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New strategies of action against the stigma of mental disorder

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Stigma of mental disorders negatively affects people who have the illness, their ... 18.84. Neurotic/somatoform. 2.48. Personality disorders. 3.03. Trends ... – PowerPoint PPT presentation

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Title: New strategies of action against the stigma of mental disorder


1
New strategies of action against the stigma of
mental disorder
  • Professor N. Sartorius, MD, PHD,
  • Geneva, Switzerland

2
The magnitude of the problem
  • Stigma of mental disorders negatively affects
    people who have the illness, their families,
    their communities as well as mental health
    personnel, treatment modes and institutions
    dealing with mental illness.
  • Stigma of mental illness transcends generations
  • Stigma of mental illness is worsens other stigmas
    those of old age, of other illnesses, of being
    a foreigner or of being poor, for example.

3
Magnitude of the problem
  • Stigma of mental illness is among the chief
    reasons for the the insufficient priority given
    to mental health programmes
  • Stigma of mental illness reduces the attraction
    of mental health professions for most of the
    excellent graduates
  • Stigma leads to a negative discrimination the
    mentally ill in almost all areas of life

4
The vicious circles of stigmamental health
services
Enhanced stigma
More involuntary adms and problem patients
Bad overall service
Poor reputation of service
Poor staff output
Poor quality staff
Little money
Deteriorating facilities
5
Discrimination in the care of IHD patients with
mental illness (W. Australia 1980-98)
6
New drugs and ten-day treatment cost of different
therapeutic categories (in USD 2004)
7
Verona, 1982-2001) Avoidable mortality (SMR) for
persons with mental disorders
8
Trends
  • It is highly probable that the stigma of mental
    illness and its consequences will become even
    more pernicious than they are now because of
  • The spread of competitiveness in societies
  • The restriction and/or per capita reduction of
    resources for health and social services
  • The strengthening of religion-based intolerance
    of non-conforming behaviour
  • The reduction of self-esteem in many populations,
    particularly in the third world

9
Trends
  • The enhancement of stigma is also likely to be
    supported by
  • The commoditification of medicine
  • The reduction of size of families and of links
    among their members
  • Urbanization
  • Increasing complexity of labour
  • The mid-position of the mentally ill on the
    tolerance curve in many societies

10
Mid position of the mentally ill on the tolerance
curve
Tolerance
10
1
20
of those different
11
Current paradigms of action
  • Campaigns of public information telling all
    comers (e.g. in the buses, cinemas) that mental
    illness is like any other and that people with
    mental illness are like ourselves
  • Lectures in the course of various studies and
    manifestations, with similar content
  • Leaflets, articles in the popular press,
  • Discussions of films, books

12
Current paradigms of action
  • Selection of topics for anti-stigma efforts on
    the basis of reviews of evidence (obtained by
    investigations)
  • Measurement of success/failure of campaigns by
    changes in attitudes of the population
  • Exhortation of media to speak about mental
    illness in a non-discriminatory manner
  • Lecturing about mental illness in schools

13
New paradigms
  • Selection of targets for action on the basis of
    views of people with mental illness and their
    families
  • Creation of anti-stigma activities for limited
    areas or groups of people
  • Tailoring programmes to behaviour typical for
    particular mental disorders
  • Introduction of antistigma work as a routine part
    of service, not in the form of a campaign

14
New paradigms
  • Focussing on changing behaviour of others, not
    their attitudes
  • Measuring effects of programme by the reduction
    of discriminatory behaviour
  • Making the enhancement of self-esteem of people
    with mental illness and their families a central
    part of the programme
  • Adjusting programmes to target groups

15
New paradigms
  • Making the time-sequence of programme dependent
    on opportunities
  • Other things being equal, making mental health
    professionals the first target of programmes
  • Relying on on law, persuasion, administrative and
    QA rules to reduce discriminatory behaviour

16
Topics for work with mental health
professionals reflecting new paradigms
  • The use and communication of diagnoses
  • The use of their language, gestures,
  • Emphasis on enhancing the patients self-esteem
    in treatment plans.
  • Congruence of statements and behaviour e.g.
  • Ensuring that the mentally ill are given a chance
    to exercise their rights e.g. voting,
  • Considering the need to maintain ones special
    privileges
  • Selection of non-stigmatizing treatments

17
Non-stigmatizing treatments
  • Without visible side-effects
  • Rapid in onset
  • Applicable in general medical settings or in
    outpatient facilities
  • Prescription not subject to special restrictions
    (e.g. those applicable to narcotic drugs) nor
    requiring specialists approval
  • Similar, in application and location, to other
    medical treatments.

18
Comparing paradigms, a summary.
Norman Sartorius 2008
19
The current and new paradigms
Norman Sartorius 2008
20
The current and new paradigms
Norman Sartorius 2008
21
Summary
  • Stigma remains the main obstacle to better mental
    health care and stronger mental health programmes
  • Recent studies and experience demonstrated that
    action against stigma can be successful in all
    settings
  • The evidence and experience obtained in
    antistigma programmes dictates the introduction
    of new paradigms of action, preserving only those
    parts of current paradigms that have shown to be
    useful and effective
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