Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose. The stigma of mental illness continues to be one of the most pervasive barriers to accessing treatment for older adults with mental health problems. While research with vulnerable populations has addressed the stigma of mental illness, it has failed to account for the influence of other stigmas such as age, race, drug addiction and poverty on accessing care nor has research sufficiently addressed the potential additive effect of multiple stigmas on obtaining mental health and substance abuse services. This study examined the existence and experiences of multiple stigmas in a sample of older adult methadone maintenance clients. Method. The data for this analysis were derived from a qualitative study of barriers to mental health treatment for older adult methadone clients. The sample of 24 clients was evenly distributed by race (African American and white) and gender, and was recruited from a freestanding methadone clinic in a large mid-western city. Two-thirds of participants were between the ages of 50 and 60, and the remaining third were over the age of 60. Face-to-face semi-structured interviews were conducted regarding barriers to service utilization; interviews were recorded and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Transcripts were first in-vivo coded (line-by-line), and similar codes were subsequently categorized into themes (Patton, 1990). Results. Eight distinct stigma experiences were identified within this sample: drug addiction (79%), mental illness (60%), aging (54%), psychotropic medications (46%), methadone maintenance (21%), poverty (21%), race (8%), and HIV status (4%). Multiple experiences of stigma were prevalent within the sample, with half of the respondents (50%) reporting at least two distinct stigmas. Slightly less than half (46%) of respondents experienced three or more different types of stigma. Another significant theme that emerged through the data was the concept of shared stigmas in the client-counselor dyad as a self-protective property. In this sample, 87.5% of participants discussed feeling more supported and less stigmatized by counselors who shared their stigmas. The two most frequently cited reasons for respondents to feel less stigmatized by their counselors were having a counselor that was older and who had a history of drug addiction. Participants also identified feeling less stigmatized when their therapist shared their race, and had experienced poverty. Clients reported that when their counselor shared their stigma it helped to break down the barriers of stigma and helped them to feel less isolated in their past experiences. Implications. These findings suggest that it is important for social work practitioners to recognize the impact of experiencing multiple stigmas on mental health and substance abuse treatment. Due to their multiple stigmatizing experiences, our data suggest that addressing client experiences with stigma may be an important component of methadone maintenance programs, particularly for older addicts who are also dealing with mental health concerns. In addition, hiring clinical staff that share certain characteristics, such as being older ex-addicts, may be an effective tool to increase rapport in treatment and break down the barriers of stigma.