Background:

1

• Background
• Stigmatisation is the process of marking
  individuals out for community sanction on the
  basis of some unacceptable deviation from the
  norm (Goffman, 1963). Stigma of mental illness is
  a recognised problem, which adversely affects
  individuals who suffer mental illness and
  probably their families. Sartorius (1998)
  believes that stigma of mental illness (SMI) and
  discrimination against psychiatric patients are
  the greatest remaining barriers to improving
  quality of life of sufferers. In 1998, The Royal
  College of Psychiatrists launched a five-year
  campaign, Changing Minds aimed at reducing SMI
  (Crisp et al, 2000).

2

• The Arabic culture and Muslim religion are
  strongly against stigmatisation
• (????? ????? ????? ?? ???? ??? ?? ??? ??? ??
  ?????? ???? ???? ??? ???? ?? ???? ??? ?? ??? ????
  ???? ??? ?????? ?????? ??? ??????? ??????? ???
  ????? ?????? ??? ???????
• ??? ?? ??? ?????? ?? ????????) ????
  ??????? ??? 11
• O you who believe! Let not a group scoff at
  another group, it may be that the latter are
  better than the former nor let (some) women
  scoff at other women, it may be the latter is
  better than the former, nor defame one another,
  nor insult one another by nicknames. How bad is
  it, to insult ones brother after having faith.
• 
  (Surah Al-Hujrat, 49, Verse 11).
• However, most of the studies about SMI have
  been conducted in western culture. This survey
  aims to study public views and experience of SMI
  in an Arabic culture

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• Aims
• To study public views experience of SMI in an
  Arabic culture.
• To explore public opinion regarding organising
  local campaigns to combat SMI.
•  
• Method
• A questionnaire of 9 questions developed by Dr
  EL-Adl
• Dr Balhaj was circulated to a sample of the
  public in UAE.
•  

4

• Main results
• Response rate 55.5 (4000 Questionnaires were
  circulated, 2222 received including 40 males,
  52.3 females 7.7 did not indicate their
  gender).
• 84.4 of responders believed that SMI is a
  problem in our society
• Majority of responders believed that risk of
  stigma is highest in case of HIV followed by
  mental illness mental retardation. Individuals
  suffering from blindness, deafness mutism are
  at lower risk.
• Individuals suffering from HIV and mental illness
  (MI) are less likely to receive public support
  sympathy while individuals suffering from
  blindness, deafness physical disability are
  more likely to receive public support sympathy.
• 37.5 believed that females suffering from MI are
  at higher risk of stigma than males while 47.3
  believed that there is no difference.
• 55.5 believed that families of individuals
  suffering from MI suffer from stigma. 56.9
  believed that the family suffers more if the
  patient is female.
• 54 believed that SMI should not be tolerated.
• 92.7 agreed that campaign to support individuals
  suffering from MI is needed and 94.9 agreed that
  campaign to improve public awareness of MI is
  required.

5

• Discussion
• SMI is not an Arabic culture phenomenon but a
  worldwide problem. Grave concern has been
  expressed in a conference held in Finland
  attended by European health ministers, on 12th
  January 2005 on the stigma mistreating
  individuals suffering from mental illness in
  European countries (Aljazeera, 2005). In 1998,
  The Royal College of Psychiatrists launched a
  five-year campaign Changing Minds aimed at
  reducing stigma of mental illness. My depression
  was awful painful (Bush, 2003). Mrs Barbara
  Bush, former US first lady, was unable to admit
  that she was suffering depression to avoid
  undermining her husbands chances during US
  presidential election.
• The high response rate 55.5 may reflect the
  public interest in expressing their views in a
  constructive way. Study results showed nearly
  equal participation of both genders (40 males
  52.3 females) with a high of age group 15
  30y (76.3). 84.4 of responders agreed that SMI
  is a problem in our society (Fig1). Majority of
  responders believed that risk of stigma is
  highest in case of HIV (73.3) followed by MR
  (62) M I (61.6). Those at lower risk include
  individuals suffering from blindness (32.2),
  deafness (30) mutism (34). Unfortunately,
  higher level of stigma has been associated with
  decrease public tendency to be supportive
  sympathetic (Fig.2 ).

