Mental Health Stigma Case Studies

Changing Hearts and Minds

The personal views listed below come from the findings of a qualitative study conducted in Southeast Queensland, which investigated the employment barriers and support needs of people living with psychosis, their experience of 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?

An undergraduate university student pointed out that in her experience, mental health was a significant omission from the school curriculum:

“I’ve never, through all of school, been taught about mental illness in any way. Genetic diseases were covered in biology, but it was never mentioned. Mental illness was just never mentioned, and it was just sort of swept under the carpet which isn’t right, because you come out the other end and don’t know how to act around people who have it ….”

A former school principal who participated in the study stated, “As a principal later in my forties, [I] came across my first case of a parent who was bipolar and somebody had to explain to me exactly what that meant.”

One participant recalled the mental hospitals of the past and how the general community was unprepared for deinstitutionalisation when it occurred:

“The problem we have is a societal thing and it’s been going on now since roughly around about the nineteen seventies when Government decided that we would have community care for people with mental illness. Up until then people with mental illness, particularly schizophrenics, were housed inside a mental hospital which had a fifteen, twenty foot high wall and no-one knew what went on in there and then they brought them out in the community but we did no education with the community of why we were, to put it bluntly, releasing these people into the community and there was no support systems provided for them … most of the people in the wider community only understand schizophrenia from a negative perspective and they don’t understand that there’s highs and lows and lows and highs and in-between things and therefore there is a very strong fear factor … how do I talk to these people? How do I approach these people? How do I even communicate with them?”

One community participant said, “I keep getting confusion between mental illness and sub-normality … you don’t know whether they’re mentally ill or actually sub-normal; you know, born with a mental deficiency …. I don’t know. What’s the difference?”

One participant diagnosed with schizophrenia said, “I think you really have to confront this idea that people with a mental illness are retarded because it’s not like you lose any of your intelligence after you go through that process.”

Another participant living with schizophrenia said, “They [the public] think schizophrenics are axe murderers. It’s quite amazing how many people you meet they [say], Ah I thought you were an axe murderer.”

Although a number of participants disclosed having a family member or acquaintance with a serious mental health condition, there was evidence that people generally tend to avoid close personal contact with individuals living with mental health conditions. A further participant diagnosed with schizophrenia said, “You tell people you’ve got schizophrenia and they run a mile.”

A university student recalled the limitations of whole of school meetings on particular topics:

“I think when they talk about it [mental health] in a big meeting it makes it seem like something that never really happens. It’s like it’s a one-off kind of thing. It’s like we’re just warning you guys you [’re] probably not going to need any of this. It’s the same as maths … you think when am I going to need this and you don’t pay attention. So that’s a shame when they do try and do things they do the wrong things that have kind of opposite side-effect.”

An employment consultant pointed out how media images may undermine education received at school:

“When I was at primary school we had mental health people, guest speakers, come in … and would speak to all the school once a month about everything but then you’d go home and [then] you’d watch some dude on TV portraying someone with bipolar and it was completely different to what they were telling you during the day.”

A Mental Health nurse compared the information on Mental Health to the education provided on other health issues:

“Everyone right from when they’re at school, you know, kids learn about diabetes and you might have a diabetic in your class, but you might have someone whose parent has a mental illness … these kids, anybody, can learn about it if it’s normalised in that way. Because how many people have mental illness? There’s at least one what in five or there’s probably more … it’s not talked about. It’s getting talked about, but it could start earlier on in people’s lives how normal having a mental is and it doesn’t mean pushing trollies is the only scope that you’ve got. You can be whatever you want to be and then try and support that, just like anybody else that has some other disability.

A teacher noted, “I’d like to see mental health awareness in the school curriculum right through, so it’s just engrained in people. —In the same [way] that we do about racism and disability now. You know kids are taught that differences are okay … (P33)

Participants referred to the benefits of early education as well as the implications of lack of education on employment prospects of people living with psychosis. For example, an Employment Consultant said:

“I feel community education has to happen but maybe it needs to happen a lot earlier in schools, yeah, so that it becomes more normalised … so that those school children then become employers, co-workers or whatever, and that support system and understanding is already there … “

Teachers included in the sample made creative suggestions as to how this message could be communicated to school children. One secondary school teacher described a successful project she had undertaken with a school class:

“I asked my supervising teacher if I could show the DVD to the students, and I did it for two classes and there was about twenty students in each of the year eleven and twelve classes … and I showed them a DVD that I’d made. It was about ten minutes long and I interviewed my brother [living with paranoid schizophrenia] in his home … and the students received it exceptionally well and a lot of them really identified with it. A lot of them sort of went, ‘Ah we look after my cousin, and she’s got schizophrenia’. How many kids in that classroom knew or had connections to people with mental illnesses was quite astounding for me actually and there was a real solidarity in the room after talking about it, and the teacher, after that, asked all of the students to write personal letters to X to say what they got out of it and as a result I took to X forty letters from the students, individually written letters, and the effect that that had on X was quite astounding and they said things like, ‘You’re a really cool dude’ and, ‘you look like a rock star’ but a lot of them said, ‘Hey you just look really normal’, ‘You sound really normal’, ‘You’ve really opened my eyes up’, ‘Thank you very much’.”

Another secondary school teacher, when asked what impact she thought it would have on teenagers if a guest with a serious mental health condition was invited into the classroom to talk about their condition, responded in this way:

“I think they’d be really interested. I reckon you could hear a pin drop ‘cause I think they’d be really wanting to know what this person goes through because I don’t think they know much about it at all.”

A carer participant shared the following experience of a group of women who contacted high schools in the local area and went into high schools:

“… the response they got was fantastic. All the kids who came forward, the parents … see it was de-stigmatising it in the community. This could happen to anyone, a friend of yours … that was the bottom line, alerting people to be tolerant that this was an illness like anything else.”

A secondary school teacher suggested the need to directly address the subject of stigma saying, “if they were actually educated on stigmas and why people put those stigmas on things … I think it would be great.”

One participant explained, “it’s a bit like a lot of discrimination. It’s easy to do when it’s not attached to a personality, but as soon as you put a personality and a real person behind that image it changes people’s perceptions. “

Another secondary school teacher suggested, “Maybe if it was just this place where they could just go and sit down and just have an informal chat to somebody. They make it very formal … you have to go and make an appointment with the guidance officer and there’s also like a chaplain there as well but he’s not there very much ’cause he travels around all the schools …. In an ideal world, I just picture a relaxed kind of room where somebody’s there all the time and … you don’t need to make an appointment or whatever. If you feel you need to talk to somebody, you just get a note from the teacher and go down to this room and you don’t have to talk and you don’t have to have a solution at the end of the talk but you can just go there and sit down … cause it’s hard as a teacher because you go there with your end goal being I want these kids to learn this by the end of the lesson but [for] some of them the first thing on their mind is not accounting and studying for their test on Wednesday. They’ve got other stuff going on so … and some of it is really serious stuff so I think there should be a more holistic approach to educating and helping them grow …”

Reference: Hampson, M., et al. (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.