Stigma and identity: the symbolic meaning of serious mental illness in healthcare interaction: towards a transformative and transactional theory

People with serious mental illness have been identified as having higher rates of mortality caused by medical illness compared to the general public. These high rates of medically related mortality have been linked to patient-related factors, provider-related factors, and system-related factors. Underlying many of these factors, the concept of stigma has been theorized to affect the healthcare that this population receives. The stigma of mental illness has demonstrated many problematic effects on basic social processes. Other stigmatized populations have demonstrated poorer health outcomes. The aim of this study was to addresses how the stigma of mental illness shapes the process of healthcare interaction for people with an serious mental illness by looking at the mindset that healthcare workers and people with serious mental illness have in regard to each other and the framework in which they interact. A qualitative study was conducted to explore how mental illness as a socially understood concept was perceived to affect people with serious mental illness and their experiences with healthcare as well as nurses in an emergency room providing care for seriously mentally ill people. Nineteen people with serious mental illness were recruited from a daytreatment center and 8 nurses from an emergency department. Data analysis was conducted following the methods of grounded theory research. The findings of this study support the stigma of mental illness as a social construct that affects healthcare as a socialized process for the seriously mentally ill v population. The stigma of mental illness is seen conceptually as something that acts internally to transform identity but is also something that acts dynamically through ongoing interactions with others. Beliefs about mental illness act to sensitize interaction between participants in healthcare, as people with serious mental illness have to interact with people who may view him or her as different, less capable, or incompetent. The caregiver is concerned about the possibility of being exposed to dangerous, abnormal, or unacceptable behavior. These elements transform the interaction and identity of both participants.