The need for a fair deal
When people with mental illness are
asked to name the greatest obstacle to recovery, discrimination and
stigma is by far the most common answer. Stigma is a prejudice,
based on stereotypes, leading to discrimination. Discrimination
remains endemic throughout UK society despite many campaigns to
eradicate it. For some groups that discrimination is compounded
because of the person’s race, disability, cultural background or
sexuality.
The practical result of discrimination
is the everyday avoidance of people with mental illness: we choose
to walk on by rather than engage with the most isolated people in
society. Many people with mental illness are so accustomed to these
rejections that they have stopped making the effort to meet new
people. But a lack of adequate social networks for themselves can
increase the chances of relapse and reduce overall recovery.
Tackling discrimination and stigma is
thus crucial in order for people with mental health problems to
live as equal citizens in society. Employers, local authorities,
schools and colleges, and public services need to take steps to
eradicate discrimination in their ranks; indeed they are bound by
law to do so. Finally, the media is a source of negative
stereotypes of people with mental illness and should use its
considerable influence to combat rather than to exacerbate
stigma.
Dignity and respect are values we all
seek for ourselves. For patients who have been treated well in
their illness or conversely patronised, neglected or coerced, these
values have special resonance. Human rights and non-discrimination
are inseparable principles for people with mental health problems
and learning disabilities. They need to be addressed together. With
the formation of the UK Commission of Equality and Human Rights the
time is ripe for a new approach.
What we are calling for
- The NHS (as an employer and as a service
provider) to take the lead in reducing discrimination against
people with mental health problems and learning disabilities, and
promoting human rights.
- The health authorities in all parts of the
UK to ensure that their disability equality schemes adequately
address their disability equality duties in relation to people with
mental health problems and learning disabilities.
- The Press Complaints Commission to carry
out periodic reports documenting the volume and content of
complaints where mental illness was a factor.
Examples of what the College will do
- The College will campaign to eliminate
discrimination against health professionals on the grounds of their
mental health in employment. Through training and guidance for
psychiatrists we will seek to reduce discrimination against service
users and to promote their use of a human rights-based approach to
healthcare.
- We will campaign for anti-discrimination
legislation to be extended in order to protect people against
discrimination by service providers on the grounds of age.
- We will campaign against the distorted
presentations of people with psychosis and other mental disorders
in the press.
- We will participate in the Moving People
campaign and new Scottish initiatives.
The case
The Report on Social Exclusion and Mental Health cited stigma
above poverty, isolation and homelessness as the main source of
social exclusion for people with current or previous mental health
problems.1 Attitudes towards people with mental health
problems remain in most respects as profoundly negative as they
were a decade ago, although public awareness of mental illness has
improved.2 For some people, problems are compounded by
additional discrimination on grounds of their race, cultural
background3 or sexuality.4
Negative attitudes (prejudice) to people
with mental health problems have been recorded throughout society –
in homes, schools, colleges, universities, our workplaces and our
local communities; from civil servants and doctors to landlords and
neighbours.1 Discrimination in the workplace drives the
low employment rate among people with severe mental
illness.5,6 People with mental health problems have both
a lower rate of employment7,8 than other disabled groups
and are more likely than other groups to want to be in
employment.9–11
Qualifications to enter the professions
which impose health standards as well as competencies can cause
discrimination. A person with a health record of mental illness
(however mild or long ago) can be denied entry to these professions
on the grounds they do not meet these standards. Local opposition
to group homes/community living ('not-in-my-back-yard') appears to
be prevalent across the country.8 A label of mental
illness makes it harder to get life, personal or holiday
insurance.12
Case study
1
Miss Reshma Patel, Service User
In my experience mental illness seems
to have a negative quality connected to it. I think the reason for
this is a lack of knowledge of the ordinary general public in
understanding the issues linked to mental health. If people were
educated more about the subject, fewer judgements would be made and
there would be a better understanding of mental health issues. I
myself have experienced discrimination particularly when applying
for jobs and promotion, and have not always obtained the fairest of
deals.
Across some
media, mental illness is typically represented in distorted
stereotypes which can foster fear and stigma among the general
public. It also contributes to false and very damaging perceptions
of the violence caused by people with mental health
problems.3
Despite this
depressing picture there are positive signs of a greater tolerance,
knowledge and understanding about common mental health problems,
and the taboo against raising them is being whittled away. This is
the time for renewed energy in the fight against
discrimination.
Case study
2
Kym Peters, Service User
I had an episode of depression and
anxiety in 1991 which resulted in an admission to an acute ward for
2.5 weeks. A couple of years later, I commenced training as a nurse
at Kingston University. Unfortunately, I again experienced
depression, which resulted in occupational health advising me to
discontinue my studies.
I went to work
as a healthcare assistant at Springfield Hospital and while there I
was put in touch with the User Employment Programme (UEP). They
provided one-to-one support, as well as a regular group support
session. I found this extremely helpful, as it enabled me to be
objective about any difficulties I was experiencing at work. It
also enabled me to share and validate my experiences with other
supported employees. Most importantly, it provided positive
feedback and encouragement. Over the course of the next few years,
I was supported in various positions at Springfield and Kingston
Trusts by the UEP. I was able to complete my studies, graduate, and
now I work in a new role as a staff nurse at Broadmoor Hospital. It
has not always been plain sailing, and while I have found it
difficult in my new role not having the support I found so valuable
at Springfield, I have maintained my links with the UEP and the
informal support has proven invaluable.
The NHS: getting its own house in order
Stigma and discrimination can occur within
the health service at both institutional and individual levels.
Negative attitudes to mental health can adversely affect policy
development, usually through omission of relevant mental health
issues. (For instance the exclusion of older people with mental
health problems from access to new mental health services.)
