Anti-stigma Campaigns Research Articles

APA Responds to Sen. Grassley

Back to table of contents Previous article Next article From the PresidentFull AccessAPA Responds to Sen. GrassleyNada Stotland, M.D., M.P.H.Nada StotlandSearch for more papers by this author, M.D., M.P.H.Published Online:5 Sep 2008https://doi.org/10.1176/pn.43.17.0003Credit: David HathcoxIn July, I e-mailed to let you know that Sen. Charles Grassley (R-Iowa) had asked APA for detailed information about the revenue that APA has received from pharmaceutical companies from January 2003 onward. The information was delivered to Sen. Grassley's office, as previously agreed, on September 2.Putting this information together was a major task for our staff. Our income from the pharmaceutical industry comes from many companies; it includes payments for advertising in APA periodicals, payments for exhibits at our meetings, support for minority and resident fellowships in leadership and research, funding for antistigma public education campaigns, and support for continuing medical education. Each specific case required an agreement or contract that we were asked to submit to Sen. Grassley; in each case we required a firewall between the source of funding and the content of the program. Indeed, because of the rigor with which we screen, rate, oversee, and evaluate the content of all our educational activities supported by pharmaceutical companies, we have received a commendation and a six-year accreditation from the Accreditation Council on Continuing Medical Education.We expect that Sen. Grassley will also ask the pharmaceutical companies to produce detailed information about grants and other financial interactions with APA. We have informed Sen. Grassley that we anticipate that there will be discrepancies between their reporting and ours because of differing accounting methods. For example, a company may include all the expenses it has incurred in relation to an educational event it supported, even though much of that money won't have been provided to APA; it will have gone to pay for expenses such as its employees' travel.It is important to remember that relationships with medical industries are a challenge for the whole field of medicine. Traditions of many years' standing are not only being questioned, but also criticized, across the board. Both the American Medical Association and the Association of American Medical Colleges have developed or are developing new standards that differ sharply from the practice of the last several decades. An informal survey of medical specialty societies indicates that APA is more or less in the middle when it comes to the percentage of revenue received from medical industries (which includes not only medications, but also devices, equipment, tests, and so on). The numbers range from 2 percent to nearly 50 percent; APA has averaged about 28 percent of our yearly annual revenue.It is also important to remember that APA has not been accused of any wrongdoing. We have been asked for information, and we have willingly provided it. Information about our pharmaceutical revenues, though not with the level of detail included in the report to the senator, have been available to our members through our members-only Web site for some years. Furthermore, information and articles about APA's relationship with the pharmaceutical industry have appeared in Psychiatric News, which has open access not only to APA members but also to the media and the public at large.APA has been proactive in examining the pros and cons of our relationships with the pharmaceutical industry. Last March, months before the senator's request, the Board established a work group, chaired by Dr. Jeffrey Geller, which was charged with producing a report detailing our pharmaceutical revenues and offering the Board options for decreasing or eliminating them. That group will produce an interim report at our October meeting and a final report at our meeting next March. Also before Sen. Grassley's request, I wrote a column in the July 18 Psychiatric News addressing transparency and conflicts of interest. We have now established a work group, chaired by Dr. Paul Appelbaum, to develop guidelines for interactions between individual psychiatrists (in addition to our professional association, APA) and medical industries. Dr. Appelbaum and Dr. Laura Roberts, both national experts on medical ethics, will also cochair a presidential symposium on this topic at our May 2009 annual meeting in San Francisco. We are developing a guide for discussing these issues with patients and an online educational program to assist you as well. You may send comments, suggestions, or information about any of these activities to me at APA at [email protected]. The times are changing, and we need to know how you feel about APA and potential conflicts of interest and what you are hearing about it in your offices, hospitals, and communities.We psychiatrists are physicians who devote ourselves to the care of people afflicted with mental illnesses, and APA exists to help us provide that care. We are proud of what we do, and we are here to answer your questions.▪ ISSUES NewArchived

Can Antistigma Campaigns Be Improved? A Test of the Impact of Biogenetic Vs Psychosocial Causal Explanations on Implicit and Explicit Attitudes to Schizophrenia

Antistigma campaigns have been promoting a medical view of schizophrenia. Given the growing body of research finding negative associations between biogenetic (BG) causal attributions and stigmatizing attitudes, this approach must be reappraised. The present study investigates the impact of different psychoeducational interventions on the etiology of schizophrenia (BG and psychosocial [PS], vs a neutral condition) and on stigmatizing attitudes in medical (n = 60) and psychology students (n = 61). Information was presented via information brochures and a video presentation. Attitudes were assessed before and after the interventions on an explicit level using the stereotype questionnaire and the Social Distance Scale as well as on an implicit level, using the Implicit Association Test. Both educational interventions produced a significant decrease in several stereotype components, which was not the case in the neutral condition. The BG intervention decreased the attribution of blame in both groups. It also decreased the stereotype unpredictability/incompetence and social distance in the medical students but increased the negative outlook on prognosis in the psychology students. The PS intervention reduced the widespread stereotype of dangerousness as well as social distance in the group of medical students. While further research into antistigma interventions is necessary, the proposal for antistigma campaigns is to take a multidimensional and balanced approach, which is adapted to target groups and provides additional facts that challenge the myths maintaining stigma.

