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Discuss the ways stigma can influence healthcare delivery for marginalised people and groups in Australian society. People from the following groups may be stigmatised. Explore this question from one of the following marginalised groups: refugees, indigenous Australians, mentally ill or homeless people, older adults or the disabled.
My definition of stigma is when someone is discriminated against and stereotyped by their mental health illness causing them to be treated unequal to others. I have made many observations in relation to stigma and mental healthcare delivery while working as an assistant nurse in a mental health hospital. In my experience, I observed staff stigmatise and discriminate against certain mentally ill patients due to the staff’s values and expectations of mental health illnesses. This caused a lower standard of care as the staff neglected certain patients if they believed mental health was not a valid health issue. When related to the sociological imagination template (Germov, 2014, p. 7, 8) this issue relates to the historical factor as in the past mental health was not valued as highly as biomedicine and there was a higher rate of stigma in mental health. It also relates to the cultural factor as the cultural values of the staff I observed impacted on the delivery of healthcare. In addition to my observations in the workplace, I also experienced stigma first hand during my adolescent years as I experienced depression. I found I was less likely to seek help and healthcare when others within my society such as peers had a lack of understanding or had specific cultural and historical views that caused them to stigmatise me. This impacted on the delivery of healthcare as health professionals were unable to help me unless I presented to them with my issues, causing a lack of healthcare in this situation. The stigma I received from my peers was due to the way the education system is structured as it doesn’t include education about mental health from an early age. It is my experience with depression followed by my observations of stigma that has helped me understand that stigma is such a universal concept affecting many people and their healthcare.
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Germov (2014, pg. 3) explains health sociology is based on the concept that health issues come about from the social world. Germov also explains (2014, pg. 3) the treatment and causes for health problems are within the social context of the individual. Therefore, if stigma and discrimination are within society, it can not only cause mental health issues, through self-stigmatizing, but also prevent them from improving, by causing individuals to not seek healthcare. Now that I have an understanding of Willis’ sociological imagination template (Germov, 2014, p. 7, 8), I am able to reflect on my experiences with a deeper understanding of the implications stigma has on the delivery of healthcare and the ability of a mentally ill person to seek help.
Cockerham & Cockerham’s (2010, pg. 24-41) reading has deepened my initial observations of how stigma impacted on my own experience of mental illness as they explain the impact globalisation has on the structure of the healthcare system and advancement in medicine, and also the cultural values and expectations of mental illness. The article (Cockerham et al. 2010, pg. 24-41) explains globalisation and the advancement of western medicine is a means to scientifically understand the body in order to improve diagnosis and treatment options. This has had an effect on all aspects of healthcare; however Cockerham et al. (2010) explain the historical neglect of mental health research, due to supernatural and religious beliefs of the past and the view that the study of the mind was the role of the church.
This reading has allowed me to understand the development of the structure of mental healthcare as historically mental health was seen as mysterious and religious (Cockerham et al., 2010, pg. 24-41). The article explains that the study of the mind was eventually thought of as medical science, but due to the past perceptions, medical science in physical health was valued higher than mental health knowledge (Cockerham et al., 2010, pg. 24-41). This perception is found within Australian society as Germov (2012, pg. 165) states biomedicine is an important model of health and illness. This may have caused the cultural values of the staff I observed in my workplace, causing them to put biomedicine above mental healthcare, often devaluing the need for mental health care. The high value for biomedicine and the high value for medical science of physical health before mental health has allowed me to understand the historical cause of stigma. I have since realized I was a victim of stigma during my adolescent years which affected my ability to seek healthcare. Healthcare needs to develop further to treat the mentally ill with the respect and dignity they deserve.
By reflecting on my experiences within mental health it is clear stigma influences healthcare delivery in two main ways 1) through the values and expectations of healthcare professionals and 2) whether or not individuals seek healthcare treatment due to stigma impacting on their perception of their mental health issue. As stated in step 2, health sociology is based on the concept that health problems are created from the social world of the individual, and both the treatment and cause of health issues can be identified in the individual’s social context (Germov, 2014, pg. 3). This topic is very broad, so I will base my reflection on the three main factors from the sociological imagination template (Germov, 2012, pg. 7-8) that present the link between a person and their society/environment i.e. the cultural values and opinions of Australian society and the way the education system is structured and how it can be improved from a critical standpoint. These factors link closely and impede heavily on the delivery of healthcare in Australia. Such implications include a lower standard of healthcare due to the values of healthcare professionals, and the inability to live up to society’s’ expectations causing self-stigmatizing attitudes, leading to a lower chance of the individual seeking out healthcare. There is the inability or decision not to seek help early due to a lack of knowledge given from the education system; however the healthcare system has advanced to create positive outcomes for someone with mental problems within Australian society. It is important to remember that cultural values and structural systems do not just affect the individual, but the society as a whole.
