Attitudes+towards+mental+illness+-+we’ve+got+to+change+our+minds


 * By James Neaum**
 * Student Number: 1286269**
 * Tutor: Emily Mann**

// I did not ask to be born like this. People don’t ask to be born blind, deaf or autistic. No one asks to be diagnosed with cancer. Treat me the same way that you would treat someone with a chronic illness. Educate yourself about my illness. If you don’t know about the disease, ask me. I will tell you. Don’t assume and don’t believe every movie that you watch. I am no more prone to take you and your kid’s hostage than your minister would be. Treat me with respect and love me for who I am. Just understand that at times I don’t understand myself...” Becky, About.com, Bipolar forum member //

**Cultural Artefact**

The graffiti-artist is addressing the viewer via a spray-painted message on a concrete wall. The photo has been taken at night and depicts a derelict, perhaps urban, area which includes the graffiti-adorned concrete wall, a wire fence and litter scattered on the ground. The text is simply stated with a lack of punctuation thereby lending a flat, possibly accusatory, tone. Whether intentional or not, the two phrases contained within the statement form a rhyming pattern. There is a mixed sense of hopelessness and anger.

**Public Health Issue** This artefact alludes to the incongruity between one person’s reality and another’s perception of that reality. When considering mental health issues, stereotypes stigmatising mental illness can cause barriers and misunderstanding in the community (Sane, 2011). In this recent Australian survey, people with mental illness and their families stated that “less stigma” would make the most significant improvement to the quality of their lives. The same survey found that over 50% of Australians believe that a person living with mental illness can “snap out of the problem” and that the illness is “a sign of personal weakness”. So, what is the impact of negativity towards those living with mental illness? Due to fear and shame, over 20% of Australians indicated that they would not tell anyone if they were experiencing mental health problems (Griffiths et al., 2006).

This essay will explore the effects of stigma associated with mental illness, review the literature of anti-stigma endeavours in Australia today, apply a social context and utilise an abstract cultural artefact to illustrate key learning.


