Public attitudes to mental distress

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Introduction
What is mental distress?
Attitudes to mental distress
How do people feel towards those experiencing mental distress?
Mental distress and other forms of discrimination
How are negative attitudes constructed?
Language and mental distress
The media and mental distress
Mental health services and mental distress
The impact of negative attitudes to mental distress
People's attitudes to their own mental distress
Impact on the rights of people in mental distress
Impact on government policy
Challenging negative attitudes
Raising awareness
Challenging language
Challenging the media nationally
Challenging the media locally
Service user involvement
Useful resources
Useful contacts
References

Introduction

This factsheet is for students and professionals, and anyone else who is interested in public attitudes to mental distress.

Public attitudes to mental distress surface in many different ways. They may be apparent in the language people use to describe mental illness, or in their reactions to those experiencing mental distress. For the purposes of this factsheet, 'negative' attitudes refer to discriminatory attitudes that are based on prejudice, stereotypes or inaccurate information.

Negative attitudes towards people with mental distress may be manifested by physical and verbal abuse, problems in the workplace or discrimination by providers of goods and services. Negative attitudes are sometimes evident in the development of government policies on mental health.

This factsheet looks at these issues, and what is being done to counteract negative attitudes.

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What is mental distress?

Surveys of the public consistently show confusion about what 'mental distress' actually is. In 2003–04, research from an anti-stigma campaign found that most young people confused mental illness with learning disability. They also associated mental health problems with violence and with being locked up in an institution. [1]

Less than half of adults questioned in the 'British Attitudes Survey 2006/07' regarded someone with schizophrenia as being disabled, despite the fact that mental health conditions are covered by the Disability Discrimination Act (1995). [2] In a 2003 Department of Health survey, 55 per cent of respondents believed the statement that 'someone who cannot be held responsible for their actions' describes a person who is mentally ill. [3]

Evidently, ignorance and misinformation about mental distress are widespread in Britain today. [4] However, confusion also reflects the complexity of the subject and differences of opinion on the nature, causes and meaning of mental distress. To find out more about this, see the Mind booklet Understanding mental illness.

Here are some perspectives on mental distress from people who are involved with mental health services:

"The idea that schizophrenia can be viewed as a specific, genetically determined brain disease has been based on bad science … the major complaints of 'schizophrenia' are rooted in daily-life problems like traumatic experience ..." (Campaign for the Abolition of Schizophrenia). [5]

"Only the most fanatical could continue to deny that genetics play a part [in the causation of mental illness]" (researcher in social psychiatry). [6]

"Mental illness is ruthless, indiscriminate and destructive ... It is certainly not a weakness, but nor is it a sign of a special 'artistic' sensitivity" (mental health service user). [7]

"Now, a year later, I am comfortable with my mental illness ... I would not wish it on anyone but it has taught me a lot. I have grown as a person ... Depression has made me strong" (mental health service user and trainee psychiatrist). [8]

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Attitudes to mental distress

The following quotations give some idea of the negative attitudes people may have to mental illness:

"It often seems a good idea to keep quiet about my mental distress. Yet when I am asked why I don't drink or why I took a year out from university, it would be nice to say, 'I was ill with schizophrenia' or 'I take medication for schizophrenia' without fear of a negative reaction." [9]

"It was last summer, a short time before users were due to go in, the van outside was plastered with slogans like 'schizophrenics go home', the fence and house daubed with paint and abuse" [10] (Irene Chaloner, General Manager, Bromley User Group).

"All societies have struggled with the impact of mental illness, and rejection and avoidance of mentally disabled people are common. Even when the mad have been accorded a place of honour, as in cultures that believe mentally ill people have been touched by the Great Spirit, they have remained outside the group and have been feared" [11] (Sam Sussman, British Medical Journal)

"Where it is not politically correct to satirise people with physical disabilities for example, people with mental health problems have always been used to provide comic value" [12] (Rebecca Coombes, Community Care).

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How do people feel towards those experiencing mental distress?

Partly because of the confusion about mental distress, people with mental health problems are often stigmatised by our society, labelled as being violent, unpredictable and dangerous.

