PDF (97kb) - Disability Agenda 6 - The National Disability Authority
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Issue 6 / December 2004 – Promoting Positive Attitudes to Mental Health<br />
<strong>Disability</strong> <strong>Agenda</strong><br />
<strong>National</strong> <strong>Disability</strong> <strong>Authority</strong><br />
Only 55% of respondents thought that people<br />
with mental health difficulties should have the<br />
same access to employment as everyone else.<br />
(NDA – "Public Attitudes to <strong>Disability</strong> in Ireland, 2002)<br />
Research consistently shows that peoples attitudes towards mental health cause unfair<br />
treatment, social exclusion and isolation of children and adults who are experiencing mental<br />
health problems. Uninformed or distorted ideas can lead to discrimination. Negative<br />
attitudes can exacerbate mental health difficulties: lowering self-esteem and increasing<br />
depression and anxiety. 1<br />
Informing and challenging attitudes in Irish society has been a strategic priority for the<br />
<strong>National</strong> <strong>Disability</strong> <strong>Authority</strong> in both of its strategic plans. <strong>The</strong> current strategic plan<br />
2004-2006 commits that the <strong>Authority</strong> will:<br />
■<br />
■<br />
Develop public awareness of disability issues and support within Irish society for<br />
inclusive policies and practices<br />
Undertake to promote the inclusion of people with disabilities in society by working with<br />
partner organisations to contribute to the education of people in Ireland around disability<br />
issues. [2004;25]<br />
><br />
1<br />
www.mindout/net/iwi/id2-attitudes.asp<br />
<strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health<br />
1
<strong>The</strong> <strong>National</strong> <strong>Disability</strong> <strong>Authority</strong> established a number of statutory advisory committees<br />
in 2002 including one on the area of mental health. <strong>The</strong> Mental Health Advisory<br />
Committee’s (MHAC) membership includes people who have experienced mental health<br />
difficulties, family members, statutory and non-statutory mental health interest groups and<br />
service providers. <strong>The</strong> MHAC identified the promotion of positive attitudes to mental<br />
health as a key priority and established a sub-committee to progress work in this area.<br />
This <strong>Disability</strong> <strong>Agenda</strong> is based on the work of the MHAC including a scoping of literature,<br />
policy and practice, a survey of mental health promotion in the Health Board Health<br />
Promotion Departments and a workshop, which drew on national and international<br />
expertise of mental health stakeholders.<br />
Public Attitudes to <strong>Disability</strong> in the Republic of Ireland (2002)<br />
<strong>The</strong> NDA carried out a survey of public attitudes to disability in 2001 in line with its<br />
strategic commitment to identify and develop public awareness of disability issues and<br />
attitudes towards people with disabilities. <strong>The</strong> study’s premise was that public attitudes<br />
towards stigmatised groups have an influence on how society treats members of particular<br />
groups, on public policy and services and on the self-perception of individuals labelled as<br />
belonging to a particular category.<br />
Public Attitudes to <strong>Disability</strong> in the Republic of Ireland (2002) reported how people with<br />
disabilities and people without disabilities in Ireland perceive disability and people with<br />
disabilities. <strong>The</strong> study covered all disabilities, including mental health difficulties.<br />
<strong>The</strong> research findings contained serious messages about how people with mental health<br />
difficulties are perceived. When respondents in the survey were asked whether people with<br />
disabilities should have the same access to employment as everyone else, only 55%<br />
though that people with mental health difficulties should have this right compared to 82%<br />
in the area of physical disability. Thirty three percent of respondents though that they<br />
should not have the same opportunities as everyone else. Only 55% of respondents felt<br />
that people with mental health difficulties should have the right to the same fulfilment<br />
through relationships and sexuality compared to 83% in the area of physical disability.<br />
<strong>The</strong>se findings indicate that attitudes to people with mental health difficulties are more<br />
