Stamping+out+Stigma+-+Is+Australia+really+making+progress+in+mental+health?

//Name: Lauren Dorn// //Student Number: n4400585// //Tutor: Katie Page//

//Well my friends didn’t know about it. I didn’t want them to know about it. I was in Year 9 and 10 at the time and you’re not really aware of what a mental illness is and people around that age, if they hear the word psychosis they think “he’s dangerous, he’s going to kill ya”. //

(Male Respondent; Cohen, Medlow, Kelk & Hickie, 2009)

//**Cultural Artefact** // media type="youtube" key="xrdikVAvK3A?version=3" height="360" width="640" align="center"

Launched as a part of Scotland’s national “See me” campaign to end the stigma and discrimination associated with mental illness, “Cloud boy” depicts an individual who is bullied and stigmatised as a result of his self-harming. This short, black and white television advertisement was first aired on Scottish TV in 2006, aimed at promoting public awareness of stigma and the negative effects it can have on a persons’ recovery from mental health problems. “Cloud boy” is one of several advertisements developed by “See me”, an alliance of five mental health organizations, fully funded by the Scottish government in a joint initiative to improve national mental health and wellbeing.

**//Public Health Issue //** The stigma and negative attitudes attached to mental illness can have serious adverse effects on those suffering from mental health problems, contributing negatively on a persons’ recovery (World Health Organization, 2011). As, demonstrated in the cultural artefact above, stigmatisation can often lead to discrimination, prejudice and distress for the mentally ill, resulting in increased feeling of social isolation and exclusion, low self esteem, decreased confidence (Baumann, 2007; Hocking, 2003) and a reluctance to seek help (SANE, 2007). In 2006, a survey conducted by SANE Australia (2007) reported that 75% of Australians affected by mental illness had experienced stigma and discrimination as a result of there illness, including 16% from health service staff. Although attitudes toward mental health problems are slowly improving (SANE, 2007), the stigma associated with mental illness still remains to provide a significant barrier to the reduction and treatment of mental illness (Senate Community Affairs Reference Committee, 2010; WHO, 2011; Wright, Jorm, & Mackinnon, 2011). These negative and stigmatising attitudes clearly present Australia with a substantial public health concern, creating a considerable barrier to the improvement of population mental health and mental wellbeing.

