World Mental Health Day (2) The Lancet Commission on ending stigma and discrimination in mental health

16 October, 2022

Citation, summary, key messages, quotes from people with lived experience.

'Based upon all the information presented in this Lancet Commission report our single, simple key message is the following: mental health is part of being human, let us act now to stop stigma and to start inclusion.'

CITATION: The Lancet Commission on ending stigma and discrimination in mental health

Graham Thornicroft et al.

The Lancet

Published:October 09, 2022DOI:https://doi.org/10.1016/S0140-6736(22)01470-2

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01470-2/fulltext

EXECUTIVE SUMMARY

It is time to end all forms of stigma and discrimination against people with mental health conditions, for whom there is a double jeopardy: the impact of the primary condition itself and the severe consequences of stigma. Many people describe stigma as ‘worse than the condition itself’. This Commission report is the result of a collaboration of more than 50 people globally. It brings together evidence and experience on the impact of stigma and discrimination and successful interventions for stigma reduction. The report is co-produced by people who have lived experience of mental health conditions and includes material to bring alive the voices of people with lived experience. The voices whisper or speak or shout in the poems, testimonies and the quotations that are featured.

The Lancet Commission on ending stigma and discrimination in mental health had six aims (panel 1). From traditional definitions of stigma, we have developed four main components to consider in this report: self-stigma (or internalised stigma), which occurs when people with mental health conditions are aware of the negative stereotypes of others, agree with them, and turn them against themselves; stigma by association, which refers to the attribution of negative stereotypes and discrimination directed against family members (eg, parents, spouses, or siblings) or to mental health staff; public and interpersonal stigma, which refer to the forms of knowledge and stereotypes, negative attitudes (prejudice), and negative behaviour (discrimination) by members of society towards people with mental health conditions; and structural (systemic or institutional) stigma, which refers to policies and practices that work to the disadvantage of the stigmatised group, whether intentionally or unintentionally.

KEY MESSAGES

1. Stigma and discrimination contravene basic human rights and have severe, toxic effects on people with mental health conditions that exacerbate marginalisation and social exclusion, for example by reducing access to mental and physical health care and diminishing educational and employment opportunities

2. Our umbrella review of 216 systematic reviews shows that interventions based on the principle of social contact (whether in person, virtual, or indirect) that have been appropriately adapted to different contexts and cultures are the most effective ways to reduce stigmatisation worldwide

3. Our evaluation of ten large-scale anti-stigma programmes around the world found that they are most effective when they involve people with lived experience of mental health conditions (PWLE) as co-producers in all aspects of development, when target groups are consulted on programme content and delivery, and when programmes are sustained over the long term

4. The media play powerful roles in increasing stigma when they reinforce stereotypes associated with mental health conditions, such as unpredictability or dangerousness, and decreasing stigma when they align with guidelines on responsible reporting, for example of suicide

5. In a global, multilanguage survey of PWLE, 391 people responded from 45 countries and territories. Most (≥70%) participants agreed that PWLE should be treated as equal to people with physical health conditions; stigma and discrimination negatively affect most PWLE; the media are an important factor in worsening stigma and discrimination; the media could play a crucial part in reducing stigma and discrimination; and stigma and discrimination can be worse than the impact of the mental health condition itself

6. The findings of this Lancet Commission show that PWLE are key agents for change in stigma reduction and need to be strongly supported to lead or co-lead interventions that use social contact

7. We propose eight key recommendations for action by international organisations, governments, employers, the health-care and social-care sectors, the media, PWLE, local communities, and civil society, each with a specific target and indicators that may be used to develop a framework for accountability and track progress towards ending mental-health-related stigma and discrimination

QUOTES FROM PEOPLE WITH LIVED EXPERIENCE

“Language is used to broadcast shame, making what was a private individual experience to a public, communally shunned and stereotype experience.”

“Words can easily be dehumanising, discriminating and stigmatising. When you become labelled, it feels like being cornered but nowhere to go.”

“Even educated people from society consider schizophrenia a death sentence for the person, like your mind is gone forever, and you have to say goodbye to the person you used to know and care about. In worse cases there are expectations of violence, abuse, and some accidents from the person with schizophrenia, there is profound lack of trust and what the person says or does is viewed through the lens of the diagnosis.”

“People see it like it is some form of weakness that comes from you. You are avoided like it is contagious. It is seen like it is not a serious problem and you can snap yourself out of it.”

“Not being able to talk to any of my family members about what I was going through. Not knowing where to start. Moreover, opening up to a friend who in turn rubbished me saying that I am demon possessed and should go to church instead of a psychologist.”

“The most difficult for me in the period as I was ill, was how the people at work treat me.”

“The best way is to involve us [PWLE] from the beginning, at the planning stage. Especially important is to try and contact a representative organization first. They usually are small, underfunded and will greatly benefit from collaboration and support.”

“My decision is to make mental health and mental illness a normal subject in my life and my circle. It's a fierce battle but I remain engaged because I have seen how many people have benefitted from my advocacy.”

“Have the person with lived experience at the centre of the programme delivery.”

“I am setting up a foundation /organisation towards it in my hometown. I have personally been very, very vocal about my struggles and how I overcame it. I believe that through heart-to-heart dialogue with people, you can communicate and help them understand.”

“Social media have two sides, it can increase stigma and it can reduce stigma. Many people talk about serious things like they know everything that's why it's dangerous. But if we are smart, we can get more knowledge or use them as campaign to reduce stigma.”

“By using discriminatory, insulting language, by using associations with violence, by using photos that insult persons with lived experience (for example “funny” TV shows where players are required to escape from a straight jacket). By using over-medicalised messages and wrong information in general. By silence. Because silence contributes to lack of knowledge.”

“There needs to always be an emphasis on choice and on agency - rather than things being done to someone regarding their mental health.”

“The language matters, but more important are the actions.”

HIFA profile: Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Global Healthcare Information Network: Working in official relations with WHO