 * Literature Review **

Mental illness is the leading cause of non-fatal disease burden in Australia with around one in three Australians experiencing mental illness at some stage in their life. Furthermore, unlike any other chronic disease, it affects people of all ages, with a significant impact on many young people: 25 percent of people with a mental disorder experience their first episode before the age of twelve and 64 percent by age 21 (National Mental Health Reform, 2011-12). Those living with mental illness put up with a lot more than their illness. People identified as having a mental health problem remain one of the most marginalised groups in society. Stigma contributes yet another major stress that they could do without (Hocking, 2003). They experience social exclusion in a myriad of domains resulting in increased unemployment, lower educational achievement, poverty, the loss of friendships, denial of housing and rejection by their neighbours and community ( Angermeyer & Matschinger, 2003 ). Hocking (2003) found that people with mental illness and their families wanted healthcare workers who “treated them with more respect”, who “would appreciate just how far a little kindness goes”, and a community that “would understand that we are not lazy or weak” and that recovery is not simply a matter of “pulling yourself together”. The end result is that many people are reluctant to seek help, are less likely to cooperate with treatment and are slower to recover self-esteem and confidence. (Hocking, 2003) There is an awareness that we need long-term strategies to fight stigma by divorcing mental illness from associated misconceptions and by improving knowledge and attitudes. Jorm et al (1997) introduced the concept of ‘mental health literacy’ to address stigma associated with mental illness and defined it as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. Australia promotes mental health literacy through national programs such as Mental Health First Aid (MHFA) which was developed to teach members of the public how to give initial help to someone developing a mental health problem or in a mental health crisis situation. It has been shown to increase knowledge, reduce stigma and increase supportive actions (Oral communications, 2010). Documented belief changes amongst the public due to effective MHL initiatives such as MHFA include: mental illness can happen to anyone; those with a mental illness are not to blame for their illness; they can recover; they do lead “normal” lives and contribute to society (Vaughan & Hansen, 2004). In order to facilitate access to appropriate mental health care, it is important that healthcare professionals have adequate levels of mental health literacy. A study by O’Reilly, Bell, Kelly & Chen (2011) assessed two groups of third year pharmacy students at the University of Sydney; one group participated in MHFA training and a control group did not receive any training. Outcome measures were completed by all participants and included an evaluation of mental health literacy and a social distance scale indicating how they felt about interactions with those suffering from mental illness. Results showed that the MHFA training significantly improved the participants’ ability to correctly identify a mental illness, enhanced confidence in providing services to persons with a mental illness and significantly reduced attitudinal negativity. It is essential that mental health literacy tools work efficiently in rural and remote areas of Australia where there are fewer health professionals, a much smaller choice of health service providers and scant community support services (National Rural Health Alliance Inc, 2009). A study by Pierce, Liaw, Dobell & Anderson (2010) assessing effectiveness of MHFA training in a rural environment reports on a project called Coach on Coach, in which Australian rural football clubs were the chosen setting and football coaches were the participants receiving MHFA training. Questionnaires were completed before and after the training to ascertain attitudes to depression, treatment options and the ability to recognise symptoms of mental illness. Results demonstrated that more that 50% of the coaches who undertook training showed increased capacity to recognise mental illness and 66% reported reduced negativity towards those living with it. In 2007, recognising the need to address the needs of Australia’s Indigenous people, the MHFA program was culturally adapted to create an Australian Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) version. The main aim of AMHFA was to improve the capacity of Indigenous Australians to recognise and respond to mental health issues within their own communities. Kanowski, Jorm and Hart (2009) conducted a study where 199 Aboriginal people undertook a five day AMHFA Instructor Training Course. These newly-trained Instructors then ran 14-hour AMHFA courses for Aboriginal people in their community. Analysis of qualitative data indicated that the Instructor Training Course and the AMHFA course were culturally appropriate, empowering for Aboriginal people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness. Additionally, due to the fact that Aboriginal Instructors were treating people in their own community, there was an increased level of comfort between Instructors and course-participants and decreased attitudinal negativity. Until recently, many mental health literacy and anti-stigma initiatives have not addressed the specific needs of Australia’s culturally and linguistically diverse (CALD) groups. Particular barriers prevalent in these groups include low education levels, low English literacy, low mental health literacy and a lack of initiatives that acknowledge the strengths that CALD communities already have in addressing stigma within their communities (Hart, Jorm, Kanowski, Kelly & Langlands, 2009). Multicultural Mental Health Australia (MMHA, 2010) has begun implementing the MMHA Stepping Out of the Shadows Stigma Reduction Program which uses a Train-the-Trainer model to deliver culturally-appropriate solutions within CALD communities. MMHA is also working with MHFA to integrate culturally relevant MHFA components into the Stepping Out of the Shadows program. This author queries whether the reverse might also be appropriate i.e. that the Stepping out the Shadows program might inform the wider MHFA initiative given the prevalence of CALD communities in Australia today.

While there have been some improvements in the mental health literacy of the Australian public over the past ten years (Griffiths et al, 2006), stigma remains the major barrier to receiving effective mental health care (Jorm, Christensen & Griffiths, 2006). Programs such as MHFA, AMHFA and MMHA appear to be effective and have the capacity to increase mental health literacy in Australia as they address the specific needs of our various communities. However, with over 50% of us still stating that a person living with mental illness can “snap out of the problem” (Sane, 2011), it is clear there is still much work to be done.

