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With respect to your second point, people outside of the mental health field seriously underestimate the skills necessary to be an effective mental health professional and this undoubtedly accounts for the attempts to parachute in untrained individuals into mental health programs. It's hard to imagine that this would happen in any other area of medicine and underscores the extent to which the entire mental health enterprise suffers from stigma and discrimination.
Christine Diemert, globeandmail.com: One of our commenters raised the issue of labels in our articles on mental health and I wondered if you could comment on it.
kristy williams from Halifax: ... I think we need to carefully consider the language we associate with mental health issues. ... the potentially discriminating label 'mentally ill people' is used multiple times. Calling unique and diverse individuals mentally ill reduces their identify to their illness - we don't refer to people with cancer as 'cancerous people'.
Perhaps terms like people who have experienced mental illness would be a more just and respectful way to describe individuals (which may be any one of use at some point in our lives) who experience such an illness.
Heather Stuart: Christine, this raises an important point. Language counts! It can support, or it can undermine. Greater sensitivity to language is an important starting point in our fight against stigma and discrimination.
Keating Gun from Canada: Hi Dr. Stuart. Isn't it true that mental health care in Canada has often been unnecessarily and detrimentally hospital-based and emanating from psychiatry when community-based services would be more effective and economical? I would like to hear your opinions on who should deliver what kinds of mental health care and in what settings to obtain the best long-term results. And, can mental illness can be prevented or minimized in some through early detection and intervention, as some trailblazing US psychiatrists are now doing, especially with children? Would allowing interested highly skilled clinical psychologists to enrol in medicare insurance plans and creating public officers of mental health to promote mental wellness and head off social ills such as family violence and gang violence and youth suicide by improving public institutions and their responses, also help? What about quality control on services being provided, and research on efficacy
Heather Stuart: Keating: People who have mental health problems or disorders benefit from a wide array of supports and services, ranging from professionally oriented to peer oriented, and from hospital to community. The real challenge is not to pit one sector against the other, but to ensure that a comprehensive continuum of care exists that can be appropriately and easily accessed by people whatever their level of need.
Mary Mary from Canada: I know that to get into certain professions, there is the clause that it must be in the best interest of the public that you be able to enter that profession (ex: nursing). Do you know if this is directed specifically at those with mental illness? Are they considering that when these people are on an appropriate medication and have support they can manage in society, granted they have the intellectual capabilities of going into that profession?
Heather Stuart: Mary: Discrimination on the basis of any disability or illness is against the law, and there are an increasing number of employers who recognize the importance of promoting a mentally healthy work-force and mentally healthy work environments. Having said this, employment discrimination is still the most frequent stigma experience cited by people with mental health problems.
Elisabeth Pereira from CALGARY: Thank you for your work. I have been reading quite a few of your articles. They are passionate, thorough and very well written. Could you describe a bit about the programs/strategies used for an anti-stigma intervention? How easy and accessible are the materials (videos, plays etc) used in anti-stigma interventions? How do you avoid harm from these interventions? E.g. people start conversations that would reinforce stigma?
Heather Stuart: Elisabeth: Thanks for your complement. We have a number of strategies that we can use to reduce mental health stigma and discrimination, ranging from public health programs that target policies and practices that are discriminatory, to contact based approaches that bring people together in positive and empowering ways. Given the pervasiveness of stigma, we think that multi-pronged, multi-level approaches work better than one-shot interventions, but we do not yet have sufficient research in this area. We also know that some of our knee-jerk reactions to fighting stigma can have paradoxical effects. This means that we have to be careful to evaluate our anti-stigma initiatives and make sure that they are improving the lives of people who have experienced mental health problems.
We don't yet have a clearinghouse in Canada for anti-stigma materials so the best thing to do is to contact advocacy groups and large mental health organizations to find out what they are doing and what materials they are using. Be sure to ask if they have conducted outcome evaluations!
Christine Diemert, globeandmail.com: We've come to the end of our time. Thanks again Prof. Stuart for joining us today.