A survey at the start of the Royal College of Psychiatrists' five-year campaign to reduce the stigma of mental illness showed just how prevalent these negative attitudes are. In the survey, 1,737 adults were asked about seven common mental health problems: severe depression, panic attacks, schizophrenia, dementia, eating disorders, alcoholism and drug addiction. In the survey, people with schizophrenia, alcoholism and drug addiction were seen as unpredictable and dangerous, although this opinion was less common in people over 65 years of age. The respondents generally saw people with mental health problems as being difficult to communicate with and empathise with. There was also little sympathy for problems that were perceived to be self-inflicted, such as addictions and eating disorders. [13]

Worryingly, more recent evidence suggests that public attitudes in England may actually be getting worse. The 2007 'Attitudes to Mental Illness' survey found an increase in prejudice across a wide variety of indicators, including not wanting to live next door to someone who has been mentally ill, not believing that people with mental health problems have 'the same right to a job as anyone else', and believing that people with mental health problems are 'prone to violence'. [14] Younger people were more likely to hold negative attitudes, in particular by wrongly associating mental ill health with 'lack of self-discipline and willpower'. [15]

Much of the literature on public attitudes omits the fact that people with direct experience of mental distress make up a significant minority of 'the public'. At any one time, one in six adults in the UK is living with a mental health problem. [16] Despite this, people who use mental health services are often cast in opposition to 'the public', especially in media coverage linking mental health problems to violent crime. [17]

For the purposes of this factsheet 'the public' includes people with and without mental health problems. Many negative attitudes are held by members of the public who themselves have mental health problems. This issue is addressed further in People's attitudes to their own mental distress.

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Mental distress and other forms of discrimination

Negative attitudes towards mental distress may be compounded by other forms of discrimination such as racism, sexism, ageism and homophobia.

Several studies have shown that African-Caribbean men are more likely to be admitted to psychiatric hospitals, diagnosed with schizophrenia and sectioned under the Mental Health Act than other groups. This treatment of black men within the mental health system has been associated with beliefs held by mental health staff – and the wider public – that black men are more likely to be violent than their white counterparts. In fact, black men are no more likely than other groups to be aggressive prior to admission to hospital. [18]

Women who use mental health services are more likely than other groups to have their physical problems perceived as 'imagined' or psychosomatic. They may also be labelled as 'attention seeking' or 'manipulative' in relation to particular diagnoses, such as borderline personality disorder or eating disorders. [19]

Older people often face the assumption that poor mental health is an inevitable part of the ageing process. [20] Similarly, a fifth of gay men and lesbians and a third of bisexuals surveyed in 2003 recounted that a mental health professional had made a causal link between their sexuality and a mental health problem. [21]

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How are negative attitudes constructed?

Language and mental distress

Negative attitudes are partly constructed through the language we use to describe mental illness. People with mental distress are often described in pejorative terms. For example, perpetrators of acts of violence are often described as 'schizos', 'nutters', 'psychos', 'fiends', 'monsters' and 'maniacs' (particularly in the tabloid press), making a clear link between violence and mental distress. In a study of the national press during 1996, it was found that pejorative terms were used in 40 per cent of daily tabloid coverage of mental health issues and 45 per cent of Sunday tabloid coverage. [22]

The noun 'schizophrenic' is often used in stories describing violent events, as if the diagnosis explains why the violence occurred. In reality, the person who happens to have a diagnosis of schizophrenia may have been taking illegal drugs or may be inherently violent.

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The media and mental distress

The press
A 2005 survey into media coverage of mental health reported that journalists did not view mental health as a subject worthy of reporting in its own right, but as an incidental source of stories about conflict, human interest, the unusual and the sensational. [23] This echoes the long-standing concerns of many who are involved in mental health about the negative reporting of mental distress in the media. [24] The 2005 study showed that most mental health stories in the media concerned crime, and that highly stigmatising language was used in such stories. Severe mental illnesses (such as schizophrenia) received particularly negative coverage: stories were constructed around the risk of violence (usually implied to be high) and public safety. 'The public' were portrayed as people with no experience of mental distress, who needed protection from those with mental health problems. People with mental health problems were quoted in only six per cent of stories. [25]

Even though much reporting of mental health issues continues to link violence and mental distress, there is some evidence of positive change. A turning point for press coverage occurred in 2003, when The Sun newspaper was forced to withdraw the headline 'Bonkers Bruno locked up', reporting the sectioning of former boxer Frank Bruno under the Mental Health Act, following an outcry from the public as well as from mental health organisations.

There is evidence that press reporting of common mental health problems such as anxiety and depression has improved in recent years. The 2005 survey found that these issues were usually treated in much the same way as any other health issue. All types of press media were judged to have produced some sensitive, balanced and thoughtful coverage of common mental health problems. [26]

In 2006, the Press Complaints Commission (PCC) published a code of practice, which bans the use of stigmatising language such as 'schizo' and 'nutter.' This is linked to the PCC's rules against the discrimination of people with mental health problems and on accuracy in reporting. The PCC now encourages journalists to contact mental health organisations, including Mind, if they need further information. [27]

Television
Television coverage of mental distress has traditionally shared many of the attitudes revealed in press coverage. Mental distress can be used in non-fiction (news and documentaries) and fiction (soap operas and dramas) to create stories about 'conflict, human interest, the unusual and the sensational'. [28] Recently, these criticisms have been applied to 'reality' TV shows such as Big Brother. Some talk shows have also been criticised for exploiting people with mental distress to provide entertainment for the viewing public. These shows can also trivialise mental distress, offering, 'clichéd soundbites of advice and easy solutions to human suffering'. [29]

