10301 Southport Lane, Suite 800 Calgary, Alberta Canada T2W 1S7 www.mentalhealthcommission.ca
10301 Southport Lane, Suite 800 Calgary, Alberta Canada T2W 1S7 www.commissionsantementale.ca
Countering Stigma and Discrimination:
Operational Plan: Version 3
September 2008
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Countering Stigma & Discrimination:
Operational Plan June 2008
Overview:
Mental illness affects everyone: men, women, children, seniors, individuals in every walk of life. It shows up as depression, anxiety and schizophrenia, to name just a few. Most individuals find ways to live with their illnesses. What proves more challenging to them is living with how they are treated by others. This behaviour is also one of the key barriers which stops people from seeking help.
Ultimately, it’s stigma and discrimination that negatively affects their quality of life.
It’s for this reason that the Commission is launching a major, national 10-year anti-stigma and discrimination reduction
campaign. This campaign will be the largest systematic effort to reduce the stigma of mental illness in Canadian history. It is much- needed and long overdue. There’s a temptation for the Commission to sprint out of the gate with a mass marketing campaign, but that would be a mistake. What is more urgently required is a deliberate and focused effort; a carefully targeted, outcomes-oriented
strategic plan based on the best available research that can be evaluated over time to measure its effectiveness.
The MHCC will work with social marketers to create such a plan.
Social marketing utilizes such common marketing practices as
3 consumer research, advertising and promotion. But unlike most marketing campaigns which are designed to increase sales and financial profit, social marketing is a planned process to influence a change that will benefit society and individuals. Previous social marketing campaigns that have been successful include anti- smoking, bullying, and drinking and driving.
In the first year, MHCC has chosen to target two specific groups:
youth and health care workers.
- Youth aged 12 to 18 are important because early
intervention makes an enormous difference over a lifetime.
For more than 70% of adults living with mental illness, onset occurred before they were 18 years old.
- Mental health workers have been chosen because, anecdotally, the medical front lines are where people
seeking help say they experience some of the most deeply felt stigma and discrimination.
MHCC will work closely with the broad mental health community of consumers, stakeholders and professionals when creating the plan.
The Commission will serve as a catalyst, mobilizing and focusing the actions of others. At the same time, it will help build a research knowledge base that will be shared with mental health scientists around the world.
Proposed Program Goals
The goals of the anti-stigma and discrimination strategy will be targeted to achieve outcomes on three levels:
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Change views of Canadians so people with mental illness are treated as full citizens by all.
Encourage organizations to adopt policies and practices to eliminate discrimination against people living with mental illness.
Ensure people living with mental illness have equal
opportunities to participate in society and in everyday life in their communities.
Defining the issue
Stigma refers to the negative and prejudicial ways in which people living with mental illness are labeled. Often that means being
labeled as nothing more than the disease itself. Stigma is an internal attitude and belief held by an individual, often about a minority group such as people with mental illness.
Discrimination refers to the way people living with mental illness are treated, intentionally or unintentionally, due to stigma. People with mental illness are often treated with disrespect, experiencing such behaviours as exclusion, bullying, aggression, ridicule and devaluation. Such discrimination can result in limits and barriers to many of life’s opportunities.
Simply put stigma refers to an attitude. Discrimination is the behaviour created by that attitude.
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MHCC S&D Initiative
There is a high level of agreement among stakeholders across the country that addressing stigma and discrimination towards people living with mental illness is an urgent priority. The Commission has been encouraged to move beyond serving as a ‘planning body’
which recommends action, to becoming a catalyst for change.
Stakeholders are also calling upon the Commission to take a human rights focus and address the structural barriers and systemic issues that deny people access to the same level of services and resources as those with other health concerns. This requires strategies
targeted at building knowledge, changing individual attitudes and behaviours, and in assisting governments and organizations in the development of policies and practices that will prevent
discrimination.
The Commission will consult members of stakeholder groups, many of whom already have initiatives underway to tackle stigma and discrimination, to help create a carefully targeted, strategic national plan. It will engage people with experience of mental illness to take a leadership role. The MHCC will be flexible to opportunities that would allow it to partner with organizations and the private sector where possible.
