Stigma. During a symposium at this year’s EPA, four specialists advocated various approaches to addressing and overcoming stigma in mental health.
Physician heal thyself!
Stigma often associated with mental health and the treatment of mental health indeed impedes recruitment of the brightest young doctors to this field of medicine at a time when it needs them the most
In a thought-provoking presentation, Julian Beezhold, Norwich, UK, told delegates that they should be proud to be psychiatrists. All too often there is a stigma associated with simply being a psychiatrist and he thinks it’s time this changed. Stigma often associated with mental health and the treatment of mental health indeed impedes recruitment of the brightest young doctors to this field of medicine at a time when it needs them the most.
It’s important to realize that three psychiatrists have been awarded the Nobel Prize for Medicine – and that’s an achievement to be proud of, he reminded delegates.
Stigma impedes help-seeking
Sarah Evans-Lacko, London, UK, reminded delegates that stigma – both personal and internal – impedes help-seeking for mental health problems, even among those individuals with early signs and symptoms of illness. However, it might be that self-identification of a mental health issue may overcome stigma to some degree, thereby facilitating help-seeking.
A vision of excellence in psychiatry needs to be shared and promoted
Self-identification of mental illness may overcome stigma
Dr Evans-Lacko described a study in which various factors associated with stigma and their likely relationship to help-seeking were analyzed. A total of 438 young people were recruited to the study, 27.3% of whom were identified as heaving abnormal or borderline behavioral issues, using the Strengths and Difficulties Questionnaire (SDQ). To gauge social distance, a vignette case history of a young person with a mental illness was given to each participant and each was then asked how likely they were to socially-interact with the person in the vignette. Following this, each participant was then asked to assess how likely they felt themselves to be experiencing early signs of mental illness using the SELF-1 questionnaire.
Those participants with SDQ scores indicative of borderline issues were more aware of having early signs of mental health problems than those with lesser psychopathology
Those participants with SDQ scores indicative of borderline issues were more aware of having early signs of mental health problems than those with lesser psychopathology. This greater self-perception was independently associated with a higher likelihood of service use. As social distance was not directly related to mental health service use, it appears that, in an effort to avoid self-stigma, stigmatizing beliefs influence self-perceptions and hence the likelihood of help-seeking. Clearly, further work in overcoming stigma is needed to ensure young people seek and obtain the help they need when symptoms first become apparent.
What really works in an anti-stigma campaign?
Social contact is highly effective and extremely important when implementing anti-stigma campaigns in society
Two speakers offered valuable suggestions on effectively campaigning to overcome stigma. Antonio Lasalvia, Verona, Italy, explained that social contact with people who have lived experience is highly effective and extremely important when implementing anti-stigma campaigns in community care. This contact can be either personal or ‘virtual’ – through use of a video, the internet or social media. Openly talking about mental health issues is important, especially giving out positive messages about recovery and any achievements attained while ill.
Anti-stigma target groups include the health sector, the workplace, schools, the police and mass media; and campaigns can range from the national to local, ideally taking a multi-level approach.
“Time To Change”
Once such multi-level campaign was described by Gaia Sampogna, Naples, Italy, who explained how social media can be used to challenge stigma effectively. She described the ‘Time To Change’ (TTC) initiative, a British program designed to reduce mental health stigma and which included a social marketing campaign (Social marketing campaigns use social media, i.e. internet-based application as the means of communicating messages).
TTC started in 2009 and each of its activities was released as ‘bursts’ lasting for a limited time. Following each activity burst, 900-1,100 individuals aged between 20-40 years of age were asked their opinion of the campaign’s impact and the level of awareness of stigma it had attained. Impact was assessed using three assessment questionnaires; MAKS (Mental Health Knowledge Schedule), CAMI (Community Attitudes towards the Mentally Ill) and RIBS (Reported and Intended Behavior Score). Awareness was ascertained through a specific, single question.
The growing trend in social network use confirms its potential role in fighting stigma
Campaign awareness represents one of the most accurate predictors of the efficacy of the campaign. Over time, those people who were aware of the TTC campaign reported higher levels of knowledge, better tolerance and support of those with mental illness, and higher levels of positive behaviors such as social inclusion of those with severe mental disorders than those who remained unaware. As Dr Sampogna concluded, the growing trend in social network use confirms its potential role in fighting stigma.