End the mental illness stigma! The Lancet releases major report

Stigma can be “worse than the disease itself.”

Writing |Ling Jun

Source | “Medical Community” Public Account

“It’s time to end all forms of stigma and discrimination against mental health issues.” October 10 marks the 31st World Mental Health Day, published simultaneously in The Lancet The Major Report on Ending Stigma and Discrimination in Mental Health states that stigma can be more terrifying than the disease itself.

The study was conducted by more than 50 experts from around the world, including scholars from corresponding institutions in Beijing, Guangzhou, and Hong Kong SAR, China, who systematically reviewed and analyzed the effects of stigma impact, and interventions that can effectively reduce stigma.

Stigma can lead to social exclusion of people experiencing mental health problems (PWLE), resulting in discrimination and loss of individual rights, including access to health services, employment rights, reports

and long-term health.

“Our major report makes eight positive and practical, evidence-based recommendations to help millions of people around the world escape the social isolation, discrimination and violations of individual rights caused by stigma.” Report co-chair Professor Graham Thornicroft said.

World Mental Health Day was launched by the World Mental Health Alliance in 1992 to raise awareness of mental health issues across the community and to combat public prejudice. According to the World Health Organization, nearly 1 billion people worldwide have mental health problems.

This report argues that the associated stigma, which takes many forms, has had a profound negative impact on all aspects of the lives of persons experiencing mental health issues (PWLE), and further exacerbated the its mental health problems.

In terms of impact on individuals, stigma and discrimination have made PWLE feel “self-shame”, “freak”, “madman”, “mental”… From surveys of PWLE groups in more than 40 countries, the researchers collected some common derogatory terms.

Reports that one in seven teens aged 10-19 suffers from a mental health problem, and that shame has a detrimental effect on their relationships with family and peers, and can even lead to Exclusion from schools and community agencies. In the survey, some teens reported “humiliation” from school staff, expressing fear, disgust and contempt for mental health issues.

Stigma in the work environment also results in a corresponding reduction in employment opportunities and income for PWLEs. “I can’t disclose my health because the company sees people with mental illness as unstable and unable to work properly,” said one respondent, which means they often don’t get a fair job or promotion, and more Vulnerable to workplace bullying.

Shame also reduces motivation among PWLE groups to seek medical help. Even after medical treatment, bias from healthcare workers can lead to misdiagnosis – interpreting somatic symptoms as “nothing more than a mental/psychological problem”. At the same time, unlike most physical ailments, mental health issues are often excluded from health insurance plans.

Full communication with people you trust is an important way to improve your mental health. But “if they are afraid of being stigmatized and misunderstood by family members, teachers and peers, they are less willing to seek help.” Zeinab Hijazi, co-author of the report, believes that it is important to eliminate stigma against mental health issues so that They are no longer discriminated against.

Social contact is the most effective way to reduce stigma

The report also commissioned a global survey of PWLEs, with nearly 400 respondents in 45 countries (mostly non-developed countries):

93% agreed that PWLE should be treated with the same emphasis as people with medical conditions, and 89% agreed that stigma and discrimination negatively impacted most PWLE. And only 46% believe that the corresponding stigma and discrimination in their country has improved in the past 10 years.

“Ending stigma and discrimination must help PWLE engage in more structured social engagement with groups that do not have these problems, including face-to-face discussions, video calls, or through theatre, film, etc.,” said Professor Dr Petr Winkler, Director of the WHO Collaborating Centre for Research and Service Development in Public Mental Health.

After reviewing 216 systematic reviews, the report concludes that various forms of social contact between PWLE and non-PWLE groups are the most effective evidence-based ways to reduce stigma and discrimination .

After further research on 10 large-scale anti-stigma intervention projects around the world, scholars also found that PWLEs were involved in all levels of project development, discussing content and progress. Negotiations, while maintaining the long-term continuity of the project, will yield significant results.

“We should move from a ‘we need to help them’ attitude to one of acceptance and inclusion,” reads a related review.Individuals who experience the disease are themselves experts in this area. Their experience is unique. “

In addition, the media is a critical part of addressing stigma and discrimination. 90% of the respondents affirmed the role of the media, but when it comes to practice, 71% believe that the media is the main factor for worsening stigma and discrimination.

Therefore, this report also makes corresponding recommendations for the media:

All national and international media organizations should systematically remove stigmatizing content and publish a policy statement and action plan based on the findings of this report on how they will actively promote mental health and sustainably Contribute to reducing stigma and discrimination on mental health issues.

For governments, international organizations, schools, employers, health service providers, etc., the report found:

Issue international guidelines stating that all forms of stigma and discrimination against PWLE are unacceptable.

Government enacts policies to support ending stigma and discrimination.

Remove prejudice against PWLEs in the workplace so they have full access to educational opportunities, job participation and return-to-work programs

National curriculum and vocational training for all healthcare personnel, taught jointly by PWLE. School curricula should also include courses for students on evidence-based interventions to deepen students’ understanding of mental health issues.

An editorial published in The Lancet at the same time stated: “All of us have a responsibility to take action in our own work and life to improve ourselves, The mental health of loved ones, friends and colleagues. Ending the stigma of mental health-related issues is what we must strive for.”


[1] The Lancet Commission on ending stigma and discrimination in mental health, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01470 -2/fulltext#seccestitle380

Source: Medicine

Proofreading: Zang Hengjia

Editor in charge: Tian Dongliang

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