Psyc 3700 Exam 3

What are the four forms of racism?

Personal, interpersonal, institutional, Structural

What is personal racism?

Private belief, prejudice and ideas

What is interpersonal racism?

Expression of racism between individuals

What is instituational racism?

Discriminatory treatment within organizations and institutions

What is structural racism?

Public policies, practices and other norms that promote group inequality

What are the 3 critical social determinants of health?

wealth

power

prestige

What are the impacts of health inequality?

Increased presence of disease, poorer health outcomes, reduced access to healthcare

What is the impact of health inequality in terms of SZ?

Increased incidence of psychopathology b/c social norms & policies influence access to:

Resources: education, healthcare, social capital

Exposure to env. Toxins & stressors: childhood trauma, neighborhood deprivation and discrimination

What are the health disparities driven by social and economic inequalities?

Economic stability

Neighborhood & physical environment

Education

Food

Community, safety, & social context

Healthcare system

Who is most affected by these disparities?

Minority cultural groups and lower SES groups

What is the key driver of health inequalities in the USA?

Structural racism

Stratification of power based on proximity to the majority cultural population (whiteness); those of African descent are the most distant category

Why does racism have enduring effects on health outcomes?

Maintained by multiple pathways by limiting access to flexible resources

Neighborhood segregation

Educational opportunities

Employment and career prospects

Is there a racial difference in the prevalence of SZ?

Yes! There is a higher incidence & prevalence of psychosis among black people of African and Caribbean heritage compared to the majority white population

Why is there a higher rate of diagnosis in minority groups?

Social inequality

Adversity/early life stress

Discrimination

Cultural biases in diagnosis:

- Misinterpretation of symptoms - cultural ignorance

- Over-diagnosis of SZ and under diagnosis of mood disorders in black individuals

What contributed to the public fear that people with SZ were violent?

Deinsitutionalization

What caused deinstitutionalization?

1955 thorazine/chlorpromazine (antipsychotic) came out and it was seen as the "cure" to SZ and by the 1970s there was widespread deinstitutionalization in the US

Where did patients go after the inpatient facilities closed?

Family

Jail

Homeless

Why wasn't outpatient care an option after deinstituationalization?

There weren't enough facilities and then there was a dramatic increase in the need for care

What are community treatment centers?

After deinstitutionalization, there was a shift to community living where people with SZ came to live together and receive treatment

What did the public think of the threat of violence?

that it was:

unsafe

erratic behavior

Common myth of mental illness

Mental illness = violence and danger

What is a fact about violence?

Within the past few years, the US has had an increase in mass violence

What percentage of violent crimes are committed by people with SERIOUS mental illnesses?

5%

What is the most likely role that people with mental illnesses have in terms of violence?

they are more likely to be victims of violence (recipients)

What is odds ratio for the risk of any violence in SZ?

a little over 1; at risk for any time of violence

What is the risk of homicide in the general population vs those with SZ? Substance use?

General population: 0.02%

SZ: 0.3%

Substance use: 0.3%

T/F Schizophrenia has a higher risk of leading people to commit homicide

FALSEEEEEEEEE there is no unique thing in SZ that leads to homicide

T/F Nordic countries that have stricter gun laws have shown an overall decline in rates of homicide in both general population and those with SZ

FALSESSESESESESESEESESES there is NO DIFFERENCE in nordic countries with different gun laws

What is violence?

behavior involving physical force intended to hurt, damage, or kill someone or something.

What is SEVERE violence?

violence that has caused significant or permanent injury

What are examples of violence to self?

- Suicide 10 to 30% in those with SZ; more common if never received antipsychotic treatment

- Self mutilation very rare; more common if never received antipsychotic treatment

What is the common contributing factor in higher rates of suicide and self-mutilation?

Psychosis

What phase of psychosis is violence most common in?

FIRST episode, before antipsychotic treatment

Do people with SZ engage in violent activity during first episode?

most do NOT

What percentage of people with SZ engage in ANY violence or just before the initial treatment

33%

16% engage in serious assault

LESS THAN 1% engage in severe assault resulting in permanent injury

What are the definitions of stigma?

- Attribute that is deeply discrediting and that reduces the person who bears it from a whole and usual person to a tainted, discounted one

- labelling, stereotyping, separation, statue loss, and discrimination

What are the two types of stigma?

Public and personal

What is public stigma?

How people WITHOUT the condition think about the people WITH the condition

What are the 3 type of personal stigma?

Perceived

experienced

internalized

Perceived stigma is....

beliefs towards themselves on how OTHERS might think of them

Experienced stigma is.....

Someone with psychosis personally experienced discrimination

Internalized stigma is.....

taking thoughts and beliefs of the condition and deems them true

How is public stigma studied?

1. perceived dangerousness

2. perceived negative reactions

3. perceived discrimination

4. emotional reactions

More negative reactions in people who....

- attribute biological causes (brain disease, heredity); aka born with it

- use labels of SZ or "mental illness"

More positive reactions in people who....

- are in contact with people diagnosed w/psychiatric disorders

- have personal experience w/diagnosis

- younger

- male

- higher educations

What is the stigma of SZ in mental health professionals?

Schizophrenia is the most stigmatized disorder among mental health professionals

What do mental health professionals report?

fewer beliefs about dangerousness

more positive beliefs about pharmacological

What are the common negative beliefs about

prognosis and desire for social distance

Is there a general consensus for age, length of practice or profession?

Nope

In MHP more biological beliefs usually means

less empathy and more dehumanization

When did public stigma interventions start in the USA?

1950s with group discussions and films

Which US president led the first anti-stigma campaigns about MH

Clinton in 1999 at the white house conference on MH

What are the 3 approaches to anti-stigma

Educational

interpersonal

social activism

Education intervention

challenge inaccurate stereotypes w/facts

Interpersonal intervention

contacts member 0f stigmatized group to lessen prejudice

Social activism intervention

protests to highlight injustice and chastise offenders for their stereotypes and discrimination

How effective are these interventions?

- education and contact are effective at changing attitudes and reducing discriminatory behaviors

- face to face contact, not a video-taped story, produces the strongest effects

- video taped is effective for ADOLESCENTS

what does self stigma do to social constructs

our ideas about ourselves are shaped by how we believe others see us

What does self stigma do to negative judgements

NJ of others get incorporated into self-concept, resulting in shame

What does self stigma do to experience

repeated discrimination, which in turn contributes to believing stereotypes are true

what does self stigma involve psychologically

social constructs

negative judgements

experience

How is personal stigma experienced and how common

Overall --> 65%

Structural --> 43%

interpersonal --> 64%

Public image --> 56%

Access to social roles --> 57%

correlation of personal stigma

lower QoL, empowerment, self esteem

Positive symptoms, depression, social anxiety

Literacy

lower social and vocational funding

lower recovery

Elements to ending stigma intervention

CBT

first person accounts

empowerment/recovery approaches

Strategies to ending stigma intervention

1. telling myth from fact

2. & 3. use CBT principles to change one's self stigmatizing thinking

4. strengthening positive aspects of oneself

5. increasing belongingness in community

6. increasing belonging with family and friends

7. responding to stigma and discrimination