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Standing up to global mental health stigma

by Guest Author on 8 Oct 2018

We’ve recently funded Professor Sir Graham Thornicroft, a leading expert in research on mental health discrimination and stigma, to carry out a global study. On the day of the world’s first Global Ministerial Mental Health Summit, he sets out what stigma looks like across the globe and how his study will make a difference.

Graham Thornicroft

Around one in four people will experience mental ill health at some point in their lives, and this year alone around 450 million people worldwide have a mental health condition. Our research shows that in many countries 80 to 90% of them experience negative stigma and discrimination.

It’s so important we carry out research on how to improve this situation globally. Over the last decade, in over a dozen countries including the UK, there have been national anti-stigma programmes and the evidence shows that these can be effective. But so far, all of these programmes have been in high-income countries.

This is why we’ve formed the INDIGO Network. We want to better understand the origins, mechanisms and consequences of stigma and discrimination across the globe, then develop new methods to reduce stigma in economically developing countries. We’ve based our study on the findings of research in high-income countries, which has shown that personal connections are the most effective way to reduce stigma.

The negative impact of stigma

Stigma refers to a cluster of negative beliefs, attitudes and behaviours that motivate people to fear, reject and discriminate against people with mental health problems. Stigma can have far-reaching and devastating consequences for those lives it touches. In many ways, the impact of stigma is remarkably consistent across the world. But there are national and regional variations.

Exclusion by friends and family can lead to increased social isolation, often making mental health problems worse. Negative impacts on employment add to the problem, with higher rates of unemployment, part-time or low-paid work, and worse prospects for promotion.

In some countries in South and South-east Asia, having experience of mental ill health, or even having someone in your immediate family with a mental health condition, can often negatively impact your prospects of marriage. As a result, people hide mental illness under a cloak of secrecy – further reducing the chances of access to treatment and recovery.

The effects of stigma and discrimination also lead to poorer access to physical health care, increasing an already elevated risk of a premature death. Due to low investment in mental health treatment and care worldwide, treatment rates are low – about 25% of people with mental ill health are treated in richer countries and only about 5% in poorer countries.

Making it personal

To address these problems, in our study we’ll focus on unconscious bias – where people treat those with mental health problems less well than others without intending to. This can occur in many different settings, including in the healthcare system. We’ll also find out more about how people manage to cope with stigma without it having a negative impact.

Once we understand the situation better, we’ll then look at how to improve personal connections between those with and without experience of mental ill health. And we’ll learn how to adapt stigma reduction interventions to the local context and culture in low and middle-income countries.

Tailoring the right tools and skills

We plan to adapt scales which measure different aspects of stigma to nine different cultures and translate them into Amharic, Arabic, English, Hindi, Kannada, Mandarin and Telugu. We’ll make these openly available as a free ‘evaluation toolkit’.

Staff from the UK, Germany, Switzerland and the USA will support staff in China, Ethiopia, India, and Tunisia to develop their research skills and their careers. They will work together to find the best ways to deal with stigma and discrimination and establish centres of excellence in stigma research in their home countries.

Once we’ve gathered enough data, we’ll carry out projects to test specific intervention methods. The methods will include using direct personal contact to reduce stigma among healthcare staff, and a public awareness programme to increase referrals for people with mental illness to attend local healthcare services. We’ll learn from these studies and adapt the instructions before releasing them as openly available ‘intervention manuals’.

By finding effective ways to reduce stigma and discrimination against people with mental ill health in low- and middle-income countries, we hope to help more people gain access to mental healthcare and achieve greater levels of social inclusion in their community.

 

Comments

As a retired UK General Pracitioner who developed bipolar disorder as a student, my mental health problems and associated stigma undoubtedly impacted upon my career. However thanks to skilled management by a series of enlightened psychiatrists to and an opportunity provided by a very progressive and empathic senior partner I was able to enjoy a long and fulfilling career as a family doctor in my community indeed I was awarded an MBE for my services. However I was eventually forced into early retirement when I felt pressurised by the effects of the 2004 contract with its emphasis on performance related pay for hitting screening related targets, and difficulty of working with a religiously driven but dubiously competent partner who refused to accept the ethos my senior partner and I had established. My health broke down under stress of trying to work with him and I reluctantly retired prematurely on health grounds.
Although immensely privileged to have enjoyed a successful career despite my mental health difficulties even in UK stigma remains prevalent. Accordingly I wish your project every success.

author avatar by John Macdonald on 09-Oct-2018 11:10:06

As a person of faith I cringed to read about the poor doctor above. Lots of people use religion as a bullying tool, tis so unfair, thats why I call myself a Christian or a person of faith. I too have suffered from the stigma of mental health issues, due to persistent depression and being a very anxious person as well, not a good combination. It took me years to realise that I was actually intelligent but I would so like for this to have been recognised sooner when I could than have had a fulfilling career. I have been told that it isn’t wise to put depression on job applications numerous times, demonstrating that the assumptions and stigma are quite common. I applaud the fact that you are undertaking this research as I also finished up off work due to stress and eventually had to leave as my employer didn’t understand what the problem was. The really sad thing is that he had a disabled son, but nothing can predict peoples discriminatory opinions and I think a lot of people would think that they were discriminating, just doing the best for the company.

author avatar by Maureen Jepson on 11-Oct-2018 14:08:04

It is not surprising that The World Health Organization predicts that mental illness will be the leading disease burden globally by 2030, given that the current medical standards of care used to diagnose mental illness do not scientifically know of any biological cause for the vast supermajority of worldwide psychiatric diagnoses and that the current medical standards of care of biologically-based treatments for mental illness, surprisingly, cause
huge amounts of iatrogenic morbidity and mortality with no scientifically proven benefit. These facts add greatly to the stigma of mental health issues as, for example, patients are all too often considered “bad patients” for not blindly accepting the unscientific and iatrogenic labels and treatments of psychiatry. These serious scientific facts and more are
proven in the twelve best-in-class expert witness references and my ethics teaching included in my 5/2/18 letter to the editor of the British Medical Journal and my 8/16/18 Medicaid.gov public comment (which are both set in the context of two real life current events U.S. public health policy crises and) available for free at the following two URL addresses:

https://www.bmj.com/content/356/bmj.j1058/rr-1

https://public.medicaid.gov/connect.ti/public.comments/showUserAnswers?qid=1897507&voteid=352593&nextURL=%2Fconnect%2Eti%2Fpublic%2Ecomments%2FquestionnaireVotes%3Fqid%3D1897507%26sort%3Drespondent%5F%5FcommonName%26dir%3Dasc%26startrow%3D1%26search%3D

Sincerely and In Biblical Love for All Healthcare Policymakers and All People Everywhere,
Thomas Steven Roth, MBA, MD
Christian Minister for Biblical Medical Ethics,
and therefore,
Religious and Scientific Refugee from the Clinical Practice of Psychiatric Standards of Care
P.O. Box 24211
Louisville, KY 40224
October 11, 2018

author avatar by Thomas Steven Roth, MBA, MD on 11-Oct-2018 20:31:06

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