 | | | | by Fenno Outen |
Patrons of Warner Village Cinemas in the UK are once again being told 'It could be you' - but this time, the adverts are not for the National Lottery.
| '1 in 4', a two-minute film made for the Royal College of Psychiatrists' (RCP) 'Changing Minds' campaign, promotes the message that anybody can suffer from mental illness - and that one person in four already does. '1 in 4 could be your brother, your sister. Could be your wife, your girlfriend...1 in 4 could be your daughter...1 in 4 could be me...it could be you.'
| What is the point of this film? According to John Cox, RCP president, it is about 'challenging the discrimination against people with mental illness' (1). In seeking to challenge discrimination and stigma experienced by those suffering from mental illness, the RCP is putting establishment muscle behind a long-standing demand of users' groups like the mental health charity MIND, who represent the mentally ill (2). This marriage has some coping issues of its own: the launch of the 'Changing Minds' campaign was marked by complaints from users' groups that psychiatrists were part of the problem where the issue of stigma was concerned. But the RCP's willingness to get involved in this potential minefield, and the arrival of '1 in 4' on our cinema screens, illustrates the steady rise up the mental health agenda of efforts to combat 'stigma'.
| The argument for targeting stigma runs something like this. Everybody is at risk of mental illness, but symptoms are difficult to admit to because of the social stigma attached to mental illness. Therefore, sufferers are ashamed to seek help and their recovery is delayed. In addition, their illness is exacerbated by their exclusion from society, which follows from their being stigmatised.
| The argument sounds logical enough. Unfortunately, to work, it has to bracket together a range of problems, and this only creates confusion. Take the widely quoted '1 in 4' figure - supposedly the proportion of people affected each year by mental health problems. This figure not only includes a range of problems not previously covered by the term mental illness, such as alcoholism and drug addiction, but also lumps together the most mild 'illness', perhaps involving a GP consultation only, with the most severe, which may require long in-patient treatment.
| | | A mere 0.014 - 0.2 percent of the population have a severe mental health problem and resist official help |
| So, for example, the Sainsbury Centre for Mental Health suggests that 10 to 25 percent of the population may present annually with some kind of mental health problems (usually in a primary care setting). But the proportion who fall into the categories 'severe' and 'severe and enduring' are 2 to 4 percent and 0.3 to 1.5 percent respectively (3).
| Most tellingly of all, so far as the stigma argument is concerned, those who have a severe mental health problem and resist official help amount to a mere 0.014 to 0.2 percent of the population. This suggests that those most in need of help, but unwilling to use mental health services due to the associated stigma, may amount to fewer than two in every thousand people. Even this figure rests on the assumption that the difficulty in engaging the severely mentally ill with services is solely due to the stigma attached to mental illness.
| In reality, and as you might expect, factors such as suspicion or paranoia, previous unsatisfactory experience of mental health services and homelessness are all likely to account for the reluctance of some of this group to engage with the services they need. Taking this into account, the actual number of people suffering from severe mental illness, who are prevented from engaging with services because of 'stigma', is likely to be even smaller than two per thousand.
| And yet '1 in 4' will play in cinemas up and down the country, to audiences unlikely ever to find themselves having to cope with mental illness. The gap between the reality of mental illness and the exaggeration of this kind of health promotion propaganda is likely to mean that, while people may well take on board the message that 'mental health affects us all', this will only encourage the current fashion for reinterpreting everything from work stress to unhappiness as a mental health problem. Meanwhile, those who really know what mental illness means remain as isolated and misunderstood as ever.
Fenno Outen works in mental health in east London
Read on:
Are you the one in four? by Josie Appleton, 19 April 2001
Is mental illness just 'different'?
(1) Information about the RCP's 'Changing Minds' campaign can be found here
(2) See the website of the mental health charity MIND
(3) Keys to Engagement: Review of Care for People with Severe Mental Illness who are Hard to Engage with Services is published by the Sainsbury Centre for Mental Health 1998
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