Group 9 Article Review Assignment

SEMESTER
JANUARY 2023
(DECAF)
MENTAL ILLNESS
ACCEPTANCE BY
SOCIETY ARTICLE
REVIEW
INSTRUCTOR: AP DR MOHD NURI AL AMIN ENDUT
No. Students Name ID No. Program
NUR QAIDATUL ANIRA BINTI ABDULLAH 22006721 PETROLEUM
1 SUWANDY ENGINEERING
AMIRUL ASHRAF BIN ABDULLAH 22006909 PETROLEUM
2 ENGINEERING
MUHAMMAD SYAHRUL SYAFIQ BIN ISMAIL 22005058 PETROLEUM
3 ENGINEERING
MUHAMMAD DANIAL AFIQ BIN MAZLAN 22006991 PETROLEUM
4 ENGINEERING
MUHAMMAD ARINA DANIEL BIN 22006858 PETROLEUM
5 MUHAMMAD AZRY ENGINEERING
27 FEBRUARI 2023
Date Accepted: _ Marks: / 10
Open
Student Declaration:
1) We have been actively involved together in the process of writing this assignment.
2) We acknowledge that this work is the result of our own work except for excerpts and
summaries, each of which we have explained the source.
3) We acknowledge having checked all the contents of this assignment and we find that it has
complied with the prescribed assignment writing guidelines.
Student’s Declaration Student’s Declaration

Photo: Photo:
Name: Amirul Ashraf Bin Abdullah Name: Muhammad Arina Daniel bin Muhammad Azry
ID No: 22006906 ID No: 22006858
Signature: Signature:
Photo: Photo:
Name: Muhammad Danial Afiq Bin NUR QAIDATUL ANIRA BINTI ABDULLAH
Name: SUWANDY
Mazlan
ID No: 22006721
ID No: 2200699122006991
Photo: Photo:
Name: Muhammad Syahrul Syafiq bin Ismail Name:
ID No: 22005058 ID No:
Criteria Excellent Moderate Poor Marks

- Format/spelling Marks: 8-10 Marks: 4-7 Marks: 0-3
-Details of the - According to a -According to some of -Does not follow the
paper perfectly defined the prescribed prescribed format
-Objectives, format formats -Details of the paper
methodologies, -Details of the paper -Details of the paper are incomplete
data are complete are incomplete -Objectives,
sources/responde -Objectives, -Objectives, methodologies, and
nts methodologies, and methodologies, and data sources are very
-Small headline in data sources are clear data sources are unclear
the paper -Each title and sub- unclear -Each title and sub-
-Conclusion title are well -Each title and sub- title are not well
-Bibliography summarized and title are well summarized.
accompanied by summarized. -The conclusion of the
comments. -The conclusion of the paper is not clear
-The conclusion of the paper is less clear -Bibliography is not
paper is clear -Bibliography is poorly well reviewed
-Bibliography is well reviewed
reviewed
Open
ARTICLE REVIEW .................................................................................................................................2
• Breaking the Stigma : Embracing Mental Illness Acceptance for a Healthier Future 2
• Issue and Challenges of Mental Health in Malaysia ..........................................................5
• Media Portrayal of Mental Illness and Its Treatment .......................................................7
ARTICLE REVIEW
• Breaking the Stigma : Embracing Mental Illness Acceptance for a

Healthier Future
The article "Barriers to and Facilitators of the Acceptance Process for Individuals with
Serious Mental Illness" provides a critical analysis of the factors that influence the
acceptance process for individuals with SMI. The authors' argument is based on a
comprehensive review of relevant literature that explores the experiences of individuals
with SMI in the acceptance process. The authors highlight the importance of
understanding the acceptance process as a critical aspect of recovery for individuals with
SMI and the need for effective interventions to support this process.
The article's arguments and conclusions are well-supported by evidence from various
qualitative and quantitative studies that examine the experiences of individuals with SMI.
The authors use a systematic approach to identify the barriers and facilitators that
influence the acceptance process, which includes personal factors, illness-related factors,
and social and environmental factors. The article's findings have significant implications
for mental health professionals and policymakers who are involved in designing and
implementing interventions to support individuals with SMI.
In conclusion, the article "Barriers to and Facilitators of the Acceptance Process for
Individuals with Serious Mental Illness" provides valuable insights into the acceptance
process for individuals with SMI. The article's arguments and conclusions are well-
supported by evidence and contribute to a better understanding of the challenges that
individuals with SMI face in their recovery. The article's findings have significant
implications for mental health professionals and policymakers, and it is recommended
that future research builds on the insights provided by this article to develop effective
interventions to support the acceptance process for individuals with SMI.
Serious Mental Illness" does not directly discuss mental illness acceptance by society.
Instead, it focuses on the factors that influence the acceptance process for individuals
with serious mental illness themselves. However, the article indirectly highlights the
importance of mental illness acceptance by society as a facilitator of the acceptance
process for individuals with serious mental illness.
For example, the article identifies social and environmental factors as important
facilitators of the acceptance process. These include family support, employment, and
access to mental health services. These factors are often influenced by societal attitudes
towards mental illness. When individuals with serious mental illness receive support
from their families, have access to employment opportunities, and can access mental
health services without stigma or discrimination, they are more likely to accept their
illness and engage in the recovery process.
Therefore, the article suggests that mental illness acceptance by society is an important
facilitator of the acceptance process for individuals with serious mental illness. This
highlights the need for society to be more accepting of mental illness and to provide the
necessary support and resources to individuals with serious mental illness to help them
accept their illness and move forward in their recovery.
Serious Mental Illness" provides a thorough examination of the factors that influence the
acceptance process for individuals with SMI. The authors' systematic review of the
literature and critical analysis of the evidence highlights the complexity of the acceptance
process and the importance of understanding the factors that influence it. The article's
comprehensive approach to examining the personal, illness-related, and social and
environmental factors that affect the acceptance process provides a valuable contribution
to the field of mental health and rehabilitation.
The article's findings have significant implications for mental health professionals and
policymakers who are involved in designing and implementing interventions to support
individuals with SMI. The authors' identification of the barriers and facilitators of the
acceptance process provides insights into the challenges that individuals with SMI face
and the support they need to move forward in their recovery. The article's evidence-
based arguments and conclusions contribute to a better understanding of the acceptance
process for individuals with SMI and provide a foundation for future research and
intervention development.
The scholarly article titled "Barriers to and Facilitators of the Acceptance Process for
Individuals with Serious Mental Illness" is a rigorous and insightful analysis of the factors
that impact the acceptance process for individuals with SMI. The authors employ a
systematic approach to review the existing literature and critically evaluate the evidence
to identify the barriers and facilitators that affect the acceptance process. The article's
comprehensive approach and careful attention to detail contribute to its strength as a
valuable resource for researchers and practitioners in the field of mental health and
rehabilitation.
The article's significance lies in its implications for mental health professionals and
policymakers who work to develop interventions that support individuals with SMI. The
authors' identification of the factors that influence the acceptance process provides
valuable insights into the challenges faced by individuals with SMI and the types of
support they require to navigate their recovery. Furthermore, the authors' critique of the
limitations of existing research underscores the need for continued investigation to fully
understand the experiences of individuals with SMI in diverse contexts. The article's
scholarly rigor and practical relevance make it a compelling and authoritative
contribution to the field of mental health and rehabilitation.
• Issue and Challenges of Mental Health in Malaysia
A piece of writing with the title "Issues and Challenges of Mental Health in Malaysia" was
published in the International Journal of Advancements in Research & Technology,
Volume 8, Issue 12, in 2018. The page numbers of the article are 1685 to 1696. The
authors of the article are Mohd Faizul bin Hassan, Erne Suzila Kassim, Muhammad
Iskandar Hamzah, and Naffisah Mohd Hassan. In this article, a comprehensive analysis of
the current state of mental health in Malaysia is provided, covering topics such as the
prevalence of mental health illnesses, the scarcity of resources that are accessible to those
who struggle with mental health, and the cultural stigma that is associated with mental
illness. The authors make a significant contribution to our understanding of mental health
in Malaysia by presenting recommendations regarding the ways in which the Malaysian
government and healthcare professionals can collaborate to improve the mental health
system in the country.
Inadequate support for individuals in Malaysia who are dealing with issues related to
their mental health is highlighted as one of the most pressing concerns in this article.
According to the authors, there is a severe shortage of mental health professionals across
the country, which results in patients frequently having to wait several months before
receiving treatment. The authors point out that most mental health clinics are in urban
areas, which makes it challenging for people living in rural areas to obtain the necessary
treatment. One of the most significant challenges faced by Malaysia's mental health
system is the social prejudice that surrounds mental illness. The authors make the point
that mental illness is stigmatised due to the widespread belief that it is the result of a
person's own lack of strength, and that this causes many people to avoid seeking help of
fear of being rejected by their peers in social settings. People who have problems with
their mental health may have a more challenging time getting prompt treatment and the
necessary recovery support, which can delay their journey to wellness. This is often the
result of cultural stigma.
The authors also highlight the reasons why it is essential to raise awareness and educate
the public about mental health issues in Malaysia.They believe that widespread ignorance
is to blame for the stigma and discrimination that is directed towards individuals who
struggle with mental health issues. The authors are optimistic that by issuing information
about mental wellness, a greater number of individuals will be encouraged to seek help
if they are experiencing issues related to their mental health, and that consequently
mental health of the general population will improve.
Mental health is a critical issue that affects people all over the world, and it is important
to understand the challenges that individuals with mental health problems face in
different countries. The article provides valuable insights into the mental health situation
in Malaysia and highlights the need for continued efforts to improve access to care and
reduce the stigma associated with mental illness.
We need to do more to dispel the negative stereotypes that surround those who struggle
with mental illness if we are serious about aiding people in Malaysia and elsewhere in
improving their mental health. These stereotypes are especially prevalent because of the
stigma that surrounds those who suffer from mental illness. There will be an increase in
the number of people who seek help for their own mental health issues as there is an
increase in the public's knowledge and understanding of issues related to mental health.
Consequently, those battling mental health issues will have easier access to the care they
require to make a full recovery.
Expanding access to care for those who struggle with mental health issues is equally as
vital as reducing the stigma that surrounds mental illness. If we increase funding for and
access to mental health services, we can make it easier for people who are struggling with
their mental health to get the help they need to get better. The article makes a
contribution to our knowledge of mental health in Malaysia, and it draws attention to the
ongoing work that must be done in order to strengthen the country's mental health
infrastructure and combat the negative stigma that still surrounds those who suffer from
mental illness. People's mental health is a global concern, and more needs to be done to
reduce the stigma associated with mental illness and increase access to treatment options
so that those who suffer from mental illness can get the help they need to recover.
• Media Portrayal of Mental Illness and Its Treatment
The article "Media Portrayal of Mental Illness and Its Treatments: What Effect Does It
Have on People with Mental Illness" by Heather Stuart explores the impact of media
representation on people with mental illness. The study aims to examine the ways in
which the media portrays mental illness and its treatments, and the impact these
portrayals have on individuals with mental health conditions.
The author conducted a literature review of existing research on the subject and found
that media representations of mental illness and its treatments can be either negative or
positive. Negative portrayals often stigmatize individuals with mental health conditions
and can lead to discrimination and social exclusion, while positive portrayals can help to
destigmatize mental illness and promote understanding and acceptance. Media
sometimes, portrayed one out of four mentally ill kill people, and some do harm to other.
Making society believe that the group is involved in violence. Since long time ago mental
illness people had been portrayed to bring violence anywhere and anyone they meet.
Media also less portrayed that mental illness can be recovered and cure from time to time
or become a productive member of society.
The study also found that media representation can directly affect the attitudes and
beliefs of individuals with mental health conditions and their decisions about looking for
and receiving treatment. For example, media portrayals that depict mental health
treatments as ineffective or harmful can discourage individuals from seeking treatment,
while positive portrayals can increase the likelihood that people will seek help. By
showing the poor environment and life in mental hospital, people with mental illness will
avoid getting treatment at all costs making they become more ill by time to time. This is
why a lot of them get violence by harming themself and others around them. If the media
portrayed a lot of positive treatment and successful people who recovered, this can
encourage them to get the treatment.
The author concludes that it is important for the media to supply exact and balanced
portrayals of mental illness and its treatments. This can help to reduce stigma, increase
public understanding of mental health, and encourage people to seek help when they
need it. Just by using the media to portray the positive of mentally illness people who
recovered, the problem that they experience and the society view of them. Can help
change people perspective on mental illness group. Thus bring a positive effect to society
and recover more people from mental illness.
This study highlights the significant role that media representation can play in shaping
public attitudes towards mental illness and its treatments. The findings suggest that it is
important for media outlets to be mindful of the impact their portrayals can have on
individuals with mental health conditions and to strive to supply exact, balanced, and
stigma-reducing portrayals of mental illness and its treatments. We agree that the media
should portrayed more positive and how the mental illness people get treated nowadays.
So that our society can help change the way people view them and help a lot of them
recover.
545889
research-article2014
QHRXXX10.1177/1049732314545889Qualitative Health ResearchMizock et al.
Article
Qualitative Health Research
2014, Vol. 24(9) 1265–1275
Barriers to and Facilitators of the © The Author(s) 2014
Reprints and permissions:
Acceptance Process for Individuals sagepub.com/journalsPermissions.nav
DOI: 10.1177/1049732314545889
With Serious Mental Illness qhr.sagepub.com
Lauren Mizock1, Zlatka Russinova2, and Uma Chandrika Millner2
Abstract
The process of acceptance of mental illness is a central component of recovery and has been linked to functioning,
illness management, and quality of life. A number of barriers and facilitators have been theorized as impacting this
process. This study was conducted with 30 participants with serious mental illness (a major psychiatric disorder with
impairment in multiple areas of functioning) to elicit the barriers to and facilitators of the acceptance of mental illness.
Grounded theory methodology was utilized to analyze the 30 semistructured interviews. Results revealed barriers to
and facilitators of acceptance of mental illness at the micro level (cognitive, emotional, behavioral, identity-related),
meso level (relational), and macro level (cultural, systemic). Clinical and research implications are discussed with
regard to facilitating acceptance of mental illness.
Keywords
bipolar disorder; depression; grounded theory; mental health and illness; psychosocial issues; qualitative analysis;
recovery; rehabilitation; research, qualitative; schizophrenia
Acceptance of mental illness has been identified by fore- Acceptance of Mental Illness
runners of the rehabilitation movement as being central to
recovery and one of the most difficult stages (Deegan, Construct of Acceptance
1996; Ridgway, 2001; Spaniol & Gagne, 1997). In this Acceptance of mental illness does not refer to accepting
context, recovery is understood as not simply symptom a traditional diagnostic label, but rather specifies a mul-
elimination but as the process of living a satisfying and tidimensional process of recognizing one’s condition
meaningful life despite having a mental illness (Davidson and actively engaging in the management of related
& Roe, 2007). This process has been linked to function- symptoms and experiences (Mizock, Russinova, &
ing, illness management, quality of life, engagement in Millner, 2014). The National Institute of Mental Health
treatment, and other positive outcomes (Amador et al., (NIMH) definition of a serious mental illness (or mental
1993; Cunningham, Wolbert, Graziano, & Slocum 2005; illness) is a major mental disorder that interferes with at
Kravetz, Faust, & David, 2000). least two areas of functioning—social functioning,
Researchers have suggested that there might be a num- vocational functioning, and activities of daily living
ber of potential barriers to and facilitators of the accep- (NIMH, 2008). Serious mental illnesses generally
tance process (Li & Moore, 1998; Spaniol & Gagne, include bipolar disorder, severe depression, and schizo-
1997); however, the literature has often included theoreti- phrenia-spectrum disorders.
cal articles or had a focus on the acceptance of a specific We previously identified acceptance of mental illness
diagnostic label. Additional knowledge of these factors is to include the following dimensions: (a) identity dimen-
needed to guide clinical intervention in facilitating accep- sion—the process of developing a positive sense of self in
tance of the symptoms and experiences related to mental the face of mental illness; (b) cognitive dimension—the
illness. The present qualitative, grounded theory study
was conducted with 30 participants with serious mental 1
Worcester State University, Worcester, Massachusetts, USA
illness to clarify the facilitators of and barriers to the 2
Boston University, Boston, Massachusetts, USA
acceptance process. Results are described with regard to
Corresponding Author:
these barriers and facilitators. Implications are also dis- Lauren Mizock, Psychology Department, Worcester State University,
cussed, to guide clinical practice and future research in 486 Chandler St., Worcester, MA 01602, USA.
this area. Email: lauren.mizock@gmail.com
Downloaded from qhr.sagepub.com by guest on June 15, 2016

