Australian Occupational Therapy Journal (2005) 52, 243–250 doi: 10.1111/j.1440-1630.2005.00504.

Research Article
Blackwell
Oxford,
Australian
AOT
2005
0045-0766
unknown
52 Blackwell
UK
Publishing,
2005
Occupational
Publishing
Ltd.Therapy
Asia PtyJournal
Ltd Literature
Lloyd etReview
PERCEPTIONS
C. al. OF SOCIAL STIGMA

Perceptions of social stigma and its effect on interpersonal

relationships of young males who experience a psychotic
disorder
Chris Lloyd,1 Dan Sullivan2 and Philip Lee Williams3
1Division of Occupational Therapy, University of Queensland, St Lucia, 2Integrated Mental Health Service,
Gold Coast Hospital, Southport and 3Princess Alexandra District Health Service, Woolongabba, Queensland,
Australia

Background: People with psychotic disorders experience
high levels of disability and impairment as a result of their
illness. Difficulty in the area of social relationships poses
a substantial problem with the majority of people with
psychosis being socially isolated. Many of them experience
an unmet need for services.
Methods: A focus group was conducted with the aim of
investigating the perceived experience of six young men
who had a psychotic disorder to gain an understanding of
the impact this had on interpersonal relationships.
Results: The major themes identified were: (i) a signifi-
cant decrease in the internal and external control of one’s
life at the onset of illness; (ii) the effects of labelling and
stigma on interpersonal relationships; and (iii) the change
in self perception that these effects bring.
Conclusion: The implications of the findings for rehabilita-
tion interventions are presented, specifically psychosocial group
interventions addressing interpersonal relationships.
KEY WORDS interpersonal relationships, psychotic dis-
orders, social skills, stigma.
Introduction
Psychotic disorders are complex illnesses often char-
acterised by episodes of relapse and often only a partial
return to full functioning (Angell & Test, 2002; Penn,
Kolmaier & Corrigan, 2000). Psychosocial disability is
prevalent among people with psychotic disorders
(Gilbert, Miller, Berk, Ho & Castle, 2003). People with
more severe symptoms, and symptoms such as dis-
organised behaviour and flat affect, and poorer social
skills are more likely to engender more negative
responses from others (Dickerson, Parente & Rignel,
2000; Ertugrul & Ulug, 2004). In response to such situ-
ations, people internalise the devaluing by others and
develop strategies such as social withdrawal to avoid
the rejection they anticipate (Ertugrul & Ulug). This in
turn reduces the stigmatised person’s range of social
contacts, thereby handicapping social adaptation and
delaying recovery (Ertugrul & Ulug). In the Australian
context, there is a significant gap in terms of service
delivery addressing psychosocial disability, with the
majority of service users not receiving rehabilitation
(Gilbert et al.). Listening to identified needs of individ-
uals involved in mental health services is considered
important in the subsequent development of services
(Barnes & Wistow, 1994). This includes making them
more responsive to the needs and preferences of
those who use them. Additionally, service users may
be empowered in decision-making about the design,
implementation, and review of these services (Barnes
& Wistow). This has direct implications for designing
services that address unmet needs and the quality of
these services.
This article describes a qualitative research project
that was carried out to explore the difficulties of
living with a mental illness and its effects on inter-
personal relationships.

Chris Lloyd PhD; Senior Lecturer. Dan Sullivan CN, BN,

MMHN; Acting Nursing Unit Manager. Philip Lee Williams
BOccThy; Occupational therapist.
Correspondence: Chris Lloyd, Division of Occupational
Therapy, University of Queensland, St. Lucia, Queensland
4072, Australia. Email: clloyd@shrs.uq.edu.au
Accepted for publication 21 April 2005.