Encouragingly, television coverage of mental distress in soap operas has improved significantly in recent years, according to the annual Mental Health Media awards. [30] Mental health conditions that have been featured on well-known soap operas include Alzheimer's disease, bipolar disorder (manic depression) and postnatal depression. These stories have been associated with improved public awareness, increased willingness among the public to talk about previously 'taboo' subjects and increased willingness among those affected to seek help. [31]

Attitudes can also be improved by well-researched documentaries on mental health issues. This can be particularly effective when people with direct experience of mental distress are involved in production and are featured in the documentary, especially if these people are already well-known personalities. A recent example is Stephen Fry's very personal documentary about his own and other people's experiences of bipolar disorder. [32]

These improvements in the visibility of mental health on television may have contributed to one of the findings of the 2007 'Attitudes to mental illness' survey: survey participants believed that television had a more powerful and positive effect on their own attitudes to mental distress than publicity received through any other medium. [33]

Films
Caricatures of people in mental distress have occurred frequently in certain film genres. Horror or 'slasher' movies often contain a 'psycho' character, or it transpires that a character is mentally ill, as, for example in Scream II. This is an easy plot device: no thought need be given to the murderer's motivation – the state of his/her mental health is seen as an explanation in itself. It also means that the character can behave in an unpredictable way.

Some of the older children's films, such as Dumbo, Batman and Spiderman, perpetuate a portrayal of mentally ill people in a way that gives false impressions of mental distress, and risk children developing unsympathetic views. [34]

More recent films have portrayed a less sensational and more sensitive view of mental distress. For example, A Beautiful Mind (2002) depicts the true story of a maths genius who has a diagnosis of schizophrenia, while Shine (1996) is the story of a brilliant pianist who has a diagnosis of bipolar disorder. However, even the more positive portrayals can represent mental distress as 'exotic', 'dramatic' or 'romantic' in ways that rarely correspond to real-life experience. [35]

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Mental health services and mental distress

Contact with mental health services can draw negative public attention to a person living with mental distress. Mental Health Act assessments carried out at a person's home can cause stigma to the patient and their family, especially if the emergency services are involved. [36] The physical side effects of some psychiatric drugs can mark a person as having a mental illness more than do their original symptoms. [37] Diagnoses of mental illness have also contributed to the stigma of mental distress. Some diagnoses, such as schizophrenia and personality disorders, can evoke particularly negative public attitudes. [38]

There is evidence to suggest that people who work in mental health services hold more positive attitudes to those with mental health problems than do other members of the public. [39] However, many service users have reported negative attitudes from mental health staff, [40] including low expectations for a service user's long-term quality of life and high expectations of dangerousness (including violence). [41]

There is also evidence that psychiatrists' attitudes to specific mental health conditions can influence the diagnosis a person receives. A recent study showed that a history of violence increased the likelihood of a patient being diagnosed with schizophrenia. [42] If more violent people are diagnosed with schizophrenia, as opposed to other mental health conditions, this can reinforce the public's association of schizophrenia with violence.

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The impact of negative attitudes to mental distress

People's attitudes to their own mental distress

Negative attitudes to mental distress are as common among people who have experience of mental distress as among those who have not. Where a person with mental distress holds negative attitudes to their own condition, this can be seen as a form of 'internalised stigma'. [43] Research into other health conditions (such as HIV and AIDS) and particular social groups (such as those who are gay or bisexual) has shown that internalised stigma can have damaging effects on the way people see themselves, including low self-esteem and feelings of self-loathing. Similar psychological effects are produced when people with mental distress experience internalised stigma. [44]

Even when people with mental distress do not internalise negative attitudes, they may still be affected by stigma in other ways. A recent study showed that for 83 per cent of mental health service users, the possibility of facing negative attitudes was a major factor in choosing whether or not to be open about their mental distress. Participants in the study anticipated negative attitudes from employers, family members and friends. The study also found that uncertainty about others' attitudes could lead to feelings of anxiety, fear and shame, and lower expectations for quality of life. [45]

A separate study investigated the effects of public attitudes on a small group of people living with schizophrenia. The study found that, as a result of negative attitudes from family, friends, health professionals and the police, people with schizophrenia often lead isolated lives in which their personal identities are subsumed within a 'diagnosis' identity. [46]

Some mental health service users have rejected negative attitudes outright and have joined forces with other service users to challenge these attitudes publicly. For more information see 'Challenging negative attitudes' and the Mind factsheet, User empowerment.

