Mental health policy and practice across Europe: an overview

52 Mental health policy and practice
Separating ‘them’ (the labelled persons) from ‘us’
The most consistent research finding on reducing discrimination or stigma
is that attitudes improve as a result of contact or familiarization with a
person/people with experience of mental health problems (Angermeyer and
Matschinger 1997; Read and Law 1999; Meise et al. 2000). Opposition to mental
health facilities disappears once the facilities open and neighbours ‘see service
users as people’ (Repper et al. 1997). Contact appears to reduce fear of the ‘other’
and to increase empathy. Contact affects attitudes whether or not the contact is
voluntary (Link and Cullen 1986; Desforges et al. 1991; Corrigan et al. 2001).
Contact can be retrospective or prospective – in other words, engineering contact
as an anti-discrimination intervention promises to be effective (Couture
and Penn 2003).
In the New Zealand Like Minds campaign, government employees receiving
training said it was the personal experience that moved them from a concern
about how people with mental illness might behave, to looking at their own
behaviour: what they could say or do when someone was mentally unwell.
Research into what types of contact have most impact on which attitudes and
behaviours is not yet conclusive (Alexander and Link 2003). Wider research into
the impact of contact in relation to groups facing discrimination (e.g. ethnic
and religious minorities) shows that key factors are that people should be
brought together under conditions of equal status, in situations where stereotypes
are likely to be disconfirmed, where there is inter-group cooperation,
where participants can get to know each other and where wider social norms
support equality (Hewstone 2003). There is some evidence in the mental health
field that supports these conclusions, particularly on equal status (Corrigan and
Penn 1999) and cooperative activity (Desforges et al. 1991). Where people with
psychiatric impairments have ongoing significant roles as employees, bosses or
teachers, or are trainers with status, this is likely to impact positively on the
attitudes of those around them. There are provisos: the impact will not occur if
the person hides their psychiatric status, or if non-disabled people see them as so
different from their stereotypes that they do not generalize from this individual,
and instead see him or her as an ‘exception’ (Hewstone 2003).
Compared to contact, specific information has less research backing as an
effective changer of attitude. Wolff et al. (1996) found in one study that attitudes
changed as a result of a community intervention, in which neighbours
were given information and met service users, even though knowledge did
not increase at all. Link et al. (1999) note that at a time in the United States
when public awareness about mental illness had grown, the desire for social
distance remained strong. Knowledge does not seem to be either a necessary or a
sufficient condition for attitude change.
Inclusion itself is a powerful way of changing non-disabled people’s beliefs
(see Box 3.2). Recent British research finds that the group with the highest DDA
awareness and the most inclusive attitudes about disability are people who
‘know someone who is disabled at work’ (Disability Rights Commission 2002).
Inclusive schools also influence non-disabled children to hold more accepting
attitudes towards disabled children (Gray 2002).
Thus, a key challenge is to make it safer for disabled people to assert the right to