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Shifting prejudice

It is time we finally removed the stigma of mental illness, says Louis Appleby

Wednesday March 22, 2006

The Guardian

Think about the last time you came across a mocking comment about mental illness - I am willing to bet it wasn't long ago. It may have been said on a chat show or at the pub, in a tabloid or a taxi. Almost certainly it included a slang term for someone whose mental health is poor. I don't need to remind you of the numerous options.

Now imagine the comment was about race, and replace the mental health slang with an equivalent word for someone who is black. In doing so, you are crossing a line between acceptable and unacceptable prejudice. Its existence is a daily reality for people with mental health problems, and shames the rest of us.

Racial slang is no longer tolerated, and discrimination based on race is universally condemned. But unthinking prejudice against people with mental ill-health persists. As a result, this common type of health problem remains taboo, something that few people are prepared to own up to, even though, if they do, there is a one in six chance that they will be confessing to a fellow sufferer. Large-scale surveys show that, at any time, 16% of the adult population have depression, anxiety or a similar condition such as agoraphobia.

The case for tackling the stigma of mental illness is partly a moral one - it has no place in a civilised society. But there is a broader argument for eradicating stigma, because of its consequences to health and quality of life. Stigma ruins lives.

Many people with mental health problems say its impact is worse than the illness itself. They may lose their job, their prospects and their relationships. They may receive poor treatment and little sympathy in casualty departments and housing offices.

The shame that goes with stigma makes people reluctant to ask for the help they need. Young men, in particular, seem to find it hard to admit being depressed and to seek treatment. It is no coincidence that the highest suicide rate is found in young men.

Stigma has its origins in fear and ignorance. Surveys of public understanding of mental illness turn up the words "violent" and "unpredictable", though most of the 600,000 people under specialist mental health care are never violent, and most violence in society has nothing to do with mental illness. In fact, studies in the UK and Denmark have found that people with mental health problems are far more likely to be the victims of violence, and that their risk of dying by homicide is six times higher than that of the general population.

This week, the government-funded anti-stigma campaign, Shift, held a major conference to share international experience. Shift recently published a survey of newspaper portrayals of mental illness that appeared to reinforce the false stereotype of the violent patient. Now the campaign is calling on the media to present factual information alongside any story on mental health, and to seek comments from a "speakers' bureau" of people with mental health problems whose experience has made them experts.

Shift is also asking broadcasters and journalists to help stamp out the use of derogatory language about mental illness and about the people who have to cope with it. No one with cancer, HIV or kidney failure has to put up with this kind of insult, and people with mental ill-health deserve the same respect.

· Louis Appleby is the NHS's national director for mental health