Mental health: Discrimination, Stigma
and Cultural Safety
• What is discrimination? (please see diagram on next
slide and handout)
– Biased information leading to a stereotype (fixed image)
– Prejudice (a way of thinking based on a stereotype)
– Discrimination (action or inaction, based on prejudice)
• What is stigma?
– Refers to negative attitudes (prejudice) and negative
behaviour (discrimination) (Canadian Mental Health
Association, 2011)
1. Biased
information leads
to stereotyping
4. Oppression
Discrimination backed up by
systemic power (e.g.
government, education,
legal, and health system
policies;
The Cycle of Oppression
Stereotyping: An often negative
exaggerated belief, fixed image,
or distorted idea held by
persons, groups, political/economic
decision makers
3. Discrimination
2. Prejudice
Action or inaction based on
prejudice
A way of thinking
based on stereotypes
Source: Adapted from: McGibbon, E., Etowa, J. & McPherson (2008). Health care access as a social determinant of
health. Canadian Nurse Journal, 104 (7), 22-27
What is cultural safety?
• Was developed by Indigenous Maori nurses in New
Zealand, originally meaning ‘no assault on a person’s
identity’
• Cultural safety moves beyond the traditional concept
of cultural sensitivity (being accepting of difference) to
analyzing power imbalances, institutional
discrimination, and colonization.
• Current concepts of cultural safety are based on the
Maori definition, and have been expanded to include a
broad range of peoples and groups who experience
discrimination and hence unsafe care…who are some
of these groups?
Discrimination, stigma, cultural safety and
the CNA Code of Ethics
1. Providing safe, compassionate, competent and
ethical care
2. Promoting health and well being
3. Promoting and respecting informed decisionmaking
4. Preserving dignity
5. Maintaining privacy and confidentiality
6. Promoting justice
7. Being accountable
Something to think about:
How are stigma, discrimination
and cultural safety all connected?
Introduction to
the Mental Status Exam
• Clinical Purpose
• Components (Text p. 138); Clinical documents
for Addictions and Dementia
Introduction to
the Mental Status Exam
•
•
•
•
•
•
•
•
Appearance, attitude, behaviour
Speech
Affect
Thought form
Thought content
Perceptions
Cognitive function
Judgment and insight
MSE: A beautiful mind
Introduction to Intersectionality
• What is it?
• Bringing together:
– The social determinants of health
– The ‘isms’ (e.g. racism, sexism, ageism,
heterosexism...)
– Geography (rural, urban, northern…)
An Intersectionality Framework for Nursing Practice, Education, Research, Policy
Intersections of
SOCIAL DETERMINANTS
OF HEALTH (SDH)
• early childhood development
• employment and working
conditions
• income and its equitable
distribution
• food security
• health care services
• housing shortages
• education
• social exclusion
• social safety nets
An Intersectionality Framework for Nursing Practice, Education, Research, Policy
Intersections of
SOCIAL DETERMINANTS
OF HEALTH (SDH)
• early childhood development
• employment and working
conditions
• income and its equitable
distribution
• food security
• health care services
• housing shortages
• education
• social exclusion
• social safety nets
Intersections of
IDENTITY as a
SDH
(the “isms”)
• immigrant status
• social class
• gender
• race
• ethnicity
• culture
• age
• (dis)ability
• sexual orientation
• spirituality
•...
An Intersectionality Framework for Nursing Practice, Education, Research, Policy
Intersections of
SOCIAL DETERMINANTS
OF HEALTH (SDH)
• early childhood development
• employment and working
conditions
• income and its equitable
distribution
• food security
• health care services
• housing shortages
• education
• social exclusion
• social safety nets
Intersections of
IDENTITY as a
SDH
(the “isms”)
NURSING
Practice
Education
Research
Policy
Intersections of
GEOGRAPHY as a SDH
Source: McGibbon, E. (2009). Health
and healthcare: A human rights
perspective. In D. Raphael (Ed.). The
social determinants of health.