© 2005 Australian Association of Occupational Therapists
Literature review
Impact of psychosis
Typically, psychotic disorders occur during late ado-
lescence and early adulthood, an important period for
emotional and social development. The onset of a
psychotic episode can lead to disability and disadvan-
tage through the disruption of educational, vocational
244
and social pursuits (McGorry & Edwards, 1997). There
is a high probability of further episodes occurring,
where function and personality may be damaged, which
may worsen over time (Dickerson et al., 2000). Jablensky
et al. (1999) found that people with psychotic illnesses
were seriously impaired in their ability to function in
everyday social and occupational domains. The results
of a study conducted by Ertugral and Ulug (2004)
found that people who reported more perceived
stigmatisation had more severe symptoms than the
people who did not perceive stigmatisation. They also
found that people reporting stigmatisation were
significantly more disabled than the group negative
for perceived stigmatisation.
Medication and psychosocial
interventions
Angell and Test (2002) stated that despite the evidence
that people with severe mental illness experience
impairments in social relationships, there is little con-
sensus about what may be done about it in the clinical
services context. From their study, they suggested
that psychopharmacological and psychosocial inter-
ventions aimed at the mitigation of symptoms facili-
tate the development of reciprocal relationships and
contribute to decreased levels of loneliness. Falloon,
Held, Roncone, Coverdale and Laidlaw (1998) in their
study concluded that treatment for psychotic disorders
is best provided by integrating specific psychosocial
intervention strategies in addition to the optimal use
of medication. The introduction of newer antipsychotic
drugs may improve the effectiveness of psychosocial
treatments (Marder, 2000). Compared to traditional
medications, the atypical antipsychotic medications have
superior efficacy with respect to positive symptoms,
some benefit on cognitive performance, and fewer side-
effects (Marder).
Stigma and self-concept
According to Caltraux (2003), stigma is socially con-
structed and is often formed subtly, as stereotyping and
prejudices gradually become an accepted part of a
cultural or social belief system. The stigma surround-
ing mental illness has marked effects on the psycho-
logical well-being and life satisfaction of people with a
mental illness (Caltraux). This is manifested in a number
of ways, ranging from limited social and vocational
opportunities to its negative effect on the self-concept
(Angell & Test, 2002). An increase in positive func-
tioning was associated with a downturn in subjectively
assessed social functioning, that is, satisfaction with
social relationships and loneliness over the 6-month
period (Angell & Test). Some people internalise the
stigma whereby he or she accepts diminished expec-
tations both for and by him or herself (Caltraux).
C. LLOYD ET AL.
These consequences may increase stress levels in the
lives of persons with a psychotic disorder, which could
lead to an increased potential for relapse and rehospi-
talisation. Stigma therefore has important implications
for the person with a psychotic disorder and their
integration into the community (Penn et al., 2000).
It has been found that interpersonal factors, such as
overall social skill, negative symptoms and perceived
strangeness, may contribute to stigma (Penn et al., 2000).
Ertugrul and Ulug (2004) found that individuals who
reported perceived stigmatisation had more severe
symptoms than individuals who did not perceive
stigmatisation. People with schizophrenia have sig-
nificant deficits in social skills, which may produce
uncomfortable and or aversive interactions with others
(Ertugrul & Ulug). By interrupting this cycle, the
adaptive abilities increase and the disability of these
individuals decrease; this was found in the study by
Ertugrul and Ulug. Social skills training may, in addi-
tion to improving social behaviour, have the potential to
indirectly impact on psychiatric stigma (Penn et al., 2000).
This issue can best be addressed by designs, which
assess perceived stigma prior to, and following, social
skills training (Penn et al.).
