Thursday, October 29, 2015

Advocacy: Economic Inequality, Stigma and Discrimination for Those with Mental Illness

Opinion: Public attitudes toward mental illness can be more damaging than the condition itself

October has been a busy month for mental health activists. Hundreds of people turned up to participate in Montreal Walks for Mental Health on Oct. 4, and other local events were held to celebrate World Mental Health Day on Oct. 10, including mental health awareness weeks at local universities.

Attempts to raise awareness are vitally important, as people with mental illness still suffer numerous social inequities. This is especially so for people with the most severe mental illnesses, such as schizophrenia.

Many of these inequities relate to the basic necessities of life. Around 80 per cent of people with a severe mental illness are unemployed, even though approximately 70 per cent express a desire to work. Likewise, roughly 35 per cent of the homeless population have a severe mental illness. Unemployment, underemployment, homelessness and poverty are frequent experiences for people with severe mental illness, contributing to a life on society’s margins.

Shockingly, life expectancy among people with a severe mental illness is considerably lower than the rest of the population, by around 15 years. This has been attributed to preventable factors including poor diet, obesity, heavy smoking, lack of exercise and high rates of diabetes. Some of these problems have been linked to the side-effects of psychiatric medication. Rates of suicide, injury and victimization are also much higher. Contrary to popular belief, people with severe mental illness are much more likely to be a victim of crime rather than a perpetrator.

Sadly, stigma and discrimination remain ever-present realities in their lives, with research indicating that public attitudes toward mental illness have not improved. This leads to thwarted opportunities and social exclusion. Indeed, many people with mental illness report that societal stigma is more damaging than the symptoms of the illness itself.

These are outrageous statistics that should not be tolerated by a humane society.

Fortunately, numerous national and local projects, many of these driven by the Mental Health Commission of Canada, are attempting to address these inequities.

One of these initiatives is an effort to reduce homelessness among people with severe mental illness: the “at home/ chez soi” project. This $110 million five-year national project tested the Housing First model in five different cities. This model quickly places homeless people with mental illness in ordinary private market rental housing, with supportive social services given as needed. Results suggest over 60 per cent of previously homeless people partaking in the program had become securely housed. These are very good rates compared to other models. Housing First is now considered a cost-effective evidence based practice that can reduce homelessness.

Another recent milestone is the release of Canada’s first ever mental health strategy, Changing Directions, Changing Lives. This states that a national priority must be to “increase awareness and reduce stigma.” The Opening Minds program of the Mental Health Commission of Canada has been tasked with leading such anti-stigma initiatives.

Impressively, they have supported dozens of targeted “contact-based education” programs reaching thousands of people. These programs consist of people with mental illness visiting workplaces, schools and various other settings to make powerful and evocative presentations about their recovery. Evaluations indicate that this is a highly effective way to reduce stigma and stereotypes among people including teachers, students, employers and health-care providers.

The federal government announced in 2015 that funding for the Mental Health Commission of Canada would be renewed for another 10 years. This will allow important activities to continue and new initiatives to commence. It is hoped that the incoming government will continue to take action to diminish stigma and promote recovery, supporting the full social integration of people with mental illness.

Rob Whitley is the principal investigator of the Social Psychiatry Research and Interest Group (SPRING) at the Douglas Hospital Research Centre. He is also an assistant professor in the Department of Psychiatry at McGill University.

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