Stigma and discrimination against people with mental illness: a critical appraisal

This editorial gives an overview of the different roots and forms of discrimination and stigmatisation towards people with mental illness. It explains the differences between stereotype, prejudice and discrimination. It further highlights some research foci of stigma research in the last decade. The emphasis was mostly on investigating the attitudes of the general population, but barely addressed other groups that have probably more intensive and more crucial contact with people with mental illness. Furthermore, only very few intervention programs were evaluated. This editorial concludes that other groups than the general population, e.g., mental health professionals, should be investigated about their attitudes to people with mental illness. Moreover, intervention campaigns should be additionally evaluated after a given period as it is not well known whether effects of interventions are long-lasting. It might be that anti-stigma campaigns, as every public health campaign, must be repeated if sustainability is the goal. Furthermore, the message must be carefully chosen. One option is to replace the "traditional" messages by focussing, e.g., on symptoms of mental illness, for instance anxiety, affective symptoms or suicidal ideations. Finally, a plea for more stigma-related research is given as research in stigma-related issues is also stigmatised.

Access to talk therapy

Mental health problems are common and, while conditions such as schizophrenia and bipolar disorder require specialist care, most treatments are provided in primary care. A large proportion of people with disorders such as depression and anxiety either do not have their condition recognized or do not receive evidence-based treatment. This year researchers at the Institute of Psychiatry and the London School of Economics were commissioned by the mental health charity Rethink (2007) to review the cost-effectiveness of treatments for mental health and to assess ways of bringing more people into contact with services through anti-stigma campaigns.

Doctors’ attitude towards people with mental illness in Western Nigeria

It had been suggested that those more knowledgeable about mental illness are less likely to endorse negative or stigmatizing attitudes. This study aimed to evaluate the attitude of doctors in Nigeria towards the mentally ill. Medical doctors (n = 312) from eight selected health institutions in Nigeria completed various questionnaires on knowledge and attitude towards people with mental illness. Beliefs in supernatural causes were prevalent. The mentally ill were perceived as dangerous and their prognosis perceived as poor. High social distance was found amongst 64.1% and the associated factors include not having a family member/friend with mental illness (OR 7.12, 95% CI 3.71-13.65), age less than 45 years (OR 2.33, 95% CI 1.23-4.40), less than 10 years of clinical experience (OR 6.75, 95% CI 3.86-11.82) and female sex (OR 4.98, 95% CI 2.70-9.18). Culturally enshrined beliefs about mental illness were prevalent among Nigerian doctors. A review of medical curriculum is needed and the present anti-stigma campaigns should start from the doctors.

Perception of the public towards the mentally ill in developed Asian country

This study assessed public perceptions and attitudes towards and causal beliefs about mental health problems in Singapore - a multi-racial country in South-East Asia. A nation-wide survey using a structured questionnaire was conducted on those aged between 15 and 69 years. The overall response rate was 68.1% with a total of 2,632 respondents. About 38.3% (95% CI, 36.4-40.2) believed that people with mental health problems were dangerous and 49.6% (95% CI, 47.7-51.5) felt that the public should be protected from them. A negative attitude towards mental health problems correlated with greater age and less education. The Chinese were more likely to want to hide their illness should they become mentally unwell while the Malays seemed to have a more tolerant attitude (P = 0.032). Public awareness and anti-stigma campaigns should focus on those commonly held misconceptions and target specific populations.

The use of puppets with elementary school children in reducing stigmatizing attitudes towards mental illness

Background: Mental health reform has resulted in individuals with mental illness, who previously resided in psychiatric institutions, being moved into the community. These individuals potentially face multi-faceted discrimination, which may impair their recovery.Aims: Most anti-stigma campaigns have been directed at adults or adolescents. We targeted children in order to evaluate the effectiveness of a puppet program to reduce stigmatizing attitudes in grades 3 – 6 students.Method: Children received a pre and posttest of their attitudes as measured by the re-factored. Opinions About Mental Illness Scale. The experimental group watched a series of three plays in which hand puppets portrayed individuals with schizophrenia, depression/anxiety, and dementia. The plays were designed to challenge stereotypes and erroneous beliefs regarding mental illness, while appealing to children.Results: Scores for the children exposed to the puppet plays improved significantly on three of the six factors of the OMI, including, Separatism, Restrictiveness and Stigmatization.Conclusions: Anti-stigma programs using puppetry show some effectiveness and should be further studied.

