Discrimination and stigma

• Prejudice and discrimination
• Assumptions about violence
• Reducing stigma
• Anti-stigma campaigns
• Discrimination around the world

Prejudice and discrimination

People with mental health problems, particularly people with a diagnosis of schizophrenia, experience prejudice and discrimination in almost every aspect of their lives. Many have said the stigma of mental ill health is more disabling than the illness itself.

Research has shown that people with mental health problems are pre-judged, find it hard to get jobs and sustain friendships and relationships. Research has also shown that ignorance, fear, and stereotypes presented in the newspapers, on the TV and at the cinema all contribute to negative attitudes towards mental ill health. Most people have little knowledge about mental illness and their opinions are often factually incorrect.

People with mental illness also get a worse deal from some NHS services offering care for physical health problems, and from travel, insurance and financial services.

People with schizophrenia may also feel discriminated against because of mental health law, which allows compulsory treatment. Side effects of medication – such as involuntary movements – may also make them feel set apart as seen as ‘different’.

Language used to describe mental ill health also contributes to discriminatory attitudes. Research carried out by the Institute of Psychiatry and Rethink asked nearly 500 secondary school students to describe people with mental health problems. They came up with 250 different words and phrases, most of them derogatory and used as insults in the playground.

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Assumptions about violence

Both the public and the media are likely to believe people with schizophrenia to be dangerous, unpredictable and violent. Since March 1993, the Department of Health has funded national surveys of public attitudes toward mental health. The 2007 survey found that some attitudes had deteriorated over the previous decade and that, in particular, the perceptions of danger posed by people with mental health problems had worsened.

Research, however, shows that public fear of violence is misplaced: the number of all murders in England rose between 1957 and 1995, yet the number of murders by people receiving treatment for mental health problems did not. Contrary to public perception, the research shows that there has been little change in the number of murders and violent incidents since the advent of community care. There is also evidence to show that people with mental health problems stand a much greater chance of being a victim of violence than those without mental ill health.

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Reducing stigma

Research carried out by the Institute of Psychiatry with Rethink has shown that the most effective way to reduce stigma is through direct personal contact with someone who has a mental illness.

One research project showed that making education about mental health a routine part of the school curriculum made a difference to the attitudes of pupils. Testimonies of people with mental health problems also made a big difference to the views of police officers. People who took part in the research said that listening to personal stories helped them challenge their preconceptions, to no longer assume everyone is violent and to treat people with respect.

Other research has recruited people with a diagnosis of mental ill health and family members to offer training to medical students and trainee psychiatrists at the start of their careers in a bid to changing discriminatory attitudes among health professionals.

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Anti-stigma campaigns

An across-England social marketing campaign was launched in January 2009 by Time to Change, which seeks to combat stigma and discrimination against people with mental health problems. Time to Change is the biggest ever anti-stigma campaign in England led by mental health charities MIND and Rethink. The Institute of Psychiatry is evaluating the success of the four-year campaign, which has financial support from the Big Lottery Fund and Comic Relief.

The campaign includes adverts that are designed to break down myths surrounding mental health problems and give people the facts. There are posters, leaflets and a toolkit available so local organisations can get involved and make sure the campaign has a high profile in their area.

The key messages in the campaign are that mental illness is more common than most people think, and that stigma and discrimination stops nine out of 10 people with mental health problems doing everyday things like going to the shops, having normal relationships with family and friends, or getting a job. Press, radio, TV and outdoor adverts also feature people with personal experience of mental health problems talking about what it is like to live with a mental illness and how others have helped or hindered their recovery.

The marketing campaign is just one element of Time to Change, which is also organising training for student doctors and teachers, supporting 28 local community projects run by MIND and Rethink groups to bring together people who have mental health problems with those who don’t, and making high profile legal challenges to discriminatory practice against people with mental health problems.

The evaluation team at the Institute of Psychiatry is carrying out regular surveys of the public to see if attitudes are changing as a result of the campaign, and surveys of people with mental health problems to see if Time to Change is having an effect on their lives. The team is also monitoring and analysing the way mental illness is portrayed in the media.

Anti-stigma campaigns like Time to Change have been proven to work in other countries. Like Minds, Like Mine, an ongoing country-wide anti-stigma campaign launched in New Zealand included a successful programme of adverts featuring celebrities speaking about their experiences of mental ill health. A series of national opinion polls over the past decade has show a gradual improvement in attitudes in New Zealand. The Scottish campaign, See Me, was launched in 2002 and is managed by an alliance of five mental health organisations. See Me has launched a national publicity programme and worked with the media to encourage responsible reporting.

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Discrimination around the world

More than 700 people with a diagnosis of schizophrenia in 27 different countries were interviewed as part of INDIGO (International Study of Discrimination and Stigma Outcomes), a research study carried out by the Institute of Psychiatry in collaboration with the World Psychiatric Association’s (WPA) Global Programme Against Stigma and Discrimination because of Schizophrenia.

47 per cent of those inteviewed said they had found it hard to make or keep friends, 43 per cent said they had experienced discrimination from family members, 29 per cent in finding a job, 29 per cent in keeping a job and 27 per cent said had experienced discrimination in intimate or sexual relationships.  64 per cent said the anticipation of discrimination stopped them applying for work, training or education programmes and 55 per cent said it stopped them looking for a close relationship. 72 per cent of those interviewed said they felt the need to conceal their diagnosis.

The results of the study were published in The Lancet in 2009. The paper was called Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey and the authors were Graham Thornicroft, Elaine Brohan, Diana Rose, Norman Sartorius, and Morven Leese.