Social skills
In a previous study by Roder et al. (2002), social skills
training was shown to be an effective intervention for
individuals experiencing disability associated with
mental illness. Skills building involves learning and
practising activities that enable individuals to acquire
the skills that are required to meet the interpersonal
and coping demands of community living. Ihnen, Penn,
Corrigan and Martin (1998), in their study, investi-
gated the relationship of social perception to social
skills in those with schizophrenia. Correlational anal-
yses revealed that the self-ratings of social skills had
the most consistent relationship with social skills
among the social perception measures, even after
controlling for symptomatology and subject demo-
graphics. They suggested that the ability of indivi-
duals to perceive his or her own social behaviours
have important functional consequences in account-
ing for social dysfunction (Ihnen et al., 1998). In their
study, Roder et al. found an improvement in social
functioning following participation in a training
program. They also found that participants showed a
significant reduction of both negative and positive
symptoms. Roder et al. recommended that social skills
training be conducted over extended periods of time.
Falloon et al. (1998) recommended that skills training
strategies include role rehearsal, constructive coach-
ing and real-life practise. They suggested that the best
results occur when skills training is targeted to each
person’s chosen goals.
PERCEPTIONS OF SOCIAL STIGMA
Occupational therapy and group
interventions
According to Bustillo, Lauriello, Horan and Keith (2001),
social skills training uses learning theory principle
to improve social functioning by working with clients
to remediate problems in activities of daily living,
employment, leisure and relationships. Occupational
therapists working in mental health rehabilitation set-
tings frequently utilise group interventions to enable
consumers to develop their capacity despite the
existence of psychiatric morbidity (Albiston, Francey
& Harrigan, 1998; Lloyd, Williams & Sullivan, 2004).
Consumers require assistance to master those skills
that relate to their own special needs. Skills training
needs to be focused on realistic life circumstances that
consumers are likely to encounter in their daily living
(Lloyd et al.). The social problem-solving model has
resulted in the acquisition of skills, and it is the
approach with some evidence that suggests that
there should be a generalisation of skills to community
functioning and of effectiveness in some routine
clinical settings (Bustillo et al.). Mental health rehabili-
tation requires that consumers are involved in the
design of their own rehabilitation plan (Bachrach, 2000).
An essential focus is on meaningful participation by
consumers in such areas as service planning and
delivery (Australian Health Ministers, 2003). Bearing
this in mind, it is necessary to work out practical ways
that consumers may be involved in their rehabilita-
tion plan and program. One such useful strategy is to
hold a focus group to determine the needs of consum-
ers and use this information in the development of a
group program based on the areas of need that are
identified (Ivanoff, 2002).
Aim of the study
The aim of this study was to explore the perceived
difficulties of living with a mental illness and its effect
on interpersonal relationships.
Method
Participants
Six young men agreed to take part in the present
study. They were the young men who were referred
to the social skills training program. As is usual in a
community-based rehabilitation program, the majority
of participants were male. The young men were under
30 years of age (range = 18–30 years, mean = 25 years),
were Australian born, and were in receipt of a disability
support pension. They all had a diagnosis of a psychotic
disorder (schizophrenia or schizo-affective disorder),
had previously been admitted to the psychiatric
245
inpatient unit (range = 1–20 times, mean = 10.5 times
on average), were receiving case management services,
and were registered with the rehabilitation service. Eight
young men had been referred to the group program,
Kick ‘N’On, a social skills group. The development of
this group has previously been reported (Lloyd et al.,
2004). This program customarily commences with a
focus group during the first session to gain an under-
standing of the participants’ experiences. This infor-
mation is then used to guide the development of the
subsequent group sessions.
Data collection
A qualitative approach was selected as the most
appropriate method for the present study because the
emphasis was on understanding the lived experience
of the young men. According to Seale and Barnard
(1998), ‘Individuals cannot be separated from the
environment in which they function; the human
experience needs to be studied as it occurs’ (p. 9).
Focus groups aim to capitalise on the interactions that
occur within the group and are useful for exploring
poorly understood areas and attitudes. Using a focus
group enables the researcher to interact with participants
to clarify responses, and follow up questions (Seale &
Barnard).
