PDF (97kb) - Disability Agenda 6 - The National Disability Authority

Issue 6 / December 2004 – Promoting Positive Attitudes to Mental Health
Disability Agenda
National Disability Authority
Only 55% of respondents thought that people
with mental health difficulties should have the
same access to employment as everyone else.
(NDA – "Public Attitudes to Disability in Ireland, 2002)
Research consistently shows that peoples attitudes towards mental health cause unfair
treatment, social exclusion and isolation of children and adults who are experiencing mental
health problems. Uninformed or distorted ideas can lead to discrimination. Negative
attitudes can exacerbate mental health difficulties: lowering self-esteem and increasing
depression and anxiety. 1
Informing and challenging attitudes in Irish society has been a strategic priority for the
National Disability Authority in both of its strategic plans. The current strategic plan
2004-2006 commits that the Authority will:
■
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Develop public awareness of disability issues and support within Irish society for
inclusive policies and practices
Undertake to promote the inclusion of people with disabilities in society by working with
partner organisations to contribute to the education of people in Ireland around disability
issues. [2004;25]
>
1
www.mindout/net/iwi/id2-attitudes.asp
Disability Agenda Promoting Positive Attitudes to Mental Health
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The National Disability Authority established a number of statutory advisory committees
in 2002 including one on the area of mental health. The Mental Health Advisory
Committee’s (MHAC) membership includes people who have experienced mental health
difficulties, family members, statutory and non-statutory mental health interest groups and
service providers. The MHAC identified the promotion of positive attitudes to mental
health as a key priority and established a sub-committee to progress work in this area.
This Disability Agenda is based on the work of the MHAC including a scoping of literature,
policy and practice, a survey of mental health promotion in the Health Board Health
Promotion Departments and a workshop, which drew on national and international
expertise of mental health stakeholders.
Public Attitudes to Disability in the Republic of Ireland (2002)
The NDA carried out a survey of public attitudes to disability in 2001 in line with its
strategic commitment to identify and develop public awareness of disability issues and
attitudes towards people with disabilities. The study’s premise was that public attitudes
towards stigmatised groups have an influence on how society treats members of particular
groups, on public policy and services and on the self-perception of individuals labelled as
belonging to a particular category.
Public Attitudes to Disability in the Republic of Ireland (2002) reported how people with
disabilities and people without disabilities in Ireland perceive disability and people with
disabilities. The study covered all disabilities, including mental health difficulties.
The research findings contained serious messages about how people with mental health
difficulties are perceived. When respondents in the survey were asked whether people with
disabilities should have the same access to employment as everyone else, only 55%
though that people with mental health difficulties should have this right compared to 82%
in the area of physical disability. Thirty three percent of respondents though that they
should not have the same opportunities as everyone else. Only 55% of respondents felt
that people with mental health difficulties should have the right to the same fulfilment
through relationships and sexuality compared to 83% in the area of physical disability.
These findings indicate that attitudes to people with mental health difficulties are more
negative than those relating to people with physical, sensory or intellectual disabilities.
This contrasts with the general findings that showed strong basis of support among Irish
people for social change and full citizenship for people with disabilities. Significant work
is required to ensure that such support is developed specifically for the inclusion of
people with mental health difficulties. 2
2
NDA – Public Attitudes to Disability in the Republic of Ireland (2002)
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The Policy Context
"…mental health care has simply not received until now the level of visibility, commitment
and resources that is warranted by the magnitude of the mental health burden. Only a
very small percentage of national health budgets go on mental health." 3
Since the 1996 publication of the report of the Commission on the Status of People with
Disability, there has been significant legislative and policy activity on equality, human
rights and disability. The establishment of the National Disability Authority, the Equality
Authority, Comhairle, the Mental Health Commission and the Human Rights Commission,
the enactment of a series of legal instruments, reviewed in Disability Agenda 5 Legal
Systems of Redress, the recent publication of the National Disability Strategy and,
internationally, work towards a UN Convention on the Protection and Promotion of the
Rights and Dignity or Persons with Disabilities and advocacy for an European Disability
Directive and have created a dynamic legislative, policy and organisational context for
equality, human rights and disability.
