Because I Am a Female: Stigma and Safety Perspectives from Racially/Ethnically Diverse Women with Serious Mental Illness

Introduction

Individuals with serious mental illnesses (SMIs) face safety risks due to their mental health conditions, often compounded by experiences of trauma, victimization, residence in impoverished neighborhoods, and histories of homelessness and substance use. Stigma and safety challenges significantly impact community integration for individuals with SMIs, particularly women, who often bear a disproportionate burden of vulnerability, gender-based stigma, violence, and other inequalities. This study investigates how women with SMIs engage in the meaning-making of their safety and stigma experiences that, in turn, influence their community integration.

Methods

From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 28 cis and trans-gender women who reported experiencing gendered stigma and a lack of safety were chosen for the current study. The interviews were analyzed using modified principles of Interpretive Phenomenological Analysis (IPA) to understand how women with SMIs made meaning of their safety and stigma encounters in their families, communities, and neighborhoods. The current analysis emphasized nuances related to gendered norms and demonstrated how these norms influenced safety-related experiences. Special emphasis was placed on the language, words, and phrases used to describe and emphasize safety-related experiences.

Results

IPA analysis resulted in the emergence of themes within a broad category of safety that represented participants meaning making about their physical safety and stigma experiences. Specifically, we used the broad themes from the ‘Navigating Safety’ model to guide the concepts explored in our analysis. Physical and psychological aspects of safety for this study were experienced in tandem, whereby the women made sense of how their experiences of a lack of physical safety in multiple contexts shaped their sense of self, internalized stigma, and their social relationships. Within the broad theme of physical safety, participants described unsafe neighborhoods, exposure to domestic violence and intimate partner violence, and vulnerability to sexual violence. Additionally, we identified how gender-based norms, race and ethnicity, diverse sources of stigma (internalized, familial, and societal), and social isolation contributed to their mental health and social relationships (particularly with family).

Discussion and Implications

These findings highlight how the compounding influence of the intersection of multiple stigmatized identities create safety challenges for the lives and community experiences of women with SMIs. Focusing on access and affordability of appropriate gender-responsive services and resources for women, including trauma-informed care, could reduce hospitalizations, mental health symptoms, and stigma so they can safely integrate into their communities.

Keywords: community integration, gender, interpretive phenomenological analysis, stigma, interpersonal violence