Discrimination and Social Support for People with Mental Illnesses: Experiences of People Who Are of Color and/or LGB

Background and Purpose:

Mental illness stigma and discrimination are common and may discourage treatment-seeking. Ideally, families and identity communities (e.g., ethnic and sexual orientation communities) provide social support and protection against discrimination, but they may not protect their members against mental illness discrimination. People with mental illnesses (PWMI) and their families who are of color report experiencing mental illness discrimination within their ethnic communities. No research has examined whether lesbian, gay, and bisexual (LGB) communities engage in mental illness discrimination against their members. Peer- and family-run programs (i.e., programs operated by PWMI and their family members) may provide support in the face of intragroup mental illness discrimination, but it is not known whether those who are LGB and/or of color find them supportive.

To fill these knowledge gaps, this study used an intersectionality perspective that recognizes that multiple identities affect people’s experiences. We asked PWMI and family members of PWMI who are of color and/or LGB to describe their experiences with (1) mental illness discrimination and support in their ethnic and sexual orientation communities; and (2) peer- and family-run programs.

Methods:

Participants were recruited through fliers sent to organizations featuring professional, peer, and/or family staff. Twenty adults participated in semi-structured interviews. (See http://fmx.sagepub.com/content/18/1/59 regarding appropriateness of sample size.) Participants identified as PWMI (n=13) or family members (n=7). Twelve were lesbian (n=5), gay (n=5), or bisexual (n=2) and 15 were of color; 7 were LGB people of color. Participants of color identified as African American, Asian American, Mexican American, and/or Native American (6 were multiracial). An iterative analysis of verbatim transcripts identified topic and in vivo codes, then themes and patterns were identified. Our theoretical framework led us to look for discrimination and supports related to identity intersections. We focused on the type of discrimination called microaggressions—everyday interactions that denigrate people who are members of certain identity groups.

Findings:

Most participants of color reported both mental illness discrimination and support in their ethnic communities. Discrimination included being called “crazy,” “loco,” or “retarded”; exclusion from gatherings; and denial that mental illnesses are “real.” Supports included emotional support, healing ceremonies, and child-care during treatment. African Americans and Mexican Americans reported extensive mental illness discrimination; Mexican Americans also described generous tangible supports. Native Americans reported varied experiences. Though asked about mental illness discrimination, LGB participants of color also described heterosexism in their ethnic communities.

Gay—but not lesbian or bisexual—participants described pervasive mental illness discrimination in their sexual orientation communities, including social exclusion. LGB participants reported numerous heterosexist experiences in peer- and family-run programs.

Commonly-experienced microaggressions across all three contexts included invalidation, assumption of inferiority, and shaming. Participants desired culturally-grounded identity-specific programs that include attention to multiple forms of discrimination.

Conclusion and Implications:

Participants expressed ambivalence toward their identity communities and peer- and family-run programs, reporting both supports and discrimination, which often took the form of microaggressions. Reducing discrimination and increasing support should be customized for different communities. Peer- and family-run programs need to address heterosexist microaggressions and consider developing identity-specific programming.