Deconstructing the mental health crisis: 5 uneasy pieces
But do people with mental illness face specific barriers or issues when Only 15 percent of participants were currently involved in a romantic relationship. Others stated that if they wanted a quick exit during an awkward date, they illness often report considerable discrimination in the dating market. 12 The Connection Between Mental and Physical Conditions. 13 Recovery 18 Distinguishing Religious or Spiritual Problems From Mental Illness. 19 Approaching a . anxious sometimes, such as when speaking in front of a group or taking a Adam Scott, Senior Graphic Designer, Integrated Marketing. Jeffrey Regan. and the Mental Patient: An Uneasy Relationship situation of the mental patient and proceeds to the analysis of the psychiatric discourse. The author fulness of the mentally ill individuals for the labor market and are not merely effects of.
Partnering up The Swedish study had a number of key findings. First up, people with a psychiatric diagnosis were less likely to be married. When they did marry, the chance of them marrying someone else with a psychiatric diagnosis was two to three times higher than for people without a psychiatric diagnosis. There was also a correlation between specific diagnoses. People with disorders that developed at a young age, like autism spectrum disorder and attention deficit hyperactivity disorder, had a tendency to marry people with the same diagnosis.
As did people with disorders that had particularly severe symptoms, such as schizophrenia. People with depression and generalised anxiety disorder were also more likely to partner with people with psychiatric disorders, but the correlation between diagnoses for these was lower. The results held for men and women. People with these disorders showed little or no increase in the chances of being married to someone else with a medical disorder of the same, or any sort.
As with most good science, the study raises more questions than it answers. Laws of attraction The laws of attraction are complex. Evolutionary theory says we mate with those who give us the highest chances of surviving and reproducing. Consequently, few stigma reduction programs have been subjected to independent review or evaluation.
The peer reviewed literature in this area, although growing, remains meager and incommensurate with the hidden burden caused by stigma. Many promising practices have been identified, but few have been implemented widely enough to assess their broad public health effects, their sustainability, their cost-effectiveness, or their transferability from high-income countries, where they largely reside, to low- and middle-income countries, where they may be most needed.
In addition, validated fidelity criteria, which identify the active ingredients in a program, are lacking. Identifying the principles and procedures underlying successful anti-stigma programming in such a way that they can be meaningfully tested using rigorous methods and, if found to be successful, widely disseminated, remains an important public mental health priority Stuart, Research is beginning to show that ill-conceived anti-stigma programming can have significant detrimental effects.
Concomitantly, industry marketing strategies have also provided the public with a wealth information on symptoms, brain-based aetiologies, and specific pharmacological solutions.
Rather than reducing stigmatized views, neurobiological explanations have had little or no effect on social intolerance, and in some cases, have deepened it Pescosolido et al.
Reducing the stigma of mental illness
These findings also suggest that using biological or professional explanations of mental illnesses, as a way of improving knowledge in low- and middle-income countries, where literacy is generally poor, may be ill advised as an anti-stigma strategy. Many community-based advocacy programs in high-income countries address stigma with good intentions, but with no sound evidence to support their activities Stuart et al. Advocacy groups rarely have the opportunity, the funding, the time, or the expertise to participate in in-depth monitoring, reflection, and learning.
They cannot afford to invest in formal evaluation research. Because they need knowledge that is contextualized, easily accessible, decision-oriented, and pragmatic, they accept a much broader range of evidence and share it more informally. Scientific knowledge, which is formal, objective, decontextualized, and peer-reviewed follows a more lengthy process so is of less value in this context Ferguson, In low- and middle-income countries, the challenge is not having different knowledge paradigms, but having limited or no capacity to generate research i.
According to The Academy of Medical Sciencesa quarter of low- and middle-income countries have no mental health researchers at all, and a further quarter of countries have five or fewer researchers in total. When they exist, mental health researchers in low- and middle-income countries are poorly funded, and have little access to resources such as research networks, fellowships, technical support, or well-resourced libraries.
At least three large national anti-stigma programs have built formal ties with university researchers to conduct evaluations of anti-stigma programming. Working together, they have crafted an extensive evaluation plan and produced evidence-based reviews of the program's activities. Changes in public attitudes were measured every year from to using items from the Community Attitudes towards the Mentally Ill Scale, the Opinions About Mental Illness Scale, and two new psychometrically validated scales: In addition, The Discrimination and Stigma Scale was used to assess discrimination experienced by people using mental health services across England.