**//Literature Review //** Mental health and wellbeing are essential components to the quality of life, contributing to individual, community and national productivity, social cohesion and social stability (WHO, 2005). The promotion of mental health improves not only individual health but also contributes significantly to the wellbeing of the whole population (Baumann, 2007). The World Health Organization (2010) recently reported that more than 450 million people worldwide suffer from mental disorders. Currently in Australia, it is estimated that 1 in 5 people will experience mental illness at some stage in their life. Recent social trends have further indicated that 45% of all Australians (aged 16-85 years) have experienced at least one mental health disorder within their lifetime (ABS, 2009). In 2009, the Australian Bureau of Statistics (ABS) reported that a total of 2132 deaths were attributed to self-inflicted harm and suicide (ABS, 2010), accounting for approximately six Australian deaths per day. However, despites these high statistics and their potentially severe impacts, a lack of public awareness and understanding of mental illness still seems to remain heavily within the Australian community (Senate Community Affairs Reference Committee, 2010). The stigma associated with mental illness can often result in mental health problems being underdiagnosed, underestimated and untreated (Baumann, 2007). Research suggests that a lack of understanding regarding illness symptoms, causes and treatment options, in addition to a limited personal exposure to those suffering from mental illness, can consequently lead to negative attitudes, stigmatisation, discrimination and social exclusion (Baumann, 2007; Cohen, Medlow, Kelk & Hickie, 2009). A recent study conducted by Cohen et al. (2009) investigating help-seeking behaviours in adolescents experiencing mental health problems, found that negative attitudes toward mental illness, in combination with a lack of knowledge and understanding from family and peers, often resulted in care not being sought by the individuals requiring help. Notably however, self-stigma (negative and stigmatising views held by an individual toward themselves) and perceived stigma (beliefs concerning stigma and negative views held by others) (Wright et al., 2011) were also been found to contribute significantly to an individuals reluctance to seek help, adhere to treatment, as well as slow their recovery of self confidence and self esteem (Hocking, 2003; Wright et al., 2011). Self-stigma and perceived stigma are two particularly important components of the stigma construct. As described by Wright et al. (2011, p. 499), the stigmatising views individuals holds toward themselves (self-stigma) and the perceived beliefs of what views are held by others (perceived stigma), can be considerably detrimental to an individuals treatment and subsequent recovery from mental illness. Empirical research has shown that people suffering from mental illness often internalise the stigmatising views widely favoured within society, believing that their mental illness makes them a less ‘valued’ member of that society (Corrigan, 2004). This ill-conceived notion, consequently leads to a diminished sense of self-worth, lowered self-esteem, self-efficacy and confidence, thus further exacerbating their already compromised mental condition (Corrigan, 2004; Horsfall, Cleary & Hunt, 2010; Wright et al., 2011). Notably, numerous studies have also identified an association between self and perceived stigma, shame and avoidance of treatment (Corrigan, 2004; Wright et al., 2011). Corrigan (2004, p. 618) argues that the affected individuals’ diminished sense of self worth is frequently experienced as shame. Prior studies have found that people who have experienced feelings of shame as a result of their mental illness, were more reluctant to be involved in treatment (Corrigan, 2004; Sirey et al., 2001). Furthermore, psychiatric services were more likely to be avoided if the diagnosed individual believed that family or friends perceived their illness or treatment in a negative manner (Sirey el al., 2001). Therefore, self-stigma and perceived stigma play fundamental roles in the avoidance of being labeled ‘mentally ill’, as well as interferes with treatment participation (Corrigan, 2004; Wright et al., 2011). Another significant component of the stigma construct, as described by Corrigan (2004, p. 616), is public stigma. Public stigma refers to the stigmatising behavior or views held by others (i.e. general public) towards a particular “out-group” (Corrigan, 2004), in this case toward those labeled mental ill. Stereotypes, prejudices, and discrimination are several key examples of negative actions directed toward those who are suffering from mentally illness. Evidence suggests that by labeling someone “mentally ill” or publicly disclosing a mental disorder, can often lead to experiences of prejudice and discrimination from family, peers, employers, landlords and the general community (Corrigan, 2004; Wright et al., 2011). Surprisingly, negative attitudes and behaviour towards those suffering mental illness has also been reported from within the health-care network (Horsfall et al., 2010; Hazelton, Rossiter, Sinclair & Morrall, 2011; Schulze, 2007). A recent study conducted by Hazelton et al. (2011) found that long-term nursing staff within an Australian mental health service, were found to display uncaring attitudes and practices towards mental health service users, contributing to the maltreatment and neglect of patients. Participants of the study also noted that staff tended to present more as risk managers rather than mental health service providers, and that patients were predominantly treated as if they might be violent or dangerous (Halzelton et al., 2011). Hazelton (2011, p. 178-179) further suggests that these stigmatising attitudes can be attributed to both the historically prejudicial and discriminatory social culture associated with mental illness, and the current lack of knowledge and understanding amongst veteran nursing staff and other health care professionals (Horsfall et al., 2010). Despite significant reform made to the Australian mental health system under the National Mental Health Strategy, in addition to dramatic increases in government funding and resource provision, concerns still remain in terms of policy priorities and their implementation (Hazelton, 2005; Hazelton et al., 2011). One major concern is the continued discrimination and stigma attached to mental illness, as previously discussed. Whilst mental health services in Australia have seen significant improvements in the last several decades, evidence still suggests that minimal progress has been made in regards to public awareness of mental health issues (Hazelton, 2005; Hazelton et al., 2011). Stereotyped beliefs regarding mental illness, including; those who are mentally ill are dangerous and violent, are socially inappropriate and unpredictable, are a result of their own character weakness, and are unlikely to improve considerable with treatment (Norman, Sorrentino, Windell & Manchanda, 2008); still remain to be fairly prominent within society (Hazelton, 2011; Horsfall et al., 2010; Cohen et al., 2009). The question is, how do we best address this issue?