1266 Qualitative Health Research 24(9)
process of developing thoughts, beliefs, and awareness identified a number of potential facilitators of and barri-
around accepting one’s mental illness; (c) behavioral ers to this process. Facilitators of acceptance included
dimension—the process of engaging in actions and emotional and social support of family and friends.
behaviors that signify acceptance of one’s mental illness; Barriers to acceptance of disability included negative
(d) emotional dimension—the process of experiencing self-judgment, perceived social discrimination, and mis-
emotions that signify acceptance of one’s mental illness; treatment from providers. In addition, these authors indi-
and (e) relational dimension—the process of engaging in cated that added levels of chronic pain and multiple
relationships and interacting with others in a manner that disabilities might pose barriers to acceptance.
promotes acceptance of the illness (Mizock & Russinova, Inder and colleagues (2010) conducted an empirical
2014). study of acceptance of a bipolar disorder diagnosis.
Facilitators included psychoeducation, positive experi-
ences with providers, and enhanced management of
Outcomes symptoms. Barriers to acceptance included changing
Acceptance of mental illness has been associated with a diagnoses, misdiagnosis, mistreatment, mistrust toward
number of positive outcomes (Ridgway, 2001; Spaniol & providers, negative side effects, and difficulties separat-
Gagne, 1997). These included the awareness of assets, ing one’s sense of self from the diagnosis. These research-
strengthening of relationships, empathy for others, prob- ers provided some information as to the process of
lemsolving, and enhanced investment in life. An empiri- acceptance of mental illness; however, additional research
cal study constrasted outcomes of people with mental is needed to examine the acceptance of mental illness
illness who utilized higher vs. lower levels of community beyond the diagnosis alone.
services (Cunningham et al., 2005). In that study, people Roe, Hasson-Ohayon, Kravetz, Yanos, and Lysaker
with lower levels of care were more likely to have higher (2008) conducted a mixed method study to investigate
levels of acceptance of mental illness. This group also acceptance of a diagnostic label through interviews with
had higher levels of understanding of the illness, com- 64 participants with schizophrenia-spectrum disorders.
munity integration, and acceptance of the need for medi- Findings revealed several group profiles with distinct
cation adherence. Furthermore, participants with higher differences with regard to the experience of acceptance.
levels of acceptance of mental illness were more likely to The first group included participants who reported
engage in the community through working, socializing, acceptance of the illness and rejection of the diagnostic
and attending church activities. label. A second group rejected the illness label and was
searching for alternative names for their mental health
experiences. The third group reported “passive insight”
Research on Facilitators and Barriers of the illness and diagnostic label. The fourth group
Little research has been conducted to investigate the described a more integrative insight of the appropriate-
facilitators of and barriers to the process of acceptance of ness of the diagnostic label and related mental health
mental illness. Spaniol and Gagne (1997) published a experiences and symptoms. The authors did not identify
theoretical article suggesting potential facilitators and specific barriers to and facilitators of acceptance of men-
barriers. The authors theorized that acceptance can be tal illness in their study.
facilitated by effective coping and the support and accep- In a related article, Roe and Kravetz (2003) suggested
tance of others, which can promote self-acceptance. In a small number of potential barriers to insight about one’s
addition, the authors indicated that acceptance might not mental illness. In their theoretical article, the authors
occur unless one has access to the resources that are argued that insight, awareness, and recognition of one’s
needed to deal with the potential losses associated with psychiatric disorder can be developed in the form of a
mental illness. The authors also referred to potential bar- narrative or story one tells about one’s illness as opposed
riers to the acceptance of mental illness, such as shame, to a set of beliefs about one’s symptoms. The authors also
stigma, and negative self-judgment. Whereas the authors described deterrents to insight, including a pessimistic
provided valuable theory on these factors, additional prognosis associated with mental illness and feelings of
empirical inquiry is required to expand this knowledge helplessness or hopelessness.
base, specifically with regard to what particular resources Warner, Taylor, Powers, and Hayman (1989) carried
are needed for acceptance to occur. out a study with 42 participants to investigate the process
Among the few empirical studies that researchers of acceptance of a label of a psychotic disorder.
have conducted on the topic of acceptance, the focus has Acceptance of the diagnosis was associated with a sense
been on accepting a physical disability or a diagnostic of self-efficacy, internal locus of control, and enhanced
label. For example, Li and Moore (1998) conducted an functioning. In addition, a combination of internal locus
empirical study on acceptance of physical disability and of control and acceptance of mental illness contributed to

