title: Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification.
abstract: Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be one of the greatest barriers to regaining a normal lifestyle and health. Research advances have defined stigma and assessed its implications and have even examined intervention strategies for dealing with stigma. We are of the opinion that stigma is a potential clinical risk factor. It delays treatment seeking, worsens course and outcome, reduces compliance, and increases the risk of relapse; causing further disability, discrimination, and isolation even in persons who have accessed mental health services. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others, and deterioration in capacity to look after one's physical health. These are preventable clinical complications. In order to deal with the impact of stigma on an individual basis, it needs to be (i) assessed during routine clinical examination, (ii) assessed for quantification in order to obtain measurable objective deliverables, and (iii) examined if treatment can reduce stigma and its impact on individuals. New and innovative anti-stigma programs are required that are clinically driven in order to see the change in life of an individual by removing potential risks. The basic requirement for dealing with an individual's stigma perception/experience is its proper assessment for origin and impact in both a qualitative and quantitative manner. We further argue that quantification would allow for regular assessment and offer more effective intervention for patients. It will also be helpful in identifying modifiable social factors to enhance quality of care planning for management in hospitals and communities. The objective of quantification is to facilitate developing an approach to bring the assessment of stigma into clinical work and formulating customized strategies to deal with stigma at the patient level. It would be expected that the assessment of stigma would become a part of routine clinical assessment to identify barriers to outcome. This article discusses the need for quantification of patients' experiences of mental illness stigma.
authors.affiliation: Department of Psychiatry, University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Canada ; University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Canada ; Lawson Health Research Institute, London Health Sciences Centre, London, Canada.
authors.forename: Amresh
authors.initials: A
authors.lastname: Shrivastava
authors.forename: Yves
authors.initials: Y
authors.lastname: Bureau
authors.forename: Nitika
authors.initials: N
authors.lastname: Rewari
authors.forename: Megan
authors.initials: M
authors.lastname: Johnston
keywords: Mental illness; quantification; risk factor; schizophrenia; stigma