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Impact on the rights of people in mental distress

Institutionalised prejudice
Organisations and professions, as well as individuals, can hold negative attitudes to people with mental distress. This can be seen as a form of institutionalised prejudice, which can affect the way people with mental health problems are treated by providers of goods and services. It can also impact on people with mental health problems who work for such organisations.

Insurance
People with mental health problems often have difficulty obtaining insurance cover, such as health, travel and life insurance, which can restrict their social opportunities and reduce their financial security. However, such discrimination is illegal in many cases. The Disability Discrimination Act of 1995 makes it unlawful to provide goods and services on less-favourable terms to a disabled person (including a person with a mental health problem) than to a non-disabled person, unless they can demonstrate a valid reason based on a specific health condition. [47]

Criminal justice system
Discrimination can also be found throughout the criminal justice system. In legal cases, evidence supplied by a person with a mental health problem may not be considered reliable, whether they are a victim or a witness of a crime. People with mental health problems are not eligible to perform jury service if they 'regularly visit a medical practitioner for treatment'. [48] This includes people who are prescribed psychiatric medication but who have not experienced an episode of mental ill health for many years.

Workplace discrimination
Stigma and discrimination faced by people with mental health problems may be particularly acute in the work place. A government report of 2004 found that one-third of people with mental health problems had been dismissed or forced to resign from their job. Almost four in ten felt they had been denied a job because of their mental health history, and over two-thirds had been put off applying for jobs for fear of unfair treatment. In many cases these fears are well-founded. Fewer than one in four employers would consider employing someone with a history of mental health problems. [49] However, some people who assumed they would be discriminated against at work found that their employers were sympathetic and supportive once they had been open about their mental health problems. [50]

The Disability Discrimination Act
The Disability Discrimination Act, which became law in 1995, was supposed to counteract the discrimination disabled people face in service provision and employment. However, the Act's definitions were so limited that many cases of gross discrimination were not covered. The number of cases brought on the grounds of mental health problems is low compared with the numbers arising from physical disabilities.

Since 2005, the amended Disability Discrimination Act has adopted a broader definition of 'disability' so that it now covers many more people with mental health problems. [51] In addition, all public bodies are now covered by the Disability Equality Duty (2006). This means that public service providers must demonstrate that their practices do not discriminate against disabled people, either as employees within the service or as service users. [52]

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Impact on government policy

Negative public attitudes to mental illness can influence government policy, particularly when these attitudes are reinforced by media coverage and when the press provides a stronger opposition than exists in parliament.

In January 1998, the then Health Secretary, Frank Dobson, criticised community care, saying: "We need to look at this right across the spectrum – from people who are just a bloody nuisance to people who may be a danger and against whom legal action needs to be taken." [53] These comments followed scathing articles about community care in the tabloid press.

A process to replace the Mental Health Act 1983 with new legislation has been under way since the late 1990s. One of the reasons for this reform is that people sectioned under the Mental Health Act can have their human rights denied in ways that are illegal under the European Convention on Human Rights. However, since the start of the reform process, some politicians have attempted to draw up legislation that will increase powers of compulsion against mentally distressed people, with insufficient protection for their human rights. The Government's first proposals, published in 2002, appeared to perpetuate the idea that people with mental distress need to be controlled by the state, for the public's safety.

The 2002 Bill, and a later draft Bill published in 2004, were withdrawn because of opposition from politicians across all the main parties and from organisations involved with mental health. Parliament passed a Mental Health Bill in July 2007, which is expected to improve the rights of people with mental distress. However, serious flaws remain. As Paul Farmer, Chief Executive of Mind, has written: "The new right to advocacy should help people who lose their liberty under the Mental Health Act to get their voice heard. However, a historic opportunity has been missed to tackle other fundamental problems – to fight race inequalities, give people with mental health problems the same rights to make choices as people with physical health problems, and to ensure that people can get help when they ask for it." [54]

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Challenging negative attitudes

Raising awareness

Several recent anti-stigma campaigns have shown that negative attitudes to mental distress are often improved when the general public is better informed.

One of the most powerful ways to improve attitudes to people with mental distress is by direct personal contact. [55] This can be through informal contact with family members, friends and neighbours who are open about their experiences of mental distress, or through interventions in which occupational groups such as healthcare workers, the police, journalists and faith group leaders are brought together with mental health service users. The World Psychiatric Association has details of such interventions through its 'Open the Doors' anti-stigma network. [56]

Attitudes can also be challenged by the acceptance of mental health service users into the work place. Some NHS Trusts now have vocational service staff whose roles include providing support to mental health services users who are seeking employment, and raising awareness among employers. Such schemes have generally reported encouraging results. [57] Over recent years, organisations in the voluntary sector have successfully worked with employers to overcome discrimination and improve employment opportunities for mental health service users. [58]

Much research on attitudes to mental distress – including the 2007 Attitudes to mental illness survey – has revealed that negative attitudes are particularly prevalent among children and young people. [59] The English anti-stigma campaign 'Shift' has begun to address this situation through Health and Education for Life (HELP), a school-based initiative in Liverpool. [60] The aim of HELP is to change young people's attitudes and coping strategies around mental health issues. In its four-year history, HELP has brought about significant improvements in young people's attitudes, and Liverpool local education authority has integrated the project into its secondary school curriculum.

