World Mental Health Day has been running for thirty years, beginning in 1992 by The World Federation for Mental Health. The World Health Organisation (WHO) has been an active supporter and campaigner. This year’s focus on 10th October was: ‘make mental health and well-being for all a global priority.’ Unfortunately stigma and discrimination are perennial barriers to inclusive mental health support, with limited access to support, housing, employment and welfare.
From Asylums to modern-day stigma
The first large-scale asylums were built in the 1800’s; heavily weighted against women who were admitted for a wide range of perceived physical or mental health conditions, including:
menstrual problems or ‘Time of life’
asthma or spinal irritation
Straight jackets were frequently used as restraints at night time and many people, men and women died in these asylums. The asylums finally closed down between the 1960’s and 1980’s.
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Throughout history, people with mental health conditions have been isolated, imprisoned or killed; thankfully dramatic improvements in attitudes and treatments have occurred throughout the 20th and 21st centuries. Stigma around mental health still continues, namely public/social stigma and self-stigma. With social stigma, negative stereotypes perpetuate people as markedly different, often based on ignorance and prejudice.
Self-stigma is the negative internalising of these public stereotypes, resulting in spiralling shame and isolation. Both types of stigma can lead to a delay in seeking treatment, exacerbating many conditions.
The impact of stigma has wider-reaching impacts, leading to further marginalisation and poverty, worsening mental health conditions.
Marginalisation through stigma
The Mental Health Foundation1 reports that nearly nine out of ten people with existing mental health difficulties report that stigma and discrimination negatively effect their lives. Those with mental health issues are marginalised further, with the following issues:
higher levels of unemployment and restricted access to decent housing
feeling socially excluded in mainstream society
often not in a steady, long-term relationship.
These issues all combine, trapping people in a cycle of mental illness, poverty and social exclusion. Stigma and discrimination surrounding mental health can further delay or stop mental health treatment and support. Those with mental health difficulties might be further stigmatised due to their race, gender, social class, sexuality or disability:
Black people are four times more likely to be detained under The Mental Health Act than white people
One in seven LGBTQIA+ people avoid seeking mental healthcare for fear of discrimination2.
Although the statistics make for grim reading, there have been some positive changes happening through educational campaigns and celebrities.
Time to change and candid celebrities
From 2007 to 2021, Mind and Rethink collaboratively launched ‘Time to change:’ a social movement and anti-stigma campaign. The campaign worked with thousands of workplaces, schools, colleges and youth groups on creating more open cultures around mental health and challenging stigmatised media content.
The campaign was a resounding success: less stigmatised attitudes to mental health and less direct experience of discrimination:
5.3 million people have improved attitudes to mental health (2007-2021)3
Those with lived experience of mental health received less discrimination across employment, family and social life and in friendships/relationships4. (2017-2019)
There have also been a line line of famous people and celebrities openly discussing their mental health from:
Prince Harry (parental stress/trauma of Princess Diana’s death)
cricketer Monty Panesar (depression/paranoia)
singers Lizzo and Jay-Z (anxiety/depression)
Over the last decade, more celebrities have been candidly sharing their mental health experiences over social media. We tend to associate authority with popularity and success; celebrities sharing their experiences normalises depression or anxiety. We then feel less alone, subsequently seeing the celebrity receive help, also gives hope for the future. This then encourages people to seek help for their own conditions.
Normalising mental health
The benefits to reducing stigma are well documented; a global study by King’s Institute of Psychiatry, Psychology and Neuroscience demonstrates that in countries where people were encouraged to talk about mental health, individuals felt less stigmatised and more empowered5. The same study concludes that talking about mental health, in the same vein as physical health also reduces the stigma.
A recent report by The Nuffield Group, a panel of expert academics and GP’s goes further and looks at the nuances around language and mental health6. The medicalised model of mental health has a tendency to diagnose difficulties within the individual: ‘what’s wrong with you?’ A distress-led model asks a different question: ‘what happened to you?’ The report also made the following recommendations:
mental health isn’t a duality: we’re not just well or unwell, it’s a spectrum
Mental health is a spectrum: in crisis- in difficulty- surviving- thriving- excelling
don’t say ‘1 in 4 suffer with mental health conditions’
say, ‘4 in 4’ instead – we all have mental health
mental health is more than the absence of mental health difficulties
use wellness and health rather than ‘illness’
By normalising workplace, school, community and family discussions around mental health, we can look after each other and help stop the stigmatising dialogues around mental health.
These are encouraging language models around mental health, allowing for more inclusivity. However there are still urgent areas where action is needed.
Getting kids talking
There are areas of society where stigma- the fear or reluctance of speaking out is causing huge concern.
One of the biggest areas of current concern is youth mental health. The charity, Papyrus thinks we don’t talk enough about suicide in schools and there is presently very little guidance on how to support those affected by suicide and preventing suicide:
Suicide is the biggest cause of death in young people, under the age of 35.
Over 200 schoolchildren are lost to suicide every year.
Whilst we can’t generalise around individual reasons for youth suicide; there are many risks factors including exam pressure, peer pressure, bullying, family breakdown, adverse childhood experiences (ACE’s) as well as existing mental health conditions.
Britain Get Talking- a campaign backed by MIND, YOUNGMINDS and SAMH in Scotland has been showing a powerful film during commercial breaks on the ITV channel. The film shows a teenage daughter and father talking, using subtitles to show unspoken thoughts. The film explores the gaps between what we feel and say-or don’t say to each other. The message is that parents/adults need to keep talking to their teenagers- even if they’re not initially forthcoming. https://www.youtube.com/watch?v=1RlGdF1L3YY
This is an excellent example of breaking through the stigma of talking about mental health, helping to normalise conversations between family members.
Although thankfully asylums are shadows of our past, we still have a long way to go to break the stigmas around mental health. Following a distress-led model, seeing mental health as a spectrum, celebrities speaking about mental health and prime-time films all help dispel unhelpful myths and stereotypes around mental health.
