Stigma and student mental health in higher education

“For some people the stigma of mental illness can cause even more negative impacts than the mental illness itself, with disempowerment occurring on social, cultural, economic and political levels (Corrigan et al., 2000; Link & Phelan, 2006).”

“The incidence of mental health problems amongst university students is steadily increasing with estimates of between 10 and 20% (Collins & Mowbray, 2005 ).”

“However, this shift in funding and emphasis, from primary care to general population wellness models, can also be viewed as a further means of stigmatisation of those diagnosed with severe mental illnesses with them deemed ‘unworthy of social investment’ (Reidpath et al., 2005, p. 1).”

“Few demands are placed on services with extremely low expectations and grave consequences (Jamison, 2006).”

“Nevertheless, there is increased evidence that students’ with mental health problems who receive appropriate support are successful in post‐secondary education (Mcgivern et al, 2003 ) experience decreased hospitalisation rates (Isenwater, Lanham, & Thornhill, 2002 ) and increased levels of self‐confidence, self‐effici…”

“…23 students with visual disability the politics of visibility and invisibility are central to the experience of disability; fear of being stigmatised Martin (2010) 54 students with disabilities not disclosing the disability because prior experience caused harm; need for training of the staff…”

“Stigma also influences college students’ abilities to access appropriate services.(42,43) A lack of understanding among family and friends, fear of appearing weak, and limited knowledge of how to access services are cited as additional major reasons for refusal to seek help.”

“Another notable barrier to seeking mental health aid is stigma [17-19], which may be perpetuated or endorsed by others or internalized by the individual [20].”

“Some studies are focussed on specific conditions such as mental health (Martin 2010; n = 54) or students from single disciplines/departments (Cole and Cawthon 2015).”

“Other data from the viewpoint of students point to the importance of self-advocacy and indicate that some do not feel the need to disclose their disability or choose not to because of fear of being stigmatized (Martin, 2010; Salzer, Wick, & Rogers 2008).”

“In other prior works, Allard (1987), Martin (2010) and Mullins and Preyde (2013), as in ours, it was recognized that responses are more inclusive towards those students with visible disabilities.”

“Social distancing, worries about their own health and the health of their families, stay-at-home orders, and limited physical interaction with others all counted toward their anxiety and stress (Zuckerman, 1989; Martin, 2010; Cao et al., 2020).”

“…was highly prevalent in the literature, permeating each of the difficulties mentioned in this review 90 The Review of higheR educaTion Fall 2013 (Martin, 2010; Megivern, Pellerito, & Mowbray, 2003; Mowbray & Megivern, 1999; Tinklin, Riddell, & Wilson, 2005; Weiner, 1999; Weiner & Wiener, 1996).”

“Exclusion/stigma and discrimination by services Stigma and discrimination were shown to negatively impact disclosure of lived experience and health-seeking behaviour and this is seen in wider contexts [73, 74].”

“The view of disability identity as a stigmatic label (Martin 2010; Thompson-Ebanks and Jarman 2018) seems to be prevalent not only among students (without disabilities) and academic staff but also among SWD themselves, particularly those with invisible disabilities.”

“Fears of stigma, discrimination, and professors’ attitudes appeared to be driving forces in student decision making regarding receipt of disability-related services, particularly among students with psychiatric disabilities (Kurth & Mellard, 2006; Martin, 2010; Salzer et al., 2008).”

“…forms of help (Kelly, Jorm, & Wright, 2007; Rickwood et al., 2005; Rickwood, Deane, Wilson, & Ciarrochi, 2007), perceived stigma (Chew-Graham, Rogers, & Yassin, 2003; Martin, 2010; Yap, Wright, & Jorm, 2011), family reputation (Wynaden et al., 2005) and age (Eisenberg, Golberstein, et al., 2007).”

“Not all people with mental illness experience “why try,” but when people with mental illness pursuing of higher education were asked about their willingness to disclose they opted to protect their vulnerable identity to avoid defamation and adverse consequences (Martin, 2010).”

“Consequently, students might not disclose a nonapparent disability for fear of stigma (Lourens and Swartz 2016; Martin 2010) and/or may not identify as disabled (Hadjikakou and Hartas 2008).”

“Furthermore, some surveys used in previous studies rely on retrospective self-reports, which are prone to measurement error (e.g. due to recall issues) and social desirability biases (Martin, 2010).”

“Previous studies to ours, for example Martin (2010) and Mullins and Preyde (2013), found that responses were more inclusive for students with visible disabilities.”

“It is known that there is stigma as an obstacle for students to benefit from school counseling services (Martin, 2010).”

“Not surprisingly, students who experience mental health issues have been reported to have lower completion rates than other students with disability (Martin, 2010).”

