Citation
Riches, S., Hoare, G., Loughran, J., Fisher, H.L. and Rumball, F. (2022), "Editorial", Mental Health Review Journal, Vol. 27 No. 4, pp. 369-371. https://doi.org/10.1108/MHRJ-12-2022-096
Publisher
:Emerald Publishing Limited
Copyright © 2022, Emerald Publishing Limited
Researching the stigma associated with less common mental health conditions: an update from the Time to Change campaign
The past decade has seen a large shift in public attitudes about mental health. Since its inception in 2007, the Time to Change campaign, together with the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, sets out to measure attitudinal, behavioural and knowledge-based components of stigma at the national level. Such national campaigns and research indicate real progress towards challenging mental health stigma in England (Henderson et al., 2016). Consequently, people with lived experience of mental health problems today face a very different situation than the one faced by previous generations.
Despite general improvements in attitudes towards mental health, significant challenges remain. For example, certain mental health conditions continue to be misunderstood and stigmatised. Recent Time to Change research, which spoke with 4,000 individuals with lived experience of mental health problems in England, shows that the reality of living with less common mental health conditions like schizophrenia, personality disorders and bipolar disorder remains largely misunderstood (unpublished fieldwork, YouGov, 2019). Over four out of five (84%) people with lived experience did not believe that perceptions around such conditions have improved over the past decade, which is a major cause for concern. Even more worryingly, a quarter (27%) of people with lived experience of less common mental health conditions felt that discrimination against them has increased over the past decade.
Research into public attitudes towards less common mental health conditions is in its infancy. Findings to date suggest increased stigma towards conditions such as schizophrenia and personality disorders compared to other mental health conditions such as depression. Exploration of newspaper coverage of mental health conditions from 2008 to 2016 has shown that there are clear and consistent differences in how mental health diagnoses, experiences and behaviours are presented (Anderson et al., 2020). Schizophrenia continues to be presented in a stigmatising way, while other diagnoses tend to be less stigmatised. The prevailing stigma towards individuals with schizophrenia is supported by research from Public Health England’s British Social Attitudes survey, which found that there was a greater desire to avoid someone presenting with behaviours commonly associated with schizophrenia than behaviours associated with depression (Dean and Phillips, 2015). Such stigma has a direct impact on access to support and services, with a systematic review highlighting that the stigma experienced by people with psychosis can influence help-seeking and service contact (Gronholm et al., 2017). Stigmatising attitudes and a lack of knowledge about less common mental health conditions can also result in discriminatory behaviours towards individuals with personality disorders (Sheehan et al., 2016). Such negative attitudes have even been reported from healthcare staff (Gedara, 2021). Research has illustrated that nursing staff are less attentive to service users with borderline personality disorder compared to those with depression or schizophrenia (Markham and Trower, 2003), suggesting potentially elevated risks of ostracisation for individuals with personality disorder diagnoses within healthcare settings. This elevated stigma may be a result of poorer public knowledge and understanding about personality disorders compared to conditions such as depression and schizophrenia (Furnham et al., 2015).
Discussions of the societal improvements in attitudes towards mental health conditions in broad, general terms, risk overlooking a lack of change, or a potential increase in stigma, towards such less understood conditions. It may even perpetuate a narrative in which certain conditions, such as anxiety and depression, are viewed in a more acceptable and sympathetic light, while less understood conditions, such as schizophrenia, personality disorders and bipolar disorder, are “othered” and stigmatised. A participant in a recent Time to Change qualitative study said that there is a risk of “perpetuating a hierarchy of conditions”, with more common conditions on one side and less common conditions on the other (unpublished fieldwork, Time to Change [George Hoare and Hannah Rawson], 2019).