** Cultural and Social Analysis ** Negative attitudes towards those living with mental illness create barriers to independence. This supports the social model of disability which asserts that, while physical, sensory, intellectual or psychological variations may cause a person to be functionally limited or impaired, these do not have to lead to disability unless society fails to take account of and include people regardless of their individual differences. The approach to this model is traced to the civil rights/human rights movements of the 1960s. It asserts that disability is a social construct that results in the denial of basic rights, and that people with disabilities are marginalised and discriminated against in the same way as racial or ethnic minorities (Goodley, 2001). Charlton maintains that the majority of disabled people have been so psychologically oppressed by society that their oppression has become internalised. As a result, they have developed a Marxian notion of ‘false consciousness’, whereby they come to believe that they are less capable than others. This aligns with contemporary research which demonstrates that, in the case of mental illness, self-stigma exists when people have negative attitudes about themselves as a result of internalizing stigmatizing ideas held by society (Barney, Griffiths, Jorm & Christensen, 2006). There is a concerted need to increase society’s mental health literacy in order to decrease stigma, self-stigma and the subsequent marginalisation of those living with mental illness in Australia. The role of the media in increasing mental health literacy and reducing stigma has been highlighted in the National Mental Health Plan 2003-2008 (Department of Health and Aging, 2003) and the National Health Reform Agreement 2011 (Department of Health and Aging, 2011) which demonstrates a link between the often negative portrayal of mental illness in the mass media, and negative beliefs among members of the community. However, it is equally important to note that while reporting that perpetuates stereotypes can lead to negative community attitudes, responsible and accurate reporting has the potential to increase the understanding of mental health issues in the general community. This would decrease the stigma and discrimination experienced by people living with mental illness (Henson et al, 2009). The SANE StigmaWatch program (SANE, 2011) monitors the Australian media to ensure accurate and respectful representation of mental illness and suicide. The program also provides positive feedback to the media about accurate and responsible portrayals of mental illness and suicide, which help break down stigma and increase understanding of mental illness. The StigmaWatch Report 2010 (Sane, 2010) indicated a drop in stigmatising reports (in comparison to previous years) across sectors in the media. It also revealed a dramatic increase (around forty percent) in positive news stories. In the last decade, Government, professional and Non-Government Organisations, such as beyondblue (Beyondblue, n.d.), have implemented initiatives to increase mental health literacy in our communities by ‘getting personal’ and focusing on the perspectives of those living with mental illness. A recent media focus in Australia has been on prevalent disorders, such as depression and anxiety, using first person accounts, along with information from politicians and health experts. The current “R U OK” campaign is very effective in this regard as, not only is it a thoughtful act to ask someone if they are OK, but it also gives us a very simple script so that we may overcome any reservations to ask the question. Those reservations contribute to stigma as we tend to distort what we don’t know. Negative attitudes towards mental illness are often fuelled by a lack of knowledge. One we know and understand, stigma disappears or at least decreases, and social inclusion can occur.

** Artefact Analysis/Learning Reflection ** My choice of cultural artefact is confronting. How could I know someone else better than they know themselves? How could I presume to know anything about their reality? Yet, for the majority of us, when we consider those who live with mental illness, that is exactly what we do – we make assumptions and we let those assumptions influence the way we interact with them. It’s time we realise that those assumptions can have a dire, negative impact. We need to change how our minds work. We need to learn how to respect everyone in our community. It is essential that we educate ourselves and others, and actively challenge our personal beliefs and attitudes. If we are to be working in important public positions (e.g. emergency departments) we should be actively engaged in anti-stigma thinking. We should be working within person-centred, recovery-oriented mindsets in order to consider every person in his/her own right, to avoid stigmatising tendencies and, importantly, to encourage people to approach us or others for assistance in times of need. Common themes that have arisen throughout this essay highlight that awareness of the facts about mental illness should be greater; we need increased mental health literacy in order to truly understand and, as healthcare professionals and caring Australians, we need to be actively involved in ensuring that minds, both mine and yours, do change. As Confucius said: // Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand. Confucius, 450 BC. //

**Reflection Task** ** Wiki: ** // CAGED WITH BODY AND MIND – An observation and discussion of the contrasting challenges faced by each nation in tackling mental health and its associated issues // **Comment: captured my attention:** Your artefact certainly captured my attention. It is hard to believe that people living with mental illness are treated this way today and, have been treated this way, or worse, for years. I found myself echoing the same question you posed: “Why?” As a human being considering other human beings, I’m hoping that the answer goes beyond “Because I can”. I agree that we must ask ourselves why we discriminate against those who live with mental illness. I believe that it must be to do with a lack of understanding about mental illness. Surely if Mr Praveen’s father understood his son, understood that his illness should not come hand-in-hand with shame, understood how his symptoms could be alleviated through medication and proper psychiatric care, surely then he would want to do the right thing by him? Having read your article, I am motivated to learn more about the global mental health movement as I do believe that there is a need for grassroots reform and definitely, there should be urgent focus on addressing the prevalence of mental health stigma in order to facilitate social integration. Not just in Mr Praveen’s India but also in our Australia. **Wiki:** // Doctors and Patients – Are We From Different Planets? // **Comment: Made me smile:** Your choice of artefact made me smile knowingly as it is so true that sometimes it can feel as though one’s doctor is ‘from a different planet’. Your reference to the power balance in the doctor-patient relationship was interesting as, unless one’s approach is patient-centric, the tendency to act in a dictatorial style might be tempting. I agree that it is important to gain an understanding of different cultures and beliefs in order to establish a comfortable and supportive rapport with one’s patient. It isn’t surprising that, in an Indigenous context, Indigenous doctors are able to establish comfortable relationships with their Indigenous patients more easily than non-Indigenous doctors. It must boil down to comfort. If you are comfortable with your health care professionals, then you are more likely to seek assistance when you need it and importantly, more likely to follow treatment recommendations. As I read your article, I was struck by the realisation that, as a health professional, my mind needs to be open to the fact that there are so many cultures out there, too many to understand expertly. I need to be aware that my assumptions about life are based on my own culture, my own upbringing, my own education and therefore I should take care to be non-judgemental and empathetic when interacting with others.

