Measuring the economic costs of discrimination exp

Authors: Steve Wright Claire Henderson Graham Thornicroft Jessica Sharac Paul McCrone

Publish Date: 2014/10/17

Volume: 50, Issue: 5, Pages: 787-795

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Abstract

Stigma and discrimination are faced by many with mental health problems and this may affect the uptake of services and engagement in leisure and recreational activities The aims of this study were to develop a schedule to measure the impact of stigma and discrimination on service use employment and leisure activities and to estimate the value of such reductionsTest–retest reliability was good for most items A substantial proportion of the sample had experienced negative impacts on employment as a result of stigma and discrimination Around onefifth had reduced contacts with general practitioners in the previous 6 months due to stigma and discrimination and the leisure activity most affected was visiting pubs/restaurants/caféIn recent years the subject of mental healthrelated stigma and discrimination and its effects on people with mental health problems has been the subject of increasing research interest 1 At an individual level stigma and discrimination may result in the social exclusion of people with mental health problems because the wider population is less willing to interact with them 2 which can mean that they participate less in valued social and leisure activities to the potential detriment of their quality of life Such stigma also impacts on help seeking for mental health and other health problems making it less likely that help is sought 3 At a more structural level these negative attitudes can become expressed in the form of discrimination in relation to civil rights housing employment and financial institutions and the highly stigmatising attitudes towards people with mental disorders can act as a disincentive to invest in mental health services to the same extent as other health care services 2 4 Such negative attitudes particularly the low perceived effectiveness of professional care can also be detrimental to the visibility and credibility of mental health services 5Economic theory suggests that individuals engage in specific activities to maximise their ‘utility’ which may alternatively be described as ‘wellbeing’ Failure to engage in desired activities would therefore result in a ‘cost’ to the individual in the form of nonrealised utility or welfare For example avoidance of visits to cafes or restaurants because of perceived discrimination will lead to a loss to the individual although the value of this is hard to determine This can also extend to engagement with activities where the benefit may be in the future For example avoidance of visiting the dentist may not result in an immediate loss but dental problems in the future would presumably represent a loss Some effects are more tangible—for example discrimination in terms of employment Discrimination in relation to mental health problems therefore is likely to come with a cost However to date few studies have explicitly addressed this 2This paper aims 1 to describe a new schedule for recording the economic impact of mental healthrelated discrimination and stigma the Costs of Discrimination Assessment CODA and 2 to investigate the extent to which beneficiaries or users of projects set up under an antistigma programme called Time to Change TTC have been affected by mental healthrelated stigma and discrimination 6 Economic impact may include costs but the main focus is on changes in activities which lead to a welfare loss for individuals While some psychometric properties of the schedule are addressed it is not intended that this be a clinical instrument that is to be used across studies Rather it is intended that it be used in its current form where appropriate or that sections of it be used in future studies or indeed that it be adapted where necessary

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