While there is unanimous agreement that stigma is an urgent issue, there is not a unified vision of what steps need to be taken.
Canadian stakeholders are divided on which of two overarching messages should be the primary focus.
6 1. Understanding mental illness as a biological illness like any
other. The bio-medical approach focuses on teaching people to identify signs and symptoms of illness and understanding treatment approaches.
2. Looking beyond illness, to recovery. This approach means reclaiming a sense of hope, purpose and connection. It fosters a new sense of optimism, addresses self-stigma and encourages personal responsibility in building a meaningful life.
Make Recovery a Focus
Based on advice from Canadian and international experts and on current research, the MHCC has made a commitment to promote recovery as a core value. There is currently, however, no shared understanding or agreement on what recovery means or how the principles can be incorporated into the decision-making and
messaging of the MHCC. In many other countries around the world, the move to develop recovery-oriented systems in well underway.
Canada has lagged behind. To address this gap, a Recovery Discussion Paper is in development for MHCC.
Research and Evaluation at the Core
Across Canada, there is relatively little research into stigma and discrimination experienced by people living with mental illness. An important goal of the MHCC is to create benchmark information through surveys, to establish where the public attitudes stand now.
7 The MHCC will continue to conduct regular targeted nation-wide surveys over the course of the ten year campaign, to determine changes in attitudes and behaviours. By supporting partnerships between program delivery and researchers, the Commission will be able to evaluate what works and what doesn’t. It will also foster linkages with international researchers, to forge a shared approach to building research on stigma and discrimination.
From the research already available we know:
An effective national anti-stigma and anti-discrimination strategy will require a multi-pronged approach focused on specific target groups who have power and influence to support or impede recovery for people with experience of mental illness.
Repeated direct peer-based contact with people who have
experienced mental illness reduces negative stereotypes. It also provides a message of hope by demonstrating the capacity for recovery.
By providing evidence-based education, about the impact of discrimination, people of influence are challenged to reconsider their beliefs and change their actions in a positive way
The key is to determine the best approaches to reach targeted groups. Specific programs and messages will also be developed to reach culturally diverse and aboriginal groups. It is crucial to engage the target communities in informing program
development and delivery to ensure the greatest impact.
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Taking a Targeted Approach
According to the experts, there is no ‘general audience’. Programs require a targeted approach to be effective. During the first year (2008-2009), the Commission will target two priority groups for its public awareness campaign: youth and health care providers.
YOUTH:
Adolescents aged 12 – 18 have been unanimously identified as an important early target for intervention. For more than 70% of adults with mental illness, onset occurred before they turned 18.
Many young people lack knowledge about mental illness and have a reluctance to seek professional help. In a recent survey, about 40% of Canadian parents said that they would be
embarrassed talking about their children’s mental health issues.
That leaves many young people who feel distanced from their families at a time when they need them most.
Among 29 OECD nations (Organization for Economic Cooperation and Development), Canada ranks twenty-first in child well-being, including mental health. (See youth fact sheet)
MHCC will look to social marketers to help create a program to reach youth. Youth are receptive to the use of technology (YouTube, Facebook. My Space, blogs and on-line discussion forums). Social marketing strategies will likely reach youth at least in part through such technology.
Targeting will also include families, friends, teachers and
guidance counselors, and youth oriented programs. This broader
9 approach is essential given that youth are more likely to turn to and friends, teachers and family for help. The presence of
supportive social networks is recognized as an essential element of recovery.
The Commission will consult with a small group of youth-based networks. Based on research, specific attitudes and behaviours will be identified and targeted for change. This will include the important role friends can play, the importance of seeking formal help as well as instilling the knowledge that hope of recovery is realistic.
The MHCC will also include the Child and Youth Advisory Committee in consultations.
MHCC will recruit youth and high impact celebrities to provide personal contact stories and key messages.
Effort will be made to identify corporate partners and sponsorships.
HEALTH AND MENTAL CARE PROVIDERS:
Anecdotal information says people who seek help with mental health problems often feel disrespected and discriminated against by health and mental care workers. Discrimination can prevent people from seeking help and/or not complying with treatment. It also can result in their loss of rights, loss of health care services, lowered expectations, and a diminished sense of hope for recovery.
