Changing Hearts & Changing Minds

The expansion of user-friendly mental health services for young people is an important goal of mental health reform in Australia; however, stigma and discrimination associated with mental health conditions constitute major deterrents to help-seeking among young people. This research reports on a qualitative study conducted in Southeast Queensland, which explored perceptions concerning the employment barriers faced by young people living with psychosis.

Stigma refers to a set of negative attributions applied to people who exhibit characteristics that distinguish them for other members of the society. Stigma has been conceptualised in terms of three key components (stereotypes, prejudice and discrimination), and stigma associated with mental illness is a worldwide phenomenon which manifests itself among adults, adolescents and children. In previous studies, some 65% of a sample of young people aged 12–18 years with mental health problems reported experiencing stigmatisation in relationships with peers, while 35% experienced stigma perpetrated by school staff. Similarly, 70% of a sample of young people aged 13–18 years discharged from psychiatric hospitalisation reported experiencing one or more aspects of stigma at 6-month follow-up.

Among young people, stigmatisation is experienced in several forms, such as disrespect, devaluation, emotional insult and being underestimated by others and there is evidence of an extensive vocabulary of derogatory terms used to refer to people living with mental illness. Stigma can have devastating impacts on young people, causing emotional pain and stress that negatively impact wellbeing and stop young people from accessing health services: several studies have identified that fear of being diagnosed with a mental health condition was one of the main barriers to early help-seeking behaviour in young people of high school age. A recent Australian study found that 52% of young people aged 12–25 years who had experienced a mental health problem in the preceding 12 months were too embarrassed to discuss their mental health problems with anyone and 49% were afraid of what others would think of them.

Adolescents and young people are especially sensitive to prevailing social attitudes held by family, friends and peers, as well as those portrayed in the media. Overcoming the social stigma associated with mental illness is therefore an important goal which must be addressed if young people are to avail themselves of the services provided. This is particularly relevant in relation to ongoing attempts to overcome the problem of a high youth suicide rate. A recent report found that in Australia suicide was the leading cause of death of children aged between 5 and 17 years of age.

Evidence suggests that public attitudes towards people living with mental illness are resistant to change and may be becoming even more stigmatised over time, yet opportunities for social learning remain limited as many individuals living with psychosis live on the fringes of society and are over-represented among the homeless, imprisoned and unemployed. Furthermore, social stigma associated with mental health problems results in a tendency to avoid interpersonal contact with individuals affected by severe mental health conditions, further limiting exposure and opportunities for social learning, and perpetuating the cycle of ignorance.

Personal contact with a person living with mental illness combined with education appears to be the most promising approach, as long as the education program is well designed: for example, previous public education initiatives that focused on biomedical explanations of mental illness appear to have had the unintended consequence of fostering a perception that mental illness is incurable. Researchers who have investigated the effectiveness of anti-stigma programmes in schools have found that personal contact with a person living with a mental health condition is an important facilitator of attitudinal change among high school students and that the personal testimonies of people living with mental health conditions were a powerful component of educational interventions.

Although attempts have been made in Australia to engage students in mental health awareness programmes such as the KidsMatter and MindMatters programmes, participation of schools in these programmes remains discretionary as does the nature, content and intensity of the programme. Within the educational context, it is quite apposite to view stigma and discrimination within the broader context of bullying. Indeed, students affected by mental health conditions provide a target for bullies, and educators have recommended integration of anti-bullying strategies into the curriculum.

This paper draws on the findings of a qualitative study conducted in Southeast Queensland which investigated the employment barriers and support needs of people living with psychosis, and examines in detail participants’ responses relating to the formal education system and their suggestions for improvements to mental health education in schools. A group of 137 volunteers were asked to respond to the following two main statements/questions, with half the time allocated to addressing each question:

Question 1: We know that many people who have been diagnosed with schizophrenia or bipolar disorder would like to work in regular paid employment. We also know that the employment rate of people with these conditions is significantly lower than the general population. Why do you think this is the case?

Question 2: What do you think would need to change to improve employment outcomes for people who have been diagnosed with schizophrenia or bipolar disorder?

Consistent with previous research findings, participants in this study viewed education as an important means to improve attitudes, increase acceptance and reduce stigma, discrimination and fear in relation to mental health conditions. Findings from this research suggest that community education may need to commence much earlier, in schools, to reduce stigma. Such a policy would seem to be workable, given that children as young as six appear to grasp terms associated with mental illness. Due to the important role of such programmes in overcoming stigma and promoting help-seeking behaviour among young people, implementation should not be left to the discretion of individual schools or teachers.

Key questions that need to be addressed are what the mental health curriculum should look like, what the central messages should be and whether the subject matter should constitute a separate course or be integrated as background material for traditional subject areas. How might anti-stigma and discrimination messages be conveyed most effectively in the educational context within the constraints of available time and resources?

Education policy in tertiary institutions providing education and training for teachers, management professionals and health professionals is also an important factor in bringing about cultural change. Formal education in schools, as well as mental health content in tertiary education courses for key professionals such as businessmen and lawyers, is necessary to overcome ignorance and increase awareness. Most educators would readily acknowledge the importance of the parent–child relationship in influencing educational outcomes. It would seem, however, that the profound impacts of parental mental health conditions on the emotional wellbeing of children and their capacity to learn may be less well understood and may deserve more attention in teacher education.

Research has found that even mental health professionals, who are considered to be the most educated members of our society in regard to mental health conditions, can hold stigmatising attitudes towards their patients. Tertiary courses for medical and allied health professionals need to extend beyond a focus on clinical treatment to a more positive recovery-oriented model which offers hope of functional recovery and reintegration into society. Findings from this research suggest that an integrated multidisciplinary approach, in which the formal education sector collaborates with the health sector and voluntary organisations to tackle the problem of social stigma associated with mental health conditions, could help improve education and understanding in the community and break down discrimination towards people experiencing mental health problems.

The findings suggest that children could be educated from an early age to be more understanding and accepting of people with mental health conditions. This in turn would reduce barriers to help-seeking and facilitate the early uptake of intervention services among young people.

Changing hearts and minds through the formal education process can potentially influence the next generation of employers, journalists, film-makers, writers and community members, paving the way for more positive attitudes and genuine social inclusion of people living with serious mental health conditions. To sum up, in the words of one research participant, education at school could create a society that is ‘more informed, … more compassionate and … more understanding’.

Reference: Hampson, E., B. Watt, R. Hicks, and A. Bode. (2018). Changing hearts and minds: The importance of formal education in reducing stigma associated with mental health conditions. Health Education Journal, Vol. 77 (2). Bond University & Griffith University, QLD, Australia. Pages 198 – 211.