Mizock et al. 1267
better functioning outcomes; however, the authors did not divorced or separated, 16.7% (n = 5) were in a relation-
identify specific facilitators of and barriers to acceptance ship with a partner or significant other, 6.7% (n = 2) were
in particular. married, and 3.3% did not provide marital status data
(n = 1). The sexual-orientation composition of the sample
included 13% lesbian, gay, or bisexual and 87% hetero-
Rationale
sexual. In terms of educational background, 43.3% (n =
As evidenced by this literature, acceptance of mental ill- 13) completed high school, 33.3% (n = 10) finished col-
ness is a construct that holds clinical importance and lege, 20% (n = 6) obtained a graduate or professional
requires additional empirical investigation. Whereas a degree, and 3.3% (n = 1) attended some high school.
small number of facilitators and barriers have been iden-
tified within the few existing articles on this topic, a
comprehensive list and category system of the barriers to
Procedure
and facilitators of acceptance of mental illness is needed We used nonrandom sampling to select participants for
to fill this gap in the literature and inform clinical care. the study based on the aforementioned selection criteria.
In addition, researchers have previously discussed fac- We recruited participants on an ongoing basis to fill
tors in the acceptance of specific diagnoses or disabili- approximately equal groups stratified by gender and
ties, but a broader focus on mental illnesses in general is diagnosis until data saturation occurred. The first author
lacking. We conducted the present grounded theory recruited participants from the targeted psychosocial
study to enhance understanding of the barriers to and rehabilitation and education center during a phone screen-
facilitators of the process of acceptance of mental ill- ing process and conducted the interviews. The psychoso-
nesses in general. cial rehabilitation and education center provided
recovery-oriented services to individuals with serious
mental illness from the local community. These services
Method were in the form of psychoeducation-based groups (i.e.,
classes) in mental wellness and physical health (e.g.,
Participants
yoga, mindful eating, wellness, and recovery planning).
Participants included 30 individuals (15 women, 15 men) The telephone screening process involved a series of
with a serious mental illness. We recruited participants questions to see if participants met criteria for participa-
from a psychosocial rehabilitation center and screened tion. Participants received a $25 incentive for participa-
them by telephone to ensure that they were at least 18 tion in the interview. As part of the informed consent
years or older and had received mental health services for process, the first author informed participants that they
at least 5 years (to ensure that they had sufficient experi- could choose to discontinue the interview at any time and
ence with mental illness). Consistent with standard defi- would receive $10 of the $25 incentive. Per the institu-
nitions of mental illness (NIMH, 2008), we also screened tional review board approval, the first author screened
participants for a primary diagnosis of bipolar disorder participants for significant signs of psychiatric distress
(n = 9), major depression (n = 9), or a schizophrenia spec- that might require the interview to be discontinued. All
trum disorder (i.e., schizophrenia or schizoaffective dis- participants completed the full interview.
order; n = 12), with significant impairment in at least two The interviews lasted a total of 40 to 60 minutes and
areas of functioning (social, vocational, academic, and took place in a private research space within the psycho-
activities of daily living). We continued recruitment until social rehabilitation and education center from which
saturation of themes occurred, determined by consensus participants were recruited. In addition, a questionnaire
of our research team, per the standards of grounded the- was used to gather demographic information. Audio
ory methodology (Mason, 2010). Saturation is achieved recordings of the interviews were transcribed verbatim.
when little new information emerges from data analysis We received institutional review board approval prior to
(Corbin & Strauss, 2008). conducting the study. Each participant signed a consent
Participants ranged in age from 19 to 72 years (M = form to participate.
45.7, SD = 13.4). The sample included 20 European We developed the semistructured interview guide (see
American participants, 5 African American participants, Appendix A) to focus on several topics related to the
3 Asian participants, 1 Latino participant, and 1 Native acceptance process associated with serious mental ill-
American participant. With regard to immigration, 10% ness, including experiences with diagnosis, symptoms,
identified as a first-generation immigrant to the United mistreatment, identity, losses, coping, and resilience. We
States, 10% as second-generation, with 80% third-gener- reviewed, revised, and modified drafts of the interview
ation or later. With regard to marital status, 53.3% (n = protocol to enhance our ability to gather qualitative data
16) identified as single/never married, 20% (n = 6) were related to the topics of interest. The following topics were

of focus in the semistructured interview: (a) experiences macro (systemic) levels. Here we present the themes
associated with mental illness, (b) sense of self related to related to the barriers to and facilitators of the process of
the diagnosis, and (c) process of acceptance of mental ill- acceptance of mental illness.
ness. In the third stage of the research interview, the first
author invited participants to describe barriers to and
Validity
facilitators of their process of acceptance of mental ill-
ness, which is the focus in this article. We maintained data quality through a number of validity
strategies. Multiple coding of interview themes by the
three researchers allowed for comparison and revision of
Data Analysis themes to enhance validity (Barbour, 2001). We used
We used the grounded theory approach for data analysis investigator triangulation among the three authors to pro-
(Corbin & Strauss, 2008; Miles & Huberman, 1994). The vide multiple perspectives on the development of codes
grounded theory method of qualitative research is known (Guion, Diehl, & McDonald, 2011). We conducted cross-
to be the most appropriate method for building theory checking of our coding in the interview transcripts to
from qualitative data about which less is known (Corbin ensure consistency and reliability (Polkinghorne, 2007).
& Strauss), and is a fundamental method for exploring We kept memos of research team meetings and redistrib-
the multifaceted stories of people with mental illness uted the memos to research team members over the
(Hasson-Ohayon, Roe, & Kravetz, 2006; Ridgway, course of the 4 months of data analysis to record themes,
2001). Grounded theory is distinct from other qualitative key quotes from the interviews, and interpretation of data
methods in having a focus on developing theory as it to enhance reflexivity (Corbin & Strauss, 2008). Finally,
emerges from the dataset, depending on how well the we used consensus in the development of the research
data fit the conceptual categories identified by the interview, in data analysis, and when disagreement arose
researcher, characterized by a constant interchange with regard to coding themes. Consensus is a research
between data collection and analysis (Suddaby, 2006). strategy often used in qualitative research to lessen bias
Grounded theory differs from content analysis in particu- and strengthen validity (Edwards, Dattilio, & Bromley,
lar in that grounded theory categories emerge from the 2004).
data, whereas in content analysis categories are estab-
lished prior to data analysis (Willig, 2001).
Data analysis was conducted by all authors. We inde- Results
pendently read and coded a sample of five interviews Facilitators of and Barriers to Acceptance of
using a line-by-line, open-coding process. We created a
new code (i.e., category label) for each new concept that
Mental Illness
emerged from participant responses during the initial We identified a number of barriers and facilitators related
review of text. After coding this sample of interviews, we to the process of acceptance of mental illness based on
established a list of codes. Two of the coders proceeded to our coding of participant responses (see Table 1). These
recode the remaining interviews according to this code factors emerged at the individual level (micro level),
list, meeting regularly to reach consensus, established by including emotional, behavioral, cognitive, and religious
equitable discussion from each team member (Hill, Knox, and spiritual factors. Factors also emerged at the rela-
Thompson, Williams, & Hess, 2005). tional level (meso level), as well as cultural and systemic
As part of the iterative process of grounded theory, we levels (macro level).
conducted data collection and analysis simultaneously,
and modified interview questions on an ongoing basis to
Micro Level: Individual Factors
address new questions. Coding was an inductive and
reductive process; we organized the data, identified com- Emotional factors. Participants described emotional barri-
mon themes and categories, and compared similarities ers to and facilitators of the acceptance process, including
and differences in the participants’ experiences (Walker factors pertaining to feelings that interfered with or fos-
& Myrick, 2006). We conducted axial coding (Corbin & tered this process. Emotional barriers involved feelings
Strauss, 2008), and once a comprehensive list of over 100 of shame, fear, guilt, frustration, and hopelessness. For
codes was gathered from all 30 interview transcripts, we example, when asked about barriers to the acceptance
aggregated codes by relating codes to one another and process, one participant stated, “Frustration [gets in the
grouping under core themes. During axial coding, we fit way of acceptance]. Nothing’s happening. Why bother?
the emerging categories of barriers and facilitators to So, less hope.” Another participant identified emotional
Bronfenbrenner’s ecological theory (1979), with factors barriers to acceptance: “I felt guilty . . . [which made it]
occurring at the micro (individual), meso (relational), and really hard to accept depression.” A third participant

Mizock et al. 1269
Table 1. Factors in the Acceptance of Mental Illness.
Levels Factors Definitions

Micro Emotional Feelings, mood, and affect that facilitate or pose barriers to acceptance of mental illness
Behavioral Engaging in actions and activities that facilitate or pose barriers to acceptance of mental illness
Cognitive Thoughts, beliefs, and awareness that facilitate or pose barriers to acceptance of mental illness
Identity Developing a sense of self in the face of mental illness that facilitates or poses barriers to
acceptance of mental illness
Spiritual & Organizational and individual beliefs, practices, and connection to the divine or transcendent that
Religious facilitate or pose barriers to acceptance of mental illness
Meso Relational Interactions and engagement with others in a manner that facilitates or poses barriers to
acceptance of mental illness
Macro Cultural Values, beliefs, practices, and stigma associated with an individual’s demographic group that
facilitate or pose barriers to acceptance of mental illness
Systemic Health care, employment, and governmental policies and practices that facilitate or pose barriers
to acceptance of mental illness
responded to the question, “What gets in the way of something positive in this notebook.” Another participant
accepting psychiatric problems?” with the statement, stated, “I just accept it for whatever reason they feel I am
“Feeling down. When you feel down, and when you can’t diagnosis of a schizophrenic, and that I accept it for what
get a job because of past experiences and because you it is. And I take the medicine for it, and I keep current
know you’re going to be in the hospital soon anyway, so with [my mental health program].”
there’s no point.”
Many participants identified both positive and nega- Cognitive factors. Participant responses included a cate-
tive feelings as facilitating the acceptance process. For gory of cognitive facilitators of and barriers to the accep-
example, one participant described this facilitator of tance process of mental illness, referring to thoughts,
acceptance as “[f]ear. Fear of losing my stability, my beliefs, and awareness surrounding acceptance of their
home, my money, my mind, to be in control. Those things mental illness. Cognitive barriers included a lack of clar-
[made me accept it].” Emotional facilitators also included ity, difficulty thinking, or negative thinking. One partici-
hope, humor, love, and pride. In another example, a par- pant described his trouble with accepting his mental
ticipant indicated, “If I could experience certain things illness given changes in his cognition: “It can be a little
that would bring me happiness. The hope of that, that stifling when you can’t really think. It can be oppressive
could happen, gets me through the day, honestly. . . . when you can’t concentrate on things.” Some participants
Hope and acceptance. Acceptance of my illness.” defined the opposite of acceptance as a cognitive state of
denial, sometimes leading to suicidality. For example,
Behavioral factors. Participants described behavioral fac- one participant indicated, “Really what gets in the way of
tors in the acceptance process, connoting the process of accepting for me, is denial. . . . It was not healthy. And it
engaging in actions and behaviors that fostered or hin- damn near cost me my life.”
dered acceptance of their mental illness. The presence of Cognitive facilitators included recognition of needing
these behavioral factors hindered the process of accep- help, awareness of strengths or benefits to the illness,
tance. Behavioral barriers included factors such as inac- self-education, self-reflection, self-knowledge, and posi-
tivity or activities such as substance abuse. For example, tive thinking and beliefs about the illness. A participant
one participant stated, “Before [acceptance] I wouldn’t described the cognitive facilitators of the acceptance pro-
say anything; I would just sleep, sleep, sleep.” Another cess to include knowledge and awareness: “Just thinking
participant discussed barriers to acceptance: “I mean, it’s about what’s going on with me. Just knowing my issues,
hard sometimes because I’ve gone off my meds [medica- just knowing my problems, just knowing how I act on a
tions] several times. . . . So that’s part of accepting my regular basis, that I accept it.” Another participant identi-
mental illness, is being dedicated to medicine.” fied facilitators to acceptance as including cognitive
Participants reported behavioral facilitators of accep- awareness and mindfulness: “Some of the basic concepts
tance, including taking appropriate medication, mindful- of mindful awareness, and just the very basics of it. Think
ness techniques, working, and writing. For example, in the present, not in the future or the past.”
when asked about what helped the process of acceptance,
a participant described writing in a “journal of your grati- Identity factors. Participant responses also included a cat-
tude. Every day before I go to bed I have to write egory of identity-related barriers to and facilitators of the

