Evidence to Reduce Stigma & Discrimination Graham Thornicroft, PhD Centre for Global Mental...

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:Graham.thornicroft@kcl.ac.uk

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 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.

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:

graham.thornicroft@kcl.ac.uk