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Challenging language

Many argue that we must find positive alternatives to the negative language that is used to describe mental distress. The act of thinking about a new non-discriminatory term may help us to reconsider some of the ideas and attitudes behind our language. Furthermore, if a label is treated as defunct, the prejudice behind it may lessen, and understanding may increase.

The following are examples of alternative terms that could be used.

The language issue is not straightforward, however. For example, there are arguments surrounding the use of 'mental distress' rather than 'mental illness'. The term 'mental distress' is used in an attempt to be as inclusive as possible – it implies a problem that anyone could have if they experienced the same traumatic event. However, what does this term do to decrease the prejudice faced by someone who has a diagnosis of schizophrenia but who believes this to be nothing to do with their previous experience? This person might argue that they should be accepted as different but treated equally. They may also feel that they do not have a 'mental illness' or 'mental health problem', but a different way of viewing and experiencing the world. Some campaigners also feel that the word 'mad' or 'schizophrenic' should be reclaimed rather than criticised.

It could also be argued that it is arbitrary to try to alter the terms people use. Replacement terms may eventually begin to take on negative connotations. For example, 'mental health' is often used to mean 'mental illness' and thus takes on a negative meaning that leads to confusion.

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Challenging the media nationally

Anti-stigma campaigns
National level campaigns carried out over the last 10 years have explicitly aimed to change public attitudes to mental distress. These campaigns include the English campaign 'Shift' and the Scottish campaign 'See Me' (see 'Useful contacts'). Both campaigns are funded by national governments and are carried out by a range of health, education and media organisations.

Crucial factors in the success of national anti-stigma campaigns appear to be political will and adequate funding. To date, funding for the 'See Me' campaign is more than 40 times more than for 'Shift'. During 2002 to 2005, public attitudes improved significantly in Scotland but deteriorated in England. Whilst a growing number of people in England wrongly associate mental ill health with violence, the number of people who do so in Scotland has almost halved over the three-year period. [61] Although it is difficult to isolate the causes of change in public attitudes, it is widely believed that the 'See Me' campaign has had a strong positive impact. [62]

Mind
As a national organisation, Mind works to improve public attitudes to mental distress, which may involve specific campaigns, such as the current 'End Stigma Now' campaign, carried out with Mental Health Media. [63] The work of changing attitudes is embedded in all of Mind's work, from lobbying for changes in government policy to supporting frontline services.

Mind Press Office
Mind's Press Office gives information and advice to journalists and programme makers, and is often asked to find people who have experienced mental distress who are willing to share their story, anonymously or otherwise. If you would like to find out more about this, contact the Press Office (see 'Useful contacts').

Mind Link
Mind Link is a national network of people who have personally experienced mental distress. As part of its work, Mind Link provides opportunities for its members to engage with the media. For more information about this, contact Mind Link (see Useful contacts).

Feedback on media coverage
It is often worth complaining about negative media coverage. Media organisations usually take the opinions of their audiences very seriously. For example, Dunlop planned a television commercial that featured psychiatric patients violently threatening a car, but withdrew it for re-editing when Mind expressed concern. [64]

You may also consider contacting the relevant industry-wide complaints body, such as the Press Complaints Commission or the Advertising Standards Authority (see 'Useful contacts').

It can be effective to praise positive presentation of mental health issues that you come across, perhaps by writing to the journalist, broadcaster, author, publisher or advertising agency.

It is helpful for campaigning organisations such as Mind and Mental Health Media if you notify them of the outcome of any complaint or praise you put forward.

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Challenging the media locally

Some user groups and health authorities, such as Leeds Primary Care Trust [65] and the Scottish Highland Users Group (HUG) (www.hccf.org.uk), have undertaken their own anti-stigma work, focusing on local media. The success of these activities largely reflects efforts to build relationships with those who work in the media and the involvement of mental health service users throughout the work. Much has been achieved by training and supporting service users to engage with local media. Involvement of service users has included providing feedback on media coverage, taking part in interviews, and designing information and publicity materials.

Several local Mind associations are involved with campaigns in their areas and Mind's Campaigns Unit has produced a guide that provides useful information and advice. For contact details, see 'Useful contacts'.

