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The “nature versus nurture” debate is a longstanding one within the field of psychology. Professionals have argued whether an individual’s biogenetics, environmental influences, or a combination of the two, is most critical in determining their mental health.
During the 20th century, researchers noticed interactions between genes and environmental exposure, leading them to believe it was unlikely that the two were independent of each other. It was not until the 21st century that interactions between biogenetic and environmental influences were sufficiently understood to have an impact on our view of mental illness and its underlying causes (Uher, 2013). As a result of these recent discoveries, we see increased acceptance that a combination of factors determines an individual’s mental health.
It is difficult to deny MI’s current pervasiveness and stigmatic effects on those living with psychiatric disorders. We can see the effects and challenges faced by those living with mental illness or MI, in both their personal lives and in the workplace (Lauber & Bowen, 2010; Kirsch, Stergiou-Kita, Gewurtz, Dawson, Krupa, Lysaght & Shaw, 2009). Furthermore, cross-sectional data reveals additional challenges experienced by those with MI who also belong to certain minority groups (Ben-Zur, Duvdevany, & Saffoury, 2014).
Nature & Prevalence
MI can be defined as a condition during which an individual’s feelings, thoughts, mood and daily functioning are disrupted (NAMI, 2014). It encompasses a wide array of disorders including depression, anxiety, schizophrenia, bipolar, substance abuse and eating disorders, among others. Severe mental illness (SMI) is defined as “any psychiatric disorder experienced by people 18 aged years and older that substantially interferes with their ability to participate in major life activities” (U.S. Department of Health and Human Service, 1999; Chronister, Chou, & Liao, 2013).
Between 1987 and 2007, the number of people who qualified for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) due to MI increased by 250% (Angell, 2011). By 2012, there was an estimated 43.7 million adults in the US living with at least one MI, which was nearly 20% of the US adult population (NIMH, 2014). The population of individuals living with MI makes up a significant portion of the global workforce and is the majority of mental health consumers seeking professional assistance from counselors, psychiatrists and social workers.
The Effects of Stigma on the Individual
Extensive literature exists supporting the notion that people living with MI experience both societal and internalized stigma, and it has been referred to as one of the most disturbing psychosocial influences on individuals living with MI (Chronister, Chou, & Liao 2013). Individuals’ exposure to stigma increases their risk of morbidity and mortality and inflicts detriment upon their health and wellbeing, which can be even more harmful than the symptoms of their mental health status (Cechnicki, Matthias, & Angermeyer, 2011). Societal and internalized stigmas provoke feelings of low self-esteem, shame and depression, and inhibit social interactions, recovery, job opportunities, adequate health coverage, and quality of life overall (Chronister, Chou, & Liao, 2010). The literature consistently supports the existence of such negative impacts of this kind of stigma on people living with MI.
Some of the key components of stigma include being labeled, ostracized, associated with negative traits and characteristics, and discriminated against (Corrigan & Penn, 1999; Link, Cullen, Struening, Shrout & Dohrenwend, 1989). People living with MI are often perceived as dangerous, unpredictable, unusual and at fault for their illness (Chronister, Chou, & Liao, 2013; Jones et al., 1984).
Angermeyer, Holzinger, Carta, & Schomerus (2011) found that even attributing an individual’s MI to biogenetic causes does not invite more empathy or reduce stigma from outside groups living without MI. In fact, it was observed that relying on genetic causes correlates with higher levels of rejection in most schizophrenia cases. These results are thought to be attributed to the idea that stereotypes of people living with MI include unpredictability and dangerousness, leaving little room for responsibility to have much influence (Angermeyer et al., 2011). Although each individual experiences their internalized stigma at varying levels of severity, as a whole, it is present.
Mental Illness and The Workplace
The importance of employment is that it delivers financial security, identity and participation in society (Lauber & Bowen, 2010). Employment is also a basic right in many nations. Additionally, Kirsch et al. (2009) describe being included in or excluded from the workforce as a “social determinant of health.” Most people living with MI express interest in finding and maintaining a job, and their employment has proven to play a vital role in their recovery process and contribute to their overall health and well-being (Lauber & Bowen, 2010; Kirsch et al., 2009). However, individuals living with MI endure the lowest employment rate of any group of people categorized as having a disability (Lauber & Bowen, 2010). This highlights a gap in the system and a need in society where social workers may have the necessary expertise to uncover a solution.
According to The Health & Safety Executive (2005) and Watson Wyatt Worldwide (2010), MI is among the top reasons for absenteeism in the workplace and also makes up the majority of individuals receiving disability benefits (Mental Health Foundation, 2009). Lauber and Bowen (2010) identify one of the most significant issues as getting employees with MI to return to work after taking a leave of absence. Fear of returning, strained relationships with coworkers and supervisors and fear of job loss are a few identified factors shown to influence employees with MI in their decision whether to return to work after prolonged absence (Lauber & Bowen, 2010).
There are also organizational elements that influence the decisions of employees living with MI whether to return to work. Organizational characteristics that are conducive to returning employees are the accessibility of health services and a supportive environment among colleagues. Characteristics of an organization that discourage employees from returning to work are limited resources, poor communication, healthcare barriers, poor colleague support, and a line manager’s inability to monitor the well-being of employees (Lauber & Bowen, 2010). Research on effective interventions to obtain and maintain employees living with MI in the workplace is limited, opening an area for social work practitioners to explore.