Patient Input Crucial To Defeating Stigma

Patient Input Crucial To Defeating Stigma

Strategien gegen die Stigmatisierung psychisch kranker Menschen und ihre praktische Umsetzung am Beispiel des Irrsinnig Menschlich e. V.

In our society people with mental illness are still stigmatised and exposed to various forms of discrimination. Individual and structural discrimination and discrimination due to self-stigmatisation can be distinguished. The association "Irrsinnig Menschlich" ("Madly human") in Leipzig will serve as a model to present approaches to reduce these different kinds of discrimination of mentally ill people. The school project "Crazy? So what!" and the film festival "Ausnahmezustand" ("state of emergency"), carried out all over Germany in 2006, will be described in more detail. The first evaluation of both projects showed a reduction of stigmatisation to be possible. Students participating in the project tended to decrease their social distance to the mentally ill. These developments were not present with the control groups. Although the majority of the audience at the film festival either knew somebody who is mentally ill or were themselves suffering from a mental illness, the results showed that watching these documentaries can result in a reduction of social distance towards mentally ill people. Only long-term efforts can make anti-stigma campaigns successful and effective. Irrsinnig Menschlich has established the framework for this.

Public opinions and beliefs about the treatment of depression in urban Turkey

Although attitudes towards psychiatric illness influence its presentation, detection, recognition, treatment adherence and rehabilitation, the lay public's opinions and beliefs about the treatment of depression have not been investigated sufficiently. The aim of this study was to determine public opinions and beliefs about the treatment of depression and the influence of perception and causal attributions on attitudes towards treatment of depression in urban areas. This study was carried out with a representative sample in Istanbul, which is the biggest metropolis in Turkey. Seven hundred and seven subjects completed the public survey form which consisted of 32 items rating attitudes towards depression. The public believes that psychological and social interventions are more effective than pharmacotherapy, and that the medicines used in treatment of depression are harmful and addictive. There was a general reluctance to consult a physician for depression, and psychiatrists were felt to be more helpful than general practitioners. The public viewed depression as treatable. A high educational level and perceiving depression as a disease is associated with positive beliefs and opinions about the treatment of depression; but the perception of depressive patients as aggressive is associated with negative beliefs and opinions about the treatment of depression. The beliefs that "psychological and social interventions are more effective than pharmacotherapy" and "antidepressants are harmful and addictive" must specifically be taken into account in clinical practice and in anti-stigma campaigns. Additional studies are needed to understand the public's tendency to conceptualise depression as a psychosocial problem. In clinical practice, depression should be introduced as a bio-psychosocial disease whatever its cause: biological, psychological or social. In addition, the differences between extreme worry and disease, and the lack of aggressiveness of depressive patients, must be emphasised.

Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma

Persons with mental illness frequently encounter public stigma and may suffer from self-stigma. This review aims to clarify the concept of mental illness stigma and discuss consequences for individuals with mental illness. After a conceptual overview of stigma we discuss two leading concepts of mental illness stigma and consequences of stigma, focussing on self-stigma/empowerment and fear of stigma as a barrier to using health services. Finally, we discuss three main strategies to reduce stigma - protest, education, and contact – and give examples of current anti-stigma campaigns. Well-designed anti-stigma initiatives will help to diminish negative consequences of mental illness stigma.

For and Against: Do Anti-Stigma Campaigns Make Sense?

Entstigmatisierung kann nur durch Bündelung aller gesellschaftlichen Kräfte auf das gemeinsame Ziel gelingen - dieses ist nur mit breit angelegten und langfristigen Gesundheitsprogrammen, „Antistigmaprogrammen”, zu bewältigen. Antistigmaprogramme sind nachweislich effektiv; sie sind ein Muss für jede Gesellschaft, die sich der Ausgrenzung psychisch Erkrankter nachhaltig entgegen stellt.

Psychiatrists as social engineers: A study of an anti-stigma campaign

Anti-stigma campaigns in the field of mental health appeared in a variety of countries and organizations during the 1990s. This paper examines one of these—the ‘Changing Minds’ Campaign of the Royal College of Psychiatrists in Britain. The paper aims to elucidate the role the campaign played in the professional project of psychiatry and situate it in a wider context of both sociology and changes in mental health policy. The interest work involved is set in the context of the long-standing controversies surrounding psychiatric theory and practice, as well as the network of other agencies and actors seeking improvements in the citizenship of people with mental health problems in a post-institutional world.

What about psychiatrists' attitude to mentally ill people?

