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.

end-stigma

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.