Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-29T09:27:41.809Z Has data issue: false hasContentIssue false
  • English
  • Français

How much does mental health discrimination cost: valuing experienced discrimination in relation to healthcare care costs and community participation

Published online by Cambridge University Press:  06 June 2014

S. Evans-Lacko ,
S. Clement ,
E. Corker ,
E. Brohan ,
L. Dockery ,
S. Farrelly ,
S. Hamilton ,
V. Pinfold ,
D. Rose  and
C. Henderson
...Show all authors
S. Evans-Lacko*
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
S. Clement
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
E. Corker
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
E. Brohan
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
L. Dockery
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
S. Farrelly
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
S. Hamilton
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
V. Pinfold
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
D. Rose
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
C. Henderson
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
G. Thornicroft
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
P. McCrone
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London E5 8AF, UK
*
*Address for correspondence: Dr S. Evans-Lacko, Health Service and Population Research Department P029, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England.

Methods.

We use data from the Mental Illness-Related Investigations on Discrimination (MIRIAD) study (n = 202) and a subsample of the Viewpoint study (n = 190). We examine experiences of discrimination due to mental illness in the domains of personal relationships, community activities, and health care, and how such experienced discrimination relates to patterns of service use and engagement in leisure activities.

Results.

Our findings show that the cost of health services used for individuals who reported previous experiences of discrimination in a healthcare setting was almost twice as high as for those who did not report any discrimination during the last 12 months (Relative Risk: 1.73; 95% Confidence Interval (CI): 1.39, 2.17) and this was maintained after controlling for symptoms and functioning. Experienced discrimination in healthcare (Relative Risk: 0.83; 95% CI: 0.81, 0.84) or in relationships (Relative Risk: 0.89; 95% CI: 0.87, 0.91), however, was associated with lower participation in, and hence lower costs of, leisure activities. Individuals who reported any discrimination in a healthcare setting had, on average, £434 higher costs associated with health service use while reported discrimination in the community was associated with increased leisure costs of £32.

Conclusions.

These findings make an important initial step towards understanding the magnitude of the costs of mental health-related discrimination.