negative than those relating to people with physical, sensory or intellectual disabilities.<br />
This contrasts with the general findings that showed strong basis of support among Irish<br />
people for social change and full citizenship for people with disabilities. Significant work<br />
is required to ensure that such support is developed specifically for the inclusion of<br />
people with mental health difficulties. 2<br />
2<br />
NDA – Public Attitudes to <strong>Disability</strong> in the Republic of Ireland (2002)<br />
2 <strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health
<strong>The</strong> Policy Context<br />
"…mental health care has simply not received until now the level of visibility, commitment<br />
and resources that is warranted by the magnitude of the mental health burden. Only a<br />
very small percentage of national health budgets go on mental health." 3<br />
Since the 1996 publication of the report of the Commission on the Status of People with<br />
<strong>Disability</strong>, there has been significant legislative and policy activity on equality, human<br />
rights and disability. <strong>The</strong> establishment of the <strong>National</strong> <strong>Disability</strong> <strong>Authority</strong>, the Equality<br />
<strong>Authority</strong>, Comhairle, the Mental Health Commission and the Human Rights Commission,<br />
the enactment of a series of legal instruments, reviewed in <strong>Disability</strong> <strong>Agenda</strong> 5 Legal<br />
Systems of Redress, the recent publication of the <strong>National</strong> <strong>Disability</strong> Strategy and,<br />
internationally, work towards a UN Convention on the Protection and Promotion of the<br />
Rights and Dignity or Persons with Disabilities and advocacy for an European <strong>Disability</strong><br />
Directive and have created a dynamic legislative, policy and organisational context for<br />
equality, human rights and disability.<br />
Within health, the <strong>National</strong> Health Strategy "Quality and Fairness – A Health System for<br />
You" (2001) committed to a new action programme around mental health and programmes<br />
to promote positive attitudes to mental health. This mirrors international proposals. In<br />
2001, the World Health Organisation stated that that public education and awareness<br />
campaigns should be launched in all countries. 4<br />
<strong>The</strong> Expert Group on Mental Health Policy’s report in 2005 will be a significant step in<br />
the delivery of the Quality and Fairness commitment. (It is noted that the Department of<br />
Health and Children’s review of disability services and the Northern Ireland Mental Health<br />
and Learning <strong>Disability</strong> Review will also report in 2005.)<br />
This legislative and policy context provides significant opportunities to realise the social<br />
and human rights model of disability and embed values such as equality, participation,<br />
quality and inclusion within policy, provision and wider Irish society as part of an<br />
integrated social change agenda.<br />
This <strong>Disability</strong> <strong>Agenda</strong> recommends the development of a population-based strategy,<br />
which uses health promotion approaches, to promote positive attitudes to mental health,<br />
informed by and building upon this context.<br />
3<br />
"Mental Health: A Call for Action by World Health Ministers", Ministerial Roundtables 2001, 54th World<br />
Assembly, Geneva<br />
4<br />
"Mental Health: New Understanding New Hope", World Health Report 2001<br />
<strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health<br />
3
Key Concepts<br />
<strong>The</strong> work of the MHAC focussed on an understanding of two key concepts Attitude and<br />
Stigma and how these impact through discrimination on the lives of people with<br />
experience of mental health difficulties.<br />
Attitude<br />
Attitude has been defined as<br />
"a learned predisposition to respond in a consistently favourable or unfavourable manner<br />
with respect to a given object"<br />
and<br />
"a psychological tendency that is expressed by evaluating a particular entity with some<br />
degree of favour or disfavour". 5<br />
Uninformed or distorted ideas expressed as misunderstanding, rejection, discrimination<br />
and abuse can have a serious effect on the mental health of disabled people and their<br />
participation within the economic, social and cultural life of society. Negative attitudes<br />
within wider Irish society may also be held by the family and friends of people with mental<br />
