Anti-stigma campaigns as a solution to the crisis of mental health care

“The Shared Society”, UK Prime Minister Theresa May’s recent speech at the Charity Commission annual meeting had four references to the stigma of mental health problems. Two of them are captured in this key excerpt:

For too long, mental illness has been something of a hidden injustice in our country, shrouded in a completely unacceptable stigma [emphasis added] and dangerously disregarded as a secondary issue to physical health. Yet left unaddressed, it destroys lives, separates people from each other and deepens the divisions within our society. Changing this goes right to the heart of our humanity; to the heart of the kind of country we are, the attitudes we hold and the values we share.

I remember the reaction when, back in 2012, Charles Walker and Kevan Jones spoke in Parliament about their own personal challenges with mental illness. The courage of these 2 MPs – Conservative and Labour – to speak out in this way, encouraged us all to put aside party differences and come together in solidarity.

That sense of solidarity will be essential in helping us to transform the support we offer those with mental health conditions and to defeat the stigma [emphasis added]  that makes addressing this issue so much harder than it should be.

The UK Independent reacted to an advance release of May’s speech with a decidedly skeptical commentary:

Theresa May pledges to tackle ‘stigma’ of mental health but dismisses call for extra funding

The Prime Minister says that mental health is one of the areas in which “the power of government” can be used to better people’s lives.

The speech however barely announces any extra cash to improve underfunded services – with just an extra £15m expected to be pledged for creating “places of safety”. This amounts to about £23,000 per parliamentary constituency.

May apparently believes solving the UK’s crisis in mental health care is about tackling stigma, not throwing money at the problem.

Speaking yesterday ahead of the speech, Ms May told Sky News’s Sophie Ridge on Sunday programme that “it is always wrong for people to assume that the only answer to these issues is about funding”.

Problems with mental health services are “more about the stigma that still attaches to mental health” than money issues, she said.

Some applauded the Prime Minister’s approach.

Sir Ian Cheshire, chairman of the Heads Together Campaign described the Prime Minister’s announcements as “extremely important and very welcome”.

“They show both a willingness to tackle the broad challenge of mental health support and a practical grasp of how to start making a real difference,” he said.

As an American, I did not know about the Heads Together Campaign. So, I googled and found:

heads together

The Duke and Duchess of Cambridge and Prince Harry are spearheading the Heads Together campaign to end stigma around mental health. Heads Together aims to change the national conversation on mental health and wellbeing, and is a partnership with inspiring charities with decades of experience in tackling stigma, raising awareness, and providing vital help for people with mental health challenges.

There has been huge progress made to tackle stigma surrounding mental health in recent decades, but it still remains a key issue driven by negative associations, experience and language. Through this campaign, Their Royal Highnesses are keen to build on the great work that is already taking place across the country, to ensure that people feel comfortable with their everyday mental wellbeing, feel able to support their friends and families through difficult times, and that stigma no longer prevents people getting help they need.

Being the 2017 Virgin Money London Marathon Charity of the Year is the perfect springboard for the Heads Together campaign. We cannot wait to see hundreds of runners hitting the streets of London in April to end the stigma and change the conversation on mental health once and for all.

Wow! Got it.  Running in the streets of London will start the conversation so that mental health services won’t need more money.

This strategy conjured up an old Onion story:

6,000 Runners Fail To Discover Cure For Breast Cancer

onion race

Despite their diligent, dedicated running, the 6,000-plus participants in Sunday’s 5K Race For The Cure did not find a cure for breast cancer.

Hopes were high, given the excellent weather and record turnout for the 11th annual event, but no viable cure for the disease was discovered along the 3.1-mile course.

“We were particularly hopeful of locating the cure somewhere around the two-and-a-half-mile mark,” race organizer Jill Broadbent said. “At that point, the route goes right past Northside Hospital and within a block of several Emory University oncology facilities. That seemed the most promising place to perhaps spot a breast-cancer cure. Regrettably, the runners were unable to do more than momentarily glimpse in researchers’ windows as they passed by.”

Disclosure: Over the past 17 years or so, I have been external scientific advisor to a progression of multilevel programs to improve the treatment of depression and reduce suicidality See for instance Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. All incorporated anti-stigma campaigns. My impression of what the campaigns contributed is that they energized communities and participating in them allowed citizens a sense of belonging to a positive movement, much like running for a cure for cancer. Anti-stigma campaigns may have been a part of a synergistic process in which the programs I was involved had benefits for the community beyond directly any measurable improvement in depression care or reduction in suicidality. We cannot tell.

The evidence for anti-stigma campaigns doing anything but influencing self-reported attitudes is weak and any effects are likely short-lived.

By no stretch of the imagination, are anti-stigma campaigns by themselves evidence-based ways of improving care for depression, decreasing levels of depression at the community level, or reducing suicidality.

But suppose, these campaigns are effective in the ways that members of the Royal Family and Prime Minister May assume. More people will feel more comfortable and more inclined, rather than less, to seek mental health services. This will further burden an already underfunded system with unacceptably long waiting periods for initiation of treatment.

A skeptical view, maybe cynical, is that an ineffective anti-stigma campaign would be politically useful, would not affecting demand for services or increasing costs, but would be quite  popular and distracting from the need for funds for a more effective response.

I blog at a number of different sites including Quick Thoughts, PLOS blog Mind the Brain, and occasionally Science-Based Medicine. To keep up on my writing and speaking engagements and to get advance notice of e-books and web-based courses, please sign up at CoyneoftheRealm.com