“In addition, many universities offer counselling, accessibility/accommodation services, intervention programmes, and awareness campaigns to help support the mental health and well-being of students (Martin 2010).”

“Mental health issues such as increased stress was found to be a factor leading to non-attendance in a study by Martin (2010) and this was linked to student workload.”

“Furthermore, studies have shown that students who experience mental disabilities have lower completion rates than other students with disabilities (Martin, 2010).”

“Research exploring the perspectives and experiences of students with disability at university is limited (Gibson, 2012; Holloway, 2010; Martin, 2010; Papasotiriou & Windle, 2012; Vickerman & Blundell, 2010; Wynaden, Wichmann, & Murray, 2013).”

“Low wellbeing has the potential to affect a student’s success in their tertiary studies (Martin, 2010), and reduced mental health can increase risky behaviours leading to acute and chronic health issues (WHO, 2014).”

“Secondly, mental health stigma can also lead to unintentional issues with identification (Canadian Association of College and University Student Services (CACUSS) & CMHA, 2014; CASA, 2014; CMHA, 2014; Kitzrow, 2003; Martin, 2010; Quinn et al., 2009; Tinklin et al., 2005).”

“…that students with a mental health disability are hesitant to disclose their condition to academic and support staff due to fears of being stigmatised (Collins & Mowbray, 2005; Martin, 2010) and/or a need to prove that they are capable in their studies despite their disability (Martin, 2010).”

“Perceived and selfstigma research has placed emphasis on a variety of settings, including therapeutic (Vogel, Wade, & Hackler, 2007), personal (Corrigan et al., 2006), and educational (Martin, 2010) contexts.”

“…problemsolving, and collectivity; promoting organization, routine, and structure; and ensuring open channels of communication between instructors and students (CACUSS and CMHA 2014; Kadison and DiGeronimo 2004; Kitzrow 2003; Martin 2010; Patton et al. 2000; Quinn et al. 2009; Sharp et al. 2006).”

“However, knowledge is often sparsely shared within the community due to stigma (6).”

“The desire for anonymity may reflect the impact of stigma related to mental health in post-secondary students, which has been shown to be a major factor influencing students likelihood of disclosing mental health issues [47].”

“Martin (2010) points out that many students are afraid of being stigmatized, especially those who are mental health service users.”

“However, many college students with mental health conditions are not seeking help because of stigma they would face from family, friends, faculty, or other students [4].”

“Existing research suggests a link between stigmatisation and mental ill health, with higher education students particularly concerned about disclosing their difficulties to friends, course mates and staff for fear of being judged (Martin 2010; Markoulakis and Kirsh 2013; Mackenzie et al. 2014; Wynaden et al. 2014).”

“Other students fail to disclose because of concerns around stigma [30, 31].”

“Friends can play a valuable role in providing early intervention in supporting students’ mental health, as friendships are established, trustworthy, and accessible to students [22, 30].”

“Students are often unwilling to declare mental health issues (Laidlaw et al., 2015; Martin, 2010), which may have influenced the reliability of responses on this issue.”

“Stigma directly inhibits helpseeking behaviors for mental health conditions, including among college students (Martin, 2010).”

“Martin ( 2010 ), in his study of 34 students with mental health difficulties, found that two-thirds of his sample had not informed anyone in their institution.”

“This is particularly concerning as variable experiences with staff can lead to potential feelings of discrimination or disadvantage by students with MHPs (Martin, 2010).”

“These reasons, along with any anticipated stigma, may be why a sizeable proportion of students identified as having PD in student surveys do not seek help from mental health services (see, e.g., Leahy et al., 2010; Martin, 2010; Stallman, 2010; Zivin, Eisenberg, Gollust, & Golberstein, 2009).”

“These findings are echoed in several Australian studies (McLean and Andrews 1999; Bathurst and Grove 2000; Vivekananda, Telley, and Trethowan 2011; Martin 2010) reporting that students chose not to disclose their mental health status for various reasons, including: the perception that some…”

“If a campus climate is fostered in which mental health issues are recognized and addressed across various campus groups, rather than stigmatized, students will be more likely to disclose, take advantage of mental health and wellness services, and utilize accommodations if they are eligible to do so.(16,46) JOURNAL OF…”

“Many students reported stigma as the primary barrier to disclosure of mental health concerns for fear of rejection from professors, jeopardizing employment opportunities, and judgement by other students for receiving supports or academic accommodations (Martin, 2010).”

“may prohibit students from seeking the support and help they need, which may ultimately limit student progress toward completion of their degree (Martin, 2010; Salzer, 2012).”

“For example, students with sensory disabilities, whether visual or auditory, disclose their conditions much more readily than those with disabilities with a higher associated stigma, such as mental disorders (Martin, 2010) or learning challenges (Kent, 2015).”