Objective. – Firstly, to assess and, secondly, to compare experts' and lay attitudes towards community psychiatry and the respective social distance towards mentally ill people. Method. – Comparison of two representative Swiss samples, one comprising of 90 psychiatrists, the other including 786 individuals of the general population. Results. – The psychiatrists' attitude was significantly more positive than that of the general population although both samples have a positive attitude to community psychiatry. The statement that mental health facilities devalue a residential area has revealed most agreement. Psychiatrists and the public do not differ in their social distance to mentally ill people. Among both samples, the level of social distance increases the more the situation described implies ‘social closeness’. Conclusion. – The strategy to use psychiatrists as role models or opinion leaders in anti-stigma campaigns cannot be realised without accompanying actions. Psychiatrists must be aware that their attitudes do not differ from the general public and, thus, they should improve their knowledge about stigma and discrimination towards people with mental illnesses.

Media coverage of mental health care in the UK, USA and Australia

Aims and Method We aimed to assess the contents and tone of articles on mental health care in the UK print media by comparing them with reporting in the USA and Australia. Two broadsheets from each country were analysed using the Internet for a random 4 months over a 1-year period. The number of articles, their content and the views expressed in them were identified and compared. Results A total of 118 articles on mental health care issues were found. The predominant tone of the articles in all three countries was negative, though there were slightly more positive articles in the USA and Australian media. Positive articles highlighted in the UK media covered mostly medical conferences and research findings. Clinical Implications Efforts to achieve a more positive attitude towards people with mental illnesses in the public, such as anti-stigma campaigns, operate against a background of predominantly negative coverage of mental health care issues in broadsheets. The coverage in the UK may tend to be even less positive than in the USA and Australia. Medical conferences and research findings can, however, be used to promote positive views of mental health care in the media.

Media coverage of mental health care in the UK, USA and Australia

Aims and MethodWe aimed to assess the contents and tone of articles on mental health care in the UK print media by comparing them with reporting in the USA and Australia. Two broadsheets from each country were analysed using the Internet for a random 4 months over a 1-year period. The number of articles, their content and the views expressed in them were identified and compared.ResultsA total of 118 articles on mental health care issues were found. The predominant tone of the articles in all three countries was negative, though there were slightly more positive articles in the USA and Australian media. Positive articles highlighted in the UK media covered mostly medical conferences and research findings.Clinical ImplicationsEfforts to achieve a more positive attitude towards people with mental illnesses in the public, such as anti-stigma campaigns, operate against a background of predominantly negative coverage of mental health care issues in broadsheets. The coverage in the UK may tend to be even less positive than in the USA and Australia. Medical conferences and research findings can, however, be used to promote positive views of mental health care in the media.

Contacts for anti-stigma campaigns and organisations

Contacts for anti-stigma campaigns and organisations

Americans More Willing To Seek Out Treatment

Americans More Willing To Seek Out Treatment

Perceived stigma and community integration among clients of assertive community treatment.

Facilitating the integration of persons with psychiatric disabilities is an important goal of community programs. In addition to limitations such as inadequate housing, poverty, and unemployment, a common barrier to community adjustment identified by people with psychiatric disabilities is their perception of being stigmatized. This study examined the relationships between perceived stigma and community integration in 95 clients of assertive community treatment (ACT) teams, using sequential multiple regression procedures. Findings indicate that despite their physical presence in the community and the intensive support they receive, ACT clients believe other community members will reject them. Moreover, this perception appears to interfere with their sense of belonging, particularly among those who also perceive less social support and who have greater psychosocial skill deficits. In the context of the present study, global self-esteem did not mediate this relationship. In addition to community focused antistigma campaigns, stigma-related issues should also be addressed with ACT clients themselves.

Coping behavior in schizophrenic patients in terms of a situation/operation theory of stress and coping

Many anti-stigma campaigns emphasize biogenetic causes to convey that schizophrenia is an “illness like others”. A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia. In contrast, psychosocial explanations attenuate prognostic pessimism and perceived otherness, but seem less suitable to reduce blame. We hypothesized that a vulnerability-stress model that combines biogenetic and psychosocial explanations would yield clearer stigma-reducing effects than the mono-causal models. In an online-experiment, 416 participants from the general population randomly received either a vulnerability-stress, biogenetic, psychosocial or control-intervention, which consisted of information text and video presentation of a case-example. Causal beliefs, stereotypes and desired social distance were assessed by self-report. Baseline causal beliefs were weakly associated with stereotypes. The vulnerability-stress intervention did not reduce stigma more effectively than the biogenetic or psychosocial intervention and was less effective in reducing perceived blame than the biogenetic intervention. Compared to the control-intervention, no intervention showed significant stigma-reducing effects, but the psychosocial and vulnerability-stress conditions both increased blame. We found no evidence for vulnerability-stress explanations as a mean to reduce stigma. We propose further research to identify more effective ways to tackle stigma.