Death by
Indifference, a Mencap Report in 2007,13 condemned
'institutional discrimination' against people with learning
disabilities in the NHS. Its call for better training of general
practitioners in learning disabilities is strongly supported by the
College.
People with mental illness and learning
disabilities can face stigma from medical practitioners, including
psychiatrists.5 Expressions of this include ‘diagnostic
overshadowing’ (where a person’s comorbid illness is not diagnosed
because the doctor doubts the reliability of their account of
symptoms) and being underinvestigated. People with learning
disabilities can be overlooked because the doctor or nurse lacks
the skill of communicating with them; they can have difficulties in
being ‘taken on’ by a general practice surgery.13 Such
treatment, resulting to a certain extent from lack of training, is
not only unfair but can be potentially illegal.
The NHS needs to lead on the reduction of
stigma and discrimination. Extending the coverage of
antidiscrimination law to protect people who suffer discrimination
on the grounds of age from service providers (such as the NHS)
would ensure that age barriers were not used to deny treatment to
older people with mental health problems.
Existing public sector duties under the
Disability Discrimination Act require the NHS as an employer and a
service provider to work to eliminate unlawful discrimination,
promote equal opportunities, eliminate disability-related
harassment, promote positive attitudes towards disabled people and
encourage participation by disabled people in public life. The
strategic health authorities and primary care trusts should address
all these issues in their disability equality schemes. Among other
things, they have the duty to remedy the low employment of people
with mental health problems in their workforces and to involve them
in shaping services. They have been slow to comply with these legal
duties. It was ‘a disappointing picture’.14
The NHS, through its regional structures,
should take the lead in ensuring that the Disability Discrimination
Act is complied with in all its activities. Annual reports should
be required from all acute, mental health and primary care trusts
documenting their actions to reduce discrimination. These reports
should include examples of local experiences and best practice,
including positive stories of overcoming stigma in that region.
Case study 3
Member of
Service User Recovery Forum
Next door neighbours move in. Seem OK
with us until they learn of our mental health problems. Four years
of harassment follows. No agencies (police, council, etc.) do
anything – is that because we tell them that we have mental health
problems? Next door neighbour even comes over to ask us what our
diagnoses are!
NHS and employment
The stigma of mental illness affects
employment in the NHS. For instance, to become accredited as a
nurse, an applicant must comply with the ‘fitness to practice’
criterion. The 2007 Disability Rights Commission's formal
investigation found these accreditation criteria to be a formidable
and an unnecessary barrier for people with mental
illness.14 The report recommended that they be
abolished, having found that a general competence standard was
sufficient to protect the public and other staff.
As Dr Perkins, Director of Quality
Assurance and User Carer Experience, South West London and St
George’s Trust, has commented:
'In
particular people with mental health problems should be employed in
mental health services. People who have successfully lived with
mental health problems have expertise that is valuable to others
who are facing similar challenges; they offer images of possibility
to both service users and staff and they break down the "them" and
"us" divide.'
Current work on discrimination and stigma
The College has campaigned against stigma
and discrimination for many years. Most recently the See Me
campaign in Scotland (www.seemescotland.org.uk/), in which the
College was a partner, was a national publicity programme with
local and national anti-stigma action.
Currently, at both national and local
levels there are government and stakeholder campaigns in which we
will participate. The Moving People campaign in England, launched
in 2008, aims to create a measurable shift in public attitudes, and
to improve the physical well-being of tens of thousands of people
with mental health problems. The College is participating in this
initiative.
References
References
1 Social Exclusion Unit (2004) Mental Health and
Social Exclusion: Social Exclusion Report. Office of Deputy Prime
Minister.
2 Shift/Care Services Improvement Partnership (2008)
Attitudes to Mental Illness 2008. Department of Health.
3 Sainsbury Centre for Mental Health (2002) Breaking
the Circle of Fear. Sainbury Centre for Mental Health.
4 King, M. & McKeown, E. (2003) Mental Health and
Social Wellbeing of Gay Men, Lesbians and Bisexuals in England and
Wales. A Summary of Findings. Mind.
5 Stuart, H. (2006) Mental illness and employment
discrimination. Current Opinion in Psychiatry, 19, 522–526.
doi:10.1097/01.yco.0000238482.27270.5d
PMid:16874128
6 Latimer, E. A. (2008) Individual placement and
support programme increases rates of obtaining employment in people
with severe mental illness. Evidence-Based Mental Health, 11,
52.
doi:10.1136/ebmh.11.2.52
PMid:18441141
7 Meltzer, H., Gill, B., Petticrew, M., et al (1995)
OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 3:
Economic Activity and Social Functioning of Adults with Psychiatric
Disorders. HMSO.
8 Read, J. & Baker, S. (1996) A Survey of the
Stigma, Taboos and Discrimination Experienced by People with Mental
Health Problems. Mind.
9 Stanley, K. & Maxwell, D. (2004) Fit for Purpose?
Institute for Public Policy.
10 Grove, B. (1999) Mental health and employment:
shaping a new agenda. Journal of Mental Health, 8, 131–140.
doi:10.1080/09638239917508
11 Owen, K., Butler, G. & Hollins, G. (2004) A New
Kind of Trainer: How to Develop the Training Role for People with
Learning Disabilities. Gaskell.
12 Thornicroft, G. (2006) Shunned: Discrimination
Against People with Mental Illness. Oxford University Press.
13 Mencap (2007) Death by Indifference: Following up
the Treat Me Right! Report. Mencap.
14 Disability Rights Commission (2007) Maintaining
Standards: Promoting Equality. Disability Rights
Commission.