Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes

Abstract

Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public’s deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students’ shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public’s multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.

Understanding the Public Stigma of Mental Illness: A Mixed-Methods, Multi-Level, Exploratory Triangulation Study.

“…Additionally, a focus on themes rather than themata may reduce the complexity of ways through culture people relate to mental illness [35]. Themes may overemphasize manifest content at the expense of latent symbols and images [36; 15], and overlook phenomenological feelings such as fear or disgust commonly indicated in the literature on health and stigma [39; 35b].…”

“…Practitioners may bene t from increased sensitivity to the public's motivated ways of understanding mental health and illness, especially considering their robust capacity to "Other" [30]. However, prevailing methods for describing public comprehension do not adequately capture how people maintain mental health-related stigma in their daily lives [35].…”

“…Efforts to evaluate public understanding often involve identifying recurrent themes in the form of repeated phrases or ideas [36]. However, this approach may unhelpfully obscure ambivalence, which could be better accounted for by employing relational rather than discrete models of public understanding (e.g., known/unknown; close/distant) [35]. For instance, it is a recurring nding that mental illness is perceived as foreign, unknown, or unfamiliar.…”