Guidelines for reducing prejudice, self-stigma and discrimination
Many of Changing Minds’ projects, events and performance-collaborations aim to reduce the prejudice, self-stigma and discrimination linked with mental health or addiction problems.
Self-stigma is the shame that people attach to having mental health problems, generally precipitated by experiencing prejudice or discrimination first-hand.
Prejudice is a preconceived opinion or judgement someone has about those who experience mental distress or addiction that is not based on reason, facts or actual experience.
Discrimination is the behaviour that comes from that shame. Discrimination involves treating people differently because of a personal characteristic like race, political view, gender, sexuality or health status.
Why don’t we say “stigma and discrimination” anymore?
The reason we concentrate on prejudice and discrimination, and not “stigma” is that stigma is a concept that is difficult to challenge (nobody believes that they’re being stigmatising).
Prejudice and discrimination on the grounds of “disability caused by mental-health problems” however, is something we can actively challenge through policy, practice and law, as it is illegal in New Zealand under the Human Rights Act to treat someone differently based on their experience of distress.
Through our partnerships and the Rākau Roroa programme we provide advice and training to help communities accept mental unwellness as a normal experience that can be understood and overcome. These projects empower people to be inclusive and supportive of each other, and so we provide these guidelines to support best practice.
What is de-stigmatising?
De-stigmatising is the process of removing the shame associated with a certain thing, in this case, the experience of mental distress. Simply being honest and real about personal experience, does not always yield material that reduces self-stigma or prejudice. Typically, destigmatising something involves presenting mental distress and addiction or substance misuse challenges as being understandable, relatable and importantly, possible to recover from.
When attempting to change negative attitudes, every element counts – from the content to its presentation. The inclusion of any aspect that reinforces ideas of dangerousness, unpredictability, inevitability (such as genetic predisposition) or the apparent durability of the experiences has been shown to increase prejudice, self-stigma and discrimination.
Research shows us that the following strategies are the most effective ways of reducing stigma:
Positive contact with a person who has experienced mental health problems and/or recovery from and is considered an equal to the target audience.
Leadership and participation by competent, intelligent people who also have experience of having their lives disrupted by mental health or addiction problems.
Emphasising how normal it is to experience mental health and addiction challenges and be able to recover from them.
Creating opportunities for the audience to relate to misunderstood or little-understood experiences by making them comparable to ordinary, everyday experiences (empathy, not sympathy building).
Providing information about dealing with challenging behaviours and responses rather than diagnoses, signs and symptoms. (Wherever possible, it is better not to mention diagnosis at all, but concentrate on the behaviour/ experience).
Demonstrating the value that can come from these experiences. And spreading the message that we can be enabled, not disabled by these experiences (#betterbecause).
Showing that people can recover or improve their experiences.
Ideally, the target audience will learn;
The human rights and the legal protections for people with mental distress or addiction experiences.
The impact of prejudice, self-stigma and discrimination on those with lived experience of mental distress and addictions and how to recognise unhelpful behaviours and attitudes, or unconscious bias in yourself and others.
The significant impact and power that language has in shaping negative attitudes, beliefs, and behaviours. Particularly by the media, by public figures and entertainment through the showcasing of isolated negative experiences. (What you say and how you say it matters).
Appropriate ways to interact with the issues and people who experience them.
That not everything people with experiences of distress or substance misuse do is connected to their experience of mental-health addiction problems.
To balance biological and psycho-social ways of understanding mental health problems and recovery. (e.g. There are many paths to recovery, many of which do not follow a traditional medical approach).
To see the individual in relation to their context and wider social community.
What increases prejudice, self-stigma or discrimination?
Research shows us that the following things are NOT destigmatising and can actually increase prejudice, self-stigma and discrimination:
Focussing predominantly on the hardest parts of trauma and distress.
You may feel that you’re being honest or that it provides great ‘drama’, but concentrating on the hardest parts of challenging experiences can be triggering for your audience. Additionally, focussing on negative experiences reinforces myths such as ‘mental health problems are scary’ and ‘people with mental health or addiction problems are dark or depressing and will make you feel bad’, or that ‘people with these experiences do not recover’. Concentrating only on these experiences also emotes “sympathy” in an audience, not “empathy” which changes behaviour (the desired effect).
Completely avoiding the hardest parts of mental unwellness.