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Family physicians, who are frequently the first port of call in the health care system, are under pressure to see as many patients as possible. Often they have too little time for patients with mental health concerns. In addition, training in mental health remains neglected in medical schools across the country. This can leave family physicians insufficiently trained to deal with the array of mental health problems and illnesses they encounter. It can also be difficult for them to access the specialized resources and backup to assist them in meeting their patient’s needs.
People with mental health issues who go to emergency rooms at general hospitals for help get pushed to the back of the queue.
Physical ailments take precedence because they are perceived as being more urgent.
The Commission has already received a high degree of interest in addressing this issue by national professional associations and alliances who wish to reach out to their members so access to care is made easier for people with mental illness.
The Commission will develop an integrated social marketing approach to reach this group. It will also conduct benchmark surveys at the outset that will help target behaviours, attitudes and readiness for change. This benchmark will allow the
program’s impact to be measured over time.
Mental health care providers anecdotally say they also
experience their own form of stigma. This is a ‘courtesy stigma’
11 due to the diminished status mental health care providers are assigned by peers. This can negatively impact morale,
recruitment and retention of mental health personnel.
Why Social Marketing
Social Marketing is comparatively new. It is defined as a planned and targeted process to create specific and measurable change that will benefit both individuals and society. It draws on marketing principles, consumer research, advertising and promotion
techniques. Instead of producing a campaign designed to increase sales and generate a profit, social marketing creates programs aimed at a segmented audience that will change attitudes and behaviours for social reasons. The success of social marketing is well demonstrated through campaigns, such anti-smoking, bullying, drinking and driving. By utilizing the specialized skills of social
marketers at the outset of its program development, the Commission can develop a strategic plan that targets its
consultations, its research and information programs to achieve measured outcomes for maximum benefit.
In developing its strategic plan, opportunities for corporate
sponsorships and partnerships will be identified. By building brand associations with blue chip companies, the Commission can
demonstrate broader support and interest in reducing stigma.
Finding Consensus with Stakeholder Groups
In September, 2008, the Commission invited representatives from national organizations working in the area of mental health and
12 mental illness to a Consensus Meeting. Both consumer and
professional organizations were included, and together they
developed the principles, values and guidelines of the Commission’s Anti-stigma / Anti-discrimination Campaign.
Many of these organizations have conducted their own anti-stigma programs. Going it alone has made it more difficult to have impact.
Ideally, with ongoing communication and sharing of information, the national initiative will result in all organizations speaking about stigma with the same evidence-based message, so the overall effect will be maximized.
Creating National Steering Councils
The MHCC will establish two national steering councils to provide guidance on the two campaigns. The councils will be comprised of diverse perspectives including: stakeholders, consumers, social marketers, creative designers, and researcher experts to provide oversight and direction for the development of the stigma and discrimination initiative and to monitor its ongoing progress. The newly established Consumer Advisory Council can be included to inform the program design.
Reaching out to the Media
The media has been singled out for special attention because of the powerful role it plays in promoting both positive and negative
stories related to mental illness. The Commission must build
13 positive relationships with journalists and media experts, and
encourage positive reporting. On an ongoing basis, MHCC will provide journalists with accurate information, and access to both compelling stories and individuals who will speak to media about their experiences.
The MHCC will also look at creating industry awards of excellence and journalism scholarships, to further allow the Commission to play a positive role in shaping media actions.
Summary of Recommended Principles and Approaches
The Anti-Stigma and Discrimination Plan will look to the following principles and approaches:
Communicate a clear, simple and enduring vision which includes:
o Reducing stigma is a shared responsibility – every Canadian can make a difference.
o Recovery is the priority focus – it builds a sense of promise and hope.
o Changing attitudes about stigma is not enough – need for focus on reducing discrimination.
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People with experience of mental illness must play a leadership role – MHCC will include them in program development and in determining message.
Wherever possible, the campaign will increase contact with people who have experienced mental illness. These
individuals will normalize mental illness, disabuse common myths and demonstrate capacity for recovery and hope.
Focus efforts on promoting rights and reducing discrimination.