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Service user involvement

The mental health service user movement has its roots in the civil and welfare rights movements of the 1960s, such as Women's Liberation, Gay Liberation and Black Civil Rights: 'Living in a climate of irreverence and radicalism, many (including mental health service users) began to question the received wisdom of the time.' [66] Much of this 'received wisdom' concerned deep-seated negative attitudes to mental illness and to those who experience mental distress. Challenging these attitudes has always been central to the service user movement.

Since the 1990s, the service user movement has led to widespread involvement of service users in the planning and delivery of mental health services. Such involvement has clearly demonstrated that people with mental distress are able to design and run their own services and to develop alternatives to the medical model in understanding mental distress. Service users have gained social power by speaking and acting collectively. In doing so, users have worked with a range of individuals and agencies, including health services, social services, the voluntary and community sectors, and local and national media. This activity continues to challenge negative attitudes to mental distress.

To find out more about service user involvement, see the Mind factsheet User empowerment and 'Useful Resources' for further information.

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Useful resources

Books and booklets

The following books are available from Mind Publications (tel: 0844 448 4448, fax 020 8534 6399 or email publications@mind.org.uk).

Campbell, P. 2006, Some things you should know about user/survivor action: A Mind resource pack, Mind.
Cobb, A. 2000, Managing for mental health: the Mind employers' resource pack, Mind.
Dunn, S. 1999, Creating accepting communities: report of the Mind enquiry into social exclusion, Mind.
Mind 2001, The bird and the word: the Mind education pack, Mind.
Mind 2005, Understanding mental illness, Mind.
Sayce, L. 2000, From psychiatric patient to citizen: overcoming discrimination and social exclusion, Macmillan.
Sayce, L., Morris, D. 1999, Outsiders coming in? Achieving social inclusion for people with mental health problems, Mind.

Mind factsheets

Diversity issues
The African Caribbean community and mental health in Britain
Mental health of Chinese and Vietnamese people in Britain
Mental health of Irish-born people in Britain
The mental health of the South Asian community in Britain

Statistics
Mental health statistics Wales
Statistics 1: How common is mental distress?
Statistics 2: Suicide
Statistics 3: Race, culture and mental health
Statistics 4: The Mental Health Act 1983
Statistics 5: The financial aspects of mental health problems
Statistics 6: The social context of mental distress
Statistics 7: Treatments and services for people with mental health problems
Statistics 8: The Criminal Justice System

Miscellaneous
Dangerousness and mental health: the facts
Legal briefing: the Human Rights Act 1998
User empowerment

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Useful contacts

The Advertising Standards Authority (ASA)
Mid City Place, 71 High Holborn, London WC1V6QT
tel: 020 7492 2222
textphone: 020 7242 8159
website: www.asa.org.uk
For complaints about advertisements.

Commission for Equality and Human Rights (CEHR)
tel: 0207 215 8415 (general enquiries)
tel: 0207 215 8741 (media enquiries only)
website: www.cehr.org.uk
The aims of the CEHR are to reduce inequality, to eliminate discrimination, to strengthen good relations between people, and to protect human rights. From October 2007, the CEHR takes over the functions of the Commission for Racial Equality, the Equal Opportunities Commission and the Disability Rights Commission. The CEHR also covers rights and discrimination relating to age, faith/belief and sexuality.

Mental Health Media
356 Holloway Road, London N7 6PA
tel: 020 7700 8171
website: www.mhmedia.com
An initiative to provide media training and support for service users. Runs 'Open Up': an anti-discrimination toolkit project.

Mind Campaigns Unit
tel: 020 8215 2424
email: action@mind.org.uk
Promotes and coordinates Mind's national campaigns and supports local groups and individuals in their campaigning activity.

Mind Legal Unit
15–19 Broadway, London E15 4BQ
tel: 020 8519 2122 (key 0 and ask for legal advice)
email: legal@mind.org.uk 
Information and advice on mental health law, including the Mental Health Act.

Mind Link
15–19 Broadway, London E15 4BQ
tel: 020 8215 2207 or 020 8215 2210
email: MindLink@mind.org.uk
Mind Link is a network of people who have personally experienced mental distress. Mind Link works to ensure that users and survivors of mental health services have a direct say in shaping Mind's policies and campaigns.

Mind Press Office
tel: 020 8522 1743 (for enquiries from the media only)
tel: 029 2039 5123 or 029 2034 6575 (for all enquiries in Wales)
email: press@mind.org.uk  (media only)
Provides guidance to journalists on dealing with mental health issues and facilitates the involvement of people with experience of mental distress in engaging with the media.

Ofcom
Ofcom Contact Centre, Riverside House, 2a Southwark Bridge Road, London SE1 9HA
tel: 020 7981 3040 (for complaints or general queries)
textphone: 020 7981 3043
email: contact@ofcom.org.uk
website: www.ofcom.org.uk 
Ofcom is the regulator the UK communications industries, with responsibilities across television, radio, telecommunications and wireless communication services. If you find a broadcast to be harmful, offensive or misleading, or if you have any other kind of complaint, contact the Ofcom Contact Centre.