development of a positive sense of self in the face of of the things that gets in the way of my acceptance, because
mental illness. Identity-related barriers pertained to inter- I wonder why I would have chosen to be broken.
nalizing negative identities as a mental patient: inferior,
disabled, untrustworthy, dehumanized, and dependent. Spiritual and religious factors that facilitated accep-
When asked about barriers to acceptance, one participant tance of mental illness included prayer, talking to God,
described the negative sense of self that got in the way of meditation, church attendance, developing a positive sense
acceptance: of spirituality, and feeling connected to one’s religion. One
participant described facilitators to her acceptance process
So, in terms of accepting my illness, you know, it’s like I as including “[s]pirituality and religion. Going to church.
don’t want to be put in sort of, or like discarded in terms of And right now, I’m looking for a new church home. I’ve
like, you know, I need this, I need that, I can’t do this, I have been going to different churches, looking for a good church
to do this. You know, like, I don’t want to accept that I can’t home, something I can identify to.” Another participant
move on or be successful and live a bright future. I definitely described a facilitator as including Buddhist beliefs:
don’t want to accept that.
I have accepted it a lot more than in the past . . . [through]
In addition, some participants reported a negative sense Buddhist practice. . . . It’s always about, “Okay, you’ve had
of self to the point of suicidality in the absence of accep- this setback,” and that you know that you can sort of get
tance. One participant described this experience: better again.
“Sometimes when I’m depressed, I just think I suck, and
that I’m a bad person, and I really get, ‘I shouldn’t be in
this world,’ and things like that.”
Meso Level: Relational Factors
Identity-related facilitators of the acceptance process Many participants described a number of relational barriers
included becoming and seeing themselves as compas- to and facilitators of the acceptance process, denoting inter-
sionate, a role model, an advocate, a support to others, actions and engagement with others in a manner that pro-
and a whole person beyond just a diagnosis. One partici- moted acceptance of the illness. Relational barriers included
pant described a facilitator of her acceptance process as lack of acceptance or discouragement from others: “When
being an advocate to others, indicating, other people don’t accept, of course, you as you are, it’s
really hard to accept depression.” “It’s people . . . scape-
I can speak to someone and advocate for them. That I can goating me out of a crowd or something. And then I feel
say like, “Listen, yeah, you know, listen. This is what like maybe I’m a bad person, so I don’t accept myself.”
happened to me. This may or may not be what happened to The majority of participants described relational facili-
you, so let’s talk about this.” tators, including feeling accepted by others, as well as
socializing, talking with, accepting help from, and receiv-
Spiritual and religious factors. Spiritual and religious facing encouragement from others. Other relational facilita-
tors also posed barriers and facilitators, referring to orga- tors included connecting with positive role models and
nizational and individual beliefs, practices, and doing positive things for others, such as advocating or
connection to the divine or transcendent. Spiritual and feeling compassion for others, or carrying out parenting
religious barriers included feeling punished by God, responsibilities. They described a number of interpersonal
anger at God, or mental illness stigma within one’s reli- facilitators, including support from groups, communities,
gion. One participant described religious barriers to peers, peer specialists, providers, partners, families, and
accepting one’s mental illness involving teachers. One participant described the value of connect-
ing with peers with similar mental illness experiences:
falling victim to the religious people who are just like, “All
“It’s like, you know, they have the same problems you do,
you have to do is embrace God and everything will just go
away.” Or . . . it’s something you did wrong, and God doesn’t
the same situations, and it really helps me accept myself.”
love you because of it, and so nobody needs to either. . . . Or Another participant spoke about the impact of this accep-
thinking that this is a punishment. tance from others: “To be accepted by other people is
very—helps me a lot. . . . For people to sympathize with
When another participant was asked about barriers to her me . . . [helps with] accepting who I am.”
acceptance process, she described spiritual and religious
views: Macro Level: Cultural and Systemic Factors
Some people who are New Age or Pagan believe that you’re Cultural factors. Cultural factors in the acceptance process
reincarnated. It makes me wonder why I would have chosen signified values, beliefs, practices, and stigma associated
this. That you have a choice of what your life is. . . . It’s one with one’s cultural group. These barriers included stigma

Mizock et al. 1271
related to cultural explanatory models of mental illness that Discussion

contributed to isolation from one’s cultural group. A Cape
Verdean participant described cultural barriers to his accep- A number of barriers to and facilitators of the process of
tance of mental illness: “Only thing about Cape Verdeans, acceptance of mental illness emerged from the data. At
they don’t accept people who have mental illnesses. Like, a the micro level, these were (a) emotional factors (feel-
lot of cultures understand it, but they, I think Cape Verdeans ings, mood, and affect); (b) behavioral barriers and facil-
don’t want to understand it.” Another participant discussed itators (related to actions and activities); (c) cognitive
barriers to acceptance of his mental illness that he felt origi- factors (thoughts, beliefs, and awareness); (d) identity
nated in stigma toward mental illness in his culture: “They factors (development of a positive sense of self in the
don’t accept mental health. Basically, if you’re diagnosed face of mental illness); and (e) spiritual and religious
with a mental disease, then you’re an outcast, a failure in the factors (organizational and individual beliefs, practices,
family, like married wrong, and so on.” A European Ameri- and connection to the divine or transcendent). Occurring
can participant described stigma in American culture as at the meso level were relational factors (interactions and
interfering with her acceptance of her mental illness: “In engagement with others in a manner that promoted
America you’re not supposed to be depressed, and if you acceptance of the illness). Finally, at the macro level
are you’re supposed to snap out of it, pull yourself up by were (a) cultural factors (values, beliefs, practices, and
your bootstraps.” stigma associated with an individual’s demographic
Cultural facilitators included explanatory models of group); and (b) systemic factors (health care, employ-
mental illness that were nonstigmatizing, awareness of ment, and governmental policies and practices).
stigma in one’s culture, taking action against cultural Bronfenbrenner’s (1979) ecological systems theory
stigma, and cultural community supports. One participant was applied to categorize the multiple levels at which
was asked about facilitators and identified a support acceptance of mental illness might occur. Facilitators of
group for women of color as being helpful to fostering and barriers to acceptance were organized within the indi-
her acceptance of mental illness: vidual (micro) level, interpersonal (meso) level, and sys-
temic (macro) level. These results suggest that people
Being a person of color, it’s not something that’s culturally with mental illness can work on self-acceptance at the
talked about. So, that’s how [this group] got started, as a way individual level, but are also impacted by factors in
to get people in touch with mental health services and to get acceptance at the interpersonal and systemic levels.
people to actually take care of themselves. Participants described the acceptance process as not
only involving self-acceptance, but also involving feeling
Systemic factors. Systemic factors in the acceptance pro- accepted by others. This finding supports previous empha-
cess included barriers to and facilitators of acceptance of sis on acceptance of people with mental illness among
mental illness at the broader, institutional level, such as members of the public (Angermeyer, Holzinger, Carta, &
health care, employment, and governmental policies and Schomerus, 2011; Karp & Tanarugsachock, 2000; Lauber,
practices. One participant described barriers to include Nordt, Sartorius, Falcato, & Rossler 2000). Our results
“stigma, the media, maybe old-school psychiatric pro- indicate that one’s acceptance of mental illness can be
cesses that aren’t really focused on recovery.” Another facilitated by acceptance from other people and systems
participant described work barriers: (i.e., family, partners, therapists, community, culture,
media, and organizations). These results are supported by
If I were turned down on [a work] application, I’d feel bad the psychiatric rehabilitation literature, which emphasizes
about it. . . . They don’t really say that that’s the reason, but the importance of natural supports and one’s relationships
sometimes they imply it though. So, they want me to be with providers in fostering recovery from serious mental
healthy at work, and I hope to be healthy at work. illness (Anthony, Cohen, Farkas, & Gagne, 2002; McCabe
& Priebe, 2004). Moreover, findings with regard to sys-
Systemic facilitators of the acceptance process included
temic factors in acceptance correspond to positive psychol-
institutional supports such as health insurance, financial
ogy theory. Researchers in the positive psychology field
resources for people with mental illness, a supportive
have discussed a “group-level” factor in well-being, in
mental health system, and vocational rehabilitation sys-
which institutions play a key role in promoting happiness
tems. One participant described systemic facilitators:
and life satisfaction (Seligman & Csikszentmihalyi, 2000).
I’m seeing a lot of organizations and programs that are The findings presented in this article related to public
more recovery-oriented now. And I think that’s what’s and personal acceptance highlight the impact of stigma
really made me get better. Because they’re focusing on on the acceptance process. Participants reported feelings
daily living and just getting better and having a meaningful of shame, rejection by others, cultural stigma, and lack of
life, and having a social network, you know? inclusion in institutional sectors as interfering with their

own acceptance process. Previous literature has indicated instilling hope; providing interpersonal, vocational, and
that because of stigma, many people with mental illness community supports; counteracting stigma; and emphasiz-
do not seek treatment (Cooper, Corrigan, & Watson, ing strengths and well-being (Farkas & Anthony, 2010;
2003). Additionally, research has indicated that people Slade, 2010). These approaches can address the emotional,
with mental illness face stigma by medical and mental relational, and systemic facilitators of the acceptance pro-
health professionals and in their interpersonal social net- cess. Clinicians can provide culturally responsive mental
works (Corrigan, 2004). The present findings add to this health care by developing a sensitivity to the cultural fac-
literature, suggesting that stigma can interfere with self- tors that might contribute to the client’s acceptance process
acceptance of mental illness across individual, relational, (Ida, 2007; Mizock & Russinova, 2013). They can explore
cultural, and systemic levels. cultural factors in acceptance with their clients and connect
them to relevant resources in the community so clients can
feel more supported within their cultural network.
Clinical Implications Acceptance and commitment therapy (ACT) is another
A number of clinical implications emerge from these approach that has demonstrated effectiveness for people
findings. For one, facilitators and barriers were found at with depression and symptoms of psychosis (Montgomery,
the individual level with regard to identity-related fac- Kim, & Franklin, 2011). Specifically, ACT is a mindful-
tors. This finding suggests that providers can work with ness- and acceptance-based approach that can be utilized
people with mental illness at the individual level to to target cognitive, behavioral, and emotional barriers
facilitate acceptance by promoting a positive sense of and facilitators in the acceptance process. Family therapy
self in the face of mental illness. This identity process and psychoeducation have also been empirically sup-
can be encouraged through the recognition of strengths, ported in mental illness treatment (Dixon, Adams, &
as well as the protection and preservation of a positive Lucksted, 2000; Karp & Tanarugsachock, 2000).
sense of self despite the challenges of the illness. These Providers can use this approach to address relational
findings also reinforce positive psychology research, facilitators in the acceptance process and help clients to
which has underscored the importance of therapists overcome relational barriers.
learning about the goals of people with mental illness
and utilizing their strengths to promote recovery and
Limitations and Future Research
well-being (Slade, 2010). Clinicians can address ambiv-
alence toward mental illness to facilitate added levels of Whereas the qualitative focus of the study warranted a
acceptance and help to integrate a positive sense of self. smaller sample size, this research would benefit from rep-
Therapists might inquire about the client’s attitudes lication with a larger sample size using quantitative mea-
toward him- or herself and mental illness, and explore sures to evaluate and extend results. We recruited
the associated impact on acceptance. Therapists can participants from one site, limiting generalizability of the
challenge negative self-attributions, and reinforce posi- data; additional investigation should be conducted in
tive and constructive self-perceptions. other regional locations. Another limitation of the study
In addition, providers might work with clients to iden- was our nonrandom selection process, which included
tify cognitive, emotional, behavioral, and spiritual/reli- individuals who were participating in a service setting.
gious strategies to facilitate acceptance. Clinicians can As a result, the participants in our study might have had
recognize that clients might face barriers to acceptance of higher levels of acceptance given that they were seeking
mental illness that result in denial, a lack of self-advo- care. Furthermore, the education level of participants was
cacy, and even suicidality. Given the findings regarding somewhat high in our sample, which might limit general-
relational and systemic factors in acceptance, clinicians izability. Finally, although we agreed by consensus that
can be sensitive to the ways in which a client’s relation- saturation had occurred, it is always possible that data
ship to his or her therapist, family, community, work- analysis with additional participants could lead to identi-
place, culture, and government might interfere with or fication of additional content (Mason, 2010).
facilitate the acceptance of mental illness. Specifically, Research to investigate cultural and gender differ-
therapists can investigate the nature of these relation- ences in the acceptance of mental illness would be benefi-
ships, systems, and supports in the client’s life, and help cial, and this research is underway (Mizock & Russinova,
to bolster and add to his or her support network. 2014). An acceptance scale can also be created to identify
Clinicians can consider utilizing a number of estab- barriers to and facilitators of the acceptance process. This
lished therapeutic approaches to facilitate the acceptance scale can assist researchers with identifying associated
process for people with mental illness. With a recovery- variables that facilitate this process and improve clinical
oriented and positive-psychology approach toward outcomes. Finally, tailoring a specific intervention to
mental illness, providers can facilitate acceptance through enhance acceptance of mental illness would apply this

