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John was bullied at school and had to listen to his mother being called a "nutter" by children and adults alike. By the age of 12, he had no friends, was failing in school and drifted into crime and drugs.

He came to child and adolescent mental health services through accident and emergency after making a serious attempt on his life. Depressed, he had come to believe the negative things both peers and professionals said about him.

His depression responded to treatment. However, the attitude of society towards the one in four people who experience a period of mental illness presents us with a greater challenge.

While welcoming the children's national service framework and funding coming to CAMHS services, a change in society's attitude to the one in four will be just as important.

It is problems such as John's that the Royal College of Psychiatrists' campaign, Changing Minds: Every Family in the Land, is addressing in its five-year national initiative. Launched in 1998, the campaign is intended to increase public and professional understanding of mental disorders and reduce the stigma and discrimination associated with them.

The campaign is unique among the current anti-stigma campaigns in that it is aimed not only at the public but also at the medical and caring professions. It has been targeting doctors and other health care professionals who are just as likely as any of us to stigmatise people with, for example, drug addiction problems or eating disorders.

One of the most active and creative aspects of this campaign has been the work done in relation to children and young people. Attitudes of young people in terms of discrimination and stigma towards minority groups or people with a mental illness are fairly fixed by the age of eight. It is difficult to engage young people with mental health issues in relation to themselves, their peer group, their families and in the wider community.

In an increasingly stressful world, the mental health of schoolchildren is a growing cause for concern. The middle school years (six-10) and early adolescence (11-14) are characterised by high rates of conduct and emotional disorders - 10-15 per cent of the population at risk - with adult-type depressive disorders at 1-2 per cent. Most depression in this period is mixed with other problems such as anxiety or, equally common, conduct disorders. Attempted suicide begins as early as 11 years.

These problems can be the result of family difficulties, a chaotic home lifestyle, complicated relationships at school, bullying and social exclusion. They can also lead to stress, eating disorders, depression, self-harm and, in extreme cases, suicide. Conduct disorders often continue into adulthood with a number of children subsequently showing antisocial personality disorders. Depression in childhood often recurs in adult life. If these problems can be addressed at an early stage, at primary school level, it is more likely that they can be alleviated or even resolved.

A small multidisciplinary group of psychiatrists, psychologists, teachers, service users and representatives from the voluntary sector has been meeting since the beginning of the campaign, under the general heading of "cycles of understanding". Within that framework, the group has developed initiatives which go some way towards helping children and young people to understand some of the origins of intolerance towards mental disorders and the nature of these illnesses.

The group has worked towards recognising and identifying difficulties that can arise for children and young people with mental disorders and those in contact with them. Reading Lights is a series of comic books for four to seven year olds to talk about what it can feel like for a young child to be different. Being "different" is difficult to accept at any time in your life, but for a young child, it is particularly challenging.

The four books have animals as their central character (Little Raja, the elephant with the troublesome trunk; Streaky, the annoying little piglet; Peaches, the puppy that screeches; and Quackeline, the duck who wanted to be a swan) and are intended to provide a framework for people who wish to support children and develop their strengths and confidence.

Identifying what influences children and young people's understanding of, and attitudes towards, mental disorder has been an important issue for the campaign. "HEADstuff" is a leaflet for 14 to 17 year olds developed jointly by the campaign and Mentality, a national charity dedicated to the promotion of mental health. The leaflet challenges perceptions of mental illness through "facts" and "fictions".


While piloting this leaflet with young people, the researchers found that nearly all the interviewees knew of someone who had self-harmed. Girls were keener to understand a mental health problem and solve it, while boys felt uncomfortable talking about it. They were ignorant of the language to use when talking about mental health problems. Schizophrenia was mistakenly seen as split personality and was associated with violent behaviour; mental health difficulties were acceptable only if associated with stress or family problems.

Building on these perceptions, our campaign recently launched a multi-media CD-Rom for 13 to 17 year olds. This initiative is intended for teachers to use as part of the personal and social health education curriculum and suggests creative teaching ideas for lessons. The CD-Rom includes the voices of young people's experience of mental illness through interviews, writing, video and audio clips and music. It looks at the six main areas of concern for young people themselves: addictions, stress, eating disorders, depression, schizophrenia and self-harm.

The campaign will end late next year. However, times are changing. Discriminating against people on the grounds of race, gender or beliefs is now unacceptable to society, and often against the law. It is essential to encourage everyone to stop and think about their own attitudes and behaviour in relation to mental disorders. If we do stop and think, we will almost certainly understand more and, as a result, become more tolerant of people with mental health problems.

The Royal College of Psychiatrists' campaign is a separate initiative from Community Care's Changing Minds campaign. See www.rcpsych.ac.uk/campaigns/index.htm

Sue Bailey is consultant child and adolescent forensic psychiatrist for Bolton, Salford and Trafford Mental Health Trust and chairperson of the Royal College of Psychiatrists' Changing Minds child and adolescent working group.

RCP’s Changing Minds campaign

Overall Objective

To bring about a major shift in attitudes and behaviour towards people with mental health problems. Mental health problems affect every family in the UK at some time.

Aims

To encourage the public to stop and think about their own attitudes, achieving greater understanding and tolerance of people with mental health problems. These include anxiety, depression, schizophrenia, Alzheimer’s disease and dementia, alcohol and other drug misuse, anorexia and bulimia.

To reduce the stigma and discrimination against people suffering from mental health problems.

To look at the public’s perceptions of danger, self-infliction, the outlook for people suffering from a mental illness and communication problems.

Sources of stigma

Diagnosis runs the risk of attaching an enduring "label" to a person which can become the focus of distorted negative images in the media and in the public mind. These images can then lead to further discrimination. In making diagnoses, doctors therefore have a special responsibility to recognise and respect the uniqueness of the individual over and above any diagnostic label.

People with mental illnesses have been stigmatised over the centuries and still are today. Psychiatry and psychiatrists are also sometimes stigmatised by others. The RCP campaign aims to tackle the problem. We are attempting to understand why some people have a tendency to stigmatise others with mental illness, and we will try to change their minds.