Procedure
Ethical approval was obtained from the Hospital Ethics
Committee. Young males referred to the rehabilitation
team had their areas of need identified before being
invited to join the social skills group program. They
shared in common the goal to meet and socialise
with other people, particularly girls. The offer took the
form of a letter inviting participation and was fol-
lowed up with a phone call to establish if the person
was intending to join the group (six people expressed
their intention of participating in the program). This
all took place as part of the usual clinical practice.
Consumers attending the group were invited to par-
ticipate in the focus group investigation. If interest was
expressed, an information sheet was provided outlin-
ing requirements for participation. Consumers were
provided with the opportunity to sign an informed
consent form. It was clearly explained to consumers
that choosing not to participate in the research would
in no way compromise their treatment or opportunity
to participate further in the group.
The focus group was 1 h in duration and was con-
ducted by two male staff members, an occupational
therapist and a mental health nurse who were the
facilitators of the young men’s group. This was held
during the first session of the scheduled group pro-
gram. The idea behind holding the focus group at
this point was that the insights gained from the young
246
men would be useful in guiding the subsequent
development of the group sessions. The focus group
was audiotaped and field notes were taken. The field
notes were compiled after the completion of the focus
group and contained a description of events and tenta-
tive explanations and interpretations (Seale & Barnard,
1998). The discussion was guided by a semistructured
group format. The following questions were used to
guide the group discussion:
1. What is it like being a young person who has
experienced mental illness?
2. In what ways, if at all, have your life goals changed
since becoming unwell?
3. What issues do you believe have an impact on
your ability to form social relationships?
4. Can you tell us about the kinds of social activities
that you are engaging in at present?
5. How would you go about initiating social activities?
6. How would you go about meeting girls and strik-
ing up a conversation?
7. What assistance do you believe would help you
form relationships with other people?
8. What assistance do you think would help you
participate more fully in social activities?
Data analysis
Before undertaking analysis, the audiotape was tran-
scribed verbatim. Coding of the data involved organising
sections of the text for the purpose of further analysis.
According to Seale and Barnard (1998), the purpose of
coding is to bring together fragments of the text in order
to create themes, which are defined as having a common
element. As the result of coding was the identification
of themes, the researcher will describe the emergent
themes. The qualitative data was analysed by hand
involving manual indexing. The data was read in order
to apply indexing to appropriate portions of text. Index-
ing was done in the margins alongside the text by using
coloured pens to mark commonalities in the content.
In qualitative research, there is much emphasis
placed on checking or verifying the analysis of the
data (Seale & Barnard, 1998). To counter possible bias,
the authenticity of the results was verified by using
participant and colleague checks. The group members
were provided with a written summary of the analy-
sis of the focus group for comment. Additionally, two
neutral colleagues not connected with the research
were invited to read the data, devise their own themes,
which were then compared with the themes identified
by the principal researcher. This consisted of provid-
ing independent colleagues experienced in both the
clinical area and focus group methodology to evaluate
the accuracy of the researcher’s interpretations. Any
differences in outcome were discussed and categories
were amended where appropriate.
C. LLOYD ET AL.
Results
Emergent themes
Three themes emerged from the present study. These
included: (i) loss of control; (ii) stigma; and (iii) change
in self-perception. Quotations from the participants
have been included to illustrate the themes.
Loss of control
Participants identified that they had a lack of say in
treatment. This related mostly to a lack of under-
standing of what was happening or why. It appeared
that there was limited explanation given to them to
assist them understanding the experience of being in
hospital and the treatment they received. In addition,
they were not included in the decision-making process
concerning their treatment.
‘You are left confused and you don’t know what is
happening and other people are making decisions about
your life and you don’t have any say in it. They just
dose you up with medication and you are walking
around the hospital looking up or racing to the toilet.’
Medication, they believed, increased their confusion.
They also experienced decreased ‘motivation’, ‘mental
ability’, and ‘autonomy’. They further reported experi-
encing becoming withdrawn and considered that they
became introverted. Being on high doses of medica-
tion led them to becoming unmotivated where all they
did was ‘watch TV, sleep and eat’. They had experi-
enced a decline in participating in social activities.