The Impact of Ethnicity
The literature suggests ethnicity also plays a role in how individuals are impacted by MI. In a study comparing quality of life in Jewish and Arab individuals living with MI, Ben-Zur, Duvdevany & Saffoury (2014) found differences between the two cultures in regards to their attitudes toward mental illness and recovery processes. They noticed the Arab community, within which they studied, was widely traditional and collectivistic, while the Jewish community displayed more individualistic, Western values (Ben-Zur et al, 2014). Perception of mental illness in the Arab culture tends to be more negative, hindering members with MI from seeking external aid or social support when necessary (Duvdevany & Abboud, 2003; Sandler-Loeff & Shahak, 2006). On the other hand, Ben-Zur et al. (2014) noted the more frequent instances of Jewish individuals living with MI seeking social support in comparison to those within the Arab community. This study also found social support to be a major contributor to quality of life in community residents living with schizophrenia, specifically (Ben-Zur et al., 2014). These findings are similar to those observed in other cultures (Bechdolf et al., 2003; Fleury et al., 2013).
Latinos and Supported Employment
In the general population, Latinos are “less likely to be employed, paid less when they are employed and more likely to live in poverty” (Therrien & Ramirez, 2000). This population is crucial for social workers to pay attention to because they are the fastest growing minority population in the US and could become a significant portion of the US workforce and/or mental health consumers.
Mueser, Bond, Essock, Clark, Carpenter-Song, Drake & Wolfe (2014) discovered that in comparison to non-Latino whites and African Americans living with MI, Latinos living with MI in the US have overall lower levels of education and disability income, they show more severe symptoms, worse psychosocial functioning and are less likely to have been competitively employed within the last five years. In regards to specific conditions, Latinos are more likely to have a mood or anxiety disorder and less likely to be diagnosed with schizophrenia. However, during the course of their study, Mueser et al. (2014) found that the Latino participants benefited the most from a supported employment program. Obtaining competitive work, working more hours and earning more wages were among the results of the Latino consumers of the supported employment program. Mueser et al. (2014) argue that the population of working Latinos living with MI would enhance both their economic standing and mental health conditions by having access to supported employment.
Regardless of the debates on the origin of mental illness and what has contributed to its rise over last two centuries, it is a prevalent social issue with multiple and various impacts on the individuals and societal systems that deal with it. The literature supports the existence of stigma against MI and the harmful effects it has on those particular individuals. We can also see in the literature where MI can intersect with ethnicity and cultural beliefs to influence attitudes toward mental health, help seeking behaviors and the recovery process. Lastly, the research on MI’s impact on employment and vice versa highlights many issues and areas for further research, problem solving and growth, presenting a need for social workers and employers to continue exploring.
Angell, M. (2011). The Epidemic of Mental Illness: Why? New York Review of Books, 1-3. Retrieved September 6, 2014, from http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
Angermeyer, M., Holzinger, A., Carta, M., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. British Journal of Psychiatry, 199, 367-372. Retrieved September 6, 2014, from http://bjp.rcpsych.org/content/199/5/367.short#cited-by
Baumeister, A. A., Hawkins, M. F., Lee Pow, J., & Cohen, A. S. (2012). Prevalence and incidence of severe mental illness in the United States: A historical overview. Harvard Review of Psychiatry, 20(5), 247-258. Doi: 10.3109/10673229.2012.726525. Retrieved September 7, 2014, from PsychINFO.
Ben-Zur, H. Duvdevany, I., & Saffoury Issa, D. (2014). Ethnicity Moderates the Effects of Resources on Quality of Life for Persons With Mental Illness Living in Community Settings. Psychiatric Rehabilitation Journal, doi:10.1037/prj0000090. Retrieved September 10, 2014 from PsycINFO.
Chronister, J., Chou, C., & Liao, H. (2013). The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness. Journal of Community Psychology, 41(5), 582-600. Doi: 10.1002/jcop.21558. Retrieved September 10, 2014, from PsychINFO.
Gibbons, B.J. (2014). Effects of employment on mental health for those with severe mental illness. Dissertation Abstracts International, 74. Retrieved September 6, 2014, from PsycINFO.
Kirsh, B. Stergiou-Kita, M., Gewurtz, R., Dawson, D., Krupa, T., Lysaght, R. & Shaw, L. (2009). From margins to mainstream: What do we know about work integration for persons with brain injury, mental illness and intellectual disability?. Work: Journal of Prevention, Assessment & Rehabilitation, 32(4), 391-405. Retrieved September 10, 2014, from PsychINFO.
Lauber, C. & Bowen, J.L. (2010). Low mood and employment: When affective disorders are intertwined with the workplace – A UK perspective. International Review of Psychiatry, 22(2), 173-182. Doi: 10.3109/09540261003716405. Retrieved September 10, 2014, from PsychINFO.
Mueser, K. T., Bond, G. R., Essock, S. M., Clark, R.E., Carpenter-Song, E., Drake, R.E., & Wolfe, R. (2014). The effects of supported employment in Latino consumers with severe mental illness. Psychiatric Rehabilitation Journal, 37(2), 113-122. Doi:10.1037/prj0000062. Retrieved September 6, 2014, from PsychINFO.
Uher, R. (2013). The changing understanding of the genetic and environmental causes of mental illness. The Canadian Journal of Psychiatry / La Revue Candienne De Psychiatrie, 58(2), 67-68. Retrieved September 10, 2014, from PsycINFO.
Williams, A., Fossey, E., & Harvey, C. (2012). Social firms: Sustainable employment for people with mental illness. Work: Journal of Prevention, Assessment & Rehabilitation, 43(1), 53-62. Retrieved September 10, 2014, from PsycINFO.
Emily Harris MSW is a former PB intern, longstanding member of Painted Brain, and infrequent but much appreciated contributor to Painted Brain News