Challenging Stigma: the Royal College campaign
2003 will coincide with the ending of the five year campaign, launched by the Royal College of Psychiatrists in 1998: Changing minds: every family in the land. The aim of the campaign was to increase the understanding of mental illness amongst the general public and professionals and therefore help reducing the stigma of mental illness. The title refers to the need to change the general views on this, in order to bring about change in behaviour and attitudes vis a vis sufferers, fighting stigma and discrimination. The title also refers to any family in this country having some direct or indirect experience of mental health problems.
In particular the focus is on six common mental disorders: anxiety, depression, schizophrenia, Alzheimers disease and dementia, drugs and alcohol abuse, eating disorders. The scope of the campaign is also to examine public perception of dangerousness and self-infliction in regards to mental illness, the prognosis of sufferers and communication problems.
Leaflets on each of the mental disorders listed above, and other dissemination activities aided the campaign. The campaign was successful in letting papers on stigma being published in journals such as "Lancet", "British Journal of Psychiatry" and others. The lay press also published some articles on the topic. Dissemination was done through the Internet as well. Unfortunately dissemination wasnt forcefully aimed at the lay public, with a general lack of public awareness, which could have impacted on its efficacy. We are eagerly awaiting the end results, however.
In 2000, Crisp et al. surveyed 1787 subjects regarding common mental disorders; responders were 65%. They perceived people with schizophrenia and drug/alcohol addiction as "unpredictable" and "dangerous", and the latter disorders and eating disorders were defined as self-inflicted. Furthermore, subjects with all six mental disorders were seen as "hard to talk to ". About one third of respondents knew someone with a mental illness.
In two previous public opinion surveys in the UK 80% of the population agreed with the statement "most people are embarrassed by mentally ill people", and 30% saying "I am embarrassed by people with mental illness" (Huxley, 1993).
Clearly, the stigma linked to mental illness is deeply rooted, and precedes psychiatry itself. Prejudices on mental disorders are common to almost all cultures (Byrne, 2000). Psychiatry hasnt done much, and probably still doesnt, to challenge these stereotypes. Unlike other groups, subjected to discrimination, the mentally ill have found it difficult to fight their battle. This is self-explanatory, due to the nature of the illness.
It seems therefore necessary for psychiatrists to actively participate in educational programmes and public dissemination activities.
To educate, however, does not merely entail increasing knowledge, which per se cannot challenge centuries of prejudices. It also means challenging the image of mental illness as portrayed by medias and common folkloristic views. This is unthinkable if prejudices amongst professional psychiatry are not challenged first. Lewis and Appleby, in 1998 asked psychiatrists to rate some vignettes, showing that they tended to give more negative judgements if people in the vignettes were described as having a personality disorder.
The temptation to leave the task of challenging stigma and discrimination to the Royal College is high, however the possibility of bringing about definitive change is probably low. Each of us plays an important role, both in the clinical encounter with individuals who are daily subjected to discrimination, and for what regards dissemination at a public opinion level.
Byrne, P. (2000) stigma of mental illness and ways of diminishing it. Advances in psychiatric treatment, 6, 65-72.
Crisp, A. H., Gelder, M.G., Rix,S., et al. (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry, 177, 4-7.
Huxley, P. (1993) Location and stigma: a survey of community attitudes to mental illness: enlightenment and stigma. Journal of mental health UK, 2, 73-80.
Lewis, G. and Appleby, L. (1988) Personality Disorders: the patients psychiatrists dislike. British Journal of Psychiatry, 153: 44-49.