Being a psychiatric patient in the community--reclassified as the stigmatized "other"

To explore the experiences of psychiatric patients living in six rural communities in Norway from a primary care perspective.

A "Knowledge workshop" (KW) was designed. It was a special kind of meeting between users of services for people with mental illness and service providers. The process and outcome were documented on flipcharts and audiotape and analysed by a qualitative method.

A main statement was constructed in order to capture the essence of meaning in the 10 main themes identified in the analysis. The statement is mainly about the process and state of being reclassified as a stigmatized "other", with serious consequences for both self-esteem and public esteem. The consequences include isolation and loneliness, low self-esteem, no paid work, lack of money, discrimination, and harassment. Other consequences include altered behaviour from others, lack of necessary conditions for empowerment, and the danger of becoming visible as mentally ill. Attitudinal change is called for.

Although the stigma of mental illness is a wellknown and much discussed fact, it has so far not really been included in the professional knowledge base. It is still practically absent from discussions of quality of care. In order for services to be relevant to people who need them, professionals can no longer ignore issues that are of major importance for users. Stigma must thus be included in the conceptual thinking about serving people with mental illness. The inclusion of stigma as an issue for quality of care could be a fruitful way forward.