The results were mixed. There was a small reduction in the discrimination reported by service users, there was no improvement in the knowledge or behaviour of the general public, but there was improved employer recognition of common mental health problems.
There were also improvements in medical students' attitudes, though these were short lived, pointing to the need for ongoing programming Smith, More detailed results have been published in the scientific literature in a special supplement of the British Journal of Psychiatry published in New Zealand's Like Minds Like Mine anti-stigma program has developed strong partnerships with policy makers at the Ministry of Health, an external social marketing firm, as well as researchers from the Institute of Psychiatry in the UK.
They assessed the personal experiences of discrimination among mental health service users and their opinions as to whether discrimination had improved over the previous 5 years. Using a modified version of the Discrimination and Stigma Scale developed by the UK-based researchers for Time to Change; they surveyed a representative sample of service users selected by officials at the Ministry of Health. Canada's Opening Minds anti-stigma initiative has developed formal partnerships with researchers at five universities across Canada and an extensive network of community providers.
Each researcher is responsible for working with research staff who are funded by Opening Minds and community partners to develop and execute evaluation approaches targeted to a specific group youth, healthcare providers, journalists, or workers.
All programs use some form of contact-based education where people who have experienced a mental health problem deliver an educational intervention centred on personal recovery stories to promote transformational learning. As in the UK, the Canadian program has also created and psychometrically tested several scales to assess changes in attitudes and intended behaviours e. A large media-monitoring project was also undertaken to assess the content and tone of key newspapers.
Finally, at the population level, researchers worked with Canada's national statistical reporting agency to develop a measure of the frequency and impact of stigma among people who had received mental health treatment in the year prior to the survey. Overall, results have been positive illustrating that contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across different target groups and sectors Stuart et al.
The next challenge is how to scale these local interventions to achieve national coverage.
- Deconstructing the mental health crisis: 5 uneasy pieces
More detailed results have been published in a special supplement of the Canadian Journal of Psychiatry published in Contributions such as these show that university community partnerships are possible and can lead to important insights that contribute to the development of best practices in stigma reduction. They also form the nexus for knowledge exchange between policy makers, providers, and researchers.
In future, partnerships and networks such as these should expand to include young researchers from low- and middle-income countries who require training opportunities, networks of practice, and research collaborations. This would broaden our understanding of how programs developed and implemented in high-income countries might translate into the context of low- and middle-income countries, help provide stable funding for the evaluation of intervention projects in low- and middle-income countries, and play an important role in global knowledge exchange.
The challenge will be to find funding to promote these global efforts. Outcomes of interest Traditional approaches to stigma reduction have focused on public perceptions of mental illnesses and the mentally ill. Consequently, there is a wealth of survey research in this area describing public knowledge and attitudes. With few exceptions, members of the lay public demonstrated poor mental health literacy, meaning they were unable to recognize symptoms of mental disorders and were unsure as to where to seek help.
Public expressions of behavioural intentions towards people with a mental illness a proxy measure of discriminatory behaviours have also been of interest.
When it comes to mental health, like attracts like
Improving the experiences of those who have a mental illness is increasingly viewed as an appropriate benchmark for judging the success of anti-stigma efforts. A number of new measurement instruments have been developed to capture the nature and consequences of personal stigma, so as to target anti-stigma programs to where they are most needed and to measure their effects Ritsher et al.
A significant limitation of the conventional approaches to stigma-reduction has been the omission of structural outcomes of change. Structural stigma occurs when institutions intentionally or unintentionally create policies, procedures, or practices that disadvantage those with a mental illness, leading to social inequities Corrigan et al.
The United Nations Convention on the Rights of Persons with Disabilities explicitly recognizes that social disadvantage flows from institutional practices, rather than individual impairments. Signatories to the convention agree to remove structural and attitudinal barriers that interfere with individuals' full and effective social participation United Nations General Assembly, An example of a national anti-stigma program with clear structural goals is Scotland's See Me campaign http: Common approaches to stigma reduction Many activities have been grouped under the rubric of stigma reduction see, for example, Gaebel et al.
The bulk of the literature pertains to programs implemented in high-income countries. The following examples highlight some of the most common approaches taken by programs to address stigma, either directly as a primary outcome, or indirectly as an assumed by-product of other activities.
Awareness raising Awareness raising interventions are typically multi-faceted and occur during a specified time in the year when key stakeholders come together to engage in activities designed to increase the public profile of mental health issues. Often an advocacy organization or a network of organizations is involved. Advocacy groups in over countries get involved. Some countries have designated a full week of awareness-raising activities where mental health advocates and stakeholders engage in a variety of events designed to promote public education and awareness.
