Historical –  set the scene

Stigma around mental health challenges is centuries old, crossing every nationality, culture and time period (Tartakovsky, 2018). As a consequence, stigma is still deep-seated in society’s ways of thinking. In addition, research links powerful negative media images with public prejudice, as reinforced by the sensationalist approach of the media which is fuelled by the motivation to be prejudiced, ignorant and fearful of mental illness (Harteneck, 2015). This escalates and perpetuates damaging stereotypes of people with mental health problems. This means that those affected by stigma are less likely to share their struggles, more likely to develop physical/mental health conditions and are less likely to access support (NHS, 2019). However, there is evidence of attitude change through lobbying by Mind and Rethink Mental Illness charities, from the Department of Health, the Big Lottery Fund and Comic Relief, through campaigns like World Mental Health Day and Time to Change and via the introduction of legislation (for example The Equality Act, 2010) that protects and seeks to support those who are experiencing mental health challenges in the workplace (Tartakovsky, 2018). Nonetheless, there is still a long way to go before the deep-rooted stigmatisation of those with mental health challenges can be fully overcome.

How to take care of ourselves and our clients?

Evidence suggests that there are lots of different ways in which we can start to improve our mental wellbeing (see – https://www.theguardian.com/careers/2017/oct/11/six-steps-to-improving-mental-wellbeing-work). The first is to connect with those around you. This includes friends, family, work colleagues and neighbours. Ask how they are. Are they having a good week? Spend some time getting to know people and building connections. NHS (2019) suggests this could also be done in the following ways:

speaking to someone new today;

having lunch with a colleague;

phoning, then perhaps visiting a friend or family member who needs support or company in addition to those who do not;

Volunteering at a local school, hospital or community group.

There is strong evidence to the effect that good relationships of all kinds, especially with family, friends and our wider communities are important for our mental wellbeing. Understandably this could be challenging for some people, especially those who experience social anxiety. Try and think of relationship building as an individual process that can be different for each of us. A phone call to a friend, a meal with a sibling, a text to a parent and/or an email to a manager are all ways that relationships, both personal and professional, can be strengthened.  Approach this at whatever level works best and if social anxiety is getting in the way of building strong relationships go and speak to your GP who can advise further, either over the phone or face-to-face.

Considering your physical activity levels is another way to improve wellbeing. Being active means different things to different people. Some people will enjoy the gym, whereas others would enjoy a walking in the countryside or the local park. Find an activity that you enjoy and make it a part of your life. Being active is great for your physical health and fitness (See – https://www.theguardian.com/lifeandstyle/2019/mar/04/moving-the-body-boosting-the-mind-running-your-way-to-better-mental-health), and evidence shows it can also improve your mental wellbeing (MIND, 2019). You could try the couch to 5K podcase for a bit of motivation which involves building up physical fitness levels so that eventually 5 k of walking or running is achieved, – see https://www.nhs.uk/live-well/exercise/get-running-with-couch-to-5k/. Sometimes physical ill-health means that exercise in any form can be challenging due to, for example, restricted movement. When considering this, talk to a physiotherapist or GP about how you can start to build on your physical health. This could include 20 leg lifts every day for a week which are then upped to 40. Or light weight dumbbells could be used whilst sitting. The important thing is to talk to a professional about what is best for you as everyone’s circumstances are different which means everyone’s situation requires individualised advice. Without this you could cause an injury so always seek out professional support.

Learning has been shown to increase mood and provide people with a way to keep the brain active. This relates to learning new skills which could mean a course at a college or school or even reading a book to stimulate interest.  One in four adults will experience mental illheath in any given year (MIND (2019), so mental health challenges are common.  A great place to start learning is to read about the current mental health initiatives. World Mental Health Day is the 10th October every year. The overall aim is to raise awareness of mental health issues around the world and organise efforts in support of mental health. On my ward (and when I am working out in the community with those who experience mental health challenges), I use World Mental Health Day to provide an opportunity for all those working in, and accessing, mental health services to talk about (or write about) their experiences. This would include exploring what more needs to be done to make mental health care a reality for people worldwide. More information on World Mental Health Day can be found at – https://www.mentalhealth.org.uk/campaigns/world-mental-health-day.

Loneliness is a proven risk factor in the developmental of mental health challenges (Tartakovsky, 2018) and therefore activities to offset the effects of poor mental health include classes in cookery, nutrition, or art. Classes can be expensive – so be creative and think outside of the box. Look out for free classes or outing and sign up. For example, The Square Food Foundation offers free cooking classes in Bristol (see – http://www.squarefoodfoundation.co.uk/cooking-from-scratch). Learning can boost self-confidence and self-esteem, help build a sense of purpose I and help us connect with others (MIND, 2019). Giving to others has been shown to give us a sense of pride and increase feelings associated with a positive mood. This could relate to volunteering in a local charity shop. Even the smallest act of kindness or empathy afford positive feedback to the giver.  Examples of this include telling someone you have missed that you have missed them or giving that great aunt you have not spoken to the ages a call. Positive mental wellbeing means feeling good about yourself and the world around you and being able to progress with your life in the way you want. The evidence is clear in showing that when we give to others, in any form, we feel better and happier in ourselves (Tartakovsky, 2018).