health difficulties, causing further damage and hurt.<br />
Stigma<br />
<strong>The</strong> original term "stigma" referred to a visible marking branded onto the body. This<br />
visible mark carried with it social ostracism and shame. In present time stigmatised<br />
individuals are<br />
"members of social groups about which others hold negative attitudes, stereotypes and<br />
beliefs or which on average receive disproportionately poor interpersonal and or economic<br />
discrimination against members of the social category". 6<br />
Stigmatisation of people who experience mental health difficulties is an excuse for<br />
inaction and discrimination that is inexcusably outmoded". 7<br />
5<br />
www-unix.oit.umass.edu/~psych586/overheads/attdef.pdf<br />
6<br />
www.asc.upenn.edu/courses/comm240/spring 2001_shlopes/2definitions.htm<br />
7<br />
<strong>The</strong> Surgeon Generals Report 1999<br />
4 <strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health
Stigma can:<br />
■<br />
■<br />
■<br />
■<br />
build upon and reinforce earlier fears and prejudices<br />
when acted upon, have appalling consequences for the individual<br />
plays into and reinforces existing social inequalities<br />
reproduces relations of power and control.<br />
One survey showed stigma as the single most negative influence on the lives of people<br />
with mental health problems. 8<br />
Mental Health Promotion<br />
In a scoping exercise, which the NDA carried out on promoting positive attitudes to<br />
mental health, many of the strategies and programmes identified emphasised the<br />
promotion of mental health and well-being as an integral part of helping to change<br />
attitudes and combat stigma. <strong>The</strong> NDA considers that health promotion provides an<br />
effective theoretical and practice framework for addressing negative attitudes and stigma<br />
towards people who experience mental health difficulties.<br />
Health Promotion is the process of enabling people to increase control over and to improve<br />
their health. Health promotion is the promotion of health enhancing activities and the<br />
suppressing of health damaging ones. It includes not only the actions and attitudes of<br />
individuals but also the policies and activities of industries, corporations, governments and<br />
other public authorities. 9<br />
<strong>The</strong> Ottawa Charter for Health Promotion outlines five ‘pillars’ of health promotion activity:<br />
■<br />
■<br />
building healthy public policy<br />
re-orienting the health services – to advocate for health and to achieve a greater<br />
balance between health promotion and the curative services<br />
■<br />
creating supportive environments – encouraging environmental measures which<br />
improve health e.g. affordable housing<br />
■<br />
strengthening community action – incorporating community development approaches<br />
into health promotion interventions so that communities are empowered to take control<br />
and improve their health collectively<br />
■<br />
developing personal skills – by consulting people to identify their needs, involving<br />
them in the process of planning and evaluation of health promotion programmes to<br />
make them relevant and accessible.<br />
8<br />
www.mindout/net/iwi/id2-attitudes.asp<br />
9<br />
"Planning for the Future" p. 108<br />
<strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health<br />
5
Mental Health Promotion can be a tool in:<br />
Strengthening individuals – or increasing emotional resilience through intervention<br />
designed to promote self-esteem, life and coping skills e.g. communicating, negotiating,<br />
relationship and parenting skills.<br />
Strengthening communities – this involves social inclusion and participation, improving<br />
neighbourhood environments, developing healthy and social services which support mental<br />
health e.g. anti-bullying, workplace mental health, self-help networks.<br />
Reducing structural barriers to mental health – through initiatives to reduce inequalities<br />
and discrimination and to promote access to education, meaningful employment, housing,<br />
services and support for people who are vulnerable. 10<br />
Mental Health Promotion Survey<br />
<strong>The</strong> MHAC undertook a short survey among Health Board Health Promotion Departments.<br />
<strong>The</strong> aims were to identify the allocation of Health Board funding to mental health<br />
promotion projects, the numbers of personnel dedicated to mental health promotion and<br />
the range of projects undertaken either solely by the Health Boards or in partnership with<br />
