Experiences of stigma and compulsory treatment in the forensic and civil mental health systems of British Columbia

A small proportion of people with mental illness use community mental health services involuntarily – either as a consequence of civil commitment or criminal justice sanctions. Compulsory community treatment is intended to protect the welfare and safety of people with mental illness; however, it may also reinforce stereotypes about the mental health system and about people who use the services. Self-stigma refers to a complex, subjective process – embedded within a socio-cultural context – characterized by negative feelings, maladaptive behaviour, identity transformation, and adverse outcomes resulting from an individual’s experience, perception, and anticipation of adverse social reactions on the basis of their mental illness. This dissertation describes a prospective, mixed-methods, longitudinal study that examined the experiences and consequences of self-stigma for people with mental illness who receive compulsory community treatment in the forensic (N = 52) and civil (N = 39) mental health systems of British Columbia. The quantitative findings indicate that compulsory community treatment does not engender additive self-stigmatizing effects beyond that which is produced by mental illness itself. As well, the notion that ‘forensic’ labelling, or receiving compulsory treatment in a specialized forensic mental health system, is associated with increased levels of self-stigma was not supported by the data. Finally, the study revealed that level of self-stigma at baseline was not a significant predictor of quality of life one year later. The qualitative data that was collected for this study provides some evidence that compulsory community treatment has the potential to create barriers that ultimately prevent people with mental illness from emerging out of stereotyped social roles. Regardless of whether they actively use treatment services on an involuntary basis, people with mental illness share a common struggle for choice, autonomy, respect, fairness, inclusion, and equality – especially in relation to how their services should be delivered. The present study indicates that these issues are interwoven into the stigmatizing experiences related to living with mental illness.