Tackling the Cost of Stigma: How can your organisation contribute to change?

The stigma associated with children’s and young people’s mental health, it’s effects and how to tackle it Department of Health & Department for Education jointly commission NCSS as a service improvement programme which helps strengthen mental health services for children and young people in England. It provides support and challenge to Targeted Mental Health in Schools pathfinder pilots and manages a range of national projects commissioned by DH and DfE. Its core regional activity is undertaken in collaboration with Strategic Health Authorities, Government Offices and local providers.

What is Stigma?

‘Children acquire attitudes about mental health at an early age’ Wahl, 2002 ‘Stigma is a societal reaction which singles out certain attributes, evaluates them as undesirable and devalues the persons who possess them’ Miles, 1981 ‘ Stigma can increase the complexity of mental health problems and the impact they have on the individual’ Social Inclusion Unit, 2004 ‘Stigma operates at a number of levels within individuals, families, education systems, healthcare, the media and social policy’ Hinshaw, 2005

• Why/

Why?

Fear?

Misunderstanding?

The fine line?

Mental Health problems belong to others?

Them and Us?

Denial?

Feeling vulnerable?

The cost of stigma

• The stigma associated with mental health problems is a major barrier to help-seeking in young people Corrigan 2000 • Mental health problems among children and adolescents are common, about 10% of young people have a diagnosable disorder Kurtz 1999 • The rates for some mental disorders, including suicide, are increasing Costello et al 2006 • Most young people who have mental health problems do not seek help – their parents are also reluctant to seek help for them Gale 2007

The cost of stigma

• Up to half of those who fail to complete secondary school have a diagnosable mental illness Stoep et al 2003 • Children and young people, and their parents more often turn to friends and family for help rather than to health professionals Evans et al 2005 • Teenagers seek help less often than adults Oliver et al 2005 • As few as 4% of young people with a mental illness seek help from a family doctor males Potts et al 2001 • Consultation rates are especially low among young Biddle et al 2004

The extent of stigma

• Studies undertaken with the general public, professionals and service users show that there is little consensus on the meaning of ‘mental health’, or the language used to describe it Brunton 1997 • Stigmatising views are not just held by the public, professionals hold them too Gale 2007 • Research has found that 44% of people who has experienced mental distress said that they had experienced discrimination from GPs. 35% of people surveyed said they had experienced discrimination from health professionals other than GPs. MHF 2006

Why Tackle Stigma?

Sadie: I had to go through so many channels. It feels like, like for years, I’ve been going through the system… Parent Gale 2006 – Childrens and Parent’s/Carer’s perceptions of mental health and stigma – PhD Research Study

Why Tackle Stigma?

Martin:

“ People who are mental are horrible…” (Aged 7)

William

: “I feel ashamed and can’t talk about it…I have a dark secret…” (Aged 10) Gale 2006 – Childrens and Parent’s/Carer’s perceptions of mental health and stigma – PhD Research Study

Why Tackle Stigma?

• Negative attitudes can begin at an early age • It can reduce access to mental health services and the effectiveness of treatment • Create fear, isolation and low self esteem in children • It can have the potential of increasing the severity of mental health problems

Fear of getting help

The severe and profound effects of stigma are known to affect children and families. Stigma can result in: • Intense feelings of shame • Social exclusion • Reluctance to seek help Wahl 1999

Robyn: …I am very scared…there is something wrong with me…I think I might be mentally ill.

Age 11 Gale 2006 – Childrens and Parent’s/Carer’s perceptions of mental health and stigma – PhD Research Study

Health Belief Models and help-seeking

(Corrigan and Watson 2005) Health Belief models help us to understand issues around how stigma can affect help-seeking, poor accessing of services and participation in interventions – People must feel able to engage with help to enjoy the benefits of services – Less that 30% of adults fail to seek help for their mental health needs – could this include parents?

