evidence to reduce stigma & discrimination graham thornicroft, phd centre for global mental...
TRANSCRIPT
Evidence to Reduce Stigma & Discrimination
Graham Thornicroft, PhD
Centre for Global Mental HealthKing’s College London, Institute of
Psychiatry
March 2014
World Health Organization Collaborating
Centre
Intended Audience & Learning Objectives
This lecture will be most informative for someone with a beginning level knowledge of the topic. By the end of this lecture, users will be able to:
• Learn about the challenge of stigma and discrimination in mental health
• Identify local- and national-level responses to stigma and discrimination
• Identify resources for addressing stigma and discrimination
Stigma
“The issue of stigma against mental illness
sometimes feels like the worst part about
it.”
Tom
Stigma
Friends
They don’t call me sad. They don’t call me bad. They don’t call me mad. They don’t call me.
© William McKnight Book title: Loud Silence, 2012
Plan
1. Challenge
2. Response
• evidence for local interventions
• evidence for national interventions
3. Resources
Plan
1. Challenge
Click book coverFor more information—
(in Slide Show mode only)
Challenge 1
What is Stigma? It has 3 components
• Problem of knowledge = Ignorance
• Problem of attitudes = Prejudice
• Problem of behaviour = Discrimination
Challenge 2
“At 16, in 1996, I suffered a bad mental breakdown
where I was hospitalised for 5 years. It was very
traumatic. There I was, the eldest son, suffering a
sudden deep depression, crying and unable to
work, often threatened by my confused Dad as
being
“weak”. --Robert
INDIGO Network
INDIGO
International Study of Discrimination and Stigma Outcomes in Mental Health
39 study sites in 35 countriesFor more information, contact:[email protected]
INDIGO NetworkINDIGO aims:
• Develop and validate a scale to measure service user’s experiences of discrimination (anticipated and experienced)
• Called: Discrimination and Stigma Scale (DISC)
• Collect international data on the nature and severity of discrimination
Discrimination and stigma scale (DISC)
INDIGO NetworkDiscrimination and stigma scale (DISC) Reported by service users with schizophrenia about experiences of discrimination:
• personal relationships • financial affairs • housing • community life • education • health & social services • family life • privacy and safety • work • children • transport and travel • avoidance
736 people interviewed, 28 countries
INDIGO Key References (Click titles for access--in Slide Show mode only)
Global pattern of experienced and anticipated discrimination Against people with schizophrenia: a cross-sectional study.
Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey.
Thornicroft G, et al. & the INDIGO Study GroupLancet 2009, 373:408-415
Lasalvia A, et al. & the ASPEN/INDIGO Study GroupLancet 2013, 381:55-62
Plan
1. Challenge
2. Response
• evidence for local interventions
Local Level Interventions
Social Contact Theory:
•Direct, personal social contact with individual(s) of the stigmatised group
is effective to reduce stigma
Local Level Interventions
Local Intervention Studies, Target Groups:•Police officers•Young people•Medical Students•Nurse Students
For references, see Note section of this slide.
Local Level Interventions(Click title for access--in Slide Show mode only)
• Compared live consumer talks, DVD filmed consumer talks, and boring lecture for nursing students
• Attitudes, compassion and behaviour improved for live consumer and DVD groups
• Both better than lecture—still better 4 months later• Recorded sessions most cost-effective
Filmed v. live social contact interventions to reduce stigma:randomised controlled trial Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, McCrone P, Norman I, Thornicroft G
Br J Psychiatry 2012, 201(1):57-64
1. Challenge
2. Response
• evidence for local interventions
• evidence for national interventions
Plan
National Level Interventions(Click title for access--in Slide Show mode only)
Messages to use in population-level campaigns to reducemental health-related stigma: consensus development study Clement S, Jarrett M, Henderson C, Thornicroft G
Epidemiologia e Psichiatria Sociale 2010, 19(1):72-79
• Recovery oriented• See the person• Social inclusion/human rights• Mental health problems are common
National Level Interventions
Time to Change, 4-Year Outcomes:
•8 papers published in British J. of Psychiatry 2013
•Consistent pattern of positive change in England
•Small to moderate sized improvements
•Most positive change is in service user reports of experienced discrimination
National Level Interventions(Click title for access--in Slide Show mode only)
The Importance of Disclosure:
Systematic review of beliefs, behaviours, and influencing factors associated with disclosure of a mental health problem in the workplace Brohan E, Henderson C, Wheat K, Malcolm E, Clement S, Barley EA, Slade M, Thornicroft G
BMC Psychiatry 2012, 12:11
Plan
1. Challenge
2. Response
• evidence for local interventions
• evidence for national interventions
3. Resources
Resources in 3 Key Domains of Stigma
What is Stigma?
• Problem of knowledge = Ignorance
• Problem of attitudes = Prejudice
• Problem of behaviour =
Discrimination
Resources on Knowledge(Click title for access--in Slide Show mode only)
Development and psychometric properties of the Mental Health Knowledge Schedule Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, Thornicroft G
Can J Psychiatry 2010, 55(7):440-448.
Resources on Attitudes(Click title for access--in Slide Show mode only)
MICA Scale (Mental Illness Clinicians Attitudes):Development and responsiveness of a scale to measure clinicians’attitudes to people with mental illness (medical student version) Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G
Acta Psychiatr Scand 2010, 1-9
Resources on Behaviour(Click titles for access--in Slide Show mode only)
Resources on Barriers to Access
(Click title for access--in Slide Show mode only)
Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G BMC Psychiatry 2012, 12:36
Resources
FOR FURTHER INFORMATION CONTACT: