Guest post: But they look like you and me!

Jo Mueller investigates how parents could hold the key to tackling mental health stigma

Alien? Or simply struggling? Views about
mental health are formed early.
Photo: nadja robot

When it comes to attitudes to mental health, things are getting worse. Despite the high-profile campaigns, stigma and discrimination against people with mental health problems seem to be on the rise. Part of the reason may be that our campaigns are promoting the wrong message. The way we often address stigma is to promote the idea that mental health problems are illnesses. The rationale is noble. Rather than give the impression that someone is weak or blameworthy, isn’t it surely better to say they are sick?

The danger of this is that the idea of something going wrong with people’s brains can be scary and alienating. Put this together with the ‘1 in 4’ idea - that one in four of us will suffer ‘mental illness’ at some point - and it can add up to a frightening message: there’s a dangerous disease out there that might strike at us any time.

Guest post: 'Schizophrenia then and now'

Continuing our recent reflections on how things in mental health have changed Richard Hallam and Michael Bender take the long view of schizophrenia

The cuckoo's nests have closed. What
else has changed in mental health?

The theme of this year’s World Mental Health Day on 10th October is Living with Schizophrenia. For those of us of a certain age, and with a historical bent, it’s also an opportunity to compare services now with those provided when we started out in the 1960s. Recently we’ve had the privilege of editing the diaries and letters of a young man, David, a patient in the mental health system five decades ago. The resulting book offers, we think, a window into the social attitudes of the time and the way mental health problems were treated.

Time to change for Time to Change?

Flo Bellamy

Does a diagnosis simply confirm
another's weirdness?
Photo: Juan Eduardo Donoso

The Time to Change campaign is the biggest mental health stigma busting campaign in the UK, receiving an estimated £21 million between 2007 and 2011.  Given this level of investment I would hope it made significant differences to stigma surrounding mental health problems.  The truth is that it hasn’t, and in some areas of stigma, prejudice has increased.

In the 2011 ‘Attitudes to Mental Illness’ survey report, many results were worrying.  It appears that the percentage of people who would not want to live next-door to someone who has been mentally ill has risen compared to recent years. Also, more of the general public believe that someone should be hospitalised as soon as they show signs of mental disturbance. It’s also more probable that a woman would be considered ‘foolish’ to marry a man who has suffered from mental illness, even though he seemed fully recovered.

And these are at the tip of the iceberg.  When it comes to measures of tolerance of the general public towards ‘mental illness’, a decrease was found.  The percentage of people who agreed we need to adopt a far more tolerant attitude toward people with mental illness in our society dropped from 91% to 86%. Given the level of investment described in the first paragraph, it’s worth asking why this is happening.

Wounded healer? A qualification without ceremony

Angela Gilchrist

Do professionals always have to wear a mask?
Image: kurogami.com

I innocently posted an item on Twitter the other day about Marsha Linehan, one of the world’s best known clinical psychologists and the creator of Dialectical Behaviour Therapy (DBT). Linehan caused a stir a little over two years ago when she announced that she, like so many of the people she has tried to help, had suffered from the experiences labelled as 'borderline personality disorder' (BPD). Admittedly, Twitter is a volatile medium in which people say many things free of the restraints that a less anonymous conversation might impose. But, even so, I was unprepared for the vitriol with which my tweet was greeted.

Service-users responded immediately and their views were unequivocal.

'It only took her 30 years to come out!' complained one, while another said that surely she could have helped more if she had revealed her own history of mental illness sooner. An attack followed on the merits of DBT, created by Linehan with the aid of insights provided by her own struggle. 

We’re (not) coming out… Not today, anyway

Salomons Service User and Carer Coordinator, Laura Lea considers why admitting to mental health problems may be such a taboo for mental health professionals.

McGowan, John (john.mcgowan@canterbury.ac.uk)

Lots of attention since we tweeted it actually. Several retweets, favourites etc. Be interested to se if that shows up in the figures from the journal’s website.

Fri 26/04

Victims of care crisis? Or psycho
killers? Who'd want to come out.

'We're comin’ out… out on the streets’ sang the late Lou Reed. That was in 1972 and now feels part of a story where people having the courage to be honest led to a sea change in attitudes to sexuality. In 2013 it still rarely feels safe to tell people I've had mental health problems. Even before that notorious Sun front page. I'm not sure what I think will happen if I declare myself. Perhaps it’s a belief that people will wonder whether it’s me or the mental illness talking. Too much emotion might be taken as a sign that I am not entirely in charge of myself. Too calm and my responses could seem blunted. Either way I don’t want people to think that my brain is out of order. After all there’s plenty of evidence to suggest admissions of mental health problems provoke pejorative associations and might not be the best thing for my future employment prospects.

In my current career though (someone whose current job actually requires experience of being a mental health service user) I'm more out than I've ever been. While it’s not always easy, I hope I’m at least a small part of a bigger change, and that coming out can be as powerful an act in mental health as it has been in sexual identity. I often wonder though how much more difficult is it to declare you have a mental health condition if you actually work in the business? Certainly a recent study of psychiatrists suggests this is the case. What if you go from being someone who is known as sane, even a ‘sanity consultant’, to someone touched by madness? The study suggests that maintaining your secret is the only answer. Doctors need to hide their status as patients.

It's Brave but is it Helpful?

Angela Gilchrist

Fighting Stigma or Frightening Stuff?
Photo: Christian Payne

When a celebrity like Stephen Fry can publicly admit that he's recently attempted suicide and others like Catherine Zeta-Jones announce they're checking into a clinic for maintenance of a bipolar disorder, it would be tempting to believe that we've reached a new point in the acceptance of mental illness.

Certainly, people are more open than they have ever been about mental distress. Celebrity accounts fill the tabloids and the internet abounds with stories from those either in the midst of recovery or resigned to a lifetime of psychiatric input. Films have leading characters with bipolar, MP's have discussed their mental health woes, and we’ve made it illegal to discriminate on mental health grounds. These are signs that we're beginning to understand mental ill-health as just another form of distress. Given all this evidence, you could be forgiven for thinking that the stigma of mental illness is a thing of the past. The reality though, sometimes seems very different.

When the Ads Don’t Work

Anne Cooke and Dave Harper 

Is your mind made up about mental illness?
This picture may dispel any doubts.
Photo: Giovanni Cassanese 

It’s a sobering thought that, for many people who use mental health services, other people’s reactions cause more distress than their original problems.   And attitudes may even be getting worse.  A recent report from the Department of Health found that whereas in 1997, 92% of people questioned agreed that ‘we need to adopt a more tolerant attitude towards people with mental illness’, in 2011 only 86% thought that we need to be more tolerant.   Worryingly, young people appeared to be the most prejudiced.

Relatively static attitudes to mental health stand in contrast to the changes there have been in attitudes about ethnicity and sexuality (we currently have a conservative Prime Minister advocating same-sex marriage).  It’s even more surprising given the effort that has gone into anti-stigma campaigns.  For example you may have seen the recent tube posters or TV ads from the government sponsored Time to Change campaign.   So what’s the problem?  Perhaps part of the answer is what campaign ads actually say. Or what they don’t. 

Silver Linings: Is Sickness a Shield Against Stigma?

John McGowan

Silver lining or more rain?
Photo: By Im Unicke

I’d been avoiding Silver Linings Playbook. Nothing against it particularly, it’s just that Very Serious films about mental health always feel like a busman’s holiday. I got corralled into seeing it by the missus though, more observant than me, who had clocked that a) it was warmly sentimental, and b) it featured a dance contest. These days plucky young hoofers channelling Patrick Swayze are all I ask of a film. And if someone is also (spoiler alert) saved by the love of a good woman, then my cup runneth over.

As well as Jennifer Lawrence’s Oscar, the talk on the internet has been about how realistic SLP is (or isn’t), and what it tells us about social attitudes to mental illness. Opinions are split between those who see it as a ground-breaking and nuanced portrait of people having emotional difficulties, and those who view its happy ending as idealised and simplistic. Lawrence has been lauded for her portrayal of Tiffany, the aforesaid good woman, who is frequently a bad girl as she seeks to drown the pain of widowhood. This makes her, according to your point of view, either an ideal candidate or the worst possible bet to get things together by dancing/falling in love with fellow recoverer Pat (Bradley Cooper).