Thornicroft Presentation

Slide1 : From Green Paper to Action Social Exclusion or Social Inclusion? EPP-PD Public Hearing on The Green Paper on Mental Health 08.06.06 Professor Graham Thornicroft g.thornicroft@iop.kcl.ac.uk World Health Organisation Collaborating Centre


My Perspective : My Perspective Psychiatrist working in community mental health services in London for 20 years Chair of committee which set policy for adult mental health services in England for current decade Professor in Mental Health Services Research Founder of European Network for Mental Health Service Evaluation (ENMESH) in 1992 Recent sabbatical to write a book on stigma, discrimination & mental health


Context: Deinstitutionalisation : Context: Deinstitutionalisation


Does Community-based Care mean Social Inclusion? : Does Community-based Care mean Social Inclusion?


What is Stigma? : What is Stigma? Problems of knowledge = ignorance Problems of attitudes = prejudice Problems of behaviour = discrimination → Exclusion


Key Domains of Exclusion : Key Domains of Exclusion Home life Work life Social life


Key Domains of Exclusion : Key Domains of Exclusion Home life Work life Social life


Discrimination at Home : Discrimination at Home Adverse reactions by family lazy / weak / amusing / avoidance Negative reactions to family members Low status or segregated housing High rates of homelessness Neighbourhood reactions to residential care


Slide11 : “At 16, in 1996, I suffered a bad mental breakdown where I was hospitalised for 5 years. It was very traumatic. There I was the eldest son suffering a sudden deep depression, crying and unable to work, often threatened by my confused Dad as being “weak”. Robert


Key Domains of Exclusion : Key Domains of Exclusion Home life Work life Social life


Discrimination at Work : Discrimination at Work Lower rates of short-listing and hiring Lower pay More often sacked for poor performance Dilemma of whether to disclose Problems getting ‘reasonable adjustments’


EPSILON StudySchizophrenia: Employment Rates (n=404) : EPSILON Study Schizophrenia: Employment Rates (n=404) Source: Thornicroft G., Tansella M., Becker T., et al & the Epsilon Study Group (2004) The personal impact of schizophrenia in Europe. Schizophrenia Research, 69, 125-132


Slide15 : “Unfortunately I have never suffered from such cruelty because when applying for jobs I never admitted to my own depression. If I had, I would never have stood a chance. People are frightened about anything to do with mental illness, they just do not understand the malady.” David


Key Domains of Exclusion : Key Domains of Exclusion Home life Work life Social life


Discrimination in Social Life : Discrimination in Social Life Less access to affordable insurance Welfare benefits and so low income Low rates of registration to vote Limitations: jury service property ownership / contracts (incapacity judgements) legal ability to sign contracts de facto seen not be a reliable witness in court Human rights fundamentally limited


Slide18 : “When I got sick for the first time I was seventeen and I was at high school. My behavior was awkward and my friends and classmates were making fun of me. I was feeling really bad about this. Then I was hospitalised. When they found out about this, they all abandoned me. I lost my friends”. Dimitris


International Study of Discrimination and Stigma Outcomes (INDIGO) : International Study of Discrimination and Stigma Outcomes (INDIGO) Graham Thornicroft, Institute of Psychiatry (IoP) King’s College London (KCL) Diana Rose, Service User Research Enterprise, IoP, KCL Norman Sartorius, WPA Global Programme to Reduce Stigma because of Schizophrenia


Discrimination and Stigma Scale (DISC) Report by consumers about experiences of discrimination in: : Discrimination and Stigma Scale (DISC) Report by consumers about experiences of discrimination in: personal relationships housing education family life work transport and travel 500 people interviewed financial affairs community life health & social services privacy and safety children avoidance 20 EU countries


Slide21 : “I have a friend who is very stigmatising when he talks about people with mental illness. For this reason I hide my problem. I know that if he knew about me he would break up our friendship.” Alexandros


Actions Needed at the EU Level 1 : Actions Needed at the EU Level 1 Application of disability discrimination laws to people with mental illness Sensitisation of employers to laws and what ‘reasonable adjustments/accommodations’ mean for people with disabilities related to mental illness eg the adoption of directive 2000/78/EC which prohibits discrimination on grounds of disability in the field of employment Measure the observation of human rights & dignity eg The Council of Europe in 2006 will initiate work to develop a “European reference tool for ethics and human rights in mental health”_


Actions Needed at the EU Level 2 : Actions Needed at the EU Level 2 Commitment to inclusion of people with mental illness in levers for change, for example: Committees setting inspection standards Inspectorates for institutions Assessments of incapacity and guardianship Eg Include people with mental illness in the Fundamental Rights Agency of the EU, which will become operational by 1 January 2007


References : References Thornicroft G. (2006) Shunned: Discrimination Against People with Mental Illness. Oxford University Press, Oxford (in press). Thornicroft G. Actions Speak Louder: Tackling Discrimination against People with Mental Illness. London: Mental Health Foundation; 2006. Pinfold V, Thornicroft G, Huxley P, Farmer P. Active ingredients in anti-stigma programmes in mental health. International Review of Psychiatry 2005; 17(2):123-131. Pinfold V, Toulmin H, Thornicroft G, Huxley P, Farmer P, Graham T. Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. Br J Psychiatry 2003; 182:342-346. Pinfold V, Huxley P, Thornicroft G, Farmer P, Toulmin H, Graham T. Reducing psychiatric stigma and discrimination--evaluating an educational intervention with the police force in England. Soc Psychiatry Psychiatr Epidemiol 2003; 38(6):337-344.