local approach to fighting stigma€¦ · work with anti-stigma 1. sensational and negative...
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ONE OF USLocal Approach to Fighting Stigma
Project Manager Johanne Bratbo &
Project Coordinator Anja Kare Vedelsby
ZIE MIJ – zonder stigma event
Holland, 31. October 2018
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Agenda
ONE OF US – a Danish approach to fighting stigma
• Vision, mission & organisation
• Strategy
• Target areas – highlights
• Evaluation
• Lessons learned
Crazy
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The Danish context• Population of 5,5 mil.
• 500.000 people with mental illness
• 8% of young people have a
mental illness
• 415.000 people currently on
antidepressant medication
• Non-psychotic diagnosis growing
fast
• Health profile: Mental health is
declining from 2013 to 2017
• 24% of people with mental illness
currently employed (compared to
44% of people with other
handicaps)
• Annual expenses linked to mental
illness: 55 bill. kr. – only 10% of
this spent on treatment
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Vision
To create a better life for
all by promoting
inclusion and combating
discrimination
connected to mental
illness
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Partners behind ONE OF US
Mandate:
Focus on knowledge, attitudes and behaviour related to anti-
stigma
No mandate for:
Critisising structure, services and financing services for
people with mental illness
1. phase: 2011-2015
2. phase: 2016-2020
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What we are working for
Mission• To increase the knowledge on
mental illness in society
• To reduce the distance that leads to stigmatisation, prejudice and social exclusion
• To increase the comprehension about mental illness in schools, work places, and all other areas where the everyday life take place
Target areas1. Service users and relatives
2. Staff in the health and social sectors
3. Labour market
4. Youth
5. The public and the media
Overall action plan with targetsand target groups for each targetarea.
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At least three important reasons to
work with anti-stigma
1. Sensational and negative portrayal of mental illness in the media
- because of a tendency to bring and disseminate the dramatic stories
linking mental illness with danger: ”Mentally ill commit more murders”…
2. Mental illness affects more people
– and more people get a psychiatric diagnosis and problems keeping a job
or staying in the educational system
3. Spread the message of recovery
- that breaks with the story of chronicity since there are current examples of
young people as well as adults still not being told about the hope for
recovery but instead are told that
their illness is chronic and they
will need medication for the rest
of their lives
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Overall project model of ONE OF US- inspired by Time to Change
Initiating, coordinating, media campaign and other supportingafforts
Planning, management, localinvolvement and mobilisation
Face to face activities
National level
Regional level
Local level
Common”branding”
National campaigns
Joint efforts
Local initiatives
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Board (partners)
Regional group
Local initiatives
Ambassadors
Regional group
Local initiatives
Ambassadors
Regional group
Local initiatives
Ambassadors
Regional group
Local initiatives
Ambassadors
Regional group
Local initiatives
Ambassadors
Localcommittee
Secretariat
Service users
and relativesProfessionals
Labor
market
Young
people
Population
and the
media
Coordinator
group
Psychiatry Network
Service user &
relatives’
organisations.
Communication
network
International
contacts
Regional level
National level
ONE OF US organisational model
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Find us here
www.one-of-us.nu
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Anti stigma methods
What doesn’t work
1. Traditional communication about
illness and symptoms
- not enough and can lead to
pseudo diagnosing
2. Simplifying problems and
challenges
Comparing mental illness to e.g. a
broken leg or diabetes. It leaves out
the fact that self perception and
relations are notably affected when
you have a mental illness. And this
is where uncertainty and distance
can occur in social contexts.
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Anti-stigma methods
What works1. Facilitating identification and
empathy without moralising by
e.g.:
✓ Social contact: Meeting people with
lived experience of mental illness and
dialogue about mental illness
✓ Film, pictures, tv, radio and theater
with people with lived experience of
mental illness
✓ Dialogue via social media (facebook
etc.)
