Page 141 - GHES-3-1

Global Health Economics and
Sustainability
Reducing public stigma related to psychosis

mental ill-health often causes family members to 19 – 24 years found that even among young and educated
experience shame, contributing significantly to public Singaporeans, strong stigmatizing misconceptions persist.
stigma (Shamblaw et al., 2015). Furthermore, Singapore’s Individuals with psychosis are often labeled as abnormal,
elitist mindset, which values success in all aspects of life, neurologically disordered, mentally ill, dangerous to
leads to viewing mental ill-health as incompatible with themselves and others, and crazy (Mankiewicz & Kam,
societal functioning and deserving of disparagement (Tan 2024). These persistent misperceptions contribute to the
et al., 2020). According to Subramaniam et al. (2017), these ongoing nature of stigma in Singapore, with historical
restrictive cultural norms can result in a sense of “loss of data showing that 73% of people with psychosis have
face,” disappointment, and heightened feelings of failure had trouble finding employment (Lai et al., 2000). The
among PMIH and their families. internalization of stigma is also evident, with 52% of
individuals with psychosis reporting low self-esteem, 47%
1.4. Stigma associated with psychosis feeling shame, and 51% believing that people who know
Individuals with psychosis are often perceived as about their condition would avoid them (Lai et al., 2000).
unpredictable, dangerous, violent, and incompetent by Recent statistics further highlight the issue: a study by Ang
the public (Angermeyer & Matschinger, 2004; Henderson et al. (2020) demonstrated that only 46.01% of community-
et al., 2013; Zvonkovic & Lucas-Thompson, 2015). For based Singaporean outpatients with psychosis were
example, a large survey by Crisp et al. (2000) revealed employed, with 51.15% working full time. Another study
that 70% of the general population viewed people with by Chua et al. (2019) reported an unemployment rate of
psychosis as dangerous. They are also seen as responsible 63.5% among participants in the Singapore Early Psychosis
for their condition and unlikely to recover (Corrigan & Intervention Programme. Furthermore, only 13.3% of
Kleinlein, 2005; Crisp et al., 2000), which can hinder access young Singaporeans with psychotic and affective disorders
to evidence-based treatments for psychosis (Mankiewicz have managed to secure senior-level jobs (Subramaniam
& Turner, 2012). These negative attitudes may arise from et al., 2022).
the disruptive and unusual behavior of individuals with 1.5. Role of psychoeducation in reducing mental
psychosis and a lack of understanding about the condition health stigma
(Angermeyer & Matschinger, 2004; Corrigan et al., 2001).
Historically, psychosis was associated with schizophrenia, a Given the public’s limited understanding of psychosis
disease paradigm that implied inherited brain abnormalities (Zvonkovic & Lucas-Thompson, 2015), interventions to
and led to ineffective medical treatments (Mankiewicz, address these misperceptions are necessary. Structured
2013; Villafana, 2017). This historical stigma continues psychoeducation is an effective method for correcting
to influence structural systems, perpetuating continued stigma-related misunderstandings, as it has shown promise
discrimination against individuals with psychosis (Lee in reducing stigma and is relatively straightforward to
et al., 2006; Vass et al., 2015) and underscoring the need for implement in mental health services (Zvonkovic & Lucas-
inclusive, multidisciplinary approaches in clinical services Thompson, 2015). Commonly integrated into cognitive
for PMIH (Mankiewicz et al., 2015). behavioral interventions (Kellett et al., 2007; Sijbrandij et al.,
2016), psychoeducation involves “any structured group
Misconception about psychosis is often pronounced or individual program that addresses a [difficulty] from
in Asian societies, where cultural beliefs reinforce a multidimensional viewpoint, including familial, social,
viewing individuals with psychosis as highly dangerous biological and pharmacological perspectives” (Economou,
and aggressive (Zhang et al., 2019). In Singapore, the 2015, p. 259). It is systematically used in treatments for
lack of awareness about psychosis leads to widespread complex mental health needs, such as cognitive behavioral
misunderstandings, with those experiencing psychosis therapy for psychosis (CBTp) (Mankiewicz & Turner, 2014;
being seen as exhibiting abnormal behavior and being Mankiewicz, 2019), behavioral family therapy (Lucksted
labeled as bizarre or unstable (Lai et al., 2000). Such et al., 2012; O’Hanlon et al., 2018), and family intervention
individuals face discrimination due to the belief that for psychosis (FIp) (Onwumere et al., 2018).
psychosis results in permanent debilitation, and even Recognizing the benefits of psychoeducation,
those who fully recover continue to experience stigma researchers have increasingly included it in stigma
and discriminatory behavior from their communities and reduction programs, with some focusing specifically on
society (Lai et al., 2000).
improving psychotic experiences (Alonso et al., 2019; Blair
Stigmatization of PMIH is a significant issue in Irvine et al., 2012; Kimmerle & Cress, 2013; Li et al., 2015;
Southeast Asia (Subu et al., 2021; Tan et al., 2020). Tan & Mankiewicz, 2024). Meta-analyses have consistently
A recent qualitative study involving participants aged shown that psychoeducation is effective in reducing stigma

Volume 3 Issue 1 (2025) 133 https://doi.org/10.36922/ghes.3363