The Time to Change campaign came to an end in 2021. From the point of view of Time to Change as a campaign to end mental health stigma and discrimination, there are two aspects of stigma about less understood conditions that should be important considerations for future campaigns and research. First, we lack over-time tracking of national attitudes towards less understood conditions. Any intervention that seeks to change national attitudes, as Time to Change has done, would ideally track those attitudes with precision throughout. To assist towards such an aim, researchers should use social media for data collection to recruit large, representative public samples (Topolovec-Vranic and Natarajan, 2016). This could be achieved by researchers regularly posting on social media platforms to reach a diverse population, liaise with organisations to promote content and use paid promotional posts to target under-represented groups. Second, we lack research into the structure of stigmatising attitudes associated with different conditions, as well as how these stigmas are constructed and negotiated in different communities. There is an association between schizophrenia and an idea of “dangerousness” (Anderson et al., 2020), but we lack the necessary context and objective measures to say definitively that less understood conditions can be confidently distinguished from stigma about other diagnostic labels. As researchers committed to change, it is crucial to have robust, reliable evidence to drive interventions and to prioritise areas of mental health stigma and discrimination that most urgently need to change. To do so, researchers must use both quantitative and qualitative methods and involve people with lived experience in all stages of the research.
Stigma associated with specific conditions is still an important issue. Without funding to continue the dedicated and targeted work that brings about change, there is a real risk that attitudes towards people with mental health problems may harden and that people with lived experience of less understood conditions could disproportionately suffer. Future research and behaviour change campaigns should therefore make it a priority to investigate public knowledge and attitudes towards people with less understood conditions or symptoms, such as personality disorders and psychosis. This may serve to increase awareness, understanding and ultimately behaviour change in the public towards those living with these symptoms or diagnoses.
References
Anderson, C., Robinson, E.J., Krooupa, A.-M. and Henderson, C. (2020), “Changes in newspaper coverage of mental illness from 2008 to 2016 in England”, Epidemiology and Psychiatric Sciences, Vol. 29, p. e9.
Dean, L. and Phillips, M. (2015), “Attitudes to mental health problems and mental wellbeing findings from the 2015 British Social Attitudes Survey”, British Social Attitudes, London.
Furnham, A., Lee, V. and Kolzeev, V. (2015), “Mental health literacy and borderline personality disorder (BPD): what do the public ‘make’ of those with BPD?”, Social Psychiatry and Psychiatric Epidemiology, Vol. 50 No. 2, pp. 317-324.
Gedara, C.K., Harpur, R.A., Jakobsen, H. and Riches, S. (2021), “Staff attitudes towards service users with a diagnosis of a personality disorder on acute psychiatric wards”, Clinical Psychology Forum, p. 344.
Gronholm, P.C., Thornicroft, G., Laurens, K.R. and Evans-Lacko, S. (2017), “Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review”, Psychological Medicine, Vol. 47 No. 11, pp. 1867-1879.
Henderson, C., Robinson, E., Evans‐Lacko, S., Corker, E., Rebollo‐Mesa, I., Rose, D. and Thornicroft, G. (2016), “Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009–2015”, Acta Psychiatrica Scandinavica, Vol. 134, pp. 23-33.
Markham, D. and Trower, P. (2003), “The effects of the psychiatric label ‘borderline personality disorder’ on nursing staff's perceptions and causal attributions for challenging behaviours”, British Journal of Clinical Psychology, Vol. 42 No. 3, pp. 243-256.
Sheehan, L., Nieweglowski, K. and Corrigan, P. (2016), “The stigma of personality disorders”, Current Psychiatry Reports, Vol. 18 No. 1, p. 11.
Topolovec-Vranic, J. and Natarajan, K. (2016), “The use of social media in recruitment for medical research studies: a scoping review”, Journal of Medical Internet Research, Vol. 18 No. 11, p. e286.
Acknowledgements
H.L.F. was supported by the Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King’s College London [ES/S012567/1]. The views expressed are those of the authors and not necessarily those of the ESRC or King’s College London.
About the authors
Simon Riches is based at the Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and South London and Maudsley NHS Foundation Trust, London, UK.
George Hoare is based at Time to Change, Mind, London, UK.
Jo Loughran is based at Time to Change, Mind, London, UK.
Helen L. Fisher is based at Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK, and ESRC Centre for Society and Mental Health, King's College London, London, UK.
Freya Rumball is based at Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK, and Oxleas NHS Foundation Trust, Dartford, UK.