Editorial

Citation

Caan, W. (2012), "Editorial", Journal of Public Mental Health, Vol. 11 No. 2. https://doi.org/10.1108/jpmh.2012.55611baa.001

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 11, Issue 2

When this journal was first launched, Arthur Crisp was a key member of its editorial board. He was then leading the Royal College of Psychiatrists’ campaign to reduce the stigma of mental illness (Crisp et al., 2000). Many of the lessons from that early campaign continue in the present work of Time to Change (see, e.g. the widely used social network www.facebook.com/timetochange). I think the late Prof. Crisp would approve of the English strategy No Health Without Mental Health (HM Government, 2011) having a key Objective that fewer people will experience stigma and discrimination:

Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease.

Self-worth is a highly valued aspect of life, and Stillman et al. (2009) showed experimentally that even transient slights or ostracism make a person’s life seem less meaningful – and the stigma associated with mental illness can produce much more persistent social exclusion than their brief experiment! The ancient class system in Britain, combined with ever-widening inequalities in wealth, mean that many Britons sometimes feel excluded from the “good life”, but chronic stigma can further exacerbate health inequalities. Based on the latest survey data from the Office for National Statistics, across the UK the most unhappy people are “the long term sick” (Hawkes, 2012). Recently this Editor joined the new, third sector Health Equalities Alliance in the hope that collective, community actions might result in a less divisive, more flourishing Britain. At least it is worth testing the “prosocial” model of David Sloan Wilson that human nature is typically “altruistic and co-operative” and that groups which co-operate maintain an evolutionary advantage over “selfish groups” (Van der Zee, 2012). Professional competence is needed here, as recently highlighted by Public Health for the NHS (2012):

Public health has an important and well-recognised role in speaking out in the public interest, especially on behalf of ordinary citizens and marginalised groups.

When feeling “disturbed” (Fonagy and Lemma, 2012) an individual can affect the thinking and behaviour of professionals engaged with them: this is one aspect of stigma where psychoanalysis has enriched competence in practice. Many supporters of No Health Without Mental Health now are concerned it will fail during the current changes to commissioning for Health and Social Care (Ford, 2012), with the economist Lord Layard warning “mental health lies at the root of so many of our social problems and yet it is shockingly neglected by our policy makers”. In this issue, Hockly and Caan describe how the impending changes in England may even be making the new, clinical commissioners ill. People with a history of addiction are widely stigmatised (Caan and London, 2008). Even before Parliament votes on the Health and Social Care Bill, there has been widespread local “disinvestment” in addiction services and reduced salience within the new umbrella organisation, Public Health England (Roberts, 2011). However, the SIPS Research Team (2012) has shown that even for people with criminal records, brief sensitive engagement around dangerous drinking through Probation followed up by 20 minutes life counselling not only reduces alcohol problems for 12 months but is cost-effective, reducing any re-offending, in a highly marginalised population. The Department of Health (2012) has just pledged to increase opportunities for research training across a wide range of healthcare staff: services will need enhanced research skills, if they are to engage excluded groups more effectively.

Groups can be marginalised by many perceived “differences”. Chowbey and colleagues in this issue investigated views of ethnic minorities in Yorkshire in relation to eating disorders, finding “ineffective communication and cultural stereotypes” undermined people’s confidence in services. Stigma is a worldwide concern and can undermine health at all ages. The older Australians reported here by Pettigrew and colleagues had limited understanding of wider mental health issues and especially the importance of staying mentally healthy themselves. Prejudice and exclusion can begin at a young age, and here the secondary school children in Lindley’s study suggest a value for early, inclusive dialogue within an educational context. Childhood sexual abuse can leave “invisible” but lasting psychological scars. It is encouraging to see in this issue Ellis’ rehabilitation report that as little as eight sessions of groupwork can substantially improve survivors’ self-esteem.

Building capacity, capability and confidence in “all staff, learners, patients, carers and the public” will need both policy guidance and new behaviour (RSPH, 2012). This will be quite a learning experience, for the entire Public Health community. Better communication would be a good starting point … . perhaps professionals can learn from the use of social media for mental health (Mental Health Network, 2011) to create improved “conversations”, with active listening?

Own brand“Stigma” means burned with a mark of shameBut the worst mutilationIs internal,When a victimBelieves they are to blame.Freedom needs voices to be understoodAnd the best intervention:Communication,Words that affirm,Respect, each personhood.

Woody Caan