Toronto: Canadian Scholar’s Press.
• rural, remote, fly-in
• East, West, North, South
• segregation and ghettoization
• unfair geographic access to public services
• lack of public transportation (or funds)
• environmental patterns: weather, pollution
dispersion, toxin location . . .
• immigrant status
• social class
• gender
• race
• ethnicity
• culture
• age
• (dis)ability
• sexual orientation
• spirituality
•...
Interectionality Example: The Social
Determinants of Mental Health
Employment and working conditions,
i.e., meaningful employment, work safety, dependable,
consistent work. Women with disabilities are twice as likely to
be unemployed (Statistics Canada, 2005). Immigrant women
face numerous stressors such as finding employment/
establishing income, which can have a serious health impact
(Meadows, Thurston, & Melton, 2001).
• Income and its equitable distribution,
i.e., adequate annual income and a family’s capacity to
meet basic needs. Overall income of most Canadian
families has steadily decreased since 1986 (CurryStevens, 2001). In some provinces, almost 30% of
children in minority families live in poverty (Canadian
Council on Social Development, 2000).
• Food security,
i.e., a family’s capacity to provide minimum nutritious
food. Food bank use doubled between 1989-2004. 41% of
food bank users are children under 18 years (Toronto Charter,
2003). Child hunger is an extreme example of family food
insecurity (McIntyre, 2004). If you experience food insecurity,
you are significantly more likely to have Type II diabetes
(Seligman, Bindman, Vittinghoff, Kanaya & Kushel, 2007).
• Housing
i.e., safe shelter, and green space for play. As more
Canadians spend more of their income on shelter, housing
security is threatened. Canada’s renter households have
average incomes that are half that of home owners (Shapcott,
2004). Damp housing further exacerbates health problems
such as childhood asthma (Bryant, 2002).
•
• Early childhood development, education, and care,
i.e., nurturing and abuse free environments; access to
appropriate child care supports and early childhood
education. Early childhood development is threatened due
to continuing levels of family poverty (Raphael, 2004).
There is a notable mismatch between known early
childhood educational opportunities and public investment
(McPherson, 2006).
• Education,
i.e., opportunity for post secondary education. Average
yearly university tuition has tripled since 1991 (Statistics
Canada, 2007). Health literacy is strongly related to level of
formal education, health outcomes, and access to care.
Except for Nova Scotia, Atlantic provinces have lower
literacy rates than the national average (Murray, Rudd,
Kirsch, Yamamoto, & Grenier, 2007).
• Social exclusion,
i.e., access to social supports and community participation.
Groups experiencing social exclusion tend to sustain higher health
risks and lower health status. These include Indigenous peoples;
immigrants; refugees; persons of color; persons with disabilities;
lone parents; children, youth in disadvantaged circumstances;
women; the elderly; unpaid caregivers; gays, lesbians, bisexuals,
transgendered people (Galabuzi, 2004).
• Social safety nets,
i.e., access to income supplements and publicly funded home
care support. Maritime provinces have the lowest per-person
spending on home care in Canada (Coyte & McKeever, 2001). Home
care has been left out of the national policy agenda, which has
grave consequences for the health of many vulnerable populations,
including elders, and chronically ill children (Shamian, 2007).
•
• Health services,
i.e., access to specialist and multi-disciplinary services. Rural
people have less access to health services and have poorer health
than urban people. Women living in the most rural areas are most
likely to report fair/poor health (CIHI, 2006). Racism in health care is
an important barrier in access to health services (Etowa, Weins,
Bernard, & Clow, 2007).
• Identity,
i.e., gender, race, ethnicity, culture, age, social class,
(dis)ability, sexual orientation, and age, to name a few, all
determine health care access and health outcomes. Gender and
race have recently been added to earlier definitions of the SDH.
These definitions have been expanded to include the broader
notion of identity as a SDH (McGibbon, McPherson, & Etowa, 2008).
Handout:
Racism as a Social Determinant
of Mental Health