Mizock et al. 1273
research directly to clinical settings. This might include

adapting the ACT model (Montgomery et al., 2011) to 2. Next, I’d like to talk with you about psychiatric
specifically enhance acceptance of mental illness. problems and how you think of yourself.
Otherwise, future research could involve the develop-
ment of a new intervention to be used within the context a. How have you been thinking of yourself
of therapy or in other treatment settings to facilitate since your diagnosis?
acceptance of mental illness. b. Have there been changes in your sense of self
since your diagnosis of this illness?
c. Some people describe that as a result of their
Conclusion experiences with the illness, they think of
In sum, providers can facilitate the cognitive, emotional, themselves or are treated like a mental
behavioral, spiritual/religious, and identity-related factors patient. Can you tell me if this is something
in the acceptance of mental illness at the micro level. Our that has come up for you or not?
findings have clarified the importance of relational and
systemic supports at the meso and macro levels to support 3. Finally, I’d like to talk with you about learning to
acceptance of mental illness. A central finding in this live with your psychiatric condition.
research was that acceptance of mental illness should be
viewed as not just an internal process but as a societal pro- a. Do you feel people can accept their psychiat-
cess because of barriers related to mental illness stigma ric problems?
and lack of public acceptance. Therefore, acceptance of b. What does acceptance of your psychiatric
mental illness is not simply an individual endeavor, but one disability mean to you?
that involves the effort of the larger community. Consumers, c. How much do you feel you’ve been able to
clinicians, peers, and other advocates can engage in activ- accept your psychiatric problems?
ism for policy changes to promote acceptance of mental d. What has helped you to work on accepting
illness among individuals and the general public. your psychiatric problems?
e. What gets in the way of accepting your psy-
chiatric problems?
Appendix A: Semistructured f. Some people feel like living with psychiatric
Interview Questions problems has brought loss to their life. Do
Instructions you feel that way?
g. How have you dealt with losses related to
The reason for this interview is to have a conversation your psychiatric problems?
about issues of mental health and your sense of self.
Please feel free at any time to let me know if there are any Declaration of Conflicting Interests
questions you have for me. The authors declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
1. I’d like to talk with you about your experience of article.
your diagnosis.
Funding
a. When were you first given a diagnosis of a
The authors disclosed receipt of the following financial support
psychiatric problem? for the research, authorship, and/or publication of this article:
b. What was the diagnosis that you were given? This research was funded by the National Institute of Disability
c. Many people report that they have been given and Rehabilitation Research Advanced Rehabilitation Research
many diagnostic labels over the years. Has Training Program in Psychiatric Rehabilitation (CFDA No.
this been your experience? 84.133P).
d. What has it been like to be diagnosed with a
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International Journal of Academic Research in Business and Social Sciences
Vol. 8 , No. 12, Dec, 2018, E-ISSN: 22 22 -6990 © 2018 HRMARS
Issues and Challenges of Mental Health in Malaysia

Mohd Faizul bin Hassan, Naffisah Mohd Hassan, Erne Suzila Kassim and
Muhammad Iskandar Hamzah
To Link this Article: http://dx.doi.org/10.6007/IJARBSS/v8-i12/5288 DOI: 10.6007/IJARBSS/v8-i12/5288
Received: 13 Nov 2018, Revised: 06 Dec 2018, Accepted: 30 Dec 2018
Published Online: 31 Dec 2018
In-Text Citation: (Hassan, Hassan, Kassim, & Hamzah, 2018)

To Cite this Article: Hassan, M. F. bin, Hassan, N. M., Kassim, E. S., & Hamzah, M. I. (2018). Issues and Challenges
of Mental Health in Malaysia. International Journal of Academic Research in Business and Social Sciences,
8(12), 1685–1696.
Copyright: © 2018 The Author(s)

Published by Human Resource Management Academic Research Society (www.hrmars.com)
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Issues and Challenges of Mental Health in Malaysia

1
Mohd Faizul bin Hassan, 1*Naffisah Mohd Hassan, 1 Erne Suzila
Kassim and 1Muhammad Iskandar Hamzah
1
Faculty of Business and Management, Universiti Teknologi MARA Cawangan Selangor,
Kampus Puncak Alam, 42300, Selangor, MALAYSIA
Email: *naffi885@puncakalam.uitm.edu.my
ABSTRACT
Mental health disorder is no crime. It needs treatment, not stigma it’s a global alarming where the
number of people who suffering with mental health illness keep increasing. Mental health problems
are one of the main causes of the overall disease burden worldwide. Mental health illness is a major
community health concern where depression and anxiety name as the two most common mental
illness. Furthermore, depression is a leading cause of disability worldwide. Mental disorders
represent a major contributor to disease burden worldwide it also affects to the economic burden.
Most people have bad stigma towards this issue. Mental health conditions are treatable.
Nevertheless, mental illness can affect anyone regardless of the age, income, social status, race
ethnicity, religion/spirituality, background or anything others aspect of culture. The issues and
challenge of mental health in Malaysia is explored as to give a big picture of the current situation that
happen today. Therefore, it raises the question on how the mental health issues can solve as to
reduce the statistic and improve their quality of life. In this paper, a case study was conducted to
gather insights from community their understanding regarding the issues and challenges of mental
health in Malaysia.
Keywords: Mental Health, Mental Ill, Global Burden
INTRODUCTION
Mental health disorder is a great public health concern throughout the world. It became an integral
part of Sustainable Development Goals agenda to transform the world by 2030. It contributes to a
substantial proportion of health problems in most countries Mental Health issues are expected to be
major problems among Malaysians. Mental health problems are among the most important
contributors to the burden of disease and disability worldwide. The global burden of mental health
disorders is a significant of public health issues (Organization, 2017). Mental illness is a major source
of loss of productivity and wellbeing as mental health is essential for economic development.
Generally Mental health is the condition which is its influenced mind in dealing the daily activities. It
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also determined on how people handle the stress and how the individuals relate to others and how
to make choices (mentalhealth.gov, 2017).
The World Health Organization (WHO) (Organization, 2013) defines the Mental Health as a state of
wellbeing in which the individual realizes their own abilities to cope the level of stresses of life which
is can be productively and fruitfully and ability to make contribution to their community from the
Malaysia landscape the Ministry of Health (1997:2) has defined of the capacity of the Individual, the
group and environment to interact with one another r to promote subjective well-being and optimal
functioning, and the use of cognitive, affective and relational abilities, towards the achievement of
individual and collective goals consistent with justice”
In Malaysia, the National Health and Morbidity Survey, conducted by Ministry of Health (MOH),
indicates that the prevalence of mental health problems among people aged 16 years and above was
29.2% as approximately 4.2 million. From this figure it shows that one in three Malaysian has
experienced the mental health problems. The current situation is very worrying as the findings
indicates that twofold increase for the reported cases related to the mental health problem over the
past 10 years of 10.6% in 1196 and 11.2% in 2006. The sufferers of mental health problem may bring
about devastating impact towards their self and tends to develop suicidal behavior. The proper
assistance and guidance need to be provided to them. (Rotenstein et al., 2016) In other words,
mental health problems are commonly higher among younger adults, with adolescents aged 16 to 19
(34.7%), followed by those aged 20 to 24 (32.1%), and those aged 25 to 29 (30.5%) (Ahmad et al.,
2015)
LITERATURE REVIEW
Mental Health in Malaysia
Malaysia's Ministry of Health (KKM), recently has been reported that one in three of the country's
adults are at risk of developing a mental health problem for the last 5 years (Health, 2011). Mental
illness is expected to be the second highest form of health problem after heart disease by 2020 (Lee
& Lai, 2017). Generally, mental health is related to the depression, anxiety and stress. By the year
2020, mental health issues are expected to be major problems among Malaysian. According to the
National Health and Morbidity Survey 2015, it is indicated that mental illness is expected to be the
second biggest health problem affecting Malaysians after heart diseases by 2020 and every 3 in 10
adults aged 16 years and above (29.2%) have some sorts of mental health problems. The Health
ministry statistics revealed of increasing number of mental health problems. The workplace is one
of the key environments that affect our mental wellbeing and health. In other hand some research
has been proved the mental health among students also keep increasing yearly (Zivin, Eisenberg,
Gollust, & Golberstein, 2009).
Challenges on Mental Health