Open the doors
website: www.openthedoors.com 
Open the Doors is a global programme lead by the World Psychiatric Association to fight stigma and discrimination relating to schizophrenia. The website provides a wealth of useful information and materials.

Press Complaints Commission (PCC)
Halton House, 20/23 Holborn, London EC1N 2JD
tel: 020 7831 0022 (switch board England)
tel: 0845 600 2757 (helpline England)
textphone: 020 7831 0123
tel: 029 2039 5570 (helpline Wales)
24-hour press office line: 07669 158 536
24-hour advice line: 07659 152 656 (for emergencies only – leave a message and you will be phoned back)
website: www.pcc.org.uk 
For complaints about the editorial content of magazines and newspapers. The PCC requires a copy of the relevant article.

See me
tel: 0131 624 8945
website: www.seemscotland.org.uk 
The 'See Me' campaign was launched in October 2002 to challenge stigma and discrimination around mental ill health in Scotland. The campaign is run by an alliance of five Scottish mental health organisations, and receives funding from the Scottish Executive. The campaign combines a national publicity programme with local and national anti-stigma action.

Shift
tel: 0845 223 5447
website: www.shift.org.uk 
Shift is an initiative started in 2004 that aims to combat stigma against mental distress and to create a society where people who experience mental health problems enjoy the same rights as other people. Shift works with young people, public services, employers and the media. Shift is part of the Care Services Improvement Partnership (CSIP), a Government-funded organisation that supports positive changes in services and in the wellbeing of vulnerable people with health and social care needs. Covers England only.

