing literature. The contemporary take on mental health, the experience of it and the impact on those who are at the receiving end of stigmatizing attitudes, especially when these are being presented by a large institution such as the media, has given space for these attitudes to be uncovered and challenged in the future.

Conclusion

The answer to the research question how does societal attitudes, in Britain, towards those with mental health difficulties affect their lived experience of it is now clear.

With stigma and stereotypical attitudes towards those with mental health difficulties being extensive in todays societies, these marginalised groups are being failed within our systems to exert their rights to live as freely as their psychiatric state will allow them. Society is putting restrictions on these individuals for what it fears they are capable of, or incapable of in some cases, not for who they are and therefore, by disregarding their experiences and showing a lack of empathy for what they may be experiencing there is a pervasion of unity in society and this negative cycle starts again. This study has aimed to dispel stigma surrounding mental health difficulties, hoping to prove that there is not an association between these issues and the negative beliefs about them in all cases. After being provided with this research, readers should be encouraged to actively seek the education advised that they need to change their ways and do better for those suffering.

The research design was effective in solving the research question and exploring the problem of stigma surrounding mental health. The qualitative methods used in this research were effective in preceding the expectations of the research that included sourcing valuable second-hand accounts on the varying existence and impact of societal attitudes on those with mental health difficulties in the UK. It was anticipated that results would show a positive correlation between negative stereotypes and stigma regarding mental health and a harmful impact on those experiencing it, however, results that were not expected included revelations of the positive impact that can be had on those with mental health difficulties by a shift in the attitudes held in society. The research clearly illustrates that negative attitudes towards mental health still exist today, but it also raises the question of how these attitudes can be addressed and changed to strive for a better future of mental health sufferers. The review of second-hand literature about this topic and the collation of these articles and books has formed knowledge that can be addressed and has been applied to our contemporary society. The research serves as a more recent piece of information, with many of previous literature dating back over 10 years ago, potentially reducing their validity, but creating a gap for new literature to fill.

To better understand the implications of these conclusions, future studies could address in more detail the cause behind these beliefs, as although it has been explored that these stigmatising attitudes date back in history and have been acclaimed as the truth for furthermore, more insight into this could enable more of a basis for them to be challenged. In addition, further research could test the effectiveness of the intervention of the tactics suggested in the discussion; marketing for mental health professionals and support teams; better education for families and the public for them to be adequately equipped with the knowledge of mental health difficulties so that they can provide support and make educated choices regarding there attitudes going forwards towards these groups; a move away from the media as a source of credible information and making more people aware of the factual sources to look to for mental health advice and information as well as guidelines for the media to ensure responsible reporting and non-dramatized depictions of mental health.

From results collected it has been shown that this research has been successful in answering the research question, how to societal attitudes towards those with mental health difficulties, in Britain, affect the lived experience of it? by suggesting that the impact these beliefs have on the individuals receiving them, is enough for them to be challenged, especially when the cause of these stereotypes being prominent in todays societies is something that can be changed. The significance of this unexpected finding has meant that this paper is important in the move towards change that will follow it, as well as an essential additive to the literature.

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Supervision Log___________________________________________________________________________

Date

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October 13th 2022 In person

6-8 min presentation

Start planning dissertation INCLUDEPICTURE "C:varfoldersjv8mq2hpl91dd7bstgl1zdtsgc0000gpTcom.microsoft.WordWebArchiveCopyPasteTempFiles6OpyMj4AYuQ8xSOchxoAAAAAElFTkSuQmCC" * MERGEFORMAT

November 10th 2022 MS Teams

Search terms discussed and updates on research plan Start drafting methodology chapter INCLUDEPICTURE "C:varfoldersjv8mq2hpl91dd7bstgl1zdtsgc0000gpTcom.microsoft.WordWebArchiveCopyPasteTempFilesAAAAAElFTkSuQmCC" * MERGEFORMAT

January 19th 2023 In person

First draft of methodology chapter

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March 23rd 2023 In person

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April 17th 2023 Discuss chapters of findings and progress update Finish for due date! INCLUDEPICTURE "C:varfoldersjv8mq2hpl91dd7bstgl1zdtsgc0000gpTcom.microsoft.WordWebArchiveCopyPasteTempFilesAAAAAElFTkSuQmCC" * MERGEFORMAT

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