We know more collectively about mental health than at any other time in history. Through a broad range of public education initiatives, we have expanded our knowledge and awareness of these illnesses, as well as the experiences of people who suffer from them.
But that crucial next step – pushing past simple knowledge and empathy to change behaviours and affect policy, breaking through the enormous stigma that continues to surround mental illness – remains elusive.
According to the Mental Health Commission of Canada, roughly one in five Canadians has experienced some form of mental illness. That’s over seven million people in this country alone. The implications of such a large number is wide-ranging, whether from a public health or socio-economic perspective. It’s an issue that continues to have mental health experts, as well as other health care professionals and policymakers, struggling to find solutions.
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Identifying stigma
One of the biggest problems remains the deeply-rooted stigma of mental illness. Dr. Heather Stuart, a professor of Community Health and Epidemiology in the Faculty of Health Sciences at Queen’s University, is a leading authority on mental illness and stigma. She’s also the Bell Canada Mental Health and Anti-Stigma Research Chair. The first thing to understand, she says, is that stigma takes a variety of forms. The first is “self-stigma”, whereby someone suffering from a mental illness feels shame and blame, and attempts to hide the fact that they have an illness rather than seek treatment.
The second, says Dr. Stuart, is “public stigma”, which encompasses publicly-held beliefs and attitudes concerning those who have a mental illness. It can manifest itself in prejudicial thinking, but also in discriminatory behaviour.
The third kind is “structural stigma”, which she identifies as an “inequitable organization of goods and services, power and resources so that people who have mental illness get less of all of the above.”
According to Dr. Stuart, all three forms of stigma remain prevalent in Canada. “There is some research to show that our attitudes have softened,” she says. “We know more. We’re a little more empathetic. But our desire to be in close proximity to somebody who has a mental illness – our desire for social distance, to keep them away – has not changed.”
Old attitudes
The extent to which things have stayed the same, in fact, is startling. A 2008 National Report Card on Health Care published by the Canadian Medical Association found that while a majority of Canadians (60 per cent) believed the diagnosis and treatment of mental illnesses was underfunded, many continued to harbour discriminatory attitudes towards those suffering from these illnesses. A plurality of Canadians (46 to 35 per cent) surveyed believed, for instance, that mental illness was often used to excuse poor behaviour.
The study also showed that while a majority of Canadians weren’t fearful of being around someone with a mental illness and would still socialize with a friend (less so with a work colleague) who had a mental illness, they wouldn’t want to rely on them for professional advice and services. Few respondents said they would hire a financial advisor (15 per cent), babysitter (14 per cent), lawyer (12 per cent), doctor (11 per cent) – or even landscaper (31 per cent) – if they knew that that person had a mental illness.
Furthermore, the corresponding increase in public knowledge about mental illness is changing the way we talk about these conditions. So while we’re less likely to hear people referring to someone as “crazy” or “mad”, labelling persists in other ways. Take, for instance, the propensity for throwing clinical terms around to describe feelings or people with certain personality traits. It’s common for someone who’s had a bad day to say they’re “so depressed right now,” or for someone to disparage a meticulous colleague for being “kind of OCD.”
Dr. Stuart calls this use of language offensive, because it trivializes a serious condition. “You wouldn’t do something similar with cancer if you were feeling bad, and yet they will say, you know, ‘The market was schizophrenic.’ All these things we have to get out of our vernacular.”
The trouble is, she adds, that stigma often prevents those from calling people out on this kind of language. “If you said something similar in a racial context or an LGBT context, people would whistle-blow on you. But they won’t here.”
Old culprits
If we’re supposedly so much more aware of mental health issues and better educated, how can it be that we’re still harbouring so many of the same old attitudes? Dr. Stuart suggests the answer may lie partly in a 24-hour news culture that tends to sensationalize mental illness – often incorrectly naming it as a factor in crime stories.
“Usually somewhere in the world, you can find an example of someone who’s done something horrific,” she says. “And sometimes the people who are reporting the news will actually come right out and say things that aren’t true. They’ll give you a really strong suspicion that there was a mental illness there. And when they find out two months later that there wasn’t, you never really hear about the retraction. So you start to link in your mind these horrific events, especially with violence, ‘Well, ipso-facto, it must be mental illness.’”
