Effect of Perceived Stigma on Community-Based Mental Health Service Use Among Jail Detainees

Many personal, situational and environmental factors serve as barriers and facilitators to community-based mental health service use. An important factor to consider is perceived mental illness stigma, which can be defined as an awareness of the potential negative stereotypes and social exclusion that may result from having a mental disorder. Models of health service use are often used in mental health services research, but these models generally fail to include perceived mental illness as a factor. This study proposed the addition of perceived stigma as an important predisposing factor in the Behavioral Model for Vulnerable Populations. Through a secondary data analysis of interview data collected from 431 female and male jail detainees, this dissertation examined the relationships between predisposing, enabling and need-based factors and mental health service use. Data was collected from jail detainees housed in the psychiatric treatment units of the Cook County Department of Corrections. The study used the World Mental Health – Composite International Diagnostic Interview, which was adapted to for a correctional population and included the Perceived Devaluation and Discrimination scale to measure perceived mental illness stigma. Findings from the research showed that a number of factors positively or negatively influenced mental health service use in this sample. Increases in perceive mental illness stigma, the main variable of interest, were shown to increase the incidence rates of service use. This finding was contrary to expected outcomes, as it was predicted that stigma would decrease incidence rates of service use. The need to receive care in spite of potentially stigmatizing service delivery and possible involvement in public, mandated or coerced care were cited as possible reasons for this finding. Other factors that increased the likelihood of using services included having positive attitudes toward mental health service use, endorsing higher levels of religiosity, being insured and having access to regular care. Findings of the study have relevance for social work education, practice and research. Efforts to reduce stigma at the individual, clinical, systems and social levels should enhance personal wellbeing, improve social inclusion, reduce devaluation and discrimination and increase mental health service use over time.