This prevents people from changing their attitudes as they will not view the story they are hearing as representative of ‘real’ mental health or addiction problems. This may allow them to maintain negative attitudes for those they deem ‘really’ unwell. For positive contact to work, you/the character must not be an exception. Ideally, people can relate to the person or character, see them as someone who has/ has had significant challenges and overcome/ recovered from/ manages well/ or flourishes because of or despite them.
Sharing extreme examples without context.
If people only hear about sensational experiences or events without hearing about the context that explains why and how that experience occurred, they can be left thinking that mental distress is extreme and unpredictable. This can increase prejudice, fear and the motivation to distance oneself from people with mental distress or addiction experiences. This has incredibly damaging, far-reaching and long-term consequences for both self-stigma and discrimination.
Sharing stereotypical images of people with experience of mental distress or addiction without countering them in any way.
For example, jokes about people with OCD washing their hands all the time, people with psychosis wandering the streets ranting, people with depression being self-involved, criminals being mad and people with borderline personality disorder being manipulative reinforce prejudice without challenging it. These can be useful ways of starting discussions about the myths that surround mental health problems but are unhelpful in isolation.
Sharing personal perspectives as if they are universally-held perspectives.
Each person is a single-subject sample only. To speak to what “People with Lived Experience” in general think or experience one must refer to research and consultation processes that have involved multiple people from diverse world-views. Personal perspectives are particularly powerful as stories, however, when we fail to acknowledge the limits of our own experiences, we inadvertently reinforce the stereotype that people with lived experience are incapable of being objective or critically evaluating their own thoughts. Failing to acknowledge the limits of our own perspectives reinforces the myth that there is a single ‘right’ way to approach mental health and that people with different perspectives are ‘wrong’ and need to be taught.
Focussing on diagnostic labels as if they are meaningful entities on their own.
‘Bipolar’ disorder is the name of a cluster of symptoms, not a disease process. Schizophrenia is the name of a cluster of symptoms experienced for a specific period of time, not a brain disorder. Depression also is not a single thing, but a label for a set of experiences. Many different things can cause these clusters of symptoms and not all people with the same label will have the same needs. A diagnostic label does not tell people what a person needs, what they have been through or what their experiences mean to them or their whānau. Forming judgements based on those labels is false.
Making generalised statements about people who experience mental distress or addiction.
Everyone is different. We cannot make assumptions about people based on their mental health status. This message is at the heart of reducing prejudice and discrimination. Distress, addiction and the people who experience them are diverse and have diverse needs. People with personal experience are their own best experts on what their needs are. Only conversation in a safe environment with the person themselves can tell a professional or whānau member what that person needs.
Emphasising a biological or ‘illness’ understanding of mental health problems.
When people see mental-health problems as an illness, sickness or disease, they are more likely to see it as something that is durable and outside of personal control. This reinforces the idea that people with mental health problems cannot gain personal autonomy.
Emphasising a solely psycho-social understanding of mental-health problems.
Focussing on things like coping, choices, behaviour, spiritual belief, and interpersonal experience without acknowledging the interconnecting role of the body and the brain as our key instruments for processing information and acting on the world, can inadvertently increase prejudice and self-stigma. People may come to view mental health or addiction problems as the individual’s or their family’s fault and personal responsibility. An understanding of biological factors (such as fight/flight/freeze responses) in conjunction with the psycho-social helps reduce attitudes that ascribe personal blame and the myth that people should ‘just snap out of it’ or ‘listen to reason’.
Emphasising any of the following myths directly or indirectly increases prejudice, discrimination and self-stigma.
People always need medication to recover.
People who take medication will need to take it for the rest of their lives.
People who use medication are weak or disempowered.
Mental health and addiction problems are lifelong conditions.
People with mental health or addiction challenges need to be looked after (done to or for instead of with).
People with mental distress or addiction experiences are unemployable.
People with mental distress or addiction experiences are dangerous.
People with mental distress or addiction experiences are unpredictable.
Mental distress or addiction happens for no reason.
Mental “illnesses” are brain diseases.
Mental distress or addiction problems are genetic.
Mental distress and addiction are an individual’s responsibility.
mental distress or addiction is caused by an inability to cope.
People with experiences of mental distress or addiction lack insight.
Mental health problems are caused by a chemical imbalance.
People with experiences of mental distress or addiction do not want to get better.
Mental distress behaviour is inappropriate or abnormal reactions to the environment.
There is nothing anyone else can do to help.
Download our Guidelines for Reducing Stigma and Discrimination