EDGES MAGAZINE Issue 29

May 2002

 

Mental Health – Still taboo?

James Sandbach

In an age of new orthodoxies such as globalisation, workplace diversity, equal opportunities, inclusive communities and respect for fundamental human rights one group has yet to receive any benefit from trends towards a more compassionate and widely based society – their world is so taboo that people who have experienced mental health problems regularly compare their exclusion from mainstream society as worse than serving a jail sentence. Break a leg and your friends sympathise – have a breakdown and all of a sudden nobody wants to know you, let alone employ you or value you as a human being.

The Government’s Social Exclusion Unit defines exclusion as a combination of problems such as unemployment, poor skills, low incomes, poor housing, high crime environments and family breakdown. For mental health service users the problems don’t stop there; every survey undertaken by Mind has revealed shocking truths about harassment within the community, for example Not Just Sticks and Stones (1995) found that of 778 users responding the survey 47% had been verbally or physically harassed in public because of their mental health problems, 14% had been physically attacked for instance had eggs thrown at them whilst being called a nutter or had dog faeces or lit paper pushed through their letter box, 62% said they had been treated unfairly and unkindly by family or friends.

Much of the responsibility for stigmatising people in mental distress rests with global media industries; some two thirds of current affairs programmes make links between mental ill health and violence although all the research shows that there have been reductions in homicides by mentally ill people over the last 20 years. Schizophrenic identity is portrayed in film and popular as an outlaw culture or else occasionally as inappropriately comic such as the recent film Me, Myself and Irene. Marketing stereotypes are also extremely unhelpful; examples range from the case of the ‘psycho trainer’ sports shoe to a major UK supermarket chain in the UK which saw fit to market a ‘schizo’ pencil - it is difficult to imagine similar marketing based around concepts like ‘cripple’ or ‘nigger’.

Mental Health organisations are striving to create a mood of disapproval of discrimination on mental health grounds to compare with the sensitisation that has begun to occur in such fields as HIV/AIDS or physical disability. The Government’s ‘Mind Out for Mental Health’ Campaign and the Institute of Psychiatry’s initiative on stigma are small steps in the right direction, but there is much work to be done. The sad fact is that across every social indicator – employment, accommodation, income, access to services people with mental health problems are lagging far behind the society and indeed well behind other socially disadvantaged groups.

Take employment – people with mental health problems have the highest rate of unemployment amongst people with long-term health problems, with only around 13% in employment. A survey by The Mental Health Foundation of those active in the labour market, 37% of people with mental health problems said they had faced discrimination when looking for work; 47% had experienced discrimination at work, and 55% couldn't tell colleagues about their experience of mental distress. In a previous survey by Mind, over a third of respondents reported that they had lost their jobs as a result of their psychiatric history, while 38% had been harassed, intimidated, or bullied at work, and 69% had been put off from applying for jobs because of their psychiatric history. Around half concealed their psychiatric history for fear of losing their jobs. Another survey of 120 companies showed that 28% would never employ someone who had previously suffered from a mental illness.

Take housing – rates of mental health problems amongst the homeless population are considerably higher that those of the general population; as many as 50% of the total homeless population have some form of mental health problems ranging from depression to severe mental health and personality disorders. Homelessness is both a cause and result of mental illness – once homeless it is impossible to access even the most basic services such as doctors and benefits offices, let alone get the help needed to face a mental health problem. People living in care settings fare little better in terms as they are unable to earn more than £15 a week without loosing benefits due to the restriction on therapeutic earnings.

Part of the problems with social exclusion lies with the paucity of services on which mentally distressed people depend. Incarceration may no longer be the order of the day, however today’s mental health services can ghettoise their users just as effectively – placing them in settings where they remain powerless, poor and lonely. Containment and sedation in the community are not the answer; people need help and support to recover and re-integrate into social and economic life. Community and support based models do exist can fail to take root due to ‘Nimby’ campaigns of public resistance. The implementation of the National Service Framework, the Governments promise of earmarked funding for delivery of mental health services and the introduction of the Supporting People Scheme are promising, but it remains to be seen how far they can redress the chronic under-funding of services.

Minds works on various different levels to address these issues; our network of Local Mind Associations around the country develop advocacy projects and services in defined geographical localities, we offer a legal advice line, contact with employers through ‘Employmentlink’ and disbursement of grants to a variety of projects such as mental health pilots in rural communities through ‘Rural Minds.’ Mind also has an important role in influencing policy through campaigning, research and education; recently we have been lobbying hard in Parliament to extend the Disability Discrimination Act to fully cover mental health, and for a radical overhaul of the Mental Health Act in a direction to address service users rights and needs. We are also working to ensure that the new structures in the NHS (primary care groups and Strategic Health Authorities) make mental health a key priority and adopt models of good practice.

Mind does not pretend to have all the answers to the problem of mental health social exclusion, however we exist to listen and work with others to address this last great taboo. A society depends on the mental well-being of individuals in order to operate as a society of rights, obligations and opportunity – it cannot function if one in four people are potential outcasts.

 

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