Tackling Stigma: Evidence Base

What does the literature tell us?

The stigma associated with mental health problems continues to be highly prevalent today, despite greater public awareness and improved knowledge.

In his study which examined the literature on mental health stigma in children, Hinshaw (2005) described the term stigma as the negative effects of a label placed on any group. Although a great deal of work on defining stigma and its relationship to mental health was undertaken over 40 years ago, the discriminatory aspects are still prominent in contemporary studies.

When exploring the impact of stigma, it has been found that the stigma itself can have a more profound effect on a person than their mental health problem. This effect has been reported to have a severe impact on the individual and the way that they perceive themselves; it can affect the person's quality of life, and cause problems integrating into society (Wahl, 1999). In fact stigma can have such a negative effect that there is a potential for mental health problems to increase in severity (Gale, 2007).

A survey in 2009 (Thornicroft et al) across 27 countries found that 47% of people with schizophrenia had experienced stigma, with 43% experiencing stigma from within their own family. Other studies with adults have similar findings.

A number of studies focusing on the experiences of children and young people have also found the extent of stigma is widespread. In one study, young people were shown description cards about children with various ill-health conditions (both physical and mental). Those that labelled a child from the description card as having a mental health problem were more likely to see them as dangerous or that the problems were not real (Pescosolido et al, 2007; McLeod et al, 2007 ).

Some studies have shown that even professionals can display stigmatising attitudes (Corrigan, 2000). A study of 5 to 11 year olds who had mental health needs, found that they were able to recognise feelings of stigma and discrimination. They also had developed negative attitudes towards others who might have mental health problems (Gale, 2007). Such findings suggest that children can develop stigmatising ideas and beliefs at an early age and that if not tackled early stigma can continue to be pervasive.

The media has also been found to play a key part in the development of negative perceptions, so a number of organisations issue guidance on reporting mental health issues responsibly and often challenge media representations.

In order to challenge the stigma of mental health problems, we need to understand how it develops and how it is influenced.

It has been suggested that developing an understanding of the meanings that mental health and stigma have for service users will prompt the development of approaches to changing attitudes (Gale, 2007).

There have been various approaches to tackling the stigma of mental health problems and the evidence base for these approaches varies. Most studies have involved an education element, which usually improves knowledge but doesn't necessarily improve attitudes. It has been suggested that education programmes alone are usually not sufficient to have a lasting impact (Thornicroft et al, 2008).

Corrigan et al (2005) suggested tackling stigma can only be successful if it combines three aspects: protest (or campaigning), education and contact. Contact refers to putting children and young people with a person with a lived experience of mental health problems, providing them with a realistic picture of mental health. This is said to be consistently effective.

Gale (2006; 2007) suggested a whole systems approach which has informed the development of the Tackling Stigma Framework and the pilot projects. This approach tackles stigma across a number of domains ensuring that changes are effected at all levels: individuals, services, organisations, the media and society. The model also advocates rigorous involvement of children, young people and their families within all its domains.

Time to Change, a project funded by the Big Lottery Fund, is the largest anti-stigma campaign of its kind. It aims to combine locally based initiatives with schools and voluntary organisations with largescale national media campaigns. The effectiveness of this campaign will be evaluated by King's College London.

There are other approaches to tackling stigma in the UK. Links to Anti-Stigma Campaigns can be found in the Resources section.

A scoping review was carried out which summarises relevant government policy; resources relating to other mental health frameworks and tackling discrimination projects amongst children and young people; research; and tackling stigma campaigns. You can download a copy of the short scoping review.


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