Can we end mental health stigma and discrimination?

“I can’t talk about it at work because companies still have the perception that people with mental illness are unstable and unable to function normally”

Stigma and discrimination against people with mental illness are widespread in societies and cultures. Stereotypes about mental health can have a huge negative impact on the well-being and livelihoods of people with mental illness, often making their condition worse and delaying or stopping them from getting help. People with serious mental disorders tend to die prematurely – on average 10-20 years compared to the general population – from preventable physical illnesses. To coincide with World Mental Health Day, 10 October, The lancet published Commission to End Stigma and Discrimination in Mental Health. This goal may sound ambitious. But the Commission’s main message is that we cannot change the status quo in mental health without tackling stigma and discrimination.

The commission is distinguished by the inclusion of people with lived experience (PWLE) of mental illness, whose poems, testimonies and quotes highlight the report. The commission frames the issue and reviews evidence and first-hand experience of what works to reduce stigma and discrimination in mental health. In collaboration with more than 50 people worldwide, the Commission is led by Professor Graham Thorneycroft (Kings College, London, UK) and Charlene Sunkel, CEO and founder of the Global Mental Health Peer Network and Schizophrenia PWLE.

They find, first, that stigma and discrimination in mental health violate basic human rights and have serious consequences that compound marginalization and social exclusion. PWLE with mental illness are often denied access to life opportunities such as employment, education, health care and active community participation. And second, the most effective interventions to reduce stigma and discrimination are those that are culturally and contextually appropriate and involve contact between PWLE and people who do not have lived experience of mental illness. This finding should accelerate the formation of outreach-based policies, with PWLE involved in all aspects of the program, from concept to implementation. They are central to reducing stigma and need to be empowered and supported to lead change.

The media has a powerful role to play. On the one hand, it feeds stigma by portraying people with mental illness as dangerous and unpredictable. On the other hand, it can reduce stigma when their reporting is accurate, responsible and nuanced; for example around suicide. Providing guidance to the media means they can be part of the solution, not the problem.

The commission also makes several specific recommendations for governments and international organizations, employers, health and social care providers and schools, including decriminalizing suicide and developing guidelines for mental health in the workplace. But implicit throughout the report is the need for a fundamental shift in the power relations between PWLE and healthcare practitioners. Stigma in health care is a major barrier to access and quality care. The authors recommend that all medical staff receive mandatory training on the needs and rights of people with mental illness, in conjunction with PWLE. They are also calling for changes in laws and policies, including on conversion therapy and involuntary detention, and investment in mental health support, particularly at the community level.

PWLE interviewed by the Commission said they were not treated as equals to people with physical disabilities. This injustice is confirmed by the financing of health care. Globally, government spending on mental health averages a paltry 2% of the total health budget. Philanthropic organizations such as the Gates Foundation do not prioritize mental health in their global strategy or investments. It is hard not to see this neglect as a form of discrimination. Many of us will experience some degree of mental illness in the course of our lives. Why then is society so reluctant to invest? A 2020 Gallup Global Survey found that 92% of respondents consider mental health to be as important to overall well-being as physical health, but people are unsure how best to manage mental health. Most felt that talking to friends and family was key, but this option relied on low stigma and discrimination. The onus is on all of us to act in our personal and professional lives to improve the mental health of ourselves, loved ones, friends and colleagues. Ending the stigma associated with mental health is a goal that must be pursued.

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  • The Lancet Commission to End Stigma and Discrimination in Mental Health
    • It is time to end all forms of stigma and discrimination against people with mental illness, for whom there is a double jeopardy: the impact of the underlying condition and the severe consequences of the stigma. In fact, many people describe the stigma as worse than the condition itself. This Lancet The Commission’s report is the result of the collaboration of more than 50 people around the world. It brings together evidence and experience on the impact of stigma and discrimination and successful interventions to reduce stigma.