Table 3 Important feedback loops found in the final Causal Loop Diagram model

B1

“Care seeking”

Adverse symptoms of mental disorders lead a person with mental disorders to seek mental health treatment, which increases the treatment she has received. This treatment reduces adverse symptoms of the mental disorders.

B2

“Treatment expenses”

Seeking care incurs treatment expenses, which increase the material poverty of the family. This material poverty reduces family’s overall ability to pay for treatment expenses, thereby reducing their willingness to seek treatment for the family member with mental disorders.

B3

“Stress of material poverty”

Seeking care incurs treatment expenses, which increase the material poverty of the family. Material poverty increases family stressors, which decreases a family’s willingness to prioritize the needs of the family member with mental disorders, resulting in that family member seeking less treatment.

R1

“Impact of treatment on family stigma”

Treatment for mental health disorder improves understanding of mental disorders by both family and the individual, which reduces stigmatizing beliefs among the family and increases their prioritization of the needs of the family member with mental disorder.

R2

“Isolation and community stigma”

Stigmatizing community norms and values create a high rate of mistreatment of people with mental disorders, which creates fear for both individuals and families and results in isolation of people with mental disorders. Isolation translates in less awareness of mental disorders in community because there is little contact with people with mental disorders, which in turn reinforces stigmatization in the community.

R3

“Community stigma driving family stigma”

Stigmatizing norms in the community also have an impact on increasing family stigmatizing beliefs about mental disorders, which in turn leads to mistreatment within the home. Mistreatment increases fear and isolation, which results in less awareness of mental disorders within the community and increases stigmatizing norms in the community, which reinforce family stigmatizing beliefs.

R4

Mistreatment and adverse symptomology of mental disorder

Mistreatment of persons with mental disorder is a source of individual stressors that negatively impacts the symptomatology of mental disorders. An increase in adverse symptomology of mental disorders reinforce family stigmatizing beliefs and increase mistreatment.