The intersection of and mental health stigma: A literature review Mari-Amanda Dyal, PhD, CHES; Sefina Haque, BSc, Abeer Osman, BSc Kennesaw State University, Department of Health Promotion and Physical Education Background Methods Results Cont’d

Any discussion of health should also entail a A review of the literature was necessary to explore the current landscape of MHL, The review revealed that MHL, stigma, and cultural discussion of , as it represents the stigma, and cultural competence as they all related to general and specific mental diversity mingled in shared research circles; acquisition and application of health-related health issues, such as depression, anxiety, and schizophrenia. Moreover, MHL however, there was no mention of cultural information. Many areas of health receive their efforts for improvement and development were reviewed to better understand the competence. due attention when it comes to health literacy. strategies that are employed ito improve mental health outcomes for all One such area is mental health literacy (MHL), populations. Several databases were accessed to ensure that the related MHL research was associated with stigma specific which refers to knowledge and beliefs about literature, specifically primary sources of data, were reviewed to the fullest extent to attitude assessment for help seeking behavior mental health and mental health issues. possible, such as PubMed, CINAHL, Web of Science, and PsychINFO. Keywords for specific mental health issues (i.e., depression used: mental health literacy, cultural competence, mental health, health literacy, and schizophrenia). Stigma was defined as self There have been great strides in MHL stigma, cultural diversity. stigma, which goes beyond the standard one- improvement in the areas of recognition and dimensional conceptualization. MHL was associated differentiation, management, and prevention of with the cultural diversity of affected populations mental health issues. However, these efforts Proposed Model with stigma identified as a barrier to help seeking have fallen short in addressing the role of behavior. Lastly, MHL efforts for improvement and stigma. That is, MHL development and development involved heavy discussion of altering improvement lacks a real focus on stigma Figure 1: Proposed Cultural Competence Model attitudes as a directive with little direction on how reduction or awareness building. *Adapted from Abbe & Halpin, 2009 to do so. Dimension Related Factors While there is acknowledgement of stigma, it is Skills Self-monitoring Discussion often referred to as a one-dimensional barrier to Relationship building Mental MHL, much like health literacy, has been a priority help seeking behavior, but it is much more than Communication Health and challenge for many decades. The MHL that. Stigma operates on many levels and makes Knowledge Perspective building Skills struggle is alive and well because efforts for an already sensitive topic worse by contributing Sense making improvement and development provide little to low self-esteem, low self-efficacy, the ‘why try’ Self & Cultural direction for reducing stigma using confirmed health effect, poor quality of life, and progression and Awareness literacy strategies, such as cultural competence, worsening of symptoms. Attitude Empathy MHL & Mental Emotional intelligence which could prove to be the missing link for Health Openness improving MHL and reducing stigma when it comes Moreover, the discussion of mental health Cultural Competence to mental health and mental health issues. sensitivity and stigma is further complicated Stigma Self é Public when considering the diversity of mental health A modified cultural competence development model Stigma issues and the cultural diversity of affected that illustrates this linkage is proposed that serves ê populations, which is saturated with varying and Mental Mental each domain of learning through specific factors that sometimes conflicting attitudes, beliefs, and Health Health build mental health cultural competence effectively Knowledge Attitudes values - very similar to stigma in that way. increasing MHL and reducing stigma. All of which is a step in the right direction when it comes to the Health literacy strategies have responded to this breakthrough that MHL needs. cultural diversity by broadening traditional skills (, document literacy, and prose Results literacy) to now capture plain language, non- REFERENCES Essential Title Contribution verbal communication, and cultural competence Articles to the Research Abbe, A., & Halpin, S. M. (2009). The cultural imperative for in an effort to improve health outcomes for professional military education and leader development. Parameters, Cheng et al., Self-stigma, mental health literacy, and Stigma is not one dimensional and 39(4), 20. diverse populations. The same cannot be said for 2018 attitudes toward seeking psychological help its interaction with MHL informs mental health literacy. Therefore, the current help seeking behavior Altweck, L., Marshall, T. C., Ferenczi, N., & Lefringhausen, K. (2015). research proposes a cultural competent approach Altweck et al., Mental health literacy: A cross-cultural Captures MHL, stigma, and culture Mental health literacy: A cross-cultural approach to knowledge and beliefs about depression, schizophrenia and generalized anxiety to MHL to address the complexity of stigma and 2015 approach to knowledge and beliefs about in a causal model for specific disorder. Frontiers in Psychology, 6, 1272. its impact on mental health issues. depression, schizophrenia and generalized mental health issues and help anxiety disorder. seeking beliefs Cheng, H. L., Wang, C., McDermott, R. C., Kridel, M., & Rislin, J. L. (2018). Self-Stigma, mental health literacy, and attitudes toward Figure 1 and Table 1 frame the research and the Na, Ryder & Toward a culturally responsive model of Emphasizes the MHL development seeking psychological help. Journal of Counseling & Development, Kirmayer, 2016 mental health literacy: Facilitating for culturally diverse groups in an starting point for a possible model modification 96(1), 64-74. help-seeking among east Asian immigrants effort to increase help seeking for cultural competence development that serves to North America. behavior in which stigma is a Na, S., Ryder, A. G., & Kirmayer, L. J. (2016). Toward a culturally to reduce stigma all in the name of MHL. barrier responsive model of mental health literacy: Facilitating help-seeking among east Asian immigrants to North America. American Journal of Table 1: Literature Review Results Community Psychology, 58(1-2), 211-225.