Let’s be mindful of stigma

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.