There are many challenges towards on mental health in Malaysia especially Public Attitudes
towards Mental illness (Yeap & Low, 2009) indicates that 62.3% of the mental illness sufferers would
not let others know about their conditions, meanwhile 61.0% believed sufferers are not to be blamed
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for their own conditions and 51.7% believed that people with mental illness are often dangerous and
violent. Vast of majority 76.5% of respondents don’t believe that anyone can suffer from mental
health problems. Stigma and beliefs also to be the main factors that contributing of challenges as it
is dominated by religious or spiritual explanation like demon possession. Malaysia comprises three
main ethnic groups: Malays (61.7%), Chinese (20.8%) and Indians (6.2%). These ethnic cultural has
brought a different definition of mental health” that may different perspective on what the mental
health really is.
As a matter of fact, the demands of living nowadays drive to the causing of depression, anxiety
and other mental health problems. Unemployment, financial crisis, marital problems, drug abuse
and surrounding factors that could have contributed to the twofold jump in mental cases in Malaysia
over the last 10 years. (Chowdhury, Islam, & Lee, 2013). Furthermore, the prevalence of mental
health problem is highest among teenagers and low-income earners. The demands of living in
current times are causing depression, anxiety and other mental health problems in young people.
From this study its revealed most of the respondents not familiar and well understand the term of
mental health especially the definition of mental health illness.
Table 1. Definition of terminology of Mental Health. (Source: The National Institute of Mental Health
(NIMH).
Type Definition
Schizophrenia A severe mental disorder that appears in late adolescence
or early adulthood. People with schizophrenia may have
hallucinations, delusions, loss of personality, confusion,
agitation, social withdrawal, psychosis and/or extremely
odd behavior.
Manic Disorder Manic disorder is characterized by extreme and
unpredictable mood changes in the sufferers
Bipolar Disorder A disorder that causes severe and unusually high and low
shifts in mood, energy, and activity levels as well as
unusual shifts in the ability to carry out day-to-day tasks.
(Also known as Manic Depression)
Depression Lack of interest or pleasure in daily activities, sadness and
feelings of worthlessness or excessive guilt that are severe
enough to interfere with working, sleeping, studying,
eating and enjoying life.
RESEARCH METHODS
Research Design
Since the aim of the research is to gain insights and capture the richness of the key issues and
challenges, a case study via sets of interviews was conducted. The method is believed to provide
empirical inquiries that investigate the contemporary phenomenon. Furthermore, the purpose and
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focus of the method is to describe the meaning, provide deep understanding, and interpretation of
the textual information derived from the interviews. In order to gain a holistic comprehension and
reflection, the interviews were conducted with the key stakeholders; health professionals, working
adults who used to suffers with mental health disorders, and healthy adults. Participants that
represent the three different groups were selected based on purposive sampling strategy.
Unstructured interviews were conducted that allows for probing the answers for more input. In
addition, by using the interview technique, the respondents had the freedom to discuss the issues on
a broader topic. Therefore, even though the aim of the study was to get insights of the key issues and
challenges of mental health, we started by asking about the mental health in general. Once the
respondents provided their feedback, we probe further by asking “why”, “how” and “what”.
Respondents Background
Unique purposeful sampling method was applied in this study. The research was interested to
understand the issues and challenges of mental health from the viewpoint of the society. Therefore,
purposeful sampling was appropriate assuming that researcher wants to discover, understand and
gain insight about the topic; thus selecting sample (which will now then been referred to as
“informant”) from which can be learned is crucial.
The informants were selected based on unique sampling, that referred to selection of sampling based
on their unique and atypical attributes, whom the researcher believes were able to provide honest
answers that will relevantly answering the research questions and assisting in achieving research
objectives. Through a personal contact, 10 informants (2 health professionals, 3 working adults who
used to suffers with mental health disorders, and 5 healthy adults) had been approached and
interviewed. They were chosen as the informants due to their profile that met the criterions set by
the researchers.
RESULTS AND DISCUSSION

The data was analyzed by following the constant comparison method. This was highlighted by Boeije
(2002) that the aim of the constant comparison method is to discover the concepts. There were four
phases involved namely, exploration, specification, reduction and integration. Following Corbin and
Strauss (2014) three coding processes of open, axial and selective were adhered to in the exploration
phase. The validation of the findings was achieved by getting the participants’ approval on the
narrative summary. The findings suggest for the following challenges and issues: lack of awareness
and ignorance, stigma, policy insurance, rising trend of mental illness, work-related stress and
negative economic impact. The summary of the findings is presented in the figure below.
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The summary of the findings is presented in the figure below.

Fig 1. Summary of key findings
No Theme Sub-theme
1 Challenges 1.1 Lack of Awareness and Ignorance
1.2 Stigma
1.3 Policy Insurance
2 Issues 2.1 Rising trend of Mental Illness
2.2 Work-related Stress
2.3 Negative Economic Impact
Detail discussion of the key findings are presented here
Challenges
The issues of mental health landscape have been spotlighted as critical issues due the number of
mental illness keep increasing year by year. there is an urgent need to further enlighten by
government and society to take this as serious matters as it give impact to the economic burden as
stated by (Teoh et al., 2017). The economic burden associated with Schizophrenia (SCZ) as substantial
and mainly attributed to productivity loss
Lack of Awareness
Many of the respondents believe that the issue of mental illness is something that is not being given
enough exposure and attention in the mass media space. Some of them pointed out that it might be
due to complacent behaviour of the mental health sufferers. These people might have experienced
certain levels of cognitive dissonance within themselves, in the sense that they would not admit
themselves suffering from mental illness despite the obvious symptoms.
Lack of awareness about the mental illnesses poses a challenge to the mental health issues. Mental
illness literacy is the knowledge and belief that recognized mental illness problems. A research by
(Kaur et al., 2014) revealed that almost one in five Malaysian adolescents are depressed. One reason
for this condition is because the insufficiency of knowledge about psychiatric illness and treatment
options for those illnesses (Loo & Furnham, 2012). (Brown, Harris, & Russell, 2010) With the proper
mental health awareness campaign, it can be promising the positive outcomes which is can enhance
the mental health literacy which is increasingly the awareness and knowledge of the mental health
disorders. Generally, the definition of health literacy can been described as “ability to access ,
understand to use the information as to promote and maintain good health (Bull, Schipper, Jamrozik,
& Blanksby, 1997). By having mental health literacy, it believes that people have basic knowledge
when they suffer or facing the symptoms. They will attempt to manage those symptoms.
Globally, it is stated that more than 70% of people with mental illness did not receive treatment from
health care staff. (Henderson, Evans-Lacko, & Thornicroft, 2013). The public needs to be equipped
with sufficient knowledge about mental illness it believes it can ensure the people with minor or
major symptoms will get a proper treatment that they need. Some of the respondents highlighted
the conservative attitude of family members of mental health patients, in the sense that they are
1690
hesitant in seeking proper medical solutions. Lack of knowledge of identify the features of mental
illness and ignorance about the access treatment, prejudice against people who have mental illness.
This reason is most people to avoid the treatment and delays for care. Generally, the factor of poor
understanding of mental illness and level of mental health knowledge associated with the mental
health increasingly (Yeap & Low, 2009).
Stigma
Stigma is a negative perception that created prejudice which leads to stereotype and discrimination
among a group of people. More over from the mental illness perspective, Stigma has been identified
as a significant barrier to help-seeking and care. The cultural context also important when studying
element of beliefs regarding mental health. The cultural by ethnic background has brought a different
definition of mental health. The concept of mental health amongst Malays defined by heredity,
periodicity, congenital, brain stain, stress, conditioning and resistance (Razali, Khan, & Hasanah,
1996). In Malay culture, vital parts in mental health including with the spiritual and religious factors.
Several respondents also noted that people with mental illness would commonly be referred to
religious practitioners or shamans, rather than medical professionals. Generally, they agreed that
people especially Malays have the tendency to associate mental illness with the term ‘gila’ (insanity)
or ‘sakit jiwa’ (illness of the soul). Rather than a scientifically proven symptom, mental illness is
commonly viewed as a supernatural phenomenon. A large part of the Malay society believe that
mental illness come from spirit possession or as a social punishment (Deva, 1995). The culture itself
have strong influence in Malay society as the general concept of mental illness is an outcome of
abandoning or neglecting traditional values(Haque & Masuan, 2002).
Malay population which is represent as the largest race in Malaysia often associated mental illness
with the supernatural causes, God punishment, and excessive mental exertion (Khan et al., 2010)
Similarly with the Malay culture, the Chinese concepts of mental health also influenced by the
traditional Chinese medical beliefs based on Confucianism and Taoism (Yip, 2005) where these
principles refer to the concepts of Yin and Yan as the symbol of life. Most of the Chinese believe that
imbalance of the Yin-Yang can cause to the mental illness. (Yip, 2005) comparatively to the Indian
believe the concept of mental health amongst Indian is centralized to the concept of the mind body
dichotomy(Wig, 1999) Whereby it indicates the four aims of life “Dharma”, “Kama”, “Artha” and
“Moksha”. Indian believe that who have suffers with the mental illness problems is cause of
imbalance of these four elements. As can been seen the elements of the cultural sensitivity of the
different faiths and belief systems are deeply influenced by the culture and religious.
This situation may be associated with society in taking traditional way in treating mental illness. There
are numerous studies that investigate about the relationship between mental health and religious
belief (Campus, n.d.) The stigma itself from community and policy makers looking at mental health
with low regards
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Policy Insurance
A number of respondents remarked on the ambiguous coverage of the existing healthcare policies.
Historically, the insurance policies that provided by insurance company did not include mental health
services until after World War II, in this prior time the insurers start to cover some of the psychiatric
care in the policies. Most of the insurance company did not recognise mental illness part of critical
ill that need to be cure by provided proper treatment. Recently insurance schemes do not adequately
address the needs of persons that being suffering with mental illness. Standard health insurance
policies do not cover for the pre-existing conditions including mental illness. This situation leads to
discourage of people seeking the proper treatment as of mental illness that they are suffering as they
do not want tarnish the medical records.
In the Long run, there are several positive implications towards of the inclusion of the mental health
insurance coverage in the policies as the mental health benefits legislation has been found to have
positive association with the increased access to care, increased diagnosis of mental health
conditions. As a result it leads to the reduced of the prevalence of poor mental health and reduced
of the suicide rates. (Lang, 2013). As a result, mental health insurance will facilitate medical care for
mentally ill and improve their outcomes, benefitting the society in the long-term.
Issues
There are several issues on mental illness that are captured and triangulated from the interview
transcripts. These include their anxiety towards the rising trend of mental illness, the widespread
phenomenon of work-related stress, and the negative economic impact associated with mental
illness.
Rising Trend of Mental Illness

Many of the respondents felt that there is an increasing trend of mental illness among Malaysians.
Nevertheless, since its considered as a taboo, people who suffer from it are deemed hesitant to
discuss it openly. Malaysians, just like other Asians, are known to have a lesser degree of openness
as compared to their western counterparts. Hence, anxiety towards social desirability and negative
connotations associated with mental illness are thought as the barriers for these patients to disclose
their symptoms to medical professionals. The respondents believe that a typical Malaysian would
perceive the risk of potential embarrassments from their social circles to outweighs the benefit
derived from medical and psychological consultations. Therefore, Malaysians are thought to be highly
sensitive and conservative regarding the mental health issue. The respondents relate the negative
outcomes of this phenomenon into recent suicidal cases that they believed should be blamed on
work-related factors.
According to the Health Ministry’s 2015 National Health Morbidity Survey (NHMS) statistics, its
indicated the increasing number up to 4.2 million Malaysians over 16 years old illustrated as around
30 percent of the segment were experienced some form of mental illness. In 2006, it was just showed
only 11.2 per cent. This is extremely alarming as there is not enough awareness on mental illnesses.
The increasing of mental health illness conditions can cause of a high direct and indirect costs that
1692
contribute to the impact quality of life and wellbeing affected people. The most reason that indicated
of increasing number of mental health cases is related to the financial constraints, family and career
problems. In terms of financial it can be the problems to manage the failing to pay bills due to the
financial difficulties. Some point of views the financial constraint leads the person to isolate their self
and lack of support due the inability to participate in social activities
Work-related Stress
Nowadays, the issues of mental health are increasingly prevalent in the workplace. This is
unsurprising since mental health is considered as one of the contributing factors towards individual’s
overall health status. Poor mental health is associated with the higher absence and presenteeism
rates. The contribution of job control to absence is greater for those in poor mental health (Bubonya,
Cobb-Clark, & Wooden, 2017) . Moreover, the occupations itself known to be associated to the high
risk of mental illness. Obviously, the working environment that related to the highly challenging are
more at risk contributes to the mental illnesses compared those who feel their working environment
less challenging. There is another side of this where organization should put priority into mental
health issues in the workplace as an integral component of employees’ wellbeing. Majority of
respondents felt that mental illness can build up slowly in a subconscious manner due to prolonged
stress from the workplace.
Mental health problems have an impact to the employers and businesses directly by the issues of
increased absenteeism and negative impacts on the productivity and profits (Rajgopal, 2010). Mental
health illness contribute to the loss of productivity (Kessler et al., 2009). Additionally, according to
the World Health Organization (WHO), Mental health disorders cost the global economy $1 trillion
from the loss of productivity a year, whereby the depression being the leading cause of the mental
illness. Conversely, by having Positive mental health it allows people to realize their full potential,
cope with the stresses of life, work productively, and make meaningful contributions to their
communities. Therefore, highlights should be given to mental health and wellness to improve
individual potential and increasing work performance.
Negative Economic Impact

