Mental health stigma
"Most people are coming to regard mental illness and disability in much the same way as physical illness and disability" – Report of the Royal Commission on the law relating to mental illness and mental deficiency, 1957.
Anti-stigma campaigns and the growing profile of mental health issues in recent years appear to have gone some way to changing views and dispelling misconceptions about mental illness.
But with nine in ten people with mental health problems still experiencing stigma and discrimination, nearly sixty years after the Royal Commission's optimistic assessment, there may still be some way to go in changing public attitudes.
What is mental health stigma and what are its implications?
Mental health stigma is summarised by the anti-stigma campaign group Time to Change as the set of negative attitudes, pre-judgements, prejudices and behaviour that can make it harder for individuals with mental health problems to live a normal life.
It includes, among other things, misconceptions about the risks posed to the public by those affected by mental health problems, and the use of pejorative or flippant language in describing mental illness and those affected by it. It may be exacerbated or perpetuated by the negative portrayal of mental illness in the media.
Mental health stigma may manifest itself in discrimination, making it harder for people to make friends, to obtain and hold down jobs, and to access housing and other services.
It may also lead to loss of self-esteem, thereby aggravating existing mental and physical health problems, and make those affected feel unable to seek the help they need to manage their condition or make a recovery.
The previous Government's commitment to reduce stigma
The previous Government made a number of commitments to reduce stigma and discrimination in relation to mental illness. Its mental health strategy, No Health Without Mental Health, had as one of its six long-term objectives that "fewer people will experience stigma and discrimination".
Meanwhile, the Deputy Prime Minister's 2014 strategy, Closing the gap: Essential priorities for mental health, contained 25 objectives, one of which was to "stamp out discrimination around mental health".
These commitments came in the context of the Government's pledge in the NHS Constitution and the NHS Mandate for 2014–15 to achieve "parity of esteem" between mental and physical health.
This follows from a recognition that those with mental illnesses are sometimes poorly served by the NHS, not least because many have co-existing physical conditions, and there is insufficient integration of mental and physical health services.
What has Parliament done?
In recent years, MPs from across political parties have pledged their support for reducing mental health stigma.
A backbench business debate in June 2012 was considered a watershed moment in tackling stigma when, for the first time, MPs spoke about their personal experience of mental health problems, and received cross-party support for doing so.
After that debate, Gavin Barwell MP announced the introduction of the Mental Health (Discrimination) Bill in the Commons, to "remove the last significant form of discrimination in law in our society".
The Private Member's Bill repealed discriminatory legislation that prevented people with mental health problems from sitting on a jury, being a company director or being an MP.
The Bill passed through the Commons and Lords with Government and Opposition support, and received Royal Assent on 28 February 2013.
Anti-stigma campaigns and changing attitudes
The principal means of tackling negative attitudes and dispelling misconceptions about mental health has been through public awareness campaigns.
The largest of these is the Time to Change campaign, run by two charities – Mind and Rethink Mental Illness – and funded by the Department of Health, Comic Relief and the Big Lottery Fund (its funding was recently extended until March 2016).
The campaign uses various media, including blogs, TV advertisements and promotional events, to raise awareness of stigma and its effects. It has also encouraged employers to sign a pledge to support employees with mental health problems, raise awareness and reduce stigma in the workplace.
Since the campaign began in 2007, there are signs that public attitudes to mental health are becoming more favourable, with a lower proportion of survey respondents expressing fear of those with mental health problems; higher support for integrating people with mental illness into the community; and higher levels of tolerance and sympathy for those with mental health problems.
Chart : Public attitudes about mental illness
Public attitudes to those with mental illness have changed over time, particularly in recent years: percentage of survey respondents agreeing with selected statements (given below and identified as 'A' to 'D' on left of chart), 1994–2013.
However, a fifth of respondents said that they would be uncomfortable talking about their own mental health with friends and family; and almost a half said they would feel uncomfortable talking to their employer about their mental health.
Strategies that seek to provide information to improve public understanding of mental health may not on their own be sufficient. Stigmatising views can be entrenched, and prevalent even among those who are knowledgeable about mental health problems.
Some campaigns, including Time to Change, have sought to provide more opportunities for the public to meet and interact with people with mental illness, an approach that research shows to be particularly effective in changing attitudes.
As Time to Change acknowledges, there is still work to be done before the stigma surrounding mental health is eradicated.
Isn't discrimination illegal?
If a mental health condition meets the definition of 'disability' under the Equality Act 2010 – namely, if it is has a substantial, adverse and long-term effect on the sufferer's day-to-day activities – then it is unlawful to discriminate against them on the grounds of that condition.
However, the legal situation may not be well-understood, particularly in the workplace. In a 2009 survey, Time to Change found that 92% of people believed that admitting to a mental health condition would damage someone's career, and 56% would not employ someone experiencing depression, even if they were the best candidate for the job.
On average, those with severe mental illness die 15 to 25 years earlier than the rest of the population, largely from preventable illnesses such as diabetes and heart disease.
- Labour: give mental health the same priority as physical with a right to access talking therapy
- Conservatives: increase funding for mental health care
- Greens: increase funding and ensure access to a mental health bed for anyone who needs one in the local NHS
- Liberal democrats: extra £500m for mental health care and increased access to talking therapies
- UKIP: increase spending by £170m a year