**//Cultural and Social Analysis //** Many countries worldwide, including Australia, have implemented national mental health awareness campaigns in order to address the stigma and negative attitudes associated with mental illness. By increasing public understanding of mental health issues, attitudes can be considerably improved (Horsfall et al., 2010). Unsurprisingly, the media is particularly important in promoting this attitudinal change, as it plays a significant contributing role in determining public attitudes toward mental illness (Morgan & Jorm, 2009; SANE, 2009). Historically however, the media has been a key contributor to the formation of negative and stigmatising attitudes towards people suffering from mental health problems (Eisenhauer, 2008; Hocking, 2003; Morgan & Jorm, 2009). Research has found that media representation of mental illness has predominantly been negative, frequently depicting the mentally ill as violent and dangerous (Morgan & Jorm, 2009). This is particularly relevant in regards to the depiction of schizophrenia and psychosis, which is often inaccurately represented, sensationalized and associated with violent and unpredictable behaviour (Morgan & Jorm, 2009; SANE, 2009). A recent article published by Morgan and Jorm (2009), proposed that two key mass communication theories, social cognitive theory and cultivation theory, can explain the process through which the media influences mental illness stigma. Social cognitive theory suggests that individuals learn about appropriate behaviour and emotional reactions, not only through direct contact but also via observation (i.e. from media sources). Cultivation theory suggests that repeated exposure to a particular type of media message can influence the formation of the beliefs and perceptions of reality to reflect that which is presented in the media (Morgan & Jorm, 2009). Collectively, these theories help to explain how the media can establish strong stigmatising views and influence cultural norms within society. As a result of its strongly influential nature, the media can provide an avenue through which positive attitudes of mental illness can be built. Through the simultaneous reduction of negative media portrayals and the increased exposure to positive mental health stories, community and social opinions of mental illness can be changed dramatically and stigmatising views reduced (Hocking, 2003; Morgan & Jorm, 2009). Media awareness campaigns also play a significant role in reducing stigma, for example; mental health organisation such as, Lifeline and Beyondblue can provide the community with correct information regarding mental illness and promote help-seeking behaviours through media advertising. Evidence suggests that these campaigns have been relatively successful in promoting mental health attitudes and behaviours (Morgan & Jorm, 2009; SANE, 2009). This is particularly evident in term of mental disorders such as; depression and anxiety, which are now comparatively more socially accepted within the Australian community (Horsfall, 2010; Morgan & Jorm, 2009; SANE, 2009). <span style="display: block; font-family: 'times new roman','serif'; font-size: 16px; text-align: justify;">Although some progress has been made in identifying and addressing the issue of stigma and mental illness, changing community attitudes requires long term public engagement and education (SANE, 2009; SANE, 2010; WHO, 2011). A commitment by Federal, State and Local governments to promote public awareness of mental illness and provide adequate support for those affected is crucial. Through increased public and community understanding of mental illness, public stigma, perceived public stigma and self stigma can be reduced, earlier recognition of mental illness development can occur and appropriate treatment sought.

**//<span style="font-family: 'Times New Roman','serif';">Artefact Analysis and Learning Reflection //** <span style="display: block; font-family: 'times new roman','serif'; font-size: 16px; text-align: justify;"> <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The above cultural artefact clearly demonstrates the importance of public awareness in relation to mental illness. Stigmatising and negative attitudes and behaviours, as displayed in the “See me” TV advertisement, can lead to increased feelings of loneliness, social exclusion and distress, often further exacerbating an individuals mental health problems. As previously discussed, the stigma and discrimination associated with mental illness can be reduced through repeated and consistent exposure to campaigns such as this one, by raising public awareness of mental health issues and promoting better understanding of how negative attitudes and beliefs can directly affect other people. This particular style of advertisement was particularly effective in provided a simple and meaningful message, showing that that someone suffering from mental illness is really no different from anyone else, yet with the positive support from others can recover from their illness.

Prior to completing this assessment, I felt that I had a fair knowledge of mental illness and Australia's current position in dealing with mental health issues. However, I was particularly surprised to learn the depth to which stigma associated with mental illness really existed, as well as discover the many facets with which were involved. As naive as it sounds, I was also surprised to learn that stigma existed so prominently within the health care system. Being that the majority of health care workers are from fairly educated and experienced backgrounds, I presumed that they would have had a significant understanding of how negative and stigmatising attitudes can contribute to a patients’ ill-health. Finally, I was disappointed to discover that Australia has not really made any progress in eliminated stigma from mental illness and that discrimination is still highly prevalent throughout the Australian community.

