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5 April 2001Printer-friendly versionEmail a friend

Is mental illness just 'different'?
A competition for schoolchildren held by WHO on World Health Day on 7 April 2001, designed to challenge the stigma attached to mental illness, may have the opposite effect.

by Fenno Outen

'Most of your classmates are healthy and happy individuals. However…'

These not-so-reassuring words are part of a UK schools' drawing and essay competition devised by the World Health Organisation (WHO). The competition has been staged for World Health Day on 7 April 2001, an annual event that this year is part of a wider campaign to 'focus attention on the stigma and discrimination surrounding mental health'. The theme is 'Mental Health: stop exclusion- dare to care'.

WHO wishes to 'engage schools in providing children with a better appreciation of mental health'. It is made clear that this will have little to do with providing factual information, since 'the intent of the lesson should not be to provide in-depth discussion of various disorders' and the emphasis 'is not on providing detailed scientific knowledge of the illnesses to be discussed', but 'on how the youngster experienced caring and/or reduced exclusion' (1).

The campaign motivates the need to raise awareness through this competition, by noting the serious consequences of 'poor mental health', including 'alcohol and drug abuse, interpersonal violence, school dropout, and self-harm, including suicide'.

WHO does seem to recognise that explaining concepts of mental illness to young children might be difficult when, in its instructions for the six to nine years age group, it suggests that 'the teacher should use examples to show that everyone is different and one person may be particularly different'.

The children entering the competition are asked to consider, 'How would you feel about being excluded if you were different?'. And, in case there were any danger of the correct answer being unclear, the open question is made redundant by the prior remark in the students' instructions, that excluded children 'will obviously feel very hurt not to be a part of the normal group'.

We should perhaps set aside the distinct practical possibility that a classroom discussion of children's experiences with the 'not so fortunate', 'particularly different', people who 'act differently' and 'get upset more easily' might have the opposite effect from the inclusive one WHO hopes for. Of more importance is the question of whether, even in principle, interventions aimed at young people based on current campaigns aimed at tackling 'stigma' are likely to benefit either those with mental illness, or their peers.

Such campaigns, after all, are not limited to WHO. The UK government, in conjunction with the National Union of Students and the National Schizophrenia Fellowship, recently launched the youth element of its own anti-stigma campaign, 'Mind out for mental health'. (2)

Children are asked to consider 'How would you feel about being excluded if you were different?'
Such anti-stigma campaigns tend to confuse the problem of mental illness with its consequences. Marjorie Wallace, chief executive of the UK mental health charity SANE, alluded to this in response to the launch of the 'Mind out for mental health' campaign: 'While young people who break down with mental health problems are still left neglected or shunted from one inadequate service to another, while there is so little decent in-patient care and places in the community providing meaningful activity, money spent on posters and pins will be wasted.' (3)

An anti-stigma campaign is a poor substitute for decent treatment or groundbreaking research. After all, there would be no stigma attached to mental illness if it were as easily dealt with as a broken leg.

A bigger problem with these campaigns, however, is that they constantly exaggerate the prevalence of mental illness. Teachers involved in the WHO competition, for example, are requested to 'emphasise that everyone can experience mental illness at some point in their lives'. This is an important element in their argument that the mentally ill should not be stigmatised because they are not really different to anybody else. As a Royal College of Psychiatrists' campaign film has suggested, 'It could be you'.

This exaggeration is often achieved by broadening the definition of mental illness to encompass everything from the most severe condition to entirely normal reactions to difficult events. One tell-tale sign of this is the use of catch-all terms like 'mental health problems', 'mental distress' or 'poor mental health'. But these attention-grabbing tactics come at a price.

Broadening the definition of mental illness encourages an unhelpful social trend, where everyday problems are reintrepreted as mental health problems. This phenomenon should itself raise questions about how much mental illness really is stigmatised today.

The focus on stigma - other people's behaviour towards the mentally ill - seems to indicate an increasing concern with people's vulnerability to the behaviour of others, and therefore the need to control that behaviour, than an increase in discrimination against the mentally ill. (4)

The presentation of mental illness almost as a normal, everyday experience is likely to prove counterproductive for those with more severe illnesses: precisely because their problems cannot be understood at the level of everyday experience. The severely mentally ill may therefore find themselves pushed further into the margins - as a consequence of the very campaigns designed to tackle their exclusion.

Fenno Outen works in mental health in east London

Read on:

Are you the one in four? by Josie Appleton, 19 April 2001

Mental illness: all in our minds? by Fenno Outen

(1) WHO competition instructions

(2) See Mind out for mental health, Department of Health press release, 11 March 2001

(3) See Mentally ill abused by the young, BBC News Online, 12 March 2001

(4) See, for example, the Mental health and brain disorders section of the World Health Organisation website

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