other agencies.<br />
Eight Health Boards responded to the survey, demonstrating the interest in addressing this<br />
area. <strong>The</strong>y survey showed that there is myriad of good work and practice occurring<br />
throughout the country, but that this lacks a co-ordinated strategic approach.<br />
Consulting with the Sector<br />
An information/consultation event titled, "Promoting Positive Attitudes towards Mental<br />
Health in Ireland – Towards the Development of a Strategy" was held by the attitudes subcommittee<br />
in 2004. <strong>The</strong> discussion amongst mental health stakeholders indicated a<br />
consensus that a strategy should meaningfully include the experience of people who have<br />
experienced mental health difficulties and promote a holistic approach to attitudinal<br />
change, addressing the interplay between the social, physical and mental/emotional health<br />
of individuals. For such a strategy to be successful, high level commitment within<br />
Government Departments (not only the Department of Health and the Department of<br />
Justice, Equality and Law Reform) is essential.<br />
10<br />
Department of Health UK – "making it happen: A guide to delivering mental health promotion"<br />
6 <strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health
Commentary<br />
Current studies and literature suggest that a diagnosis of mental illness causes more<br />
discomfort and stigma than other categories of disability. Research consistently shows that<br />
social, exclusion, unfair treatment and isolation of children and adults with mental health<br />
difficulties can result from public attitudes to mental health.<br />
Action needs to be taken to harness the overall positive attitudes of the general public to<br />
people with a disability and target the areas, which show negative attitudes. <strong>The</strong>re is the<br />
need for a comprehensive strategy adopting a multi-level and multi-pronged approach.<br />
This should focus on the broad issues, which contribute to the stigmatisation of people<br />
with mental health difficulties and adopt an holistic model in partnership with key<br />
stakeholders in promoting attitude change and reduction in stigma and discrimination.<br />
A strategic framework on informing and challenging attitudes should:<br />
■<br />
involve all mental health stakeholders, particularly people who have experienced<br />
mental health difficulties and used mental health services, who should be paid for<br />
their expertise<br />
■<br />
■<br />
■<br />
■<br />
■<br />
be grounded in a human rights and equality analysis<br />
address socio-economic factors and the broad determinants of health and this should<br />
be equality proofed across the nine areas of equality<br />
be characterised by an integrated collaborative partnership approach<br />
include an audit of activity on mental health promotion and attitudinal work<br />
be informed by pilot projects focusing on specific target groups e.g. younger males.<br />
<strong>The</strong> NDA can provide leadership in this area by:<br />
■<br />
conducting research on attitudes towards people with disabilities and the impact of<br />
negative attitudes on the lives of people with disabilities, their significant others and<br />
wider Irish society<br />
■<br />
continuing to develop a strategy to promote positive attitudes to mental health, in<br />
partnership with key stakeholders.<br />
<strong>Disability</strong> <strong>Agenda</strong> Promoting Positive Attitudes to Mental Health<br />
7
<strong>Disability</strong> <strong>Agenda</strong> is a series of short reports produced by the <strong>National</strong> <strong>Disability</strong> <strong>Authority</strong>.<br />
Previous editions cover:<br />
1. Education<br />
2. Pilot of proposed <strong>National</strong> <strong>Disability</strong> Study<br />
3. Personal assistance services<br />
4. Further Education, Training and Employment<br />
5. Legal Systems of Redress<br />
For further copies of this or any of the reports please contact: 01 608 0400<br />
or email: nda@nda.ie<br />
www.nda.ie<br />
<strong>Disability</strong> <strong>Agenda</strong><br />
Issue 6 / December 2004<br />
Promoting Positive Attitudes to Mental Health<br />
<strong>Disability</strong> <strong>Agenda</strong> is available<br />
in alternative formats on request<br />
from the NDA<br />
<strong>National</strong> <strong>Disability</strong> <strong>Authority</strong><br />
25 Clyde Road, Dublin 4<br />
Tel: 01 608 0400<br />
Fax: 01 660 9935<br />
Email: nda@nda.ie