The cultural perception of being responsible for our healthcare (Germov, 2014, pg. 8) within Australia has profound implications for people with mental illness as they are often unable to take responsibility of their healthcare. Their inability take charge clashes with views of society and in turn stigma develops. Angel and Thoits (1987) explain that culture mandates the behaviors, response and help-seeking attitudes of individuals’ to their illness, and Chacon (2009) states cultural factors play a large role in help-seeking. Hence the value of being responsible for our healthcare juxtaposed with the failure of the individual to do so, causes the mentally ill person to steer away from seeking treatment, as they are made to believe they have failed their society. Weiss (2010) has given me insight into this value from the doctor’s point of view and that is doctors cannot help us if we won’t help ourselves. This is true to some extent, however in the case of someone with a debilitating mental illness, they are often unable to help themselves. During my experience, I also felt as though I could not help myself as my illness caused a lack of self-confidence and respect to help myself. This ultimately causes a lack of healthcare and a failure of the healthcare system to deliver care due to the values and expectations of society and healthcare professionals.
Cappelen & Norheim (2005) have given me insight into another viewpoint of being responsible for our own health. It is explained that lifestyle choices have a huge impact on our health and hence why some believe putting responsibility on the individual is fair (Cappelen & Norheim, 2005). However, if a person has chosen to take illegal substances for example, that have ultimately caused a mental illness, who should decide whether or not they are discriminated against for doing so? And should the extent to which a disease is a result of individual choices be allowed to affect the degree to which it is given priority? This brings up the cultural values of the health professionals that I observed who had a high value for biomedicine and little understanding of how their views were being imposed on their patients, causing discrimination against them.
From a critical perspective (Germov, 2013, pg. 7), healthcare delivery can be improved through the structure of the education system. If more education about mental health is provided within the curriculum for young students, stigma among the mentally ill will be reduced due to a greater understanding and acceptance of mental illness among the younger generation. Programs such as headspace, as well as mental health resources, guidelines, and support will help improve the mental health and wellbeing of individuals (State Government Victoria, 2014). This is turn will improve healthcare delivery as the mentally ill will feel less like they have failed their society and more likely to seek treatment.
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Looking back on my experience, the delivery of healthcare is strongly impacted by the values, expectations and stigma of Australian society towards mental illness. By improving education in Australia we may be able to reduce stigma providing better healthcare outcomes to patients.
By answering this eModule question, I have developed the graduate attribute of demonstrating respect for the dignity of each individual and for human diversity. I have expanded my knowledge on the impact of stigma on both myself and the individuals within my care, giving me a better respect for the dignity of the individual. Germov (2014) has given me a deeper knowledge that individual problems can be faced by the majority of society at one point or another, giving me the understanding that others, like me, often feel a sense of devalued dignity due to the values and expectations of society as a whole. I have a wider knowledge of the impact my experience had on myself as an adolescent, and would not allow others to feel the same way or experience the same issues. This has allowed me to better care for others keeping in mind the impact of stigma on healthcare delivery, ultimately giving me the skills to become a better nurse.
Angel, T., & Thoits, P. (1987). The impact of culture on the cognitive structure of illness. Culture, Medicine and psychiatry, 11(4), 465-494. Doi: 10.1007/BF00048494
Cappelen, A.W., & Norheim, O.F. (2004). Responsibility in healthcare: a liberal egalitarian approach. Journal Med Ethics, 31, 476-480. doi:10.1136/jme.2004.010421
Chacon, C. (2009). Depression: the tole of cultural factors and perception of treatment. Retrieved from http://scholarworks.sjsu.edu/cgi/viewcontent.cgi?article=4998&context=etd_theses
Cockerham, G.B., & Cockerham, W.C. (2010). Globalization: Health benefits and risks. In Health and globalization (pp. 24-41). Cambridge, UK: Polity Press.
Germov, J. (2014). Ethnicity, health, and multiculturalism. In J. Germov, Second opinion: An introduction to health sociology (5th ed.). (pp. 163-183). South Melbourne, Vic: Oxford University Press.
State Government Victoria. (2014). Student mental health and suicide response/planning. Retrieved from http://www.education.vic.gov.au/school/principals/health/pages/studenthealth.aspx
Weiss, P.J. (2010). Take responsibility for your own health. Retrieved from http://www.kevinmd.com/blog/2010/12/responsibility-health.html
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