In general, the respondents have expressed their concerns on the negative economic impact as a
consequent from the widespread mental illness suffered by Malaysians. In this regard, Malaysia is
not an isolated case since mental illness are recognized as a global problem that affects the
productivity and socio-economic conditions of that country. Besides, the respondents acknowledge
that mental illness can directly affects business owners in terms of potential revenue lost due to
absenteeism and subsequent reduction in productivity levels.
The Issues of mental health is a global issue as indicates as 12% part of global burden disease. By the
year 2020 they will account for nearly 15% of disability-adjusted life-years lost to illness. In the other
hand, mental disorders affect the level productivity as it is related to the economy impact due to
treatment cost. Apart of the burden to the personal itself, it can be affect to the economic itself where
the labour supply losses Canada Economic burden of mental illness shows that estimated around $51
billion per year as to cover the health care costs, loss of productivity and reductions in healthy related
1693
quality of life (Smetanin et al., n.d.). Mental disorders imposed a huge economic burden on
individuals and the society in China (Xu, Wang, Wimo, & Qiu, 2016).
CONCLUSION AND RESEARCH IMPLICATIONS

The findings of the study provide the evidence for the key issues and challenges of mental health
issues in Malaysia. Mental illness can affect to every part of a person’s life, including their physical
health, occupation, family and social life and relationships. The results and the experience of this
study clearly stated the mental health issues in Malaysia landscape is an urgent need to further
enlighten by government and society to take this as serious matters. The government should
highlight the mental health issue as country agenda as increase in funds for the Health Ministry to
implement and execute more anti stigma campaigns aiming to develop a positive healthy public
attitude in relation
The results of this study also revealed that mental health is common and can affect anyone without
age, race boundaries. Greater awareness about mental health and early diagnosis can reduce the
statistic of suffering from mental health related problems. Nevertheless, there is room for
improvement for the findings and methods to do future research.
Acknowledgment
The authors gratefully acknowledge the help of Universiti Teknologi MARA in providing the Research
Grant Scheme Fund (Project Number: 600-IRMI/MYRA 5/3/BESTARI (038/2017) and Faculty of
Business and Management for supporting the research work.
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 2006 Adis Data Information BV. All rights reserved.
Media Portrayal of Mental Illness and

its Treatments
What Effect Does it Have on People with Mental Illness?
Heather Stuart
Department of Community Health and Epidemiology, Abramsky Hall, Queen’s University,
Kingston, Ontario, Canada
Abstract This article reviews dominant media portrayals of mental illness, the mentally
ill and mental health interventions, and examines what social, emotional and
treatment-related effects these may have. Studies consistently show that both
entertainment and news media provide overwhelmingly dramatic and distorted
images of mental illness that emphasise dangerousness, criminality and unpredict-
ability. They also model negative reactions to the mentally ill, including fear,
rejection, derision and ridicule.
The consequences of negative media images for people who have a mental
illness are profound. They impair self-esteem, help-seeking behaviours, medica-
tion adherence and overall recovery. Mental health advocates blame the media for
promoting stigma and discrimination toward people with a mental illness. Howev-
er, the media may also be an important ally in challenging public prejudices,
initiating public debate, and projecting positive, human interest stories about
people who live with mental illness. Media lobbying and press liaison should take
on a central role for mental health professionals, not only as a way of speaking out
for patients who may not be able to speak out for themselves, but as a means of
improving public education and awareness. Also, given the consistency of
research findings in this field, it may now be time to shift attention away from
further cataloguing of media representations of mental illness to the more chal-
lenging prospect of how to use the media to improve the life chances and recovery
possibilities for the one in four people living with mental disorders.
1. Background of negative imagery with some of the most malig-