Within health, the National Health Strategy "Quality and Fairness – A Health System for
You" (2001) committed to a new action programme around mental health and programmes
to promote positive attitudes to mental health. This mirrors international proposals. In
2001, the World Health Organisation stated that that public education and awareness
campaigns should be launched in all countries. 4
The Expert Group on Mental Health Policy’s report in 2005 will be a significant step in
the delivery of the Quality and Fairness commitment. (It is noted that the Department of
Health and Children’s review of disability services and the Northern Ireland Mental Health
and Learning Disability Review will also report in 2005.)
This legislative and policy context provides significant opportunities to realise the social
and human rights model of disability and embed values such as equality, participation,
quality and inclusion within policy, provision and wider Irish society as part of an
integrated social change agenda.
This Disability Agenda recommends the development of a population-based strategy,
which uses health promotion approaches, to promote positive attitudes to mental health,
informed by and building upon this context.
3
"Mental Health: A Call for Action by World Health Ministers", Ministerial Roundtables 2001, 54th World
Assembly, Geneva
4
"Mental Health: New Understanding New Hope", World Health Report 2001
Disability Agenda Promoting Positive Attitudes to Mental Health
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Key Concepts
The work of the MHAC focussed on an understanding of two key concepts Attitude and
Stigma and how these impact through discrimination on the lives of people with
experience of mental health difficulties.
Attitude
Attitude has been defined as
"a learned predisposition to respond in a consistently favourable or unfavourable manner
with respect to a given object"
and
"a psychological tendency that is expressed by evaluating a particular entity with some
degree of favour or disfavour". 5
Uninformed or distorted ideas expressed as misunderstanding, rejection, discrimination
and abuse can have a serious effect on the mental health of disabled people and their
participation within the economic, social and cultural life of society. Negative attitudes
within wider Irish society may also be held by the family and friends of people with mental
health difficulties, causing further damage and hurt.
Stigma
The original term "stigma" referred to a visible marking branded onto the body. This
visible mark carried with it social ostracism and shame. In present time stigmatised
individuals are
"members of social groups about which others hold negative attitudes, stereotypes and
beliefs or which on average receive disproportionately poor interpersonal and or economic
discrimination against members of the social category". 6
Stigmatisation of people who experience mental health difficulties is an excuse for
inaction and discrimination that is inexcusably outmoded". 7
5
www-unix.oit.umass.edu/~psych586/overheads/attdef.pdf
6
www.asc.upenn.edu/courses/comm240/spring 2001_shlopes/2definitions.htm
7
The Surgeon Generals Report 1999
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Stigma can:
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build upon and reinforce earlier fears and prejudices
when acted upon, have appalling consequences for the individual
plays into and reinforces existing social inequalities
reproduces relations of power and control.
One survey showed stigma as the single most negative influence on the lives of people
with mental health problems. 8
Mental Health Promotion
In a scoping exercise, which the NDA carried out on promoting positive attitudes to
mental health, many of the strategies and programmes identified emphasised the
promotion of mental health and well-being as an integral part of helping to change
attitudes and combat stigma. The NDA considers that health promotion provides an
effective theoretical and practice framework for addressing negative attitudes and stigma
towards people who experience mental health difficulties.
Health Promotion is the process of enabling people to increase control over and to improve
their health. Health promotion is the promotion of health enhancing activities and the
suppressing of health damaging ones. It includes not only the actions and attitudes of
individuals but also the policies and activities of industries, corporations, governments and
other public authorities. 9
The Ottawa Charter for Health Promotion outlines five ‘pillars’ of health promotion activity:
■
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building healthy public policy
re-orienting the health services – to advocate for health and to achieve a greater
balance between health promotion and the curative services
■
creating supportive environments – encouraging environmental measures which
improve health e.g. affordable housing
■
strengthening community action – incorporating community development approaches
into health promotion interventions so that communities are empowered to take control
and improve their health collectively
■
developing personal skills – by consulting people to identify their needs, involving
them in the process of planning and evaluation of health promotion programmes to
make them relevant and accessible.
