LGBT History Month 2017

This month is LGBT History Month in the UK. The idea of the month is to reflect on the history of the LGBT community and also think about how the community may evolve from here. The guys over at Carvaka thought it would be a good idea (and I agree by the way!) to produce an infographic to celebrate all that is great about the LGBT community to mark the month. The graphic lists some of the community’s most successful people, which include Giorgio Armani, Peter Thiel, David Geffen, Megan Ellison and Elton John.

To show just how far the community has come in securing equal marital rights for its members, the infographic shows all of the countries in the world where same-sex marriage is now fully recognised. However, there is still much work to do, particularly in Russia, the Middle East and much of Africa where prejudice is still common. Some interesting stats are also included, such as that 1.7% of the UK population identify as being part of the LGBT community, but this number rises to 3.3% when people aged 17-24 are analysed. This disparity points to a lost generation of older LGBT people who could never bring themselves to come out; it is through initiatives such as LGBT History Month that these people are encouraged to be who they really are without fear of prejudice or ridicule.

I hope you enjoy this infographic and during the month of February reflect on from whence the community has come, all that is great about it and how it might develop into the future. Happy LGBT History Month!

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Where there is a will, there is a way to beat stigma

This post is the fifth and final entry in a series of posts reporting on the World Psychiatric Association (WPA) International Congress 2016, which I attended in Cape Town in November.

There is no country in the world, rich or poor, in which anti-stigma programmes related to mental illnesses won’t succeed if there is the will to do so and if a few basic lessons are adhered to, according to former WPA President Professor Norman Sartorius, speaking at the WPA Congress in 2016.

During his session, titled The Stigma of Mental Illness – End of the Story?, Professor Sartorius shared the lessons he has learned over thirty years as a founding member of the anti-stigma movement.

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Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Professor Sartorius said many programmes against stigma had been developed worldwide, including the Open the Doors programme developed by the WPA and the INDIGO programme. Major national, regional and provincial programmes had also been set up.

The most important lesson of all, he said, was that “anti-stigma programmes must start with a self-examination of those who will lead the programme.
“If their prejudices are not dealt with, the programme could lose credibility,” he said.

When selecting priorities for a programme, Professor Sartorius recommended that three criteria should be applied, namely:

  1. Do people with mental illness and their families see this area as a problem for them?
  2. Is it likely that the project will be a success?
  3. Does the work require planning over the time horizon?

“For instance, in Canada, we asked patients first, ‘What is it that disturbs you the most?’
They said, ‘What really disturbs us is when a doctor or hospital treats us like dirt…’. So we went to hospitals in Calgary to observe and interview the staff. Many of the doctors weren’t aware that they were seen that way. We talked to them and tried to change their attitudes.
“Six months later, the people with mental illness said this was the first time anyone had asked them what was needed to make their lives better.”

Professor Sartorius said another key lesson when setting up anti-stigma programmes was to “Choose the one that will be successful, or else people get fed up”.
He also advised, “Do not make plans further than you can foresee, for example if there is going to be a change of government.”

While overall rules for the programme are useful, the professor emphasised that flexibility is needed to make the most of opportunities that may arise.

Further important takeaways learnt from his research were that:

  • The key to success is the existence of a small group of dedicated workers who will stay with the programme for at least five years, with a likeable, charismatic leader and team.
  • Campaigns are useful only if they are intensifications of steady, continuous work on stigma. “Isolated campaigns are likely to be experienced as useless or harmful by those most concerned. For example, a one-year campaign in Sweden failed … Programmes must carry on into the future.”
  • The scientific evaluation of whether the attitudes to people with mental illness have changed should rely on changes in the behaviour of all concerned.
  • Programmes against stigma should address, and be tailored for, well-defined groups of people. “A programme addressed to a policeman will be different from one for teachers or judges. Sharp focus is important.”
  • Simply providing knowledge does not reduce stigma. Additional knowledge can increase stigma because of selective perception processes. “Training in specific skills in relationships with mentally ill people should be offered.”

Professor Sartorius said it is important to bear in mind that help and support to programs often comes from unexpected sources. “There is much good will that is never used because nobody asked for it.”

The previous post in this series covered creative ways of caring for mental health patients. My other reports from the WPA include ideas for psychiatrists to break down the walls of racism and discrimination present in mental healthcare in South Africa. Other posts discussed psychiatrists’ implicit contract with society, as well as African Union Commission Chair Nkosazana Dlamini-Zuma’s address at the opening ceremony of the WPA Congress, in which she called for international organisations to place more emphasis on mental health funding and activism.

Creative care for mental health patients

This post is the fourth in a series of posts reporting on the World Psychiatric Association (WPA) International Congress 2016, which I attended in Cape Town in November.

When Promise co-founder Dr Manaan Kar Ray was punched in the face in 2006 by a patient with whom he believed he had a good rapport, he found himself ashamed, mentally exhausted, and anxious about doing his job.

A second incident, in which a patient smashed a glass ashtray against a wall and chased him down the corridor, exacerbated his stress.

Today, years later, he has acknowledged the assault and the subsequent reflection provided him with a different frame of reference as to how mentally ill patients viewed the use of restraints in their treatment and whether, in their eyes, this constituted unprovoked violence.

Dr Kar Ray spoke at the WPA Congress. Together with Expert by Experience Sarah Rae, he created Promise, a proactive care initiative aimed at seeking out and embracing new ideas and, in the interests of patient-centred care, working to develop compassionate and creative alternatives for the care of patients with mental illness.

This was inspired by 2013 research that found huge variation in the use of restraint across England, with one centre reporting 38 incidents and another more than 3,000. There were also concerns about the face-down, or “prone” restraint method, plus related injuries, which numbered more than 1,000 in a single year.

Kar Ray, also a consultant psychiatrist at Fulbourn Hospital in Cambridge in the UK, pointed out that the use of mechanical constraints was commonplace in Europe and the developing world, and that he was sure “we can do better than this”.

“Our vision for Promise is to promote dignity by eliminating coercion in mental health. We need to have the courage to challenge the status quo, and not accept that because things have been this way for a long time, we should carry on this way,” he told delegates attending the congress.

Promise started with five founding members, are now thirty strong, and are constantly attracting more people keen on sharing and celebrating good practice. For caregivers, Kar Ray stressed that Promise’s message was clear: “We must contain the situation to keep patients and caregivers safe. But every time we lay hands on a patient is an opportunity for us to think whether there was something better we could have done upstream, ahead of the situation developing. If we can enhance the patient experience, maybe those situations don’t necessarily have to happen in the first place,” he said.

The Cape Town Promise Charter was signed following the session, and Kar Ray said this would help raise questions here, too, about whether restraint was indeed a necessity in the care of people who are mentally ill.

“Perhaps it’s not a necessary evil. Perhaps we are just stuck in the limitations of the past. And perhaps we need to shift out of that mindset, into a future full of possibilities,” he said.

The previous post in this series covered how psychiatrists can help break down the walls of racism and discrimination. My other reports from the WPA include an exposition of psychiatrists’ implicit contract with society, as well as African Union Commission Chair Nkosazana Dlamini-Zuma’s address at the opening ceremony of the WPA Congress, in which she called for international organisations to place more emphasis on mental health funding and activism.