Mental health policy and practice across Europe: an overview

Tackling social exclusion 51
not homogenized into a common, global understanding of mental ill health as
‘disease’.
Several authors have discussed possible reasons for the frequent use of the
brain illness/disease model in anti-discriminatory work. Rose (1998) notes that
in the 1950s and 1960s the notion of ‘an illness like any other’ was central to the
community psychiatry movement, which sought to reduce coercion in favour
of care, strip madness of its terrors and make mental health services a branch of
ordinary medicine. There is thus profound professional investment in the
‘illness like any other’ model, which may help explain its assumed usefulness
in the absence of empirical evidence. Pharmaceutical companies may have
vested interests in the illness conception, as it opens up markets for the sale of
bio-medical solutions. Relatives of mental health service users can find comfort
in the ‘brain disease’ model as the emphasis on nature rather than nurture
absolves them of behavioural responsibility. However, there is no evidence
that any particular model of what madness/mental illness is, or what causes it, is
any more useful than any other model in anti-discrimination work. Far too
much confidence has been placed in the brain disease model, which may compound
rather than challenge the stereotypes of dangerousness and, particularly,
incompetence.
The assumption that public understanding of the ‘illness’ model is positive is
so deep-rooted that it sometimes emerges in research studies as an assumed (not
demonstrated) positive outcome. For instance, the Royal College of Psychiatrists
cited as a success of their Defeat Depression campaign an increase in the proportion
of the public believing that depression was ‘a medical condition like any
other illnesses’ (Royal College of Psychiatrists 1995). Stuart and Arboleda Florez
(2001) use knowledge that schizophrenia is a biological illness as one of several
indicators of accurate public knowledge, in order to assess links between accurate
knowledge and stigma. This type of research does not enable us to ascertain
whether belief in an illness model is linked, positively or negatively, with
important outcomes from the service user’s point of view, such as social distance.
It is necessary both for research and for evidence-based practice to
discard the assumption that biological understandings reduce discrimination.
Causation is not the key to countering discrimination.
More promising are messages that ignore causation, focusing rather on contribution
and equal citizenship, breaking the links with violence and incompetence.
The disability rights model – which draws attention to disabling barriers
and to people’s rights to participate, with adjustments where needed – seems
much more likely to effect changes in attitude and behaviour than the chimera
that as scientific understanding of causation percolates through society, so discrimination
will ebb away. Evidence to support or contradict this approach is
limited. However, the New Zealand government’s Like Minds project appears to
have had some success in reducing discriminatory attitudes, especially desire for
social distance, while there is some evidence that conventional programmes
raising awareness of biological causation may not effectively reduce stigma
(Angermeyer and Matschinger 2005). More research is needed in this area
to provide policy-makers with evidence for how best to reduce discriminatory
attitudes and behaviours.