8
www.mindout/net/iwi/id2-attitudes.asp
9
"Planning for the Future" p. 108
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Mental Health Promotion can be a tool in:
Strengthening individuals – or increasing emotional resilience through intervention
designed to promote self-esteem, life and coping skills e.g. communicating, negotiating,
relationship and parenting skills.
Strengthening communities – this involves social inclusion and participation, improving
neighbourhood environments, developing healthy and social services which support mental
health e.g. anti-bullying, workplace mental health, self-help networks.
Reducing structural barriers to mental health – through initiatives to reduce inequalities
and discrimination and to promote access to education, meaningful employment, housing,
services and support for people who are vulnerable. 10
Mental Health Promotion Survey
The MHAC undertook a short survey among Health Board Health Promotion Departments.
The aims were to identify the allocation of Health Board funding to mental health
promotion projects, the numbers of personnel dedicated to mental health promotion and
the range of projects undertaken either solely by the Health Boards or in partnership with
other agencies.
Eight Health Boards responded to the survey, demonstrating the interest in addressing this
area. They survey showed that there is myriad of good work and practice occurring
throughout the country, but that this lacks a co-ordinated strategic approach.
Consulting with the Sector
An information/consultation event titled, "Promoting Positive Attitudes towards Mental
Health in Ireland – Towards the Development of a Strategy" was held by the attitudes subcommittee
in 2004. The discussion amongst mental health stakeholders indicated a
consensus that a strategy should meaningfully include the experience of people who have
experienced mental health difficulties and promote a holistic approach to attitudinal
change, addressing the interplay between the social, physical and mental/emotional health
of individuals. For such a strategy to be successful, high level commitment within
Government Departments (not only the Department of Health and the Department of
Justice, Equality and Law Reform) is essential.
10
Department of Health UK – "making it happen: A guide to delivering mental health promotion"
6 Disability Agenda Promoting Positive Attitudes to Mental Health

Commentary
Current studies and literature suggest that a diagnosis of mental illness causes more
discomfort and stigma than other categories of disability. Research consistently shows that
social, exclusion, unfair treatment and isolation of children and adults with mental health
difficulties can result from public attitudes to mental health.
Action needs to be taken to harness the overall positive attitudes of the general public to
people with a disability and target the areas, which show negative attitudes. There is the
need for a comprehensive strategy adopting a multi-level and multi-pronged approach.
This should focus on the broad issues, which contribute to the stigmatisation of people
with mental health difficulties and adopt an holistic model in partnership with key
stakeholders in promoting attitude change and reduction in stigma and discrimination.
A strategic framework on informing and challenging attitudes should:
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involve all mental health stakeholders, particularly people who have experienced
mental health difficulties and used mental health services, who should be paid for
their expertise
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be grounded in a human rights and equality analysis
address socio-economic factors and the broad determinants of health and this should
be equality proofed across the nine areas of equality
be characterised by an integrated collaborative partnership approach
include an audit of activity on mental health promotion and attitudinal work
be informed by pilot projects focusing on specific target groups e.g. younger males.
The NDA can provide leadership in this area by:
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conducting research on attitudes towards people with disabilities and the impact of
negative attitudes on the lives of people with disabilities, their significant others and
wider Irish society
■
continuing to develop a strategy to promote positive attitudes to mental health, in
partnership with key stakeholders.
Disability Agenda Promoting Positive Attitudes to Mental Health
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Disability Agenda is a series of short reports produced by the National Disability Authority.
Previous editions cover:
1. Education
2. Pilot of proposed National Disability Study
3. Personal assistance services
4. Further Education, Training and Employment
5. Legal Systems of Redress
For further copies of this or any of the reports please contact: 01 608 0400
or email: nda@nda.ie
www.nda.ie
Disability Agenda
Issue 6 / December 2004
Promoting Positive Attitudes to Mental Health
Disability Agenda is available
in alternative formats on request
from the NDA
National Disability Authority
25 Clyde Road, Dublin 4
Tel: 01 608 0400
Fax: 01 660 9935
Email: nda@nda.ie