Stigma of mental disorder and substance misuse often constitutes a significant barrier to accessing support. Stigma has significant consequences for help-seeking, including problem recognition, initiation of help-seeking and engagement with support services (Makanjuola et al., 2016). While stigma is often experienced by the individual, families and communities are also frequently exposed to stigma, as they are blamed for causing or perpetuating the family member’s difficulties. Some cultural groups experience greater stigma than others, with many migrant communities reluctant to access mental health services (Dockery et al., 2015). As a consequence, seeking help often depends on the assistance of family members and community support networks; however, many migrants lack these networks due to resettlement (Lubman, McCann, Renzaho, Kyle, & Mugavin, 2014). Even when community networks are available, stigma of mental disorder and substance misuse deters or delays help-seeking, often until problems are severe (Lubman et al., 2014). Migrants from sub-Saharan Africa report high levels of stigma of mental disorder (Ayazi, Lien, Eide, Shadar, & Hauff, 2014) and substance misuse (Horyniak et al., 2014). However, understanding and addressing the cultural and psychosocial influences on stigma can improve community support for informal and formal help-seeking by people with these problems. The aim of this qualitative study was to explore the stigma experience of mental disorder and substance misuse, and its influence on help-seeking, for youths and parents from sub-Saharan African migrant communities in Melbourne.
Methods:
Individual interviews were undertaken with 28 youths and focus group discussions took place with 41 parents and key community leaders. Triangulation allowed the researchers to examine and compare and contrast diverse perspectives about the phenomenon of stigma of mental disorder and substance misuse. An inductive thematic analysis of the data was undertaken.
Results:
Two overarching themes, and related sub-themes, reflected youths’ and parents’ perceptions of stigma associated with mental disorder and/or substance misuse and their effect on informal and formal help-seeking: public stigma deterring help-seeking, and public stigma reinforcing self-stigma. Participants reported high levels of public stigma and self-stigma about mental disorder in particular, and to a lesser extent to substance misuse. Stigma was attributable, in part, to a lack of awareness of mental disorder and substance use, personal shame and fear of community rejection, which deterred or delayed informal and formal help-seeking. Many young migrants were caught in a double bind situation, where they were unwilling to access support within their own community, but were also reluctant to approach mainstream service providers. Strategies are needed to counteract public stigma and self-stigma and promote informal and formal help-seeking by youth and parents from sub-Saharan African communities.
Conclusion:
The negative effect of stigma on help-seeking has been reported in a range of migrant and refugee communities in different countries, highlighting the need to develop and implement effective and appropriate supports (Abebe, Lien, & Elstad, 2017). Mental health nurses are well-placed to address these issues. A potential approach is to engage with and educate sub-Saharan African communities through organisations that provide education and support to new migrants and refugees to settle in their region and in schools. Education about mental disorder and substance misuse, and personal contact with people with these issues, may reduce public stigma and self-stigma, improve mental health knowledge, and thereby enhance help-seeking. Mental health nurses could also help to break down formal help-seeking barriers by improving their cultural sensitivity and emphasising the professional and confidential nature of interactions. Employing more sub-Saharan African clinicians to help enhance help-seeking from their communities may also reduce stigma and increase help-seeking.
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