1. Evidence to Reduce Stigma & Discrimination Graham Thornicroft, PhD Centre for Global Mental Health King’s College London, Institute of Psychiatry March 2014 World Health Organization Collaborating Centre

2. Intended Audience & Learning Objectives This lecture will be most informative for someone with a beginning level knowledge of the topic. By the end of this lecture, users will be able to: Learn about the challenge of stigma and discrimination in mental health Identify local- and national-level responses to stigma and discrimination Identify resources for addressing stigma and discrimination

3. Stigma “The issue of stigma against mental illness sometimes feels like the worst part about it.” Tom

4. Stigma Friends They don’t call me sad. They don’t call me bad. They don’t call me mad. They don’t call me. © William McKnight Book title: Loud Silence, 2012

5. Plan 1.Challenge 2. Response evidence for local interventions evidence for national interventions 3. Resources

6. Plan 1.Challenge Click book cover For more information— (in Slide Show mode only) Click book cover For more information— (in Slide Show mode only)

7. Challenge 1 What is Stigma? It has 3 components Problem of knowledge = Ignorance Problem of attitudes = Prejudice Problem of behaviour = Discrimination

8. Challenge 2 “At 16, in 1996, I suffered a bad mental breakdown where I was hospitalised for 5 years. It was very traumatic. There I was, the eldest son, suffering a sudden deep depression, crying and unable to work, often threatened by my confused Dad as being “weak”. --Robert

9. INDIGO Network INDIGO International Study of Discrimination and Stigma Outcomes in Mental Health 39 study sites in 35 countries For more information, contact: Graham.thornicroft@kcl.ac.uk

10. INDIGO Network INDIGO aims: Develop and validate a scale to measure service user’s experiences of discrimination (anticipated and experienced) Called: Discrimination and Stigma Scale (DISC) Collect international data on the nature and severity of discrimination Discrimination and stigma scale (DISC)

11. INDIGO Network Discrimination and stigma scale (DISC) Reported by service users with schizophrenia about experiences of discrimination: personal relationships financial affairs housing community life education health & social services family life privacy and safety work children transport and travel avoidance 736 people interviewed, 28 countries

12. INDIGO Network

16. INDIGO Key References (Click titles for access--in Slide Show mode only) Global pattern of experienced and anticipated discrimination Against people with schizophrenia: a cross-sectional study. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Thornicroft G, et al. & the INDIGO Study Group Lancet 2009, 373:408-415 Lasalvia A, et al. & the ASPEN/INDIGO Study Group Lancet 2013, 381:55-62

18. Plan 1.Challenge 2. Response evidence for local interventions

19. Local Level Interventions Social Contact Theory: Direct, personal social contact with individual(s) of the stigmatised group is effective to reduce stigma

20. Local Level Interventions Local Intervention Studies, Target Groups: Police officers Young people Medical Students Nurse Students For references, see Note section of this slide.

21. Local Level Interventions (Click title for access--in Slide Show mode only) Compared live consumer talks, DVD filmed consumer talks, and boring lecture for nursing students Attitudes, compassion and behaviour improved for live consumer and DVD groups Both better than lecture—still better 4 months later Recorded sessions most cost-effective Filmed v. live social contact interventions to reduce stigma: randomised controlled trial Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, McCrone P, Norman I, Thornicroft G Br J Psychiatry 2012, 201(1):57-64

22. 1.Challenge 2. Response evidence for local interventions evidence for national interventions Plan

23. National Level Interventions (Click title for access--in Slide Show mode only) Messages to use in population-level campaigns to reduce mental health-related stigma: consensus development study Clement S, Jarrett M, Henderson C, Thornicroft G Epidemiologia e Psichiatria Sociale 2010, 19(1):72-79 Recovery oriented See the person Social inclusion/human rights Mental health problems are common

26. National Level Interventions Time to Change, 4-Year Outcomes: 8 papers published in British J. of Psychiatry 2013 Consistent pattern of positive change in England Small to moderate sized improvements Most positive change is in service user reports of experienced discrimination

27. National Level Interventions (Click title for access--in Slide Show mode only) The Importance of Disclosure: Systematic review of beliefs, behaviours, and influencing factors associated with disclosure of a mental health problem in the workplace Brohan E, Henderson C, Wheat K, Malcolm E, Clement S, Barley EA, Slade M, Thornicroft G BMC Psychiatry 2012, 12:11

28. Plan 1.Challenge 2. Response evidence for local interventions evidence for national interventions 3. Resources

29. Resources in 3 Key Domains of Stigma What is Stigma? Problem of knowledge = Ignorance Problem of attitudes = Prejudice Problem of behaviour = Discrimination

30. Resources on Knowledge (Click title for access--in Slide Show mode only) Development and psychometric properties of the Mental Health Knowledge Schedule Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, Thornicroft G Can J Psychiatry 2010, 55(7):440-448.

31. Resources on Attitudes (Click title for access--in Slide Show mode only) MICA Scale (Mental Illness Clinicians Attitudes): Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version) Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G Acta Psychiatr Scand 2010, 1-9

32. Resources on Behaviour (Click titles for access--in Slide Show mode only)

33. Resources on Barriers to Access (Click title for access--in Slide Show mode only) Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G BMC Psychiatry 2012, 12:36

35. Resources FOR FURTHER INFORMATION CONTACT: graham.thornicroft@kcl.ac.uk