**Links**  Beyond Blue   [|http://www.beyondblue.org.au] RUOK? [] SANE Australia []

**Reference List** Angermeyer, M. C., & Matschinger, H. (2003). The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. //Acta Psychiatrica Scandinavica//, //108//(4), 304–309. doi: 10.1034/j.1600-0447.2003.00150.x

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Barney, L.J., Griffiths, K.M., Jorm, A.F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions//. Australian and New Zealand Journal of Psychiatry.// //40//(1). 51-54. Retrieved from []

Beyondblue. (n.d.). beyondblue Strategic Research – Overview. Retrieved November 4, 2011 from http://www.beyondblue.org.au/index.aspx?link_id=6.1309

Goodley, D. (2001). ‘Learning difficulties’, the social model of disability and impairment: challenging epistemologies". // Disability & Society //// 16 // (2). 207–226. doi ** : ** 0.1080/09687590120035816

Griffiths, K. M., Nakane, Y., Christensen, H., Yoshioka, K., Jorm, A.J., & Nakane, H. (2006). Stigma in response to mental disorders: a comparison of Australia and Japan. //BMC Psychiatry, 6//(1), 21. doi: 10.1186/1471-244X-6-21

Hart, L.M., Jorm, A.F., Kanowski, L.G., Kelly, C.M., & Langlands, R.L. (2009). Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems//. BMC Psychiatry//, //9//(1), 47. doi:10.1186/1471-244X-9-47

Henson, C., Chapman, S., McLeod, L., Johnson, N., McGeechan, K., & Hickie, I. (2009). More us than them: positive depictions of mental illness on Australian television news. //Australian & New Zealand Journal of Psychiatry, 43//(6), 554–560. doi: 10.1080/00048670902873623

Hocking, B. (2003). Reducing mental illness stigma and discrimination – everybody’s business. //The Medical Journal of Australia//, //178//(9), s47-s48. Retrieved from []

Jorm, A. F., Christensen, H., & Griffiths, K. M. (2006). The public's ability to recognize mental disorders and their beliefs about treatment: changes in Australia over 8 years. //Australian & New Zealand Journal of Psychiatry//, //40//(1), 36-41. doi:10.1111/j.1440-1614.2006.01738.x

Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B., & Pollitt, P. (1997) ‘Mental health literacy’: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment//. Medical Journal of Australia, 166//(4), 182-186 Retrieved from []

Kanowksi, L.G., Jorm, A.F., & Hart, L.M. (2009). A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: Description and initial evaluation//.// //International Journal of Mental Health Systems, 3//(1), 10. doi:10.1186/1752-4458-3-10

Multicultural Mental Health Australia. (2010). //Stepping out of the shadow.// Retrieved from []

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Oral communications (main conference). (2010). // Pharmacy Practice, 8 // (1885642), s47. Retrieved from @http://search.proquest.com/docview/840378446?accountid=13380

O’Reilly, C.L., Bell, J.S., Kelly, Patrick J., Chen, T.F. (2011). Impact of mental health training on pharmacy students’ knowledge, attitudes and self-reported behaviour: A controlled trial. //Australian and New Zealand Journal of Psychiatry, 45//(7), 549-557. doi:10.3109/00048674.2011.585454

Pierce, D., Liaw, S-T., Dobell, J & Anderson, R. (2010). Australian rural football club leaders as mental health advocates: An investigation of the impact of the coach on coach project//.// //International Journal of Mental Health Systems//, //4//(1), 10. doi:10.1186/1752-4458-4-10

R U OK. (2011). []

SANE Australia. (2010). //Sane StigmaWatch 2010//. Retrieved from []

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Vaughan, G., & Hansen, C. (2004). “Like Minds, Like Mine”: A New Zealand project to counter the stigma and discrimination associated with mental illness. // Australasian psychiatry: bulletin of the Royal Australian and New Zealand College of Psychiatrists ////, 12//(2) 113–117.