Transcript Document

Empowerment, Disclosure & Group Identification
“Those who do not have power over the stories that
dominate their lives, power to retell them, rethink them,
deconstruct them, joke about them, and change them…
truly are powerless because they cannot think new
thoughts.”
Salman Rushdie
The consumer role in reducing self-stigma, discrimination & enhancing social inclusion
Prepared by: Neasa Martin, Constance McKnight & Joan Edwards Karmazyn for the NNMH
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LEADERSHIP different sharing quality of life rejection WORK fragile citizen
Stigma & Discrimination
Stigma is real, damaging & pervasive. More painful than
mental-ill health. It continues long after symptoms resolve.
Stigma takes many forms:
Public stigma: is the harm caused when the public
endorses the prejudice & discrimination of mental illness.
Courtesy stigma: is the devaluation experienced by
caregivers & professionals.
Discrimination: is the external behaviour & institutional
arrangements that deny people rights or limit their social
inclusion.
Impacts Every Area of Life
 Social exclusion: Unemployment,  Education, 
persistent poverty. Social isolation,  Friendships, 
withdrawal of family.  Negative portrayal by media (blame,
violent, incompetent, impulsive). Harm to families.
 Loss of human rights: Use of seclusion, restraint &,
involuntary treatment. Denial of housing, insurance, public
office, mortgages, loss of parental rights. Increased risk
containment  criminalization, re-institutionalization in
prison. Policy & funding neglect by governments.
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Self-Stigma
Self-stigma: is the harm caused when people internalize
negative stereotypes impacting self-esteem & self-efficacy.
Results in self-blame, feeling hopeless & helpless. Limits
recovery & increases risk of suicide.
Label avoidance: self-stigma leads to people avoiding
labeling by not accessing mental health services.
Who suffers from self-stigma?
People who identify with their ‘diagnostic label’, are aware of
& agree with stereotypes, those who fear disclosure, are
socially isolated & fail to pursue work, housing, civic
participation & entitlements. Those with high ‘disease
awareness’ but lack a positive group identification.
What protects people from self-stigma?
Rejection of stereotypes & de-emphasizing diagnostic labels.
Group identification, participation in the fellowship of peersupport/self-help. A commitment to recovery. Empowerment
& righteous anger. Reframing experience positively. Finding
meaning & purpose. Building self esteem & self-efficacy.
Developing a sense of mastery.
 Impact on health care: Pessimism & focus on limitations.
Under funding of mental health services. Less choice &
access to recovery/ rehab services. Poor medical care,
chronic illness,  lifespan (10 years).
Self-stigma ‘circuit breakers’
By increasing visibility of people with mental health issues.
Building peer support networks. Affirming human rights.
Challenging negative attitudes & stereotypes. Promoting
systemic changes reflecting recovery practices. Participating
in public education activities. Self-disclosing to inspire others
& give hope.
How is Stigma Formed / Stopped
Diagnostic Labeling & Stigma
Three inter-related problems:
1) A lack of knowledge  ignorance
2) Ignorance  prejudice & negative emotions
3) Prejudice  avoidance & discrimination
Three-pronged solution:
1) Education (by consumers, about their experience - not
illness, targeting the influential, emphasizing rights &
promoting hope, recovery & inclusion)
2) Positive contact (with consumers who disabuse myths,
between peers, & when there is a shared goal)
3) Protest (fighting inequities, demanding rights, fighting
negative media, & seeking systemic changes)
Need to focus on discrimination: Information alone does
not change attitudes. Changing attitudes may not change
behaviour or improved quality of life. Focusing on
empowerment, rights & social inclusion DOES improve
QOL. Work at a systems level with all stakeholders to
improve policies, practices, laws & their enforcement.
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
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This approach does reduce “blame” and the public is more
supportive of treatment. BUT they are also more fearful of
people with mental illness who they see as having no control
and are therefore more dangerous. This leads to rejection &
social distance.
There is less stigma when…
Mental health problems are seen as part of our ‘shared
humanity’ & an understandable consequence of life
circumstances.
When there is less emphasis placed on medications,
hospitalization & medical treatment. Supports are provided in
the ‘mainstream’ community. More public acceptance when
government(s) fund treatment & services.
ignorance
purpose harm peers suicide knowledge negative education survivor indifference experiential expertise
Importance of Peer Support
Research (although limited) confirms peer-support:
Is highly valued by consumers who participate.
Builds group identification & reduces self-stigma.
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Key Messages
Outcome of anti-discrimination programming MUST:
 Promote human rights including policies, practices & laws.
Significantly reduces hospitalizations (number &
duration), decreases symptom distress, use of
emergency & other expensive medical services.
 All stakeholders work to remove systemic barriers.
Increases social contacts, builds supportive networks &
enhances quality of life.
 Mental ill-health is framed as part of our shared humanity NOT a disease of the brain.
Helps to re-frame distressing experiences positively.
Normalizes the experience of mental ill-health.
 Focus on enhancing social inclusion & quality of life;
Supports disclosure & neutralizes self-stigma.
Empowers people by participating in advocacy,
education & by providing support to others.
 People are seen as citizens & not problems to be solved.
Housing, employment, education & training, income
security, safety, improved health & mental health,
recovery-focused care, stop discrimination, supportive
communities, access to mainstream services…
Supports recovery. Helps people learn self-management
strategies, awareness of resources & how to navigate
professionally run services.
Consumers MUST lead anti-discrimination programs:
Participation in systemic advocacy strengthens selfefficacy, empowerment & promotes recovery.
 They understand the issues & provide the army for battle.
Consumer employment within mental health services
reduces stigma & discrimination amongst health care
providers.
Peer-support identifies solutions & supports systemic
change. Consumers hold stakeholders accountable.
Consumer-led economic development initiatives affirms
capacity to work & reduces pessimism re: recovery.
 Because this reflects “best practice” & enhances success.
Funding of empowerment / support programs is critical:
 For the success of anti-discrimination programming.
 To reduce self-stigma, promote recovery & improve QOL.
 For achieving systemic change.
Building a research evidence-base is essential but…
Reflect consumer priorities in publicly funded research.
Under Funding is Discriminatory
“Illness like any other” does not work
Framing mental illness as biologically based, genetically
influenced & chemically mediated ‘disease’ of the brain
increases pessimism regarding recovery, desire for social
distance, tolerance for coercive treatment & public
acceptance of the violation of people’s human rights.
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 Includes participatory-action & qualitative research design.
Research reflects:
 Consumers are agents NOT objects in research delivery
Robust consumer leadership as an internationally
recognized ‘best practice” in reducing discrimination.
 Knowledge is share in accessible & meaningful ways.
Peer support & group identification is critical to
overcoming self-stigma & improving quality of life.
Consumer-focused recovery is the heart of anti-stigma
messaging and reform.
Reducing self-stigma removes a barrier to pursuing
treatment, work, friendships & enhances recovery.
Peer-support is recognized in Canada & worldwide as a
“best practice” in mental health service delivery.
It works & is cost effectiveness.
Consumer leadership drives systemic transformation &
peer-support builds consumer leadership.
In Canada peer-driven services are under-funded &
devalued.
This is systemic discrimination.
For Further Information
National Network for Mental Health
55 King St. Suite 604
St Catharines, ON L2R 3H5
Toll Free: (888) 406-4663
Phone: (905) 682-2423
Fax: (905) 682-7469
http://www.nnmh.ca/