WITHDRAWN: Stigma and Safety - Perspectives from Women with Serious Mental Illnesses

Introduction

Community integration is a common goal of recovery-oriented mental health services for individuals with serious mental illnesses (SMIs). Having a mental illness has been identified as a safety risk factor for individuals with SMIs, who often have extensive experiences with trauma and victimization, live in high poverty neighborhoods, and have histories of homelessness and substance use. Negative stigma and safety experiences are known to shape the community experiences and the processes of community reintegration for individuals with SMIs. However, we know little about how women with SMIs navigate their safety and experience stigma. The current study explores how women with SMIs experience stigma, interpersonal, and sexual violence and a general lack of safety.

Methods

From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 20 women, who reported experiencing gendered stigma and a lack of safety, were chosen for the current study. The participants were, on an average, 36 (sd=12.01) years old and had diagnoses of schizophrenia, bipolar or major depression. The interviews were analyzed using principles of constructivist grounded theory thematic analysis and ResearchTalks' "Think and Shift, Sort and Sift" approach, including diagramming, memoing, creating “episode profiles,” and monitoring salient topics using a parsimonious set of codes.

Results

Gendered stigma and unique safety-related experiences emerged as central themes in our analysis. Participants described experiences that highlighted the intersection of gender and SMI as a distinct risk factor from existing risk factors associated with having an SMI. For instance, women described experiences of discrimination while looking for employment that were rooted both in their gender and SMI identity. They also discussed implicit gender-based roles and expectations in the family that lead them to take on disproportionately more responsibilities like childcare and housework as compared to other members of their family. Participants also discussed pressures related to unrealistic societal expectations around their appearance and weight adding to the existing stigma of having a mental illness. About safety-related experiences, women described a number of violence-related instances (e.g. sex trafficking, interpersonal violence, sexual and physical harassment and violence on the street). Participants discussed an added vigilance around their safety that led them to modify their behaviors (e.g. avoiding going out in the dark, not making eye-contact and choosing what to wear) to avoid harassment and violence.

Discussion and Implications

These findings highlight the dynamic role that an intersection of gender and SMI identity play in the lives of women with SMIs. While having an SMI diagnosis is itself a risk factor that predisposes individuals to experiences of stigma and a lack of safety, being a woman creates a multiplicative layer of vulnerability that is experienced in varied ways. The findings highlight unique gender-based systemic, interpersonal and individual inequalities that perpetuate stigma and instances of violence against women with SMIs. A nuanced understanding of stigma and safety concerns would enable practitioners and policymakers to tailor interventions and policies according to the unique needs of women with SMIs experiencing violence and stigma.