1. PUBLIC EDUCATION STIGMA: CREATING AND PREVENTING Paul Cosyns, Hans Schanda 1Ghent group Barcelona 2012 Ghent-Group Meeting Barcelona, September 20 th - 22 nd, 2012

2. DOUBLE OR TRIPLE STIGMATIZATION OF FORENSIC PATIENTS/MENTALLY ILL OFFENDERS Stigma 1 of being an offender of being ‘violent’ Stigma 2 of being a psychiatric patient of being ‘insane’ or ’mad’ Stigma 3 of being ‘incalculable’ of being ‘dangerous’ 2Ghent group Barcelona 2012

3. “DANGEROUSNESS”: A KEY ISSUE FOR THE PUBLIC “…Much of the mystique of psychiatry comes from the public awareness of this role. Indeed, some of the public hostility to psychiatry is also related to this role … construed as the psychiatrist relinquishing his medical function for a police one.” Gunn J, Monahan J. Dangerousness. In: Gunn J, Taylor PJ (eds). Forensic psychiatry. Clinical, legal and ethical issues. Oxford: Butterworth-Heinemann (Oxford 1993), pp 624-645. (p 624) 3Ghent group Barcelona 2012

4. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Media: Politicians, lawmakers: Ghent group Barcelona 20124

5. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: By doing proper work; by our ‚terminology‘,by the way we speak about our patients; however, some of our patients behave in a way that explains social rejection (“biologically determined“ rejection/exclusion) General mental health professionals: Medical students, police, prison staff, judges: Public: Media: Politicians, lawmakers: Ghent group Barcelona 20125

6. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Media: Politicians, lawmakers: Ghent group Barcelona 20126

7. “The data suggest that public education programs by advocates for the mentally ill along the lines of ‘people with mental illness are not more violent than the rest of us‘ may be doomed to fail … And they should: the claim, it turns out, may well be untrue.“ (Monahan 1992) 7Ghent group Barcelona 2012

8. “Whether they like it or not, psychiatrists are expected by the population at large to select mentally disordered people who were dangerous to themselves or to others, and to treat them.“ Gunn J, Monahan J. Dangerousness. In: Gunn J, Taylor PJ (eds). Forensic psychiatry. Clinical, legal and ethical issues. Oxford: Butterworth-Heinemann (Oxford 1993), pp 624-645. (p 624) 8Ghent group Barcelona 2012

9. THE PROBLEM OF COMMUNITY PSYCHIATRY Desire for harmony Desire for being the ‘good guys‘ Inability to decively set limits in time As long as these qualities determine the course of action in problematic situations, community psychiatry is in need of services which unburden it from treatment and care of ‘difficult‘ patients. (According to Nouvertné 2006)

10. ACTING OF MENTAL HEALTH PROFESSIONALS IN THE RUN-UP TO FATAL INCIDENTS  Persistent reluctance to admit to hospital.  Admissions, when they occurred, were brief.  Poor mental state evaluations.  At each stage professionals tried to downplay the seriousness of the whole matter.  Variety of obviously incorrect statements.  Violence, threats and cries for help were largely undetected or ignored.  When aggression did occur it was dealt with by rejection. (Gunn 1996)

11. ROUTINE, EVERYDAY PRACTICE Ghent group Barcelona 201211 Forensic psychiatrists General psychiatrists Information (dangerousness, risk groups, risk factors, ralapse rates, special needs, special treatments, social exclusion, excess mortality, ‘treatment works‘), telling the truth, being honest

12. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Media: Politicians, lawmakers: Ghent group Barcelona 201212

13. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Directly (own experience), indirectly via the media (proactive, independent of severe incidents), defining mental illness (is mental illness primarily defined by dangerousness?), relapse rates, “treatment works“ Media: Politicians, lawmakers: Ghent group Barcelona 201213

14. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Media: “Intelligent use“ of the media? (addressing only the serious media? Should we include also the gutter press, also the entertainment-TV-channels?) Politicians, lawmakers: Ghent group Barcelona 201214

15. OUR CONTRIBUTION TO REDUCE STIGMA? WHOM SHOULD WE ADDRESS? HOW SHOULD WE DO THIS? Ourselves: General mental health professionals: Medical students, police, prison staff, judges: Public: Media: Politicians, lawmakers: How can we cope with the deep distrust of politicians and lawmakers and in psychiatrists?; being honest, telling the truth; proactive, defining mental illness (is mental illness primarily defined by dangerousness?), relapse rates, “treatment works“, expenditures!!! Ghent group Barcelona 201215

16. IN CASE OF A SEVERE INCIDENT Ghent group Barcelona 201216 Forensic psychiatrists General psychiatrists Information (dangerousness in general, risk groups, risk factors, ralapse rates, special treatments, ‘treatment works‘), telling the truth, being honest