Article for the new Parliamentary Health Magazine PH7 March/April 2002

Ending the stigma

If there was no shame attached to a visit to a psychiatrist then people would be more likely to seek help when they need it, writes Lynne Jones MP

People with a mental health problem are still perceived as dangerous and a nuisance that is best dealt with by separation from the rest of society. As a result, even though one in four of us will experience some form of mental ill health, the stigma associated with this condition prevents sufferers and their families and carers from being open about their circumstances. Thus there is not the pressure for improvements in services associated with other health needs.

It is therefore to the government’s credit that it took the decision in 1999 to give Mental Health the same priority as coronary heart disease in the programme of national service frameworks. These are being developed to lay down models of treatment and care which people will be entitled to expect in every part of the country. For mental health there are standards in five areas. I was particularly pleased that Standard One addresses Mental Health Promotion and states that health and social services should combat discrimination against individuals and groups with mental health problems and promote their social inclusion. An extra £700million was allocated over three years. It was acknowledged that implementing the National Service Framework fully across the NHS and social services and throughout other agencies could take up to 10 years. The need to reform the Mental Health Act to reflect modern treatments and care was also accepted.
So how are we doing three years on?

Sadly the debate on reform of mental health legislation has concentrated primarily on the issue of compulsion (as a result of the government proposal to extend compulsory treatment to community settings and to detain people with a severe personality disorder) though, to be fair, government ministers have stated that they want to see the use of compulsory treatment decline. This will not happen whilst services remain fragmented and crisis-driven and professional workloads remain unwieldy. Expectations raised by pledges of extra funding for Mental Health Services have not been met. According to parliamentary answers I received, only about half of the £700 million has been allocated and the proportion of NHS funding spent on Mental Health Services has risen from only 12.2 per cent in 1996/7 to 12.5 per cent in 1999/00. Furthermore the lack of joined-up government is evident from the decision of social security ministers to introduce compulsory interviews for claimants of disability benefits. Worry about benefits is a major contributory factor in psychiatric morbidity.

Despite good intentions there is a danger that pressures from more popular causes will mean the momentum for reform and improvement may be lost. The All-Party Group on Mental Health is working with mental health charities, professional workers and service users and their carers to try to ensure the government keeps on track.

If the quality of all mental health services is to reach that of the best, there must be greater respect for the contribution that people with mental health problems and their carers can make. Public perceptions will not be changed nor stigma overcome unless more service users are able to openly discuss their experiences.

Every family in the land is touched in some way by mental illness and yet the overwhelming public perception is that mentally ill people are dangerous and their problems self-inflicted. The only logical interpretation of this inconsistency is that people bottle up their own experiences, whether as a sufferer or as a relative or carer, because of the stigma that continues to be associated with mental illness. Thus is the low priority given to mental illness perpetuated.

We must break out of this cycle. Urgently-needed reform in legislation must put at its heart the need to treat people with respect. Those subject to compulsion should be seen as victims of inadequate services rather than treated as convicts. Respect requires that service users should have a say in their treatment – they are usually the greatest experts in their condition! Advance treatment directives should be given statutory status and people with capacity should not be treated against their will.

We must end the use of "confidentiality" as the excuse for preventing relatives and carers from being involved. Service users should be encouraged to include their close family in discussions about their treatment, which should not just be about doling out medication. Mentally ill people and, indeed, people suffering from "personality disorder" (the difference is usually artificial), have often experienced some trauma in their lives, which needs to be understood. Except in exceptional circumstances, family members are vital to this process and their continued support must be nurtured. Only if a patient specifically wants to maintain confidentiality, should next of kin be excluded. Measures need to be introduced to positively review such exclusion.

One day there will be no more shame attached to a visit to a psychiatrist than to any other type of medical practitioner and people will seek help when they need it. We are a long way from that day but we are responsible for putting in place the changes that are needed to ensure that that day comes as soon as possible.

Lynne Jones is the Labour MP for Birmingham Selly Oak and co-Chair of the All-Party Group on Mental Health


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