**//<span style="font-family: 'Times New Roman','serif';">References //** <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian Bureau of Statistics. (2010). //Cause of death in Australia//. Retrieved from Australian Bureau of Statistics website [] Australian Bureau of Statistics. (2009). //Australian Social Trends 2009//. Retrieved from Australian Bureau of Statistics website [] Baumann, A.E. (2007). Stigmatization, social distance and exclusion because of mental illness: the individual with mental illness as a ‘stranger’. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">International Review of Pychiatry, 19 //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">(2), 131-135. doi: 10.1080/09540260701278739 Cohen, A., Medlow, S., Kelk, N. & Hickie, I. (2009). Young people’s experiences of mental health care: implications for the headspace National Youth Mental Health Foundation. //Youth Studies Australia, 28//(1), 13-20. Retrieved from [] Corrigan, P. (2004). How stigma interferes with mental health care. //American Psychologist, 59//(7), 614-625. doi: 10.1037/0003-066X.59.7.614 Corrigan, P., Markowitz, F. & Watson, A. (2004). Structural levels of mental illness: stigma and discrimination. //Schizophrenia Bulletin, 30//(3), 481-491. Retrieved from [] Eisenhauer, J. (2008). A visual culture of stigma: critically examining representations of mental illness. //Art Education, 61//(5), 13-18. Retrieved from [] Hazelton, M. (2005). Mental Health Reform, citizenship and human rights in four countries. //Health Sociology Review, 14//(3), 230-241. doi:10.5172/hesr.14.3.230 Hazelton, M., Rossiter, R., Sinclair, E. & Morrall, P. (2011). Encounters with the ‘dark side’: new graduate nurses’ experiences in a mental health service. //Health Sociology Review, 20//(2), 172-181. doi:10.5172/hesr.2011.20.2.172 Hocking, B. (2003). Reducing mental illness stigma and discrimination – everybody’s business. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Medical Journal of Australia, 178, //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> S47-S48. Retrieved from [] Horsfall, J., Cleary, M. & Hunt, G. (2010). Stigma in mental health: clients and profesionals. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Issues in Mental Health Nursing, 31, //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> 450-455. doi: 10.3109/01612840903537167 Morgan, A.J. & Jorm, A.F. (2009). Recall of news stories about mental illness by Australian youth: associations with help-seeking attitudes and stigma. //The Australian and New Zealand Journal of Psychiatry, 43//(9), 866-872. doi:10.1080/00048670903107567 Morrell, S., Page, A. N., & Taylor, R. J. (2006). The decline in australian young male suicide. //Social Science & Medicine, 64//, 747-754. doi: 10.1016/j.socscimed.2006.09.027 Norman,R., Sorrentino, R., Windell, D. & Manchanda, R. (2008). The role of perceived norms in the stigmatization of mental illness. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Social Psychiatry Pyschiatric Epidemiology, 43, //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">851-859. doi: 10.1007/s00127-008-0375-4 SANE Australia. (2007). //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Research bulletin 4:stigma and mental illness //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. Retrieved from [] SANE Australia. (2009). //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Research bulletin 10: stigma, the media and mental illness //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. Retrieved from [] SANE Australia. (2010). //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Research bulletin 12: social inclusion and mental illness //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. Retrieved from [] Schulze, B. (2007). Stigma and mental health professionals: a review of the evidence on an intricate relationship. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">International Review of Psychiatry, 19 //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">(2), 137-155. doi: 10.1080/09540260701278929 Senate Community Affairs Reference Committee. (2010). //The hidden toll: suicide in Australia//. Retrieved from Parliament of Australia website [] See Me Scotland. (2007, March 1).See me - Self harm anti-stigma TV advert [Video file]. Retreived from [] Sirey, J.A., Bruce, M.L., Alexopoulos, G.S., Perlick, D.A., Raue, P., Friedman, S.J. & Meyers, B.S. (2001). Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. //American Journal of Psychiatry, 158//(3), 479-481. doi: 10.1176/appi.ajp.158.3.479 World Health Organization. (2011). //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">World Report on Disability //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. Retrieved from World Health Organisation website [] World Health Organization. (2010). //Mental Health: strengthening our response//. Retrieved from World Health Organization website [] World Health Organization. (2005). //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Mental Health Declaration for Europe: Facing the challenges, building solutions. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Retrieved from World Health Organization website [] Wright, A., Jorm, A, F., & Mackinnon, A. J. (2011). Labeling of mental disorders and stigma in young people. //Social Science & Medicine, 73//, 498-506. doi: 10.1016/j.socscimed.2011.06.015

**//<span style="font-family: 'Times New Roman','serif';">Other Reflections //**

I thing that you bring up some interesting points about internet addiction not really being an addiction, but rather being an individual lifestyle choice. Although, I'not totally sure that I agree with you. I've heard that in Asia, particularly China that internet addiction is so bad that they they have internet rehab to help cure people from their addiction to the internet. I do agree that it may just be a result of changing times and the accessability to technology such as i-phones.
 * Wiki:** Internet Addiction of just a sign of the times **Comment:**

Great Wiki Kate! I found your research to be very thorough in discussing the current problems with adherence. I aggree that this is definately a big problem when it comes to treating mental disorder like depression. I also understand that non-adherence is also strongly linked with medication side effects. I've read that often the severity of side effects can be much worse than the relief from depressive symptoms, particularly at the beginning of treatment. Although it would probably be too expensive to implement, it would definately help people give medication more of a chance if care monitoring and follow ups were made. Again great reseach Kate :)
 * Wiki:** Depression - In the pursuit of happiness
 * Comment:**