A community approach to suicide and mental ill-health : the role of stigma, help-seeking and group identification

Our lives, and the events that punctuate them, do not play out within a vacuum. Rather, we are all part of an intrinsically connected network of people that cumulatively influence our thoughts, feelings and behaviours. Even the seemingly individualistic act of taking one’s own life is irrefutably linked to the social environment in which it occurs. With over 800,000 lives lost each year, the equivalent of one death every 40 seconds (World Health Organisation (WHO), 2014), suicide is recognised as a major global health issue. A dominant research theme across multiple disciplines is thus the prevention and prediction of future suicidal behaviour. The research outlined in this thesis will add to this growing body of literature by exploring, through the lens of the social identity approach, how social determinants may enhance or exacerbate protective and risk factors linked to suicidal behaviour in community settings. For the purpose of this thesis, these factors are stigma of mental ill-health, help-seeking, and well-being in those bereaved by suicide. Four empirical papers, as follows, are presented in this body of work: Paper 1 demonstrates how, within a university community (N = 493) in which there are high levels of stigma of mental-ill health, students that identity more highly with the university group exhibit greater reluctance to avail of on-campus mental health services. Paper 2 examines the relationship between identification and stigma of mental illhealth. Mediation analysis shows how higher identification with a community group (N = 626) results in perceiving lower levels of stigma amongst group members, via increased perceptions of social support. This effect is amplified when participants identify highly with more than one group. Paper 3 tracks measures of stigma and attitudes towards mental ill-health and helpseeking before and after community-based mental health services were introduced in two towns in Ireland (N = 1074). All measures evidence positive change after these services were introduced, demonstrating how the arrival of such services, and the subsequent increased visibility of the issue of mental ill-health, can help alter public perceptions of both mental illhealth and help-seeking. Paper 4, the final paper in this thesis, examines a measure of well-being in those bereaved by suicide before and after taking part in a community-based suicide awareness event (N = 3716). This event serves a dual purpose of acting a fundraiser, whilst also drawing attention to the immense issue of suicide and bringing together those who may have previously been isolated in their grief. Results show a significant increase in well-being amongst individuals who have lost a loved one to suicide after partaking in the event, and this effect can be explained through identification with other participants who may have experienced a similar loss. Cumulatively, this thesis makes a substantial theoretical contribution by demonstrating, first, that identification with a community group can have a significant impact on well-being, the stigma of mental ill-health and help-seeking, and how this impact can be either positive or negative depending on the context and group in question. Second, it evidences that measures of stigma, attitudes, and well-being amongst community respondents are subject to change based on the visibility of the issue of mental ill-health and suicide in local environs, with resultant practical and applied implications for the provision of services and tackling the stigma of mental ill-health in community settings.