SUMMARY POINTS • Everyone has the right to good mental health & well-being. But mental health-related stigma and discrimination are invisible walls that make it harder for people to access this – and many other – rights. • Making mental health & well-being for all a global priority involves directly addressing the stereotyped views about mental health conditions and how they affect people. • The stereotyped attitudes about mental ill health, which we call mental health-related stigma, can lead to the discrimination of people who have or are perceived to have mental ill health, which makes it harder for them to earn an income, have a voice in issues that affect them, gain access to quality health care, be part of their community and recover their mental health. • These negative attitudes also make leaders less likely to prioritize mental health in the political agenda and allocate funding to mental health-related programmes or services. • Mental health-related stigma and discrimination are often grounded in limited knowledge and understanding of mental health and well-being and its importance in our lives. • Mental health literacy campaigns and social contact interventions are the best ways of promoting people’s understanding of what it’s like to live with a mental health condition and the importance of mental health & well-being, which in turn helps in reducing stigma and discrimination. • Improving people’s understanding of the importance of mental health and well-being can reduce stigma & discrimination in short-term. WHAT: Mental health-related discrimination and stigmatization • “Stigma” refers to the negative, stereotyped views of people with a particular trait or condition, like depression, anxiety, an intellectual or learning disability, schizophrenia or any other mental health condition. • For mental ill health, these negative views may include that people with mental health conditions or who are experiencing mental ill health are weak, lazy, incapable, or violent or dangerous. People can also internalize these negative views, leading to poor self-esteem and a negative sense of self. • Discrimination refers to when some people are treated differently from others because of one or more characteristics they have or are perceived to have (such as a mental health condition) and, as a consequence, are deprived of their human rights (WHO QualityRights slides). • Negative attitudes and discriminatory behavior toward people with mental ill health are widespread, including in the WHO European Region: -- One study of 1085 people from 35 countries across the world found that 3 out of 4 experienced discrimination in at least one area of life (https://pubmed.ncbi.nlm.nih.gov/23083627/). -- Across the OECD countries, 1 in 4 thought that people with mental health conditions should be excluded from holding public office • The media can exacerbate misconceptions by portraying people with mental health conditions as dangerous, irresponsible or incapable of making rational decisions (World Mental Health Report 2022). • Stigma leads to social isolation and discrimination, which impacts a person’s ability to earn an income, have a voice in issues that affect them, gain access to quality health care, be part of their community and recover their mental health (World Mental Health Report 2022). • Stigma also affects the implementation of policies, including financing allocation, and to what extent mental health services are considered an essential element of care. • Discrimination can be embedded in organizations or even laws – organizations may have discriminatory hiring policies, preventing people from getting a job if they disclose that they have a mental health condition, while countries may have discriminatory laws that denies people access to a driving license or their own identity documents (World Mental Health Report 2022). • The right to work is one of the most commonly violated rights for people experiencing mental health problems. Even when people who are living with a mental health condition are able to get a job, they are often underpaid (World Mental Health Report 2022). • Negative views and discriminatory behaviors can come from anyone – family, friends, employers, including health care professionals. • Health care professionals may attribute a person’s complaints to their mental health condition, leading to the neglect and worsening of physical health conditions. • Many people would rather suffer in silence rather than risk the discrimination and ostracization that comes from seeking help for their mental health problems. • People with a mental health condition may not disclose that condition or use health care services because they fear being discriminated against. • Only 1 in 4 people with a severe mental health condition like psychosis are served by mental health systems. This can be partly explained by the stigmatization of mental health conditions, especially psychosis. HOW: End discrimination and stigmatization • Mental health-related stigma and discrimination are invisible walls that can impede people with mental health conditions from fully participating in their society and communities. These walls are present in schools, workplaces, governments, health care settings, even homes. • It is important to remember that everyone can experience mental ill health at any point in their life. • Mental ill health is caused by a complex range of biological, social, and psychological factors, not just “brain chemistry” or genetics. It is not a character failing • Ending the discrimination and stigmatization of mental health conditions requires the involvement of all these settings, most especially people living with mental health conditions. • Developing mental health awareness campaigns, health care interventions, and policies or laws in partnership with people living with mental health conditions can give them a sense of control over their lives and improve their self-esteem, while also reinforcing the most evidence-based anti-stigma intervention: promoting social contact. • Partnerships can also give health care professionals, ministers, and other experts a better sense of what it’s like to live with a mental health condition, which is then reflected in how policies and programmes are designed. Mental health awareness campaigns • Globally, only about half of countries have a mental health awareness or anti-stigma program at the national level (MH Atlas 2020). • The most effective method of improving mental health-related knowledge and attitudes in the short term is actually meeting and interacting with people who are living with mental health problems, or hearing their stories and feelings about what it’s like (World Mental Health Report 2022). • Sharing what it’s like to have mental ill health and experience discrimination can boost confidence and empower others to resist negative self-labels. • Awareness campaigns can also offer people with mental health conditions a sense of personal empowerment to challenge internalized stigma as well as overtly challenge commonly held prejudices and stereotypes. WHO actions • WHO has a toolkit that is available to everybody that can help in reducing mental health-related stigma and discrimination while promoting human rights, called WHO QualityRights. • WHO has made the QualityRights toolkit available to everybody • WHO also recently launched WHO QualityRights e-training, a free course that can help people with mental health conditions, their family and friends, and health care professionals. • The QualityRights e-training can be accessed here: https://www.who.int/teams/mental-health-and-substance-use/policy-law-rights/qr-e-training • Breaking down the walls of stigma and discrimination requires active collaboration between every sector of society, which makes coalitions such as the pan-European Mental Health Coalition well suited to tackling the issue. • WHO/Europe’s pan-European Mental Health Coalition is tackling stigma and discrimination as one of its key priority areas of collaboration. • Information on the Coalition can be found here: https://www.who.int/europe/initiatives/the-pan-european-mental-health-coalition Important URLs World Mental Health Report WHO: Mental Health Atlas Policy brief: WHO and ILO call for new measures to tackle mental health issues at work WHO: guidelines on mental health at work WHO HQ: World Mental Health Day web page Sources World Mental Health Report 2022. https://www.who.int/teams/mental-health-and-substance-use/world-mental-health-report Andersson, M. and Harkness, S. 2017. https://journals.sagepub.com/doi/abs/10.1177/2156869317733514 Campion, J., et al. 2022. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00199-1/fulltext Dobson, K. and Wolf, S. 2021. https://dx.doi.org/10.1037/sah0000323 OECD. 2021. https://www.oecd-ilibrary.org/sites/a0815d0f-en/1/3/1/index.html?itemId=/content/publication/a0815d0f-en&_csp_=fe4f5bb759b8e18551cbfb86eddc4c7a&itemIGO=oecd&itemContentType=book#section-d1e595) Walsh, D. and Foster, J. 2021. https://www.frontiersin.org/articles/10.3389/fpubh.2020.569539/full Further pictures: Further WHO pictures, 2022