Stigma and Discrimination in the Mental Health Workplace

Recent studies show that mental health professionals around the globe, despite their involvement in anti-stigma efforts, continue to hold stigmatizing attitudes and demonstrate discriminatory behavior toward people with mental illnesses (e.g., Peris, Teachman & Nosek, 2008; Schulze, 2008). In particular, the desire for social distance from people with mental health conditions appears to be equal to or more prevalent among mental health professionals than the general public (Nordt, Rossler, & Lauber, 2006; Ucok, Polat, Sartorius, Ercok, & Atkinson, 2004.) With an increasing number of people diagnosed with mental illnesses joining the mental health workforce as peer employees, we wanted to know whether they perceive the presence of stigma and discrimination by mental health professionals in the workplace. Perceived discrimination is critical to examine because perceptions “characterize reality for those who report it” (Banerjee, 2008, p. 381) and perceived discrimination based on other stigmatized identities has been associated with negative mental health outcomes (e.g., Banks, Kohn-Wood, & Spencer, 2006; Kessler, Mickelson, & Williams, 1999; Ren, Amick, & Williams, 1999; Sanders-Thompson, 1996).

We examined the following research questions: Do peer employees' perceptions of discrimination against service recipients differ from mental health clinicians' perceptions? Do peer employees' perceptions that they experience stigma and discrimination in the workplace differ from clinicians' perceptions about whether discrimination occurs? If differences exist, do other factors (e.g., gender and ethnicity) affect perceptions?

Using a snowball sample, we surveyed 103 mental health system employees using a semi-structured online interview. Participants were 51 peer employees and 52 licensed mental health clinicians working in a U.S. southwestern state. Measures included gender, ethnicity, social inclusion of peer employees, and two dependent variables: perceptions of unfair treatment of service recipients and the coworker discrimination index, a two-item scale that measures coworker stigma and discrimination related to peer employees.

We used SPSS GLM to construct models for the two dependent variables. The model predicting different perceptions of unfair treatment of service recipients was robust with an adjusted R2 of .562 (p <.000). The model for differences in perceptions of coworker discrimination, adjusted for years in the mental health workplace, had an adjusted R2 of .216 (p <.000). In both models, women of color and peer employees who felt socially excluded in the workplace were more likely to perceive unfair treatment of service recipients. Female peer employees who felt less socially included were more likely to perceive discrimination in the workplace.

The differences in perceived unfair treatment of service recipients suggest that mental health clinicians are less likely than peer employees to identify clinician behaviors or organizational policies as unfair. The differences in perceived discrimination by coworkers suggest that organizational interventions are needed to help clinicians understand that their behavior may be perceived as discriminatory. Further research is need to examine the prevalence of perceived discrimination in other mental health settings; identify behaviors and practices that are perceived as discriminatory; explore the predictors and outcomes of perceived discrimination in the mental health workplace; and explore the effectiveness of interventions designed to address perceived discrimination.