– Stigma has been a ‘key’ barrier to engagement with services – People behave in rational ways to diminish threats – STIGMA is one of those threats, hence the reluctance to seek help at an early stage and the real possibility of end up in a crisis

The impact of services on children’s mental health and stigma

(Gale, 2006) Children and parents identified that children’s services contributed to their feelings of stigma This was attributed to: – Deficits in professionals knowledge – Difficulties in initially asking for help, and barriers to accessing help – Stigmatising attitudes from professionals – Poor communication strategies, between agencies and with families – Lack of clarity about what services provide and their referral criteria – Not understanding what specialist CAMHS does – Very poor access to information about what to expect from CAMHS

Based the Tackling Stigma Framework (Gale, 2006) The toolkit brings together • Practical Guidance • Best Practice Examples • Case Studies • Resources • Literature

The Tackling Stigma Framework

(Gale, 2006)

Mainstreaming

Tackling stigma ethos

should be

embedded

across the system of care at a

strategic level

Citizenship and Participation

Involving children, young people, and families

as citizens, partners and decision-makers.

They should be

at the centre

of the Tackling Stigma process

Language and Definition

Develop a

shared understanding

of mental health and

language

in partnership with

children and families

Information and Education

Develop

user friendly information

about services – a quick win!

Create robust, local

education programmes

which include

information about stigma

Communication

Develop

inclusive working models

that ensure children and their families are

active partners in their care.

They should always be

informed and enabled to make choices

Effective Systems

Services should be

timely, accessible and responsive.

Transparent referral criteria

and

clear care pathways

help

reduce confusion and reluctance

Media as Allies

The media play a part in portraying

negative stereotypes

of people with mental health problems.

Get their support

give

a positive message

to

Mainstreaming the framework-what can you do to tackle stigma?

• Include all agencies that work with children and all levels of provision • Change or critique our ethos and values base • Look at our whole system • Include the approach in the Children’s plan and children’s mental health strategies • Develop Children, Young People and their families as Partners • Think especially about vulnerable children

Steps to implementing the framework

Key Messages from evaluation of the Tackling Stigma Framework

•

Partnership working and strategy

opportunities to re-engage partners was integral. The Framework created • The two key elements are

Mainstreaming

and embedding

Participation

. Children and Young people should be at the centre • The

key success factor

was children and young people’s

involvement

• Involvement of the

voluntary sector partnerships and creative sectors

has enabled access to a wide range of • The Framework has

complemented

TaMHS national initiatives such as SEAL and

Top Tips for implementing the Tackling Stigma Framework

• Form partnerships early • Ensure sustainability is built in to plans • Have a project lead in place • Stay focused on children and young people • When designing information and services for children remember children are the experts!

• Involve children and young people from the beginning • Shop around for media help – and don’t let them charge too much!

• Be creative in developing resources and delivering the message • Use the arts in the widest sense to let them engage children and young people

Key Messages from Children and Young People

‘Before I was involved in the 5 a day campaign I had very stereotypical views of people with mental health problems, thinking they were ‘mad people’. I was shocked that mental health problems can affect 1 in 4 people’

Key Messages from Children and Young People

‘If anything my views are stronger, I want to see improvements for young people going through similar things’ ‘We are raising awareness that other young people with mental health problems are not alone. People will hear our views…this will help to make services better as we can share positive and negative experiences.’

www.chimat.org.uk/tacklingstigma

Website www.chimat.org.uk/tacklingstigma

Suggested Further Reading

• NCSS (2010) Tackling Stigma: A Practical Toolkit. NCSS, www.chimat.org.uk/tacklingstigma • Gale, F (2007) Tackling the stigma of mental health in vulnerable children and young people. In P.Vostanis (Ed)

Mental Health Interventions and Services for Vulnerable Children and Young People

. London, Jessica Kingsley.

• Street C & Herts B (2005)

young people Putting Participation into Practice: A guide for practitioners working in services to promote the mental health and wellbeing of children and

. London, YoungMinds

Acknowledgement:

The images in these presentations have been taken from the Tackling Stigma Toolkit www.chimat.org.uk/tacklingstigma and have been made available for this purpose by Foundation Design www.foundationdesign.co.uk

.