nant depictions of madness and horrifying illustra-
The media have produced some of the most sen-
sitive, educational and award-winning material on tions of psychiatric treatments. The fact that the
mental illness and the mentally ill. However, they latter greatly outweighs the former, and is more
have also been responsible for creating a vast store memorable, is of immense concern to people with
100 Stuart
mental health problems, their family members and Television portrayals do little to convince the
mental health professionals. viewing public that people with a mental illness can
This article reviews key issues relating to fiction- recover or become productive members of society.
al and non-fictional media portrayals of mental ill- Mentally ill characters are frequently portrayed as
ness and highlights the social, emotional and treat- disenfranchised with no family connections, no oc-
ment-related effects these may have for people with cupation and no social identity.[6] Even the camera
a mental illness. The role of the media as allies in shots used to film mentally ill characters differ from
anti-stigma activities will also be discussed in order those used to film other characters. Mentally ill
to promote greater awareness of the importance of characters are usually filmed alone with close-up or
advocacy in the field. Articles highlighted in this extreme shots, reinforcing their isolation and dislo-
paper have been selected to illustrate dominant cation from the other characters and from the com-
themes, provide interesting examples and draw at- munity. In one instance where it was possible to
tention to key issues. No attempt is made to provide follow a character through an episode of mental
a comprehensive listing, synthesis or critical review illness, the differences in photographic technique
of all publications in this area. Consequently, de- disappeared as the character recovered.[3]
tailed recommendations for future research or policy
Movies such as The Snake Pit and One Flew
reform are not made.
Over the Cuckoo’s Nest have also dramatised the
oppressive and inhuman effects of psychiatric treat-
2. Fictional Portrayals of Mental Illness in ments.[7] Early images of forced confinement, elec-
the Entertainment Media troshock and psychosurgery horrified audiences and
cast serious and lasting doubts upon the nature of
psychiatric treatments and the motivation of psychi-
Denigrating fictional images of mental illness is
atric professionals. Whether for grim or for comic
both frequent and potent. In the US, one-fifth of
effect, the mental health field has been consistently
prime time programmes depict some aspect of
portrayed as a place where unbalanced and malevo-
mental illness and 2–3% of the adult characters are
lent individuals thrive.[8]
portrayed as having mental health problems.[1,2] One
in four mentally ill characters kill someone, and half Stigmatising portrayals of mental illness also find
are portrayed as hurting others, making the mentally clear expression in children’s television. For exam-
ill the group most likely to be involved in vio- ple, in New Zealand, almost half of all programmes
lence.[1] The offence rate of mentally ill characters aimed at children <10 years of age contain one or
with speaking parts is 10-fold that of other television more references to mental illness.[9] Mentally ill
characters (30% vs 3%, respectively). Mentally ill characters are portrayed as objects of amusement,
characters are also victimised more often than other derision and fear; and a host of disparaging terms
characters, although this may have declined over link mental illness to a loss of control. The generic
time in favour of more violent portrayals.[1-4] Over- nature of mental illness portrayed in children’s tele-
all, mentally ill characters are portrayed as signifi- vision – lacking specific symptoms or diagnoses –
cantly more violent than other characters and signif- invites negative generalisations to all mentally ill
icantly more violent than real people with a mental people.[9] Similar negative and stereotypical images
illness.[2] The message that mental illness causes are found in Disney animated films.[10] The majority
violence has been consistent since the early days of (85%) contain verbal references to mental illness
television.[5] and 21% of all principal characters are referred to as
 2006 Adis Data Information BV. All rights reserved. CNS Drugs 2006; 20 (2)
Media Portrayal of Mental Illness and its Treatments 101
mentally ill – a higher prevalence of mental illness sures that a steady diet of these real-life incidents
than in children’s television programmes. Similar to will be available to the viewing audience. A single
their television counterparts, mentally ill film char- dramatic event (or a cluster of events) has the power
acters are the objects of fear, derision or amusement; to overshadow positive news stories and anchor
and verbal references to mental illness are used to deep-seated cultural fears.[22,23]
denigrate, segregate, alienate and denote another News items also reinforce cultural stereotypes by
character’s inferior status. using them to provide the context for ‘factual mater-
ials’ presented. Stories are written in such a way that
3. Mental Illness in the News they require the reader to employ negative cultural
stereotypes and common sense understandings of
The journalist’s job is not to tell the news, but to
what it means to be mentally ill, to interpret story
sell the news. A good story catches public attention
material and co-create the message.[17,24,25] Narrative
either by focusing on conflict and controversy or by
‘frames’ containing a standard set of propositions
raising issues of public safety – all perspectives that
(or script) are routinely used to transform neutral or
may place journalists in direct conflict with mental
sketchy information into easily recognisable stereo-
health advocates.[11] News media, particularly news-
types.[18,24,26] Audiences recognise the frames and
papers, are among the most frequently identified
fill in the gaps. In this way, deliberately sketchy or
sources of mental health information. This gives
generic depictions implicitly link mental illness to
them great scope to dispel inaccurate and stigmatis-
violence by encouraging audiences to draw on pre-
ing stereotypes perpetuated in the entertainment me-
existing stereotypes to this effect.[17,18,25,27] While it
dia or to reinforce and amplify them. Consequently,
there has been substantial interest in identifying is difficult to frame any group as irredeemably evil
recurrent themes used by news media to represent over a sustained period,[25] negative news depictions
‘real-life’ mental illness and the mentally ill. Results of mental illness have changed little over the
show that news representations of mental illness years.[12]
echo those found in the entertainment media and are As well as drawing upon existing negative ste-
largely inaccurate and negative.[5,12-15] Reporters reotypes, bias is introduced into stories whenever
emphasise the violent, delusional and irrational be- perspectives are limited. The type and extent of
haviour of people with a mental illness, and often information provided can contribute to negative cul-
sensationalise headlines or story content in order to tural stereotypes by limiting the views presented and
attract attention.[16-19] the solutions proposed.[26] Journalists use multiple
Not every news account is sensationalised, inac- sources and different views to create story balance.
curate or negative.[20,21] However, balanced news With respect to mental health stories, two important
portrayals of violent incidents involving people with and qualitatively distinct perspectives have been
a mental illness may be more vivid, anxiety-provok- absent from journalistic accounts. Firstly, people
ing and memorable. Consequently, they may con- with mental illnesses and their personal stories of
tribute to stigma and discrimination by providing recovery are rarely included as sources for news
‘factual evidence’ that reinforces fictional depic- items.[15,28] In a national prospective study of New
tions. The real-time translation of incidents into Zealand news items dealing with mental health or
visual images by news cameras that ‘don’t lie’ pro- mental illness, Nairn and Coverdale[29] could identi-
vides overwhelming authentication for cultural ste- fy only five stories out of 600 (0.8%) that offered
reotypes. The global reach of the nightly news en- readers perspectives from people who had been di-
102 Stuart
agnosed with a mental disorder. Secondly, mental fearful public to justify forced legal action, coercive
health professionals have scorned and avoided me- treatment, bullying and other forms of victimisa-
dia contact.[30] Consequently, their perspectives tion.[38,39] The exclusive focus on dysfunctional be-
have been seriously under-represented. Less than haviour in the absence of personal recovery stories
15% of newspaper articles dealing with mental ill- also promotes pessimistic and sceptical views of
ness include quotes or perspectives from psychiatric psychiatric treatment, and contributes to a lack of
experts.[31] mental health resources and policy initiatives.[6] Be-
cause negative media images generate intense emo-
4. Consequences of tional responses, they can exert exceptional power
Negative Depictions over audiences and are even capable of overriding
positive personal experiences,[40] corrective infor-
Media socialisation begins at an early age, even
mation[41] and positive news.[20] For example, de-
before children have the capacity to distinguish fact
spite much research evidence demonstrating the ef-
from fiction.[32] Television viewing occupies more
fectiveness of psychiatric interventions and treat-
of a child’s time than any other structured activity,
ments, the treatments are often viewed with
including school. By the time American children
profound suspicion by funders and decision makers,
begin school, they will already have spent the
with the result that they are difficult to access and
equivalent of 3 school years watching television.[33]
are monitored with more than the usual zeal.[42]
Thus, by the time they reach adulthood, they will
Similarly, even though empirical studies show that
have ‘witnessed’ untold numbers of media murders
the majority of people with a mental illness never
committed by someone with a mental illness. In this
commit a violent act or that they are more likely to
way, each new generation of viewers will learn how
be victims rather than perpetrators of violence, the
to think about the mentally ill, how to use negative
public significantly over-estimates the frequency of
and derisive terminology, and how to respond emo-
violence committed by people with mental disorders
tionally. They will also gain a clear idea of how
and greatly exaggerates their own personal risk.[43]
others would treat them were they to become men-
Indeed, they feel more reassured to learn that some-
tally ill.[33]
one was stabbed to death in a robbery, than stabbed
Studies show that heavy exposure to media
to death by a psychotic man.[44]
images of mental illness not only cultivates misin-
formation about crime and misconceptions about People with mental disorders and their families
those who commit crimes, but also engenders intol- are acutely aware of negative images of mental
erance toward people with mental illnesses and neg- illness in the entertainment and news media.[16,45]
atively influences the way in which the public evalu- Most directly blame the media, citing images link-
ates mental health issues.[26,34-37] The news of a ing mental illness to violence as a central source of
killing by someone with a mental disorder is multi- stigma.[46] Negative media images are profoundly
plied by the number of times it is reported over distressing to people who have a mental illness and
television, radio and cyberspace, giving the mistak- their family members, and often have direct social
en impression that violence among the mentally ill is repercussions. In the US, the majority of family
a frequent and recurring event. Public fear and rejec- advocates responding to surveys report having en-
tion of the mentally ill increases, and stereotypes are countered media depictions of the mentally ill that
consolidated each time a violent act is reported.[34] left them feeling angry, hurt, sad and discouraged.
The presumption of dangerousness can be used by a Media emphasis on extreme and violent cases, inac-
curate portrayals, and derogatory and disrespectful distress associated with these adverse effects were
use of language were particularly troubling.[47] In the controlled.[51]
UK, three-quarters of mental health service users
polled reported that media coverage of mental health 5. Summary and Discussion
was unfair, negative and unbalanced, and half indi-
Long before people ever meet someone with a
cated that the media coverage had had a negative
mental illness or encounter a mental health profes-
effect on their own mental health.[48] One-third said
sional, they have formed opinions and developed
their family and friends had acted differently toward
prejudices. The media create and perpetuate mental
them because of the negative media coverage. One-
health stigma and discrimination through repeated
third said that media coverage had put them off use of negative and inaccurate images of the mental-
applying for jobs or volunteering, and one-quarter ly ill, mental health professionals and mental health
said they experienced hostility from neighbours and treatments.[37] Regardless of the genre studied, the
local communities because of these reports.[48] The media have been found to provide overwhelmingly
expectation that one will be stigmatised because of a dramatic and distorted images of mental illness that
mental illness produces social dysfunction and disa- emphasise dangerousness, criminality and unpre-
bility.[49] People with mental disorders are afraid to dictability. The media also model reactions to the
disclose this fact to others. They fear being found mentally ill, including fear, rejection, derision and
out, suffer low self-esteem and limit their social ridicule. Through programmes aimed at children,
contacts in an effort to avoid stigma and discrimina- the entertainment media act as a powerful socialis-
tion.[47] In this way, media portrayals of mental ing agent, communicating dominant cultural stereo-
illness can directly affect people with mental illness- types and giving vivid examples of the language and
es by impeding their social participation and inter- behaviours that are to be used in adult life. The
fering with their recovery. images found in the entertainment and news media
interact to create, reinforce and amplify stigmatising
Mental health professionals are also acutely
images of mental illness. Factual and fictional
aware of the effects of negative media images on
images are mutually reinforcing. News coverage of
patient outcomes. They see popular depictions of
adverse events involving people with a mental ill-
mental health professionals as unethical, exploita-
ness anchors cultural stereotypes in day-to-day
tive or mentally deranged, and psychiatric treat-
events and provides real-life and close-to-home ex-
ments as oppressive and controlling, promoting amples of how mental illness is linked to violence or
widespread distrust of mental health providers and criminality. In fact, in this context, balanced report-
avoidance of psychiatric treatments.[31] They blame ing of violent incidents may provide the strongest
negative media imagery for treatment-related ‘evidence’ to support negative cultural stereo-
problems, such as a denial of symptoms, failure to types.[20]
seek treatment, failure to accept treatment and poor Media images have profound implications for
adherence with treatment regimens.[50] For example, people who have a mental illness, not only in terms
in a recent study of people receiving outpatient of their own self-image, help-seeking behaviours
treatment for depression, medication adherence was and recovery, but also both for the level of fear and
predicted by the perceived severity of the illness and hostility they experience when they interact with
the level of perceived stigma, even when other relat- members of the general public and encounter com-
ed factors such as medication adverse effects or the munity intolerance, and for the lack of supportive
104 Stuart
policies and programmes.[52] The media are blamed Only in a small number of cases is more active
for creating and perpetuating stigma and discrimina- lobbying required.[56] In addition, the advent of
tion toward people with a mental illness which, in movies such as A Beautiful Mind provide important
turn, limits help-seeking behaviour, medication ad- opportunities for mental health experts to use media
herence and illness recovery. images as a platform for public discussions designed
Given the universally negative view of the media to promote greater understanding of mental illness
by people with mental health problems, their fami- and greater compassion for the mentally ill.[57]
lies and mental health professionals, it is also impor- If appropriately enlisted, the media may chal-
tant to recognise that the media may also be enlisted lenge stigma and promulgate mental health
as a formidable ally in helping to challenge public messages.[20,58] However, integrating mass media
prejudices, initiate public debate and project posi- outreach and public education into clinical psychiat-
tive, human interest stories about people who live ric practice remains largely unexploited. Kutner and
with mental illness.[20,30,45] Media professionals may Beresin[59] recommend that mass media training be
also be eager and responsive targets for anti-stigma integrated into clinical residency and continuing
efforts and proactive lobbying, particularly if this professional education to help mental health profes-
improves communication between reporters and sionals develop the skills required to work effective-
psychiatric experts (which includes both people who ly with the media and get their messages across in
have a mental illness and mental health providers), more proactive ways. Skills programmes to help
and facilitates access to better information.[13,53] For people who have a mental illness act as community
example, despite negative news portrayals, reporters spokespeople may also help to redress the imbalance
are generally accepting in their attitudes toward in media reporting and put a more sympathetic and
mental illness.[54,55] At least they have been found to human face on the issues. Speakers Bureau
be no more authoritarian, distant or restrictive than programmes involving people with a mental illness
other groups, and they do not consider that the have been effectively used worldwide to improve
mentally ill are more dangerous than the general the knowledge and attitudes of high school students
population. This has led to speculation that media toward people with serious and persistent mental
coverage may be negative as a result of broader illnesses, such as schizophrenia.[60] In recognition
industry pressures that foster particular angles or that “psychiatrists suffer from stigma too”, Per-
story lines, such as the need to sensationalise stories saud[61] suggests that media lobbying and press liai-
in order to gain a competitive edge, a lack of time to son should take on a central role for the profession,
do otherwise, lack of access to mental health experts not only as a way of speaking out for patients who
to present opposing views and other industry con- may not be able to speak out for themselves, but also
straints (including gate-keeper effects from editors as a means of improving public education and
as they determine which stories will be published awareness about what psychiatrists do and the avail-
and what slant they will take).[54,55] In an effort to ability of effective treatments, and as a way of
promote respectful depictions of mental illness, taking a more proactive role in helping the public
SANE Australia (a charitable advocacy group) regu- recognise and manage mental disorders. Similarly,
larly approaches the creators of stigmatising images Cutcliffe and Hannigan[13] advocate for greater
to help them understand the potential harm of those proactive lobbying on the part of psychiatric nurses
stigmatising images. The majority of individuals to stimulate constructive debate, positive story lines
approached are apologetic and happy to change. and information exchange.
15. Wahl OF. News media portrayal of mental illness: implications

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18. Coverdale J, Nairn R, Claasen D. A legal opinion’s conse-
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with bipolar affective disorder. Psychiatr Serv 2001; 52 (12): Canada.
1627-32 E-mail: hh11@post.queensu.ca
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Student’s Declaration Student’s Declaration

Criteria Excellent Moderate Poor Marks

• Breaking the Stigma : Embracing Mental Illness Acceptance for a

With Serious Mental Illness qhr.sagepub.com

Lauren Mizock1, Zlatka Russinova2, and Uma Chandrika Millner2

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Table 1. Factors in the Acceptance of Mental Illness.

Levels Factors Definitions

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related to cultural explanatory models of mental illness that Discussion

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research directly to clinical settings. This might include

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Issues and Challenges of Mental Health in Malaysia

Received: 13 Nov 2018, Revised: 06 Dec 2018, Accepted: 30 Dec 2018

Published Online: 31 Dec 2018

In-Text Citation: (Hassan, Hassan, Kassim, & Hamzah, 2018)

Copyright: © 2018 The Author(s)

Vol. 8, No. 12, 2018, Pg. 1685 - 1696

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Issues and Challenges of Mental Health in Malaysia

Challenges on Mental Health

RESULTS AND DISCUSSION

The summary of the findings is presented in the figure below.

Rising Trend of Mental Illness

Negative Economic Impact

CONCLUSION AND RESEARCH IMPLICATIONS

Malay patients: impact on treatment. Acta Psychiatrica Scandinavica, 94(4), 229–233.

Media Portrayal of Mental Illness and Its Treatments: What

Article in CNS Drugs · February 2006

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 2006 Adis Data Information BV. All rights reserved.

Media Portrayal of Mental Illness and

1. Background of negative imagery with some of the most malig-

15. Wahl OF. News media portrayal of mental illness: implications

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