NSF(S): National Schizophrenia Fellowship (Scotland)

Report on the First International Conference on Reducing Stigma and Discrimination because of Schizophrenia, Leipzig, September 2001 NSF (Scotland) participants Oksana Last and Catherine Bryce
For a set of photographs taken during the conference, click here

Contents

Introduction
Summary of main points
Items in brief
What NSF (Scotland) can take from the conference
References

One speaker quoted Albert Einstein, and his words summarise the challenge facing the conference delegates: 'It is harder to break a prejudice than an atom'
Introduction
This is a report on some of the main points raised at the World Psychiatric Association co- sponsored conference and of issues which may be of importance for NSF (Scotland). Delegates from all over the world attended. There were a number of parallel sessions, so it was not possible to attend every one. Hearing the various talks from around the world makes us understand that the fight against stigma is on a global scale.
Perhaps the most important outcome was the sense of how different cultures and government strategies results in people with mental illness receiving different approaches and quality of treatment. Despite the variations, however, there is an underlying sense of international commitment and unity in challenging stigma.

The conference � summary of some of the main points made

The vicious circles of stigma (Norman Sartorius, past president of WPA and present European President of the WPA Global Programme, Geneva, Switzerland)

Stigma because of mental illness creates vicious circles that strengthens it. The circle can be broken at any point and it can stop reinforcing itself, something can be done by employing a wide diversity of different interventions. The individual forms a cycle, so does the family as do the mental health services.
The individual is weighed down by the illness which brings about stigma and this in turn leads to discrimination. That disadvantages the person who has low self esteem which makes him less able to resist and so the circle of stigma continues.
The family is burdened with shame, guilt and worry which leads to reduced reserves (less power) thus giving less support to other members of the family which causes conflict among members of the family, separation, divorce, another child leaving, and this in turn leads to increased stress for all (less support), bringing on the appearance of the stigmatised disease (and then re-appearance) which brings us back to shame, guilt and worry.
For mental health services there is a stigma which produces more involuntary admissions and problem patients thus leading to poor reputation of the service so not enough money which leads to deteriorating facilities and hence poor quality staff whose output is also poor offering bad overall service which then enhances stigma. 500 million people in the world do not get services.

Stigma caused by changing cognitions of schizophrenia (Emiko Namihira (Tokyo, Japan)
Until the end of WW2, people in most Japanese districts believed that abnormal behaviours were the result of possession by animal spirits or deities. Stigma has been due to long hospitalisation and medicalisation of schizophrenia which is now on a par with the stigma of leprosy which had always been great but stigma in leprosy disappeared when cured.

Attitudes and knowledge of secondary school students (Chiara Buizza,et al, Brescia,Italy)

A research study in which a control group was given no information about attitudes to mental illness, while others were given detailed information.
There was clear evidence of prejudice in students at the start of the study and the objective is to understand the ways in which education can reduce the impact of stigma

Challenging attitudes through a school based project (Aidan Fay, Dublin, Ireland)

Project aimed at post primary students to promote positive attitudes to mental health through the medium of public speaking
It is well worth investing in changing the attitudes of the young as they are the adults of tomorrow

Secondary school students' attitudes towards people with schizophrenia (Beate Schulze et al, Leipzig, Germany)

In this project one key result was that after the education of students, there was a noticeable weakening of the positive effect over time
Conclusion: a long term goal must be to establish mental health as a topic in the curriculum which is returned to again and again

Not just 'users of services' but 'contributors to society' (Liz Sayce, Manchester, England)

The way we use language about mental health service users is a key factor in changing attitudes.
Equally important is stressing the positive contribution to society that those with a mental illness make.

Mental health in Ghana (Ama Edwin, Ghana)

This was one of the sessions which gave an insight into the diversity of treatment, attitudes, and so forth across the world.
Here in Ghana for example problems of poverty, ignorance and illiteracy predominate
In addition, other diseases like the killers malaria and HIV dominate

Working with the media to reduce stigma (Barbara Hocking, SANE Australia, Melbourne)
Examples of proactive work such as that of the teenage soap opera 'Home and Away' and the reactive work through the StigmaWatch programme were described in this presentation. See their website www.sane.org. (This organisation is different from the UK Sane.)

In brief

Speakers from Austria, Brazil, Canada, Chile, Egypt, Greece, India, Italy, Morocco, Poland, Slovakia, Spain and Switzerland gave presentations involving schools which were based on the WPA pilot study in Calgary, Canada.
The role of the media and the prevalence of a negative approach to mental illness was highlighted � the emphasis is always on the negative and the sensational though there were positive ways to overcome this - one of which, we at NSF (Scotland) have signed up to - the Media Award.
It is important also to take into account the views of the stigmatised, the mentally ill themselves. This was at the core, and though families were represented it was with constant reminders to the presenters and audience that they play an important part.
There is evidence of stigma built in to institutions like hospitals and their staff.
Reform of methods of treatment can be part of the war against stigma

What we in NSF (Scotland) can take from the conference

Targeting the young, especially 11-18 year olds, is key, but given the tapering off of the impact of positive education, it is important not to adopt a 'one shot' approach to changing attitudes, but to seek ways of reinforcing the impact of the initial session.
This is just the beginning of a long struggle to overcome stigma, and it is clear that a multiplicity of approaches is needed, with international collaboration and co-operation at the forefront.
Our presence at the conference strengthened our role in the fight against stigma as well as helping us to inform others of our organisation and its work, especially as being separate from London-based nsf who, constantly claimed to be UK-wide despite our objections.
NSF (Scotland)'s involvement in encouraging more positive attitudes in the media is a central part of the fight against stigma.
We must continue to work with others to continue 'chipping away' at stigma and continue to maintain this as one of our top priorities.

PS One ironic note is that the day on which the conference began was the anniversary of the beginning of World War Two. Remember the victims of Hitler's decree causing 200,000 mentally ill to be killed. So it was good that this first world conference on stigma was held in Germany.
Many thanks to Ely Lilly and NSF (Scotland) for sponsoring us. This was a most enjoyable and informative event, if somewhat exhausting.

References

References detailed below have been lodged with the Information Service:

A copy of the conference abstracts
A signed copy of Don't call me nuts! Coping with the stigma of mental illness by Patrick Corrigan and Robert Lundin � dealing with the pain of self-stigma, to disclose or not to disclose � - this will be reviewed for the next newsletter.
The Pathfinder User Employment Programme � SW London & St George's Mental Health NHS Trust, March 2000, and a Progress Report August 2000.
Presentation � Not just users of services but contributors to society � Springfield University Hospital, Tooting, London.
Various leaflets from as many of the organisations represented as we could get hold of giving contact details.
Various newsletters and lists of publications.
'It is Normal to be Different', understanding and treatment of psychoses. Brochure developed by persons who have experienced psychotic states, family members and scientists who work together in the German 'Psychosis-Seminars'.
Guide for Journalists and Broadcasters Reporting on Schizophrenia � from Ireland.

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