Still “crazy” after all these years?

Written by Danelle Pettman (UCL Psychiatry)

Dr Claire Henderson’s talk ‘Still “crazy” after all these years? How public attitudes to mental health have changed over time’ began with the unusual request of asking the audience to get on their feet.

She asked us to imagine that we were experiencing a current episode of mental illness and then asked us to sit back down only if we would tell our partners and family about it. I remained standing as I imagined telling my mum and boyfriend; a few others sat.

Then, she invited us to sit if we would tell our friends. I was still standing but it was more a hover as I went through my friends and decided which ones I would tell; a few more in the room sat.

Finally she invited us to sit if we would share news of our mental health problem with the people in our workplace; this was answered with a large thud as the majority of the audience (including me) sat down.

This simple exercise highlighted the stigmatisation of mental illness, in this case anticipatory, that Dr Henderson and her colleges aim to study.

Safely back in our chairs, we were presented with mounds of research looking at the stigma concerning mental health over time. Encouragingly, the data highlighted that there is general consensus among the research that attitudes towards people with mental health problems have improved since the 1990s.

For example, questions about social distance e.g. “Would you be happy with someone with a mental health problem being your neighbour?” have been answered with less prejudice in more recent years.

There are, however, worrying anomalies in the data. An interesting example presented was that between 2000–2003, attitudes towards people with mental health problems worsened in England when compared with Scotland.

It was highlighted that this increased negativity coincided with several high-profile homicides involving people with mental health problems in the English press. Interestingly Canadian researchers found that, during a six-year content analysis of newspaper coverage of mental illness, 40% of articles had danger, violence and criminality as a direct theme. Only 19% of articles discussed treatment or recovery and worryingly these figures did not significantly change over time.

We were then informed that in the UK, researchers found a reduction in negative articles about depression between 1992 and 2008, but that things stayed much the same with schizophrenia.

In terms of current mental health attitudes, Dr Henderson highlighted that in times of financial hardship, public attitudes to mental health can harden and become more prejudiced; much like attitudes to immigration.

The research indicates that the impact of stigma and subsequent discrimination can range from problems with relationships and dating to economic hardship. There is also evidence that the unemployment gap between people with, and without, mental illness widened during the recent recession period.

The most worrying example in the data presented was that people with mental health problems have a reduced life expectancy of about 15–20 years, with the proposed cause for this being disparities in access to healthcare between those with, and without, mental health problems.

The implications of this stigma and prejudice are huge, with one in four people being diagnosed with a mental health problem.

We were made aware of attempts to combat these attitudes and their harmful effects with large public awareness interventions in the UK, Australia, US and Germany looking to combat this stigma.

The current campaign in the UK is ‘Time to change’, which uses social marketing (adverts on public transport) and education for specific groups such as teachers and mental health professionals.

Dr Henderson also pointed to the high-profile campaigners such as Stephen Fry, Ruby Wax and Frank Bruno in helping raise the profile of these stigma issues, but she argued that people from all sectors, not just celebrities, need to come forward to make this more meaningful and highlighted the work of Alistair Campbell in educating journalists about mental health.

During the question and answer session Dr Henderson was asked why the awareness campaigns were not aimed at the newspapers and media. She reported that a significant amount of work has been done between UK newspapers and mental health charities to improve reporting of suicides, but that in other areas of reporting on mental health, newspaper editors’ primary focus is to sell newspapers in difficult financial times and this does not always fit with less radical reporting of mental health.

Finally, Dr Henderson mentioned the ‘twitter storm’ around the ‘mental patient’ fancy dress costumes being sold by UK supermarkets. While outbursts of public opinion like this are very fast paced and difficult to measure in terms of formal research, she felt that social media could be a potential tool in the future for researchers measuring public attitude and charities promoting mental health.

The overall outlook for mental health seemed positive in terms of public attitude over time, but the key to sustain and build on improvements seems to rest on constant mindfulness and openness around mental health, especially in the media.

This event took place as part of UCL Diversity Month.