Perceived vs. Measured Stigma Against Persons with Mental Disorders

1. Perceived vs. Measured Stigma Against Persons with Mental Disorders Marjorie L. Baldwin W. P. Carey School of Business Arizona State University Steven C. Marcus School of Social Policy and Practice University of Pennsylvania Supported by Grant #RO3 MH 67087-2 from the National Institute of Mental Health.

2. Introduction • Background • Persons with serious mental illness (SMI) are subject to strong stigma that contributes to discrimination and poor outcomes in the labor market • Persistent and pervasive • Consistent across cultures and geographic regions • Virtually unchanged despite improved treatments • Stereotypes of persons with mental illness • Symptoms are controllable • Dangerous • Incompetent • Little hope for improvement

3. A person with this disability would be acceptable 5 - in my family 4 - as a friend 3 - as a co-worker 2 - only at a distance 1 - in an institution/out of sight Diabetes 4.40 Blindness 3.44 Epilepsy 3.18 Paraplegia 2.86 Alcoholism 2.55 Cerebral palsy 2.27 Mental illness 2.02 AIDS 1.96 Stigma rankings

4. Work outcomes • Persons with mental disorders in the labor market • Low probability of employment • Low wages relative to non-disabled workers and workers with general medical disorders • Measures of the impact of stigma • Statistical measure of discrimination – ‘unexplained’ wage differential • Self-reported experiences of discrimination • Research Question • Do self-reported measures of job-related discrimination by persons with SMI correlate with statistical measures of discrimination?

5. Data • 1994-95 National Health Interview Survey – Disability Supplement • Disability – “unable or limited in ability to participate in a major activity, including work and household responsibilities” • Eligibility criteria • Age 18-65 • Employed • SMI includes mood disorders (n=914), anxiety disorders (n=703), psychotic disorders (n=86) • Sample • 66,341 persons with no disability • 917 persons with SMI who do not report stigma experiences at work • 222 persons with SMI who report stigma experiences at work

6. Self-reported experiences of discrimination

7. Mean hourly wages for persons with SMI by self-reported discrimination status

8. Statistical measure of discrimination • Outcomes measure: hourly wage rate • Xi is a vector of variables that control for • functional limitations • demographic characteristics • human capital characteristics • job-related characteristics • Miidentifies persons with SMI

9. Controls for Functional Limitations • IADL help • using the telephone, paying bills, taking medications, preparing light meals, doing laundry, going shopping • ADL help • eating, bathing, dressing, getting around the home • Physical limitations • lifting ten pounds, reaching over head, walking three blocks • Activity limitations • work, housework, school • Social limitations • participation in social, recreational, family activities • Cognitive limitations • confusion or memory loss, problems making decisions, needs supervision for his/her own safety

10. Demographics Age Gender Race Region Human capital Education Physical disorder Substance use disorder Job characteristics Union member Part-time worker Industry Occupation Employer-provided health insurance Other control variables

11. Statistical estimates of discrimination by self-reported discrimination status

12. Statistical estimates of discrimination by self-reported discrimination status

13. Discussion • Self-reports of job-related discrimination are correlated with statistical measures of discrimination • Workers with SMI know when they are being discriminated against • Why are some workers with SMI subject to discrimination while others are not? • In some cases, SMI is ‘invisible’ - workers typically choose not to disclose their illness • Functional limitations may make the illness more ‘visible’ to employers and co-workers - generating stigma responses • Workers in the group reporting stigma experiences do, in fact, report greater functional limitations

14. Study Design • Open-ended, semi-structured interviews with key stakeholders • 20 “employees” • 15 with affective disorders, 2 with anxiety disorders, 3 with psychotic disorders • 25% have a college degree • 80% are currently employed • 16 “employers” • Asked to recall experiences supervising a particular employee with SMI • Most described supervising employees with affective disorders or psychotic disorders

15. Law enforcement officer • Harassment • “There were comments and innuendos, and people were always making fun of him because he’s a little different.” • Avoidance • “People were reticent to get involved in cases with him and didn’t want to work with him.” • “We are not real progressive with [dealing with mental illness] you know. … The first response by most of my peers is ‘get rid of him, fire him.’“ • Fear • When he did things “that were sometimes a little far out there [his co-workers] would get real worried. …They would come in and say ‘you really need to talk to him.’”

16. Art salesperson • Not an illness • “Because most of it was in her mind. You know it wasn’t anything anybody could assist her with or help her with really.” • I think she “made up a lot of her own problems that were really not occurring, but she either made them up or caused them to occur so that everyone would pay attention to her.” • I just said, “go and take care of it. You know, go to the doctor, get whatever help you need, get whatever drugs you need, get whatever…” • Avoidance • “Nobody wanted to even deal with her. And so that made it even more difficult being in an atmosphere where there was a lot of negativity.” • Harassment • One co-worker, “instead of helping her, which was part of his job, he would hinder her … almost to the point of being mean to her in certain instances.”

17. Graphics designer • Fear • “People were kind of scared because he is a really big guy and he would kind of look, sort of paranoid. They got afraid for their safety.” • Not an illness • “People thought he was weird. They just thought the guy you know whacked out or flipped out.” • “You have experienced managers and supervisors that don’t know what is going on. They just think this guy is a nut case.” • Avoidance • “They started avoiding him. His co-workers don’t want him back - it would be very difficult for him to come back to that workplace.”

18. Conclusion • Stigma against mental illness in the workplace persists more than a decade after passage of the ADA • Can be detected statistically and in worker self-reports and in discrimination complaints to the EEOC • Subjects workers to harassment, exclusion, and differential treatment in the workplace • May or may not be detected in national surveys • Anti-discrimination legislation has not had much effect on the work climate for persons with SMI • The best way to address the situation appears to be education