Transcript Evidence to Reduce Stigma & Discrimination

Evidence to Reduce
Stigma & Discrimination
Graham Thornicroft, PhD
Centre for Global Mental Health
King’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 cover
For 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 countries
For more information, contact:
[email protected]
INDIGO Network
INDIGO 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
INDIGO Network
Discrimination and stigma scale (DISC)
Reported by service users with schizophrenia about
experiences of discrimination:
• personal relationships
• financial affairs
• housing
• education
• family life
• work
• transport and travel
• community life
• health & social services
• privacy and safety
• children
• avoidance
736 people interviewed, 28 countries
INDIGO Network
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.
Thornicroft G, et al. & the INDIGO Study Group
Lancet 2009, 373:408-415
Global pattern of experienced and anticipated discrimination
reported by people with major depressive disorder: a cross-sectional
survey.
Lasalvia A, et al. & the ASPEN/INDIGO Study Group
Lancet 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)
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
• 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
Plan
1. Challenge
2. Response
• evidence for local interventions
• evidence for national interventions
National Level Interventions
(Click title for access--in Slide Show mode only)
Messages to use in population-level campaigns to reduce
mental 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:
[email protected]