Radical action can end stigma, discrimination against people with mental health conditions: Lancet report

New Delhi: Radical action is needed to end stigma and discrimination against people with mental health conditions and their families globally, according to a report published in The Lancet journal.

The Lancet Commission Report on Ending Stigma and Discrimination in Mental Health, which sets out key recommendations to achieve this goal, is a result of collaboration of more than 50 contributors worldwide.

Through this report, the commission aims to define stigma, summarise the evidence of how people with lived experience of mental health conditions worldwide currently experience stigma and assess the impact of large-scale programmes to combat stigma among others.

The report summarises the evidence received for effective interventions through an umbrella review of 216 review papers, most of which address aspects of public stigma.

The clearly emerging core finding is that forms of social contact, direct or indirect, between people who do and do not have lived experience of mental health conditions is the most effective evidence-based way to reduce stigmatisation.

More inclusive policies, legislation and plans that were more effective in reducing stigma were generally linked with community-based treatment, programmes of public education and media activities, including participation of champions, who had lived experience of mental health conditions.

Increasing inclusivity in programmes for individuals with various learning disabilities, such as through use of hearing aids, Braille texts, and sign language, audio-visual displays and diagrams for people with poor literacy and communication problems have contributed to improved access to care.

Peer victimisation was reduced after an average of 25 weeks of involvement in a programme using social contact to bring peers with and without disabilities together for shared activities in school and community settings, the report said.

In relations to suicide, the report claims, results showed that psychoeducation and interpersonal contact significantly reduced stigma, which was sustained at 1-month follow-up.

Overall, the Commission lists the components of stigma intervention as such: advocacy, collaborative community-based care, constructive discourse, gatekeeper training, protest, psychoeducation, social contact and social networking.

Additionally, the report also explores the roles of the media, traditional and newer digital media, in promoting or reducing stigma.

The Commission has provided a four-part definition of stigma in its report: Self-stigma, stigma by association, public stigma and structural stigma.

Self or internalised stigma occurs when people with mental health conditions are aware of and agree with the negative stereotypes with others and turn them against themselves.

Stigma by association, the report says, refers to the attribution of negative stereotypes and discrimination to family members or mental health staff, such as blaming family members for the onset of substance abuse conditions.

Public or interpersonal stigma is better understood through three separate but related components: knowledge, attitudes and behaviours.

While knowledge refers to the absence of accurate knowledge and attitudes to the negative emotional reactions towards the affected, behaviour refers to the rejection and social exclusion of the affected by discrimination.

Structural, systemic or institutional stigma refers to the policies and practices that work to the disadvantage of the stigmatised group, intentionally or unintentionally.  Stigma, according to the report, is often seen as a barrier to policy change, sometimes through lack of public demand for governmental action and investment, and also through misinformation, misunderstanding and lack of awareness of positive policy options among policy makers.

Globally, people with mental health conditions commonly experience restrictions in employment, voting, property ownership, marriage and divorce.

The Lancet Commission, through this report, recommends using person-first language, rather than identity-first language, that is, a person with a mental health condition or with a lived experience of a mental health condition.

Culture, the report goes on to say, also has a strong influence on stigma because of the role that it plays in deciding what is considered socially accepted behaviour and on defining the causes of mental health conditions and how they are treated.