Participants believed that they required assistance
to regain control of their lives. For example, they
thought that listening to other people who had a men-
tal illness and who had learnt to adapt to living with a
disability would be beneficial, especially if they were
‘working and leading a normal life’.
‘Like role training … you meet past mental patients
who have made it and are successful. They lost
friends. What strategies did they use? It would be a
help ... past experiences and opinions.’
This, they felt, might provide them with some
useful suggestions to help them form relationships
with others. They also believed that it was important
for them to be able to talk about their experiences, to
share these with others, and hear the opinions about
forming relationships with others, especially the things
they identified as the ‘not to do things’. This involved
the participants in situations where they relied on the
group leaders to teach or encourage them about
situations where they might best not participate. They
believed that talking about past experiences and
opinions would be of help to them.
PERCEPTIONS OF SOCIAL STIGMA
Stigma
Participants reported that the effect of labelling and
stigma had an effect on their relationships. Having a
mental illness was hard to acknowledge and they felt
somewhat ‘odd’ or ‘strange’ as a result of being diag-
nosed with a mental illness. They found that following
a diagnosis of mental illness, their relationships changed.
This included the relationships with their friends:
‘It has closed doors to my friends in such a way they
say they can look at it from the outside.’
‘When everyone around you considers you mentally
ill, it is hard to get out of that sort of person.’
Participants considered that relationships with friends
and other people had become more superficial and
they found it hard to be themselves rather than some-
one who had a mental illness and had been labelled as
such. This, they felt, was because they had a mental
illness. They also found that relationships with family
members changed, whereby they were given less
say in what they did or wanted to do as the family
increasingly took control of decisions affecting them.
It was almost like they did not exist as independent
people any more.
Change in self-perception
Participants experienced unclear expectations of girls
because of a lack of confidence and motivation since
they were diagnosed with a mental illness. This had
an effect on their ability to set goals, their ability to do
things and function normally, and the length of time
to recover. It was as though they felt that they would
not be ever able to reach the goals they had previously
set and had to lower them, as their goals had changed
according to their circumstances. They felt that the
medication caused them to be slower and as well their
daily goals had become much simpler than they had
been previously.
Changes in self-perception influenced their rela-
tionships with others. They did not know what to
expect of themselves anymore. This impacted on their
social circle and ability to socialise.
‘Don’t know what to expect, the first thing might be
how to start a relationship not knowing what to
expect. If or not they have a mental illness also. As I
was in a relationship with a girl and she had bipolar
the same as me. The doctor would say it is not a
good thing for us to be together because you would
never get anywhere.’
Participants experienced a sense of decreased self-
worth owing to their illness. They identified that they
247
felt that other people were better than them because
they did not have a mental illness. In addition, they
expressed uncertainty about what all other people
expected of them and how they could meet these
expectations.
‘One thing is dealing with the problem once you are
diagnosed, trying to cope with the time, it takes a
long time to recovery, takes months and months if
you had a bad episode to recovery and get back to
your normal life’.
Participants took a considerably long time to recover,
and interruptions such as relapses and hospitalisa-
tions delayed their recovery even further. They felt
that their illness had hindered their ability to do things
normally in their daily lives. Participants expressed
that many aspects of their lives were not as they
should be in terms of daily routines and in terms of
meeting and socialising with people of the opposite
sex. They felt that the girls, in general, whom they
would be interested in, would not be able to cope
with their mental illness.
‘There is only a small percentage of women that
would like you for who you are. Having a mental
illness narrows that down even further.’
Participants doubted their ability to interact with
girls. This appeared to relate to what they had to offer
another person. They appeared uncertain about their
personal qualities, which would make them likeable
or acceptable to others of the opposite sex. By having
a mental illness, they felt that this decreased their
chances even more of being able to independently
meet and socialise with girls.