“In two studies, disclosure of mental health status was seen as a necessary step toward gaining additional support and special consideration in education (Martin, 2010; Venville, Street, & Fossey, 2014).”

“Stigma is a socially constructed mark of disapproval, shame or disgrace that causes noticeable disadvantages through the restriction of opportunities (Martin, 2010).”

“Academic staff may find it difficult to support students and report a lack of training, time and knowledge of how to do so (Martin, 2010; Quinn et al., 2009; Tinklin, Riddell, & Wilson, 2005).”

“Another source of difficulty for students with mental health disorders is social stigma and negative opinions (Blacklock et al., 2003; Martin, 2010).”

“In examining first-year students and faculty expectations, Martin (2010) stressed that education systems do not foster collaboration between secondary schools and tertiary studies but she identified high school teachers as having the most influence over the development of student tertiary…”

“Stigma is cited as one of the reasons why help-seeking behavior is low among students [98, 99].”

“Lack of youth-friendly training among staff, lack of a dedicated space for young people [11], waiting times due to inconvenient operating times and low numbers of staff [12–14], poor staff attitudes [15], and stigma [16] have also been commonly identified as perceived barriers for adolescents and young adults accessin…”

“Unlike most other studies mentioned above, Martin (2010) found that the majority of students who disclosed details of their mental health condition to university staff had improved outcomes, receiving helpful assistance, primarily for extensions of time to submit work.”

“It can negatively affect their studies and can create a self-image of not being tough or resilient enough to succeed (J. M. Martin, 2010).”

“Seeking support at university, which requires students to disclose their needs and diagnoses, can be a complex and emotionally challenging process (Martin, 2010; Reed & Kennett, 2017).”

“…of Psychiatrists 2011) and, while a large evidence base on mental health outcomes exists reflecting students in HE (Andrews and Wilding 2004; Blanco et al. 2008; Eisenberg, Golberstein, and Gollust 2007; Martin 2010; Mori 2000; Zivin et al. 2009), little comparable evidence exists within FE.”

“Martin (2010) found that the majority of the students surveyed with mental health difficulties had not disclosed their health-related problems to university staff, even though they affected their studies.”

“Supporting health profession students to be able to self-manage high levels of anxiety and stress is especially vital as most international students are less likely to seek help from university health and well-being services (Martin, 2010).”

“Furthermore, they can be subject to forms of rejection, humiliation, and social disapproval (Ariel, 2016; Davis, 2005; Kreider et al., 2015; Martin, 2010; Mullins & Preyde, 2013; Pierre, 2016).”

“Student perceptions of the role of lecturers in higher education were signi fi cant in making students feel unsafe or uncomfortable when deciding whether to disclose illness, disability, or mental distress (Martin, 2010).”

“Evidence has shown that such mental health difficulties affect the physical [10] and psychosocial [11] well-being of academic students, even resulting in them performing worse and dropping out more frequently [12,13] than mentally healthier students.”

“” The issue of stigmatization is also raised by Trammel [42] and Martin [43].”

“Despite having mental health services available on most campuses, many students go without professional help (American College Health Association, 2011; Martin, 2010).”

“Our findings align with previous research showing that some students conceal their mental and emotional issues (Martin, 2010), thereby obscuring prevalence estimates of serious symptoms and disorders that this population might be particularly vulnerable to.”

“The influence of family and friends on stigma and help-seeking is an area for further study.(25) There is evidence that stigma reduction campaigns involving social contact are effective in the short term.”

“Stigma results in an avoidance of treatment and education about MH issues, thereby limiting an individual’s willingness to get help for themselves [9] or offer effective help to others [10].”

“Australian students have also expressed concerns over stigma within employment (Martin 2010) and generally students with MHC discuss concerns over stigma (Hartrey, Denie ff e, and Wells 2017; Kain, Chin-Newman, and Smith 2019).”

“These difficulties were mentioned in a similar study; the students surveyed were mentioned as being more likely to be distracted during classes by a family member or household chores, but also by video games and social media [39,40].”

“Students with mental health issues may be afraid to disclose their condition and seek support for fear of discrimination or disadvantage, although they are also more likely to have difficulties with their studies and to feel anxious or worried (Martin, 2010).”

“In examining first-year students and their expectations of universities, Martin (2010) stressed that education systems do not foster collaboration between secondary schools and tertiary studies.”

“…participatory arts interventions particularly attractive for improving their wellbeing given the negligible emphasis on mental health within Open Arts (Margrove et al. 2012) and the high stigma regarding mental health issues in the student body (Chew-Graham, Rogers, and Yassin 2003; Martin 2010).”