While these often generate numerous activities, it is difficult to know whether awareness-raising programs meet their objectives, as they have not been comprehensively evaluated. Many awareness-raising activities are designed to open a dialogue about mental health on the assumption that bringing it out of the shadows will improve social tolerance.
Stigma reduction is a hoped-for side effect. For example, Active Minds is an awareness-raising non-profit organization that targets students in universities with chapters across most of the USA, as well as in Canada, and Ecuador http: The goal is to reduce the stigma surrounding mental health issues by empowering students to speak openly about their mental health problems through student-run mental health awareness, education, and advocacy.
They have designated October 5 as the National Day Without Stigma where they encourage students to watch their language, chalk their support by chalking supportive messages about mental health across campusesand reach out to someone who may be struggling with a mental health problem. By raising awareness about mental health they hope to create communities of support and promote help seeking.
Bell Canada's Let's Talk day is an example of a large national program that uses technology and social media to open a public dialogue about mental illnesses. During one day in January, national celebrities, such as Clara Hughes a six-time Olympic medalist and others invite Canadians to join the conversation about mental health and the stigma surrounding mental illnesses.
Bell uses the day to raise money for mental health research and community initiatives by donating 5 cents for message sent on the Bell network, thus raising 5—6 million dollars each year. Organizations such as Time to Change http: These programs capitalize on the momentum that electronic networking can have to raise awareness and fight stigma. Literacy programs Literacy programs try to improve knowledge about mental illnesses, their signs and symptoms, their treatments, and where to go to seek help on the assumption that reduced stigma will be a natural by-product.
For example, beyondblue http: In this case, stigma reduction is not the primary outcome of interest, but a means to an end. As with awareness programs, an underlying assumption is that improved knowledge and awareness about stigma and discrimination will arm individuals to take appropriate action. For example, with respect to discrimination by the insurance industry in Australia, beyondblue undertook extensive research to document the scope and nature of the problem, then provided information on their web page indicating how insurance companies discriminate and what potential solutions could be implemented to resolve this problem.
They also provided information on how individuals could get involved by lodging a complaint or an appeal and where to go for support and legal advice. However, it is not clear whether the information provided by beyondblue has resulted in increased insurance equity for people with a mental illness. Population-based literacy programs often use mass media campaigns to transmit health messages to a wide public audience.
Few studies have examined the impact of such campaigns on stigma reduction, and those that have, report mixed, limited or no results. Often, campaigns are judged by the amount of penetration usually measured by recall or visits to a web sitebut even this may be meager.
For example Corrigan describes a large campaign in eight pilot sites in the U. Beginning in Novembermonthly visits to the web site tripled from tobut this translated into an audience penetration of only 0. Mass media campaigns may not be cost-effective compared with other more direct stigma-reduction approaches, particularly when baseline levels of literacy are high Stuart et al. Two media campaigns undertaken in Canada as part of anti-stigma programming also failed to show change over time.
The first was a radio campaign that was undertaken as part of the Canadian pilot program of World Psychiatric Associations' global anti-stigma program to convey the message that schizophrenia was treatable Stuart, Over radio messages narrated by a local psychiatrist including a short story by someone with lived experience of schizophrenia were aired at different times during the day for several months.
However, there was no improvement in knowledge, attitudes, or socially distancing behaviours. These results show that audience penetration here measured by awareness may not be correlated with key outcomes as is often assumed. Various media sources were used to transmit messages emphasizing treatment and recovery, including first-person accounts of people who had experienced a mental illness.
Navigating through the 5 uneasy pieces will be difficult, requiring global thought leaders and national and international organizations to articulate plans and strategies for the development of specific targets and mechanisms for funding research. It would be important to ensure that as innovative treatments are developed, they are made accessible to developed and low-income countries as well as to vulnerable and marginalized groups within Canada.
Nations should be held responsible for giving mental illnesses as prominent a place in health care as other noncommunicable diseases. Centre for Addiction and Mental Health. Mental Illness and Addictions: The global economic burden of non-communicable diseases. World Economic Forum; Neurotransmitter, peptide and cytokine processes in relation to depressive disorder: Comorbidity of depression with neurodegenerative disorders.
Examining a progressive model of self-stigma and its impact on people with serious mental illness. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Out of the shadows at last: Evid Based Ment Health. What have we learned? Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: Traumatic stress and human DNA methylation: Toward the future of psychiatric diagnosis: Kirmayer LJ, Crafa D.
What kind of science for psychiatry?