Discussion
The present study sought to gain an understanding of
the lived experience of young males diagnosed with a
psychotic illness and the impact that this had on their
social relationships. The main themes identified in the
present study were the lack of control over their treat-
ment, stigma, and the uncertainty they experienced in
self-perception.
The issue of having to take medication and the
effect that this had on the young males was along
the lines of a pervasive theme. Medication impacted
upon their ability to function in a number of ways,
specifically feelings of confusion, loss of confidence,
low motivation, increased social withdrawal, their
ability to think clearly, feelings of discomfort with side-
effects, and a loss of autonomy. They found that they
lacked understanding of what was happening to them
and why. This finding highlights the fact that there is
248
a need to provide specific psychosocial interventions
in addition to the optimal use of medication (Falloon
et al., 1998), as was the case in this example. Many
people with psychotic disorders in Australia receive
psychotropic medication but are often denied the
opportunity to receive psychosocial interventions
(Gilbert et al., 2003), which is unlike what has been
discussed here. This is for the most part due to these
services simply not being available (Jablensky et al.,
1999), unlike in the present study.
The attitude of the consumers to medication was
disturbing. This is an important area to address. First,
attending a medication group, which emphasises the
biology of mental illness and the necessity of taking
medication despite uncomfortable side-effects, might
be useful. In addition, teaching consumers to discuss
their side-effects with the prescriber is most important.
As practitioners, we need to be able to explain the
importance of mediation adherence and strategies for
managing their illness, but our consumers need to learn
to be assertive about speaking about the side-effects.
Participants identified that being diagnosed with a
psychotic disorder ‘closed doors’ for them. This, they
said, was a result of how others viewed them as well
as their own changed self-perception and expectation.
Other authors have observed similar changes (Ertugrul
& Ulug, 2004; Penn et al., 2000). Once the young males
had been diagnosed and were receiving treatment,
they felt the effects of unclear expectations. This related
to what others expected of them and what they
expected of themselves. They considered that they
had lost confidence because of the stigma of having a
mental illness. Stigma influenced their relationships
with their friends and they began to feel that other
people were better than they were because they did
not have a mental illness. Stigma has important impli-
cations for the social inclusion of people with psychotic
disorders into the community (Ertugrul & Ulug).
The issue of girls emerged strongly, with the young
males feeling that many of the girls they would be
interested in would not be able to deal with the fact
that they had a mental illness. In addition, their rela-
tionships changed with their family, with the family
increasingly wanting to have more input into their
lives. In many ways, they saw that the relationships
they had with others around them had become
increasingly superficial. The existence of meaningful
relationships has long been recognised as a protective
factor against psychiatric relapse (Commonwealth
Department of Health and Age Care, 2000). However, as
shown, many issues associated with having a psychotic
illness negatively impact on an individual’s ability
to maintain relationships. Participants in this group
identified their negative symptoms, medication, and a
lack of opportunity to learn appropriate social skills
C. LLOYD ET AL.
as barriers to maintaining relationships. The use of a
group intervention to support young men in this has
the potential to not only allow young men to lead
more fulfilling lives, but also reduce the financial
burden to society by building resilience, promoting
community participation, and therefore reducing
re-admission rates.
The young men in the present study had a number
of ideas about what they believed would be helpful in
assisting them to deal with the issues they were experi-
encing. They thought that group interventions should
incorporate such aspects as role-plays, excursions into
the local community, hearing from girls about their
expectations of relationships, and importantly, to hear
talks from people with mental illness who were success-
ful in achieving their life goals. Subsequently, the
group program was structured to cover the following
aspects: opportunities to share their experiences and
network with other group members, role playing social
interactions, practise situations in the local community
and home-work assignments, hear invited women
speakers discuss girls’ expectations and appropriate
behaviour when meeting girls and planning a date,
and hear invited male speakers share with the group
how they managed their disability and achieved their
goals. The focus was on assisting the young men to
feel more in control, develop self-confidence, and pro-
mote self-esteem through participation in activities
that were meaningful to them.
