People with schizophrenia experience discrimination from family members, while looking for or trying to stay in employment, and while trying to make and keep friends. Such discrimination is found consistently across 27 nations worldwide. These are the conclusions of an Article published Online First and in an upcoming edition of The Lancet, written by Professor Graham Thornicroft, Institute of Psychiatry, King's College London, UK, and colleagues from the INDIGO* study group.
Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour — this can lead to impoverishment, social marginalisation, and low quality of life. In this analysis of 27 countries — rich and poor — the authors aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. Face-to-face interviews were done with 732 people with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC) which produces three subscores: positive experienced discrimination, negative experienced discrimination, and anticipated discrimination.
The researchers found that negative discrimination was experienced by 47% of participants in making or keeping friends; by 43% of participants from family members; by 29% in finding a job; by 29% in keeping a job, and by 27% in intimate or sexual relationships. Positive discrimination was very rare (at less than 5%). Anticipated discrimination affected 64% of participants in applying for work, training or education (ie, they did not apply for a job because they expected to fail because of discrimination by employers), and 55% looking for a close relationship. Most participants (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced.
The authors conclude: "This study opens a new arena of research characterising the nature and extent of discrimination against people with mental illness... Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.
"Even allowing for the possible effect of anticipated discrimination influencing patients' views of their experiences, negative experienced discrimination in many domains of life might be related to prior coercive mental-health service intervention. If confirmed by further studies, this finding might guide mental-health services to promote social inclusion and to rely less upon compulsory treatment in the future."
In an accompanying Comment, Beate Schulze, Research Unit for Clinical and Social Psychiatry, Centre for Disaster and Military Psychiatry, Zurich, Switzerland, says: "The INDIGO study is breaking new ground, pointing to the kind of research we need to more fully understand stigma and discrimination. By investigating actual discrimination and self-stigma, the study brings together the structural and cognitive perspectives that have not previously been combined... However, what remains to be done is to determine the effect of discrimination on health and social outcomes and translate these findings into effective public-health strategies."
Professor Graham Thornicroft, Institute of Psychiatry, King's College London, UK T) +44 (0) 207 848 0735 / +44 (0) 207 848 0483 E) g.thornicroft@iop.kcl.ac.uk
Camilla Palmer, Press Office, Institute of Psychiatry, King's College London, UK T) +44 (0) 20 7848 0483 E) Camilla.Palmer@iop.kcl.ac.uk
Beate Schulze, Research Unit for Clinical and Social Psychiatry, Centre for Disaster and Military Psychiatry, Zurich, Switzerland T) +41 76 50 71 306 E) beate.schulze@bli.uzh.ch
Full Article and Comment: http://press.thelancet.com/discriminationfinal.pdf
Notes to editors:
*INDIGO = International study of discrimination and stigma outcomes
**27 countries: Austria, Belgium, Brazil, Bulgaria, Canada, Cyprus, Finland, France, Germany, Greece, Hungary, India, Italy, Lithuania, Malaysia, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Switzerland, Tajikistan, Turkey, UK, USA
Please also note:
4Th Annual Anti-Stigma Conference: The research publication coincides with the start of a major International conference on mental health discrimination entitled 'Stigma and Discrimination: Evidence for Action' organised by the Institute of Psychiatry between 21 and 23rd January 2009. The UK Minister of State for Care Services the Rt Hon Phil Hope MP will address the conference and the Liberal Democrat Shadow Health Secretary, Norman Lamb MP, and Anne Milton MP, Shadow Minister for Health will also be speaking.
The conference will bring together 240 delegates from over 50 countries worldwide including service users, carers, health practitioners and researchers, government ministers, voluntary organisations and NGOs all interested in stigma and discrimination.
Today also sees the launch of the Time to Change campaign – England's most ambitious programme to end discrimination faced by people with mental health problems, and improve the nation's wellbeing. Mental Health Media, Mind and Rethink are leading this diverse programme of 35 programmes funded with over £18m from the Big Lottery Fund and Comic Relief and it is being evaluated by the Institute of Psychiatry, King's College London. For more information: Camilla.Palmer@iop.kcl.ac.uk / Louise.Pratt@iop.kcl.ac.uk
Journal
The Lancet