Can we talk about mental health stigmas?

"You look too good to be ill," Svjetlana Opačić (37) from Banja Luka, Bosnia was told by a psychiatrist after she came in to get help.

One night, Opačić was reading a book written by an acquaintance and dedicated to the author’s son who had experienced depression and committed suicide. "I hope you found peace in that last flight," the mother wrote to her son. That night, Opačić wondered if she might be able to find peace somehow, too, and swallowed all the pills she had in her dispenser. Quickly afterwards, however, she asked her mother to remove them all and said that she wanted to go to the doctor. 

"Hey, what's that? Have we come in pajamas?" A different psychiatrist asked Opačić as they warmly welcomed her in and thus gained her trust for the rest of her life. 

Opačić has been struggling with epilepsy, anxiety-depressive disorder and borderline personality disorder for decades. She shared her experience with journalists and health experts during the three-day workshop on ethical reporting on mental health, held in mid-June in Neum. The workshop was part of a 14-year-long mental health reform project in Bosnia financed by the Swiss government with some €5 million. 

BURDEN of stigma is HEAVIER THAN the ILLNESS

Experts claim that mental illness is by far the most stigmatised medical condition. Nearly 60 percent of people suffering from mental health problems say that the stigma affects them more than the illness itself.

"The causes of stigma are prejudices and stereotypes, and they stem from ignorance and lack of information,” psychiatrist Goran Račetović told FairPlanet. “The most painful consequences are being isolated, which is one of the strongest primordial human beings' fears, and being disabled in the exercise of fundamental rights.”

“There is a thin thread between stigma and discrimination,” Račetović added, “and we all know there are legal issues against discrimination.I wish for the same level of reaction for stigma too.” 

The stigma is multileveled; it is manifested in preconceptions held by family and community members, health workers and the healthcare system in general, but is also entrenched in the people suffering from mental illnesses themselves. 

"For instance, we are sitting in a waiting room. A person is entering. Another is whispering: he has SCH,” Opačić recalled.

MENTAL HEALTH services are the first to see budget cuts 

After Opačić described how she had once spent ten hours being tied to a hospital bed, which is two and half times more than is allowed in particular situations, several participants explained how the stigma within the healthcare system works.

The most blunt evidence of the stigma is the paltry resources allocated to mental health centers."You have one medical worker per night in a department with 20 patients, and the standard is at least three," one of the psychiatrists said. 

"Forced to reduce the budget, the health centre decided to close the mental health department completely. We fought against it, but we didn't manage. Finally, we asked why not to close paediatric. They answered that paediatric is important," another recalled. 

"Wherever you have clinical centres all over the Balkans with a lot of buildings, you may be quite sure the most ruined one is of psychiatry,” said Zlatan Perišić, a press officer at the Bosnian Federal Ministry of Health. “Furthermore, if the list of state-funded drugs has to be reduced, guess which ones go out first?"

Patients must arrive ‘messy’ and ‘smelly’ to be hospitalised

Almost half of the persons with mental health issues have been stigmatised by health professionals. 

"Once I was told by a psychiatrist [that] if I had come filthy and messy, he would have admitted me to the hospital,” said Edin Hodžić, a 53 year-old from the town of Vitez in Bosnia. “So it seems it was a mistake I hadn't appeared ragged, unshaven and smelly." 

If persons with mental illness face such prejudices among mental health experts, what should be expected from the rest of the population?

"I was diagnosed with schizophrenia and PTSP. I remember the time my neighbours used to scare children with me,” Hodžić added. “Today I take care of my mother. I attend occupational therapy and run an NGO for promoting the rights of people with mental health issues.”

HOW COULD THE MEDIA HELP?

A group of experts from the media and healthcare sectors in Bosnia created a guidebook for ethical reporting on mental health. They found that a negative context prevails in most reports on mental health issues, that offensive terminology is used and that people with mental health difficulties are associated with violence (although they are more often the victims of violence and abuse).

"Someone's diagnosis must not become a basic characteristic of a person nor their identity,” warned neuropsychiatrist Esmina Avdibegović, addressing the participants of the workshop in Neum. “Imagine the media report that a person with diabetes committed murder. It is equally unacceptable to report that a mentally ill person did it without proving whether it is relevant for the case."

Instead of further stigmatising people suffering from mental health problems, the media should dispel myths around the issue. Examples of such myths are that mental disorders are rare, that people with mental health issues are dangerous and violent, that they cannot work, that they should categorically be hospitalised and that they cannot recover.

The role of the media is immeasurable in preventing the spread of so-called moral panic towards vulnerable groups and individuals, but also in crafting proper terminology for discourse.

"Once, I attended the World Mental Health Day, where journalists looked for statements. When the host suggested the users of mental health services, the journalist replied: 'We don't need users.' I've heard this with my own ears," Opačić recalled. 

Opačić is a lawyer, a certified caregiver for the elderly, a human rights activist and an active member of the Association for Support of Families, Persons and the Community in Mental Health ‘Together’.

"I'm fine now. I'm in a relationship. I'm [working] two jobs. I'm planning a family," she added. 

Image by: Nikko Macaspac