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References

[1] Dunion, L. Gordon, L. 2005, 'Tackling the attitude problem', Mental Health Today, March, pp.22–25.
[2] O'Hara, M. 2007, 'Living with a label', The Guardian, 24 January.
[3] Department of Health 2003, Attitudes to mental illness: survey 2003, The Stationery Office.
[4] Thornicroft, G. et al. 2007, 'Stigma: ignorance, prejudice or discrimination?' British Journal of Psychiatry, 190; 192–3.
[5] Anon 2007, 'Bad science', Openmind, 143, p.9.
[6] Burns, T. 2007, 'Mental illness is not just about life experiences', The Guardian, 12 January.
[7] Allan, C. 2006, 'Misplaced pride', The Guardian, 27 September.
[8] Ahmed, A. 2007, 'Prejudice within', Psychiatric Bulletin, vol. 31, p.153.
[9] Garnett, B. 2007, 'Keeping secrets', Openmind, 143, p.12.
[10] Repper, J. Sayce, L. Strong, S. Willmot J., Haines M. 1997, Mind report 'Tall stories from the back yard'.
[11] Sussman, S. 1997, 'The community's response to mentally ill people', British Medical Journal, 314, p.458.
[12] Coombes, R. 1995, 'Sense and sensibility', Community Care.
[13] Haghighat, R. 2000, 'A unitary theory of stigmatisation', British Journal of Psychiatry, 177, pp.207–215.
[14] TNS 2007, Attitudes to mental illness 2007, Shift/CSIP.
[15] TNS 2007, Attitudes to mental illness 2007, Shift/CSIP.
[16] Mind factsheet 2005, Statistics 1: How common is mental distress?
[17] Perkins, R. 2006, 'Who are 'the public'?' Openmind, 142, p.14.
[18] Mind factsheet 2006, Statistics 3: Race, culture and mental health, Mind.
[19] Mind factsheet 2006, Women and mental health, Mind.
[20] Mind report 2005, Access all ages, Mind.
[21] King, M., KcKeown, E. 2003, Mental health and social wellbeing of gay men, lesbians and bisexuals in England and Wales, Mind.
[22] Ward, G. 1997, Making headlines, mental health and the national press, Health Education Authority, p.14.
[23] CSIP/Shift 2006, Mind over matter: improving media reporting of mental health, Sainsbury Centre for Mental Health, p.11.
[24] Baker, S. and MacPherson, J. 2000, Counting the cost: mental health in the media, Mind.
[25] CSIP/Shift 2006, Mind over matter: improving media reporting of mental health, Sainsbury Centre of Mental Health.
[26] CSIP/Shift 2006, Mind over matter: improving media reporting of mental health, Sainsbury Centre for Mental Health, p.12.
[27] Brook, S. 2006, 'Press told to mind its language', The Guardian, 22 November. See also the Press Complaints Commission Code of Practice at www.pcc.org.uk/cop/practice.html
[28] CSIP/Shift 2006, Mind over matter: improving media reporting of mental health, Sainsbury Centre for Mental Health, p.11.
[29] Clarke, J. 2004, 'Mad, bad and dangerous: the media and mental illness', Mental Health Practice, July, vol.7, no.10, pp.16–19.
[30] Jackson, C. 2006, 'Truly, madly, weekly', Mental Health Today, October, pp.10–11.
[31] Jackson, C. 2006, 'Truly, madly, weekly', Mental Health Today, October, pp.10–11.
[32] BBC 2006, 'Stephen Fry: the secret life of the manic depressive,' www.bbc.co.uk/health/tv_and_radio/secretlife_documentary_shtml
[33] TNS 2007, Attitudes to mental illness 2007, Shift/CSIP.
[34] Wahl, O. F. 2003, 'Depictions of mental illnesses in children's media', Journal of Mental Health, 12, no. 3, pp. 249–258.
[35] Lott, T. 2007, 'Losing the plot', The Guardian, 12 December.
[36] Chaplin, R. 2000, 'Psychiatrists can cause stigma too', British Journal of Psychiatry, 177, p.467.
[37] Sartorius, N. 2002, 'Iatrogenic stigma of mental illness', British Medical Journal, 324, p..1470-1471.
[38] Mind 2006, Dangerousness and mental health: the facts, Mind.
[39] Kingdon, D. et al 2004, 'What attitudes do psychiatrists hold towards people with mental illness', Psychiatric Bulletin, 28, pp.401-406.
[40] Thornicroft, G. 2006, 'Tackling discrimination', Mental Health Today, June, pp.26-29.
[41] Markham, D. 2003, 'Attitudes towards patients with a diagnosis of 'borderline personality disorder': Social rejection and dangerousness', Journal of Mental Health, 12, 6, pp.595-612.
[42] Clark, T. and Rowe, R. 2006, 'Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis', Psychiatric Bulletin, 30, pp.254-256.
[43] Thornicroft, G. 2006, 'Tackling discrimination', Mental Health Today, June, pp.26-29.
[44] Long, C. 2005, 'Recovery in mental health', Naidex, www.naidex.co.uk
[45] Anon 2006, 'Poll shows mental health stigma', BBC News online, 6 November.
[46] Knight, M. T. D. Wykes, T. and Hayward, P. 2003, '"People don't understand": an investigation of stigma in schizophrenia using Interpretative Phenomenological Analysis (IPA)', Journal of Mental Health, 12, 3, pp. 209-222.
[47] Mind factsheet 2005, Insurance cover for people with mental health problems, Mind.
[48] Criminal Justice System (2007) www.cjsonline.gov.uk/juror/summoning/eligibility
[49] ODPM 2004, Mental health and social exclusion: Social Exclusion Unit report, ODPM, p.27.
[50] Green, G., Hayes, C., Dickinson, D., Whittaker, A. and Gilheany, B. 2003, 'A mental health service users' perspective to stigmatisation', J Mental Health, 12, 3, pp.223-235.
[51] Disability Discrimination Act 2005, Chapter 13, Section 18 Meaning of "disability", The Stationery Office.
[52] DRC 2007, Disability Equality Duty www.drc.org.uk
[53] Anthony Bevins, 'Dobson denies call to scrap care in the community', Independent, 19 January 1998.
[54] Farmer, P. 2007, 'Mental health bill represents a missed opportunity for humane and progressive legislation, says Alliance', Mental Health Alliance online, 3 July.
[55] Thornicroft, G. 2006, 'Tackling discrimination', Mental Health Today, June, p.28.
[56] World Psychiatric Association 2007, Open the Doors, www.openthedoors.com/english
[57] Forrest, E. 2005, 'The route to work', Health Service Journal, 15 December, pp.24-26.
[58] Batty, D. 2007, 'Finding work - and new hope - after mental ill-health', The Guardian, 26 March.
[59] TNS 2007, Attitudes to mental illness 2007, Shift/CSIP.
[60] Shift 2007, 'The HELP project,' http://shift.org.uk/young-people/the-help-project.html
[61] Scottish Executive 2005, Well what do you think? The second national survey of public attitudes to mental health, mental wellbeing and mental health problems, Scottish Executive.
[62] Mind Press Release, 2007, New research reveals alarming increase in mental health prejudice in England, Mind.
[63] 2007, 'End stigma now: we need your views' Mental Health Media www.mhmedia.com/moving.html
[64] Baker, S. 2 July 1998, 'Mental illness is no joking matter', Community Care.
[65] Bispham, P. and Cameron, I. 2007, 'The media get the message', Community Care, 22 February.
[66] Mind factsheet , User empowerment. Mind.

This factsheet was written by Louise Flory, Information Unit, August 1998 and updated by Rachael Twomey, Mind Information Unit, July 2007.