The implications for service provision are substan-
tial. There needs to be a change in the way care of
young men (and possibly others) is planned and
delivered in order to address the disability associated
with psychotic disorders. First, a multidisciplinary
approach needs to be taken in order to plan effective
interventions to address identified needs. It is reason-
able to suggest that members of the multidisciplinary
team should collaborate when planning treatment
interventions. This approach brings a greater depth to
the proposed intervention than those carried out
solely by one discipline, as they each bring their special-
ised skills to the design and implementation of re-
habilitation programs. In addition, there needs to be
recognition by health-service managers that it is not
enough to facilitate recovery simply by providing
medication and access to some form of case manage-
ment. Sane Australia (2002) concluded that many
people with psychotic disorders are living on the edge
of effective treatments and were suffering profound and
costly disability, which could be reduced if effective
treatments were developed and introduced more
systematically at onset and during the initial course
of the illness. If spending on rehabilitation programs is
addressed in a significant way, there are a number of
indirect cost savings from psychosocial rehabilitation.
PERCEPTIONS OF SOCIAL STIGMA
This flows from better health outcomes that diminish
the demand for clinical services and increases the like-
lihood of gaining employment and being fully partici-
patory community members (Sane Australia). What
can be unequivocally argued is that the human cost is
much greater in the absence of interventions such as
those described above.
Limitations of the study
Although focus groups have strength in the produc-
tion of data through interaction, there are a number of
limitations associated with the present study, which
need to be considered when reviewing the findings.
These include the sampling procedures, where the
researchers were known to the participants and
were the group leaders of the program that they were
attending, which could possibly contribute to bias.
However, the use of a focus group was found to be a
versatile and invaluable means for development of
the social skills program, which directly targeted the
identified needs of the young men.
Future directions
This qualitative study was the second part of a study
investigating the social functioning of young males
with psychotic disorders following participation in a
psychosocial group intervention. A quantitative research
design was then used to examine the association
between attending the group program and changes
in social functioning. Further research needs to be
directed towards determining the most effective way
of addressing the effects of stigma and changes in
self-perception experienced by young people with
psychotic disorders.
Conclusion
The present study found distinct themes emerging
from young males with psychotic disorders. These
included a loss of control, stigma and changes in self-
perception. Psychotropic medication is an important
intervention, however, attention needs to be paid to
the psychosocial impairments experienced by people
with psychotic disorders. The findings from this study
highlight the need to provide psychosocial interven-
tions specifically targeting the effects of stigma (both
internalised and externalised), self-perception, and
skills training relating to interpersonal relationships.
Rehabilitation of people with mental illness seeks to
promote social inclusion and community participa-
tion. The provision of psychosocial interventions is
one strategy, which may assist young men participate
more fully in roles and activities that are meaningful to
them, thereby improving their quality of life. Further
evaluation of these interventions using quantitative
249
methods would be useful in determining the most
effective strategies to address deficits in social
functioning.
Acknowledgements
This program received a Certificate of Recognition
and a developmental grant from Eli Lilly Australia
Pty. Ltd. We are grateful to the group members who
willingly participated in this study. At the time this
research was conducted, the authors worked for
Rehabilitation Services, Integrated Mental Health Service,
and Gold Coast Health District. This article is based
on a presentation at the OT Australia Queensland
State Conference, Sunshine Coast, September 2004.
References
Albiston, D., Francey, S. & Harrigan, S. (1998). Group pro-
grammes for recovery from early psychosis. British Journal
of Psychiatry, 172, 117–121.
Angell, B. & Test, M. (2002). The relationship of clinical
factors and environmental opportunities to social func-
tioning in young adults with schizophrenia. Schizophrenia
Bulletin, 28, 259 –271.
