Confronting Goffman: how can mental health nurses effectively challenge stigma? A critical review of the literature.

This paper critically reviews the issues and questions surrounding the ways in which mental health nurses can best address stigma in the 21st century. It begins with a brief discussion of the nature and definition of the term stigma and explores some of the theoretical basis behind it before drawing out potential flaws in the theory and using this as the basis for an exploration of the way in which stigma is formed and shaped by public and professional attitudes. The discussion then turns to the underlying principles of contemporary mental health legislation and evaluates the tensions between various strands of UK legislation, the way in which risk is perceived and managed by practitioners, and whether risk-averse practice perpetuates stigma. This leads onto the question of how mental health law itself might contribute to the perpetuation of stigma by removing power and responsibility from the hands of service users. Finally, the discussion concludes with some suggestion about how a future change in the principles of mental health law might alter the way in which mental health problems are perceived and allow nurses to practice in a way that is less focussed on risk management and places more emphasis on recovery.