Standing up to global mental health stigma
We’ve recently funded Professor Sir Graham Thornicroft, a leading expert in research on mental health discrimination and stigma, to carry out a global study. On the day of the world’s first Global Ministerial Mental Health Summit, he sets out what stigma looks like across the globe and how his study will make a difference.
Around one in four people will experience mental ill health at some point in their lives, and this year alone around 450 million people worldwide have a mental health condition. Our research shows that in many countries 80 to 90% of them experience negative stigma and discrimination.
It’s so important we carry out research on how to improve this situation globally. Over the last decade, in over a dozen countries including the UK, there have been national anti-stigma programmes and the evidence shows that these can be effective. But so far, all of these programmes have been in high-income countries.
This is why we’ve formed the INDIGO Network. We want to better understand the origins, mechanisms and consequences of stigma and discrimination across the globe, then develop new methods to reduce stigma in economically developing countries. We’ve based our study on the findings of research in high-income countries, which has shown that personal connections are the most effective way to reduce stigma.
The negative impact of stigma
Stigma refers to a cluster of negative beliefs, attitudes and behaviours that motivate people to fear, reject and discriminate against people with mental health problems. Stigma can have far-reaching and devastating consequences for those lives it touches. In many ways, the impact of stigma is remarkably consistent across the world. But there are national and regional variations.
Exclusion by friends and family can lead to increased social isolation, often making mental health problems worse. Negative impacts on employment add to the problem, with higher rates of unemployment, part-time or low-paid work, and worse prospects for promotion.
In some countries in South and South-east Asia, having experience of mental ill health, or even having someone in your immediate family with a mental health condition, can often negatively impact your prospects of marriage. As a result, people hide mental illness under a cloak of secrecy – further reducing the chances of access to treatment and recovery.
The effects of stigma and discrimination also lead to poorer access to physical health care, increasing an already elevated risk of a premature death. Due to low investment in mental health treatment and care worldwide, treatment rates are low – about 25% of people with mental ill health are treated in richer countries and only about 5% in poorer countries.
Making it personal
To address these problems, in our study we’ll focus on unconscious bias – where people treat those with mental health problems less well than others without intending to. This can occur in many different settings, including in the healthcare system. We’ll also find out more about how people manage to cope with stigma without it having a negative impact.
Once we understand the situation better, we’ll then look at how to improve personal connections between those with and without experience of mental ill health. And we’ll learn how to adapt stigma reduction interventions to the local context and culture in low and middle-income countries.
Tailoring the right tools and skills
We plan to adapt scales which measure different aspects of stigma to nine different cultures and translate them into Amharic, Arabic, English, Hindi, Kannada, Mandarin and Telugu. We’ll make these openly available as a free ‘evaluation toolkit’.
Staff from the UK, Germany, Switzerland and the USA will support staff in China, Ethiopia, India, and Tunisia to develop their research skills and their careers. They will work together to find the best ways to deal with stigma and discrimination and establish centres of excellence in stigma research in their home countries.
Once we’ve gathered enough data, we’ll carry out projects to test specific intervention methods. The methods will include using direct personal contact to reduce stigma among healthcare staff, and a public awareness programme to increase referrals for people with mental illness to attend local healthcare services. We’ll learn from these studies and adapt the instructions before releasing them as openly available ‘intervention manuals’.
By finding effective ways to reduce stigma and discrimination against people with mental ill health in low- and middle-income countries, we hope to help more people gain access to mental healthcare and achieve greater levels of social inclusion in their community.