Finally, learning how to practice mindfulness or even to meditate has been shown to have a positive impact on wellbeing. I practise mindfulness: this includes taking time out to be more aware of the present moment, including my thoughts, feelings, body and the world around me. There is increasing evidence in support of mindfulness and how this can increase self-awareness and a more positive sense of self (MIND, 2019).

Current campaigns – successes and challenges?

‘Time to Change’ is the name of England’s largest mental health anti-stigma campaign and was launched in 2009. It is led by the mental health charities Mind and Rethink Mental Illness and is funded by the Department of Health, the Big Lottery Fund and Comic Relief. The Time to Change campaign has succeeded in adding to  a decrease in mental health stigma, according to Corker et al (2013). Between 2008, (the year before the campaign was launched), and 2011 there was a significant fall in the level of discrimination reported to have been experienced by people using mental health services and a small increase in the proportion of people who reported experiencing no discrimination. However, the Corker et al (2013) study used a limited sample who were mainly male and who were in recovery, so it’s possible that this isn’t a true reflection of the whole population. To make sure statistics are complete, we’d need to make sure we include females and those who are not accessing services. Although limited research such as this does show some positive change, more research is still needed.

What we can do moving forward?

Education campaigns can also help reduce stigma, according to (Tartakovsky, 2018). The research suggests, however, that not all age groups are included in this. This affords an opportunity to develop campaigns specific to different communities as stigmatisations comes in many different forms and from many different places.

I have watched a number of education campaigns that involve individuals with a mental health problem telling their personal story, either through film clips or face-to-face in workshops, with an emphasis on hope and recovery. Such ‘social contact intervention’ is proven to be an effective way to reduce stigma and discrimination (Harteneck, 2015). There is an urgent need for a drastically balanced view from the media. So, in view of this, educational campaigns should target the media to ensure a more balanced and accurate coverage of mental health issues. This is crucial as the media can perpetuate negative stereotypes through inaccurate and distorted reporting of news stories. Surveys of newspapers in England show that just under half of the articles on mental health are stigmatising, using pejorative language and/or emphasising the risk of violence to others (Tartakovsky, 2018). Another way to combat stigma is through an anti-discrimination policy and legislation. Legislation has already proved successful in reducing the discrimination experienced by people on grounds of gender, race or sexual orientation (Harteneck, 2015). The Equality Act (2010) made it unlawful in Great Britain to discriminate directly or indirectly against someone who has a disability in work, education, public services and  other specified situations. The Act defines a disability as a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on a person’s ability to carry out normal day-to-day activities. The definition of long-term is a year or more, or mental illness that had recurred for the same length of time. As such, this definition could include people with a wide range of mental health problems such as learning difficulties, depression, schizophrenia, bipolar disorder, post-traumatic stress disorder and obsessive-compulsive disorder, some of which co-occur (Harteneck, 2015). The Act also requires employers to make reasonable adjustments in the work- place not only for mental illness but also for people with a diagnosis of dyslexia or dyspraxia.

To conclude:

The evidence is that those with mental health challenges have, historically, been treated unfairly with a clear emphasise on deprivation of their rights. More recently, things have started to improve with the introduction of specific policies on mental health together with information on ways to help maintain positive wellbeing and reduce mental health difficulties. Nonetheless, government initiatives can only do so much and there is still a need for the media to offer balanced and realistic perspective on what mental health means which can  help to further destabilise the negative stereotyping and stigma.

References and resources:

Celebrity supporters of the ‘Time to Change’ anti-stigma campaign discuss mental health problems in a series of video interviews. Cited on: https://www.time-to-change.org.uk/media-centre/spokespeople, accessed 11 10 19.

Corker, E., Hamilton, S., and Henderson, C. (2013). Experiences of discrimination among people using mental health services in England 2008-2011. British Journal of Psychiatry. Volume 202, pages 58 – 63.

Harteneck, P. (2015). 9 Ways You Can Improve Your Mental Health Today. Cited on: https://www.psychologytoday.com/us/blog/women-s-mental-health-matters/201510/9-ways-you-can-improve-your-mental-health-today, accessed 01 11 19

Information about Time to Change (England’s biggest programme to challenge mental health stigma and discrimination). Cited on: see https://www.time-to-change.org.uk/media-centre/spokespeople, accessed 22 10 19.

MIND (2019). How to improve your mental wellbeing. Cited on: https://www.mind.org.uk/information-support/tips-for-everyday-living/wellbeing/#.Xb6bYzP7SMo, accessed 22 10 19.

Moving the body, boosting the mind: running your way to better mental health. Cited on: https://www.theguardian.com/lifeandstyle/2019/mar/04/moving-the-body-boosting-the-mind-running-your-way-to-better-mental-health, accessed 01 11 19.

Six steps to improving mental wellbeing at work. Cited on: https://www.theguardian.com/careers/2017/oct/11/six-steps-to-improving-mental-wellbeing-work, accessed 05 11 19.

Tartakovsky, M. S. (2018). 15 Tips to Boost Your Well-Being and Happiness. Cited on: https://psychcentral.com/lib/15-tips-to-boost-your-well-being-and-happiness/, accessed 01 11 19.

User friendly information leaflets on a wide range of mental health problems, produced by the Royal College of Psychiatrists. Cited on:  https://www.rcpsych.ac.uk/mental-health/problems-disorders, accessed 01 11 19.