At the same time, these connections are bolstered by a litany of popular crime shows that depict individuals with mental illnesses as merciless killers.
“When they’ve done their analyses of prime time movies and shows, something like a quarter or more of the characters are mentally ill and dangerous,” she says. “And the mentally ill characters are ten times more likely to be violent in shows than any other character. So it gives us an exaggerated sense of violence and unpredictability.”
Awareness campaigns: breaking through the stigma
Public education seems to be the best way to combat the stigma of mental illness, and there have been countless awareness campaigns in different parts of the world that have attempted to bring about not just greater understanding of the issues, but also to change behaviours. But what experts are finding is that, even among awareness campaigns, some ways of raising awareness are more effective than others in producing desired outcomes.
Mark Ferdinand, National Director of Public Policy for the Canadian Mental Health Association, is quick to stress that the mere practice of raising awareness has so far proven insufficient. The trouble with awareness campaigns, he says, is that they’re often too all-encompassing in their approach.
“One-size-fits-all doesn’t and just cannot work in addressing mental illness,” he says. “So if we don’t take a much more targeted approach to addressing different populations, we will continue to make wrong assumptions as it relates to initiatives that we think will have an effect on the largest proportion of the population as possible.”
One highly-publicized campaign in recent years has been Bell’s “Let’s Talk” initiative, which features high-profile Canadians who have mental illnesses. Both Dr. Stuart and Ferdinand praised the campaign for addressing stigma by promoting conversation – as opposed to a more top-down educational approach. The ability to become self-aware about one’s own condition and share their experiences, says Ferdinand, is a key step in the path to recovery.
Bell’s use of a high-profile athlete, Clara Hughes, as its spokesperson has garnered the campaign considerable publicity. It raises a concern, however, that perhaps putting up a successful Canadian who has successfully managed her condition may not be painting a fully representative picture. Does it, for example, further marginalize the plight of people who have mental illnesses and are destitute, who have addictions or are homeless? Does it speak to the experience of an individual who may not benefit from the social support network of an individual like Hughes?
Ferdinand doesn’t think this is a problem; rather, he believes that a well-known success story can inspire others to open up about their own experiences.
“If people like Clara Hughes and others are able to talk about it,” he says, “maybe it provides them with the confidence to at least take a small step forward and say, ‘This does not have to be as bad as it might seem. If she can do it, maybe I can.’”
Dr. Stuart agrees with Ferdinand about Hughes’ positive role in normalizing interaction and breaking down stereotypes about people with mental illness, but argues that the message needs to come from a variety of sources as well. “Celebrities shine a light on the issue, but we also need to have normal everyday folks,” she says.
“Otherwise we run the risk of having people say, ‘Well, I’m not an Olympic athlete, there’s no way I can do that.’”
From better awareness to better policy
If campaigns can boost awareness, adjust attitudes and promote conversations around mental illness, the next step is to find ways to translate these gains into substantial public policy improvements.
And right now, the existing policies are broken in a variety of areas. Dr. Stuart notes that families are often left on the hook to care for those suffering from various mental illnesses. It’s not uncommon for caregivers to quit their jobs to do so, and yet the support and resources to these families remains lacking.
“In the mental health world, It’s not easy for a family member to be included in the therapeutic process – they’re excluded regularly – because of privacy legislation,” she notes. “When somebody’s sick and not feeling well, or paranoid or angry, they may not want their family member involved. And there’s really not much thought about advanced directives or things that could allow a psychiatrist or health care provider to continue to feed information to a family member, even when someone is paranoid and objecting. So families are often working in the dark.”
Ferdinand stresses the difficulty in finding the right conditions to affect policy change, although it’s apparent to him that people need to pressure their governments to take action if it’s going to happen at all.
“We need to start figuring out how, when and under what circumstances will policy change occur in the area of both mental health as well as health policy,” he says. “We know that politics, leadership, planning, advocacy and citizen engagement and participation are the missing ingredients that remain to be broached by the mental health community to see the type of change with regard to the reduction of both stigma, but also the positive reaction in terms of improving mental health policies for people.”