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• 37.5 of responders believed that females are at
  higher risk of SMI, while 47.3 believed that
  there is no difference (Fig.3 ).
• 55.5 believed that families of mentally ill
  individuals suffer from SMI. This finding agrees
  with the findings in a study in Morocco by Kadri
  et al (2004). Furthermore, 56.9 believed that
  the family suffer more if the patient is a
  female. EL-Adl et al (2005) found that female
  gender is a risk factor for delayed access of
  first episode psychosis to care in rural Egypt.
  This generally agrees with Van (1996) White
  (1998) and may indicate that SMI is worse when
  the sufferer is a female.
• 54 of responders believed that SMI should not
  be tolerated (Fig.4) more than 90 believed
  that there is a need for campaigns to support
  individuals suffering from mental illness,
  improve public awareness of mental illness
  combat SMI (Fig.5a,5b). Interestingly, all age
  groups both genders were equally represented in
  supporting these campaigns. The World Psychiatric
  Association (WPA) has identified SMI as a major
  global challenge. Stigma its consequences pose
  major obstacles to recovery promote psychiatric
  disability (Stuart, 2005). A new WPA section on
  SMI has been established awaiting final
  approval at WPA Congress in Cairo, 10 15
  September 2005. I would like to urge Arab
  Psychiatrists to join contribute to this
  section.

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• Conclusion
•  
• The study results indicate that SMI is a problem
  in our society and affect the sufferers their
  families. Individuals suffering from HIV mental
  illness are at highest risk of stigma. Campaigns
  to support sufferers, improve public awareness of
  mental illness combat stigma are needed.

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•      References
•  
• -     Al-Hujrat (Surah 49, Verse 11) The Noble
  Quran Interpretation of the meanings of The
  Noble Quran in The English Language. Translated
  by Professor M Al-Hilali Dr M Khan. Printed in
  1993 published by Maktaba Dar-us-salam.
• - Aljazeera (2005) Health news European
  countries neglect of mentally ill
• individuals. www.aljazeera.net
• -      Bush, B. (2003) Larry King Live, 28th May
  2003, CNN.
• -      Crisp, A.H. Gelder, M.G. Rix, S.
  Meltzer, H.I. Rowlands, O.J. (2000)
• Stigmatisation of people with mental
  illnesses. British Journal of Psychiatry,
• 177, 4 7
• -    EL-Adl, M., EL-Mahdy, M. Anis, M. (2005)
  First episode psychosis Factors associated with
  delayed access to care in a rural Egyptian
  setting. Accepted for presentation at 22nd Annual
  Conference of the Arab Medical Union in Europe
  (Arabmed), Ajman University, UAE, 26th 31st
  March 2005.
• -      Goffman, E. (1963) Stigma. Englewood
  Cliffs, NJ Prentice Hall.
• -   Kadri, N., Manoudi, F., Berrada, S.
  Moussaoui, D. (2004) Stigma impact on
  Moroccan families of patients with schizophrenia.
  Canadian Jounal of sychiatry, 49 (9) 625 629.
  
• -   Sartorius, N. (1998) Stigma What can
  psychiatrists do about it? Lancet, 352, 10581059.

15

• Dr Thuraya Balhaj, MBChB, Senior House Officer,
• Ministry of Defence, UAE.
• Dr Mamdouh EL-Adl, MBChB, MSc, MRCPsych,
• Consultant Psychiatrist,
• Northamptonshire Healthcare Trust NHS,
  Upton, Northampton,
• NN5 6UH, UK.
• Tel [phone] Fax 44-
  01604-595178.
• Correspondence thuraya00_at_hotmail.com
  
• mamdouh.eladl_at_nht.northants.nhs.uk
•  
•