Keywords

Health economicsmental health servicesmental illnessstigma
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 5 , October 2015 , pp. 423 - 434
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angermeyer, MC, Matschinger, H, Schomerus, G. Attitudes of the German public to restrictions on persons with mental illness in 1993 and 2011. Epidemiology and Psychiatric Sciences. First published online: 4 April 2014, doi:10.1017/S2045796014000183 Google Scholar
Brohan, E, Clement, S, Rose, D, Sartorius, N, Slade, M, Thornicroft, G (2013). Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Research 208, 33–40.CrossRefGoogle ScholarPubMed
Clark, R, Anderson, NB, Clark, VR, Williams, DR (1999). Racism as a stressor for African Americans. A biopsychosocial model. American Psychologist 54, 805–816.CrossRefGoogle ScholarPubMed
Clement, S, van Nieuwenhuizen, A, Kassam, A, Flach, C, Lazarus, A, de Castro, M, McCrone, P, Norman, I, Thornicroft, G (2012). Filmed v. live social contact interventions to reduce stigma: randomised controlled trial. British Journal of Psychiatry 201, 57–64.CrossRefGoogle ScholarPubMed
Clement, S, Schauman, O, Graham, T, Maggioni, F, Evans-Lacko, S, Bezborodovs, N, Morgan, C, Rusch, N, Brown, JS, Thornicroft, G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine. First published online: 26 February 2014, doi: 10.1017/S0033291714000129.Google Scholar
Corker, E, Hamilton, S, Henderson, C, Weeks, C, Pinfold, V, Rose, D, Williams, P, Flach, C, Gill, V, Lewis-Holmes, E, Thornicroft, G (2013). Experiences of discrimination among people using mental health services in England 2008–2011. British Journal of Psychiatry 55, s58–s63.CrossRefGoogle ScholarPubMed
Corrigan, P (2004). How stigma interferes with mental health care. American Psychologist 59, 614–625.CrossRefGoogle ScholarPubMed
Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JD, Rusch, N (2012). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric Services 63, 963–973.CrossRefGoogle ScholarPubMed
Curtis, L (2011). Unit Costs of Health and Social Care. Personal Social Services Research Unit, University of Kent: Canterbury.Google Scholar
Dinos, S, Stevens, S, Serfaty, M, Weich, S, King, M (2004). Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. British Journal Psychiatry 184, 176–181.CrossRefGoogle ScholarPubMed
Earnshaw, VA, Quinn, DM (2012). The impact of stigma in healthcare on people living with chronic illnesses. Journal of Health Psychology 17, 157–168.CrossRefGoogle ScholarPubMed
Evans-Lacko, SE, Spencer, CS, Logan, JE, Riley, AW (2010). Patterns and predictors of restrictive health care service use by youths with bipolar disorder. Administration and Policy in Mental Health and Mental Health Services Research 37, 379–387.CrossRefGoogle ScholarPubMed
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.CrossRefGoogle ScholarPubMed
Evans-Lacko, S, Henderson, C, Thornicroft, G, McCrone, P (2013). Economic evaluation of the anti-stigma social marketing campaign in England 2009–2011. British Journal of Psychiatry 55, s95–101.CrossRefGoogle ScholarPubMed
Farrelly, S, Clement, S, Gabbidon, J, Jeffery, D, Dockery, L, Lassman, F, Brohan, E, Henderson, C, Williams, P, Howard, LM, Thornicroft, G (in press). Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross-sectional study. BMC Psychiatry.Google Scholar
Friedrich, B, Evans-Lacko, S, London, J, Rhydderch, D, Henderson, C, Thornicroft, G (2013). Anti-stigma training for medical students: the Education Not Discrimination project. British Journal of Psychiatry 55, s89–s94.CrossRefGoogle ScholarPubMed
Gary, FA (2005). Stigma: barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing 26, 979–999.CrossRefGoogle ScholarPubMed
Hafkenscheid, A (1993). Reliability of a standardized and expanded Brief Psychiatric Rating Scale: a replication study. Acta Psychiatrica Scandinavica 88, 305–310.CrossRefGoogle ScholarPubMed
Hall, RC (1995). Global assessment of functioning. A modified scale. Psychosomatics 36, 267–275.CrossRefGoogle ScholarPubMed
Hatzenbuehler, ML, Phelan, JC, Link, BG (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health 103, 813–821.CrossRefGoogle ScholarPubMed
Henderson, C, Corker, E, Lewis-Holmes, E, Hamilton, S, Flach, C, Rose, D, Williams, P, Pinfold, V, Thornicroft, G (2012). England's time to change antistigma campaign: one-year outcomes of service user-rated experiences of discrimination. Psychiatric Services 63, 451–457.CrossRefGoogle ScholarPubMed
Jeffery, D, Clement, S, Corker, E, Howard, LM, Murray, J, Thornicroft, G (2013). Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry 13, 120.CrossRefGoogle Scholar
Lasalvia, A, Zoppei, S, Van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, Bacle, SV, van Audenhove, C, van Weeghel, J, Reneses, B, Germanavicius, A, Economou, M, Lanfredi, M, Ando, S, Sartorius, N, Lopez-Ibor, JJ, Thornicroft, G (2012). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381, 55–62.CrossRefGoogle ScholarPubMed
Link, BG, Struening, EL, Rahav, M, Phelan, JC, Nuttbrock, L (1997). On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior 38, 177–190.CrossRefGoogle ScholarPubMed
Logan, JE, Riley, AW, Barker, LE (2008). Parental mental and pain-related health and pediatric ambulatory care sensitive emergency department visits and hospitalizations. Health Services Research 43, 656–674.CrossRefGoogle ScholarPubMed
Manning, WG, Mullahy, J (2001). Estimating log models: to transform or not to transform? Journal of Health Economics 20, 461–494.CrossRefGoogle ScholarPubMed
McCrone, P, Knapp, M, Henri, M, McDaid, D (2010). The economic impact of initiatives to reduce stigma: demonstration of a modelling approach. Epidemiology and Psychiatric Sciences 19, 131–139.CrossRefGoogle ScholarPubMed
Mojtabai, R (2010). Mental illness stigma and willingness to seek mental health care in the European Union. Social Psychiatry and Psychiatric Epidemiology 45, 705–712.CrossRefGoogle ScholarPubMed
Office for National Statistics (2012). Annual Survey of Hours and Earnings.Google Scholar
Rose, D, Willis, R, Brohan, E, Sartorius, N, Villares, C, Wahlbeck, K, Thornicroft, G (2011). Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiology and Psychiatric Sciences 20, 193–204.CrossRefGoogle ScholarPubMed
Rusch, N, Corrigan, PW, Wassel, A, Michaels, P, Larson, JE, Olschewski, M, Wilkniss, S, Batia, K (2009). Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. British Journal of Psychiatry 195, 551–552.CrossRefGoogle ScholarPubMed
Rusch, N, Evans-Lacko, S, Clement, S, Thornicroft, G (2011). Stigma, discrimination, social exclusion, and mental health. In Routledge Handbook in Global Public Health (ed. Parker, R. and Sommer, M.), pp. 394–401. Routledge: New York.Google Scholar
Schomerus, G, Angermeyer, MC (2008). Stigma and its impact on help-seeking for mental disorders: what do we know? Epidemiology and Psychiatric Sciences 17, 31–37.CrossRefGoogle ScholarPubMed
Sharac, J, McCrone, P, Clement, S, Thornicroft, G (2010). The economic impact of mental health stigma and discrimination: a systematic review. Epidemiology and Psychiatric Sciences 19, 223–232.CrossRefGoogle ScholarPubMed
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408–415.CrossRefGoogle ScholarPubMed
Webber, M, Corker, E, Hamilton, S, Weeks, C, Pinfold, V, Rose, D, Thornicroft, G, Henderson, C (2013). Discrimination against people with severe mental illness and their access to social capital: findings from the Viewpoint survey. Epidemiology and Psychiatric Sciences 23, 155–165.CrossRefGoogle ScholarPubMed
Wright, S, Henderson, C, Thornicroft, G, Sharac, J, McCrone, P (submitted for publication). Measuring the economic costs of discrimination experienced by people wiht mental health problems: Development of the Costs of Discrimination Assessment (CODA).Google Scholar