Australian Health Ministers. (2003). National mental health
plan (pp. 2003 –2008). Canberra: Australian Government.
Bachrach, L. (2000). Psychosocial rehabilitation in the treat-
ment of schizophrenia — what are the boundaries? Acta
Psychiatrica Scandinavica, 102, 6 –10.
Barnes, M. & Wistow, G. (1994). Learning to hear voices:
Listening to users of mental health services. Journal of
Mental Health, 3, 525 –540.
Bustillo, J., Laurielo, J., Horna W. & Keith, S. (2001). The
psychosocial treatment of schizophrenia: An update.
American Journal of Psychiatry, 158, 163 –175.
Caltraux, D. (2003). Internalized stigma: A barrier to employ-
ment for people with mental illness. International Journal of
Therapy and Rehabilitation, 10, 539 –543.
Commonwealth Department of Health and Aged Care
(2000). Promotion, prevention and early intervention for mental
health — a monograph. Canberra: Commonwealth of Australia.
Dickerson, F., Parente, F. & Ringel, N. (2000). The relation-
ship among three measures of social functioning in outpa-
tients with schizophrenia. Journal of Clinical Psychology, 56,
1509 –1519.
Ertugrul, A. & Ulug, B. (2004). Perception of stigma among
patients with schizophrenia. Social Psychiatry and Psychiatric
Epidemiology, 39, 73 –77.
Falloon, I., Held, T., Roncone, R., Coverdale, J. & Laidlaw, T.
(1998). Optimal treatment strategies to enhance recovery
from schizophrenia. Australian and New Zealand Journal of
Psychiatry, 32, 43 – 49.
Gilbert, M., Miller, K., Berk, L., Ho, V. & Castle, D. (2003).
Scope for psychosocial treatments in psychosis: An
overview of collaborative therapy. Australasian Psychiatry,
11, 220 –224.
Ihnen, G., Penn, D., Corrigan, P. & Martin, J. (1998). Social
250
perception and social skills in schizophrenia. Psychiatry
Research, 80, 275 –286.
Ivanoff, S. D. (2002). Focus group discussions as a tool for
developing a health education programme for elderly
persons with visual impairment. Scandinavian Journal of
Occupational Therapy, 9, 3–9.
Jablensky, A., McGrath, J., Herrman, H., Castle, D., Gureje, O.,
Morgan, V. et al. (1999). People living with psychotic illness:
An Australian study 1997–98. An overview. Canberra: Com-
monwealth of Australia.
Lloyd, C., Williams, P. L. & Sullivan, D. (2004). Kick’n’On:
Helping young males kick back into life. Australian e-
Journal for the Advancement of Mental Health, 3, www.
auseinet.com/journal/vol3iss2/lloyd.pdf.
Marder, S. (2000). Integrating pharmacological and psycho-
social treatments for schizophrenia. Acta Psychiatrica
Scandinavica, 102, 87– 90.
C. LLOYD ET AL.
McGorry, P. & Edwards, J. (1997). The early psychosis training
pack. Macclesfield, Cheshire, UK: Gardiner-Caldwell
Communications Ltd.
Penn, D., Kohlmaier, J. & Corrigan, P. (2000). Interpersonal
factors contributing to the stigma of schizophrenia: Social
skills, perceived attractiveness, and symptoms. Schizophrenia
Research, 45, 37– 45.
Roder, V., Brenner, H., Muller, D., Lachler, M., Zom, P.,
Reisch, T. et al. (2002). Development of specific social skills
training programmes for schizophrenia patients: Results
of a multicentre study. Acta Psychiatrica Scandinavica, 105,
363 –371.
Sane Australia (2002). Schizophrenia: Costs — an analysis of the
burden of schizophrenia and related suicide in Australia.
Melbourne: Sane Australia.
Seale, J. & Barnard, S. (1998). Therapy research processes and
practicalities. Oxford: Butterworth Heinemann.