Target changing both attitudes and behaviours by developing evidence-informed educational resources and training
activities.
Deliver programs locally while keeping an eye to the entire country.
Create multi-sector partnerships
Target ‘high impact’ groups – create messages that are target specific
Work with media leaders to educate them on issues related to stigma and mental illness with the goal of improving public understanding of issues around stigma and discrimination.
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Youth Quick Facts
i Prevalence rate of mental health concerns in children and youth is estimated at 20%. The prevalence of distressing and
debilitating mental health problems among Canadian children is 15% with 5% suffering extreme impairment. Many adult mental illnesses have their onset in adolescence.
The most common presenting mental health problems in teens are: depression, anxiety, disruptive behaviour disorders, eating disorders, ADHD and development disorders.
Although teenagers and young adults suffer more from the
mental disorders than other age groups, they are the least likely to use any resources for problems concerning their mental
health or use of alcohol or illicit drugs.ii Up to 80% of youth will not receive any mental health services.
Feelings of hopelessness, isolation and a lack of social support can lead to feeling suicidal in adolescence. One in ten teens commits suicide and rates are highest for males. It is the second cause of death after accidents.iii
Poor mental health among adolescence has been linked with behaviours that can damage physical health in the short-term and mental health into adulthood.
In a recent Canadian survey shame and stigma combined were the main reason why people said they would not seek help.iv
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Stigma comes from a lack of knowledge which is pervasive
among Canadians. It is relatively simple to de-stigmatize mental health with youth. v
Almost half (48.7%) of male teens said that can’t or don’t talk to anybody about their mental health concerns. 72.9% of female teens said that they feel really stressed. 47.9% of female youth said that they feel really depressed.vi
Surveys of youth behaviour show that the doctor is the last person that teens confide in with emotional concerns. Peers and teachers come first.
The mental health needs of adolescents may be the least well served. Transitional youth (between ages 16 and 24 years of age) fall between the cracks of youth and adult services.
Involving youth in decision-making, program design and building peer-to-peer support is considered the ‘best practice’ approach.
Focusing on wellness, avoiding the treatment-related trauma attached to first diagnosis, and focusing support on community and home based care are also considered essential elements.
Prevention and early intervention is most effective in adolescence and enhancing individual skills and building protective factors may be more important than reducing risk factors.
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People with serious mental illness, such as schizophrenia and related disorders, have the highest rate of unemployment and underemployment of all people with disabilities, at a rate of around 90%.vii This results in a life-long experience of poverty and social exclusion. Eighty percent of people with serious mental illness want to work.viii
i Canadian Collaborative Mental Health Initiative. Establishing collaborative initiatives between mental health and primary care. Feb. 2006.
http://www.ccmhi.ca/en/products/toolkits/documents/EN_CompanionToolkitforChildrenandAdolescents.pd f
ii http://www.statcan.ca/Daily/English/030903/d030903a.htm
iii Government of Canada. The Human Face of Mental Health and Mental Illness in Canada. 2006.
http://www.mooddisorderscanada.ca/docs/Human_Face_of_Mental_Illness_in_Canada_October_2006 .pdf
iv Bourget, Beverley and Chenier, Richard. (2007). Mental Health Literacy in Canada: Phase One Report Mental Health Literacy Project. Canadian Alliance on Mental illness and Mental Health. Last accessed Sept. 27, 2007 at: www.camimh.ca/files/literacy/MHL_REPORT_Phase_One.pdf
v OUT OF THE SHADOWS AT LAST: Transforming Mental Health, Mental Illness and Addiction Services in Canada, The Standing Senate Committee on Social Affairs, Science and Technology, PART III:
Service Organization and Delivery. http://www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci- e/rep-e/rep02may06part2-e.htm#_Toc133223093
vi Youth Net Research http://www.youthnet.on.ca/main_english.php?section=viewarticle&article=7 vii http://www.parl.gc.ca/38/1/parlbus/commbus/senate/com-e/soci-e/rep-
e/report1/repintnov04vol1part1-e.htm#_ftn130#_ftn130
viii Source: World Health Organization (2000). Mental health and work: Impact, issues and good practices. Available at: www.who.int/mental_health/media/en/712.pdf