2. Challenging myths with facts
3. Intrude with messages without
being intrusive
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Generel strategy
1. ONE OF US activities and materials – developed specifically
for the target areas and target groups based on documented
methods
2. Linking to activities carried out by relevant stakeholders
(ambushing):
✓Saves resources not to plan and carry out all activities ourselves
✓Increases chances of implementation in the long term
✓An opportunity to be present with messages, materials and contact in settings
where people usually wouldn’t expect to be confronted with issues related to
mental illness
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ONE OF US ambassadors
– social contact in many different settings✓ People with lived experience of mental
illness
✓ Have the ability to put their ownexperience into perspective. Importantthat they are well on the way in theirrecovery process or in a good place in their lives
✓ Three-days training course with otherambassadors about communicating and targeting their personal stories. Regionallyorganised
✓ Currently app. 100 active ambassadorsnationally
✓ Evaluation in the fall 2014 documents thatbeing an ambassador contributes to onesown empowerment and recovery
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Social contact activities - categories
• Presentations for differenttarget groups
• Festivals
• Workshops and training
• Conferences
• Stand
• Development of materials
• Other creative events
In 2017 nationally,
regionally and locally:
121 ONE OF US-activities
(announced on website)
412 ambushing activities
(internal registration)
- 90% included
ambassadors
About 533 actitivites in total
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Personal benefit from involvement in the
campaign top 5 – recovery elements!
0 20 40 60 80 100
Improved ability to assesswhen to disclose
Improved ability to copewith prejudices
Increased hope for future
Increased self-esteem
Improved ability to be openabout my experiences with
mental illness
To a high degree
To some degree
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”To which degree did/does having a mental illness
dominate your self-perception – before and after
becoming an ambassador in ONE OF US?”
Before
To a highdegree
To somedegree
To alesserdegree
Not at all
After
To a highdegree
To somedegree
To alesserdegree
Not at all
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Main activities in ONE OF US
- a selection
General strategy:
• Website: Knowledge, tool kits, films, surveys - available
for all to use
• Merchandise disseminated nationally, regionally and
locally
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Service users and relatives
Discrimination survey 2013 & 2015
- some conclusions
➢ Self-stigma is a major problem
➢ Experienced discrimination increases risk of self-stigma
➢ The more someone states that their mental illness
dominates their perception of themselves and in contact
with others, the more experienced (self-)stigma
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Service users and relatives
Discrimination survey 2015
0 10 20 30 40 50 60 70 80
Avoided education
Avoided job
Avoided relations
Avoided contacts
Hidden illness
Self stigma
Often Sometimes
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Service users and relatives
Self-stigma pilot project in DK
Translated and adapted from ”Narrative Enhancement
and Cognitive Therapy” by Philip Yanos et. al. in 2008
• 20 session manualized group intervention
• Consists of 3 elements:
• Psychoeducation
• Cognitive restructuring
• Story-telling exercises
Narrative element is based on findings from psychotherapy research supporting that narrative change is a major part of the process of identity transformation
Randomised control trial currently carried out in a Western region of Sweden
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The labour market
Dialogue cards: 1 example out of 34The back of the card holds case examples and advice from
service users and jobcentre staff
Question for reflection:
What do you regard as the greatest barriers to an inclusive labour
market?
Labour
market
Entrance
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The labour market
Promoting openness among men
at construction sites
Translation:
Not everything protects
you from dark thoughts.Often, the first step is the hardest.
Reach out to one another.
On the helmet:ANXIETY
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The labour market
Film: The Applicant
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Young people
Interactive website ”Break the Silence”
Elements• Voxpop film
• Five interactive films w. guidelines for teachers
• Guidelines for teacher about film analysis, media production and debate
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Young people
ONE OF US high school program
• Collaborating partner provides
a nationwide network at high
schools.
• 50 classes each school year
• ONE OF US provides an
assignment that follows the
curriculum requirements for
marketing and sales classes:
Develop a campaign to create
more oppenness about mental
health problems
➢ The teacher decides that
the class should work on
the assignment
➢ ONE OF US offers an inital
session for the class
including a personal story
from a young ambassador
➢ Prizes for the best
campaign proposals
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Young people
High school program: Evaluation results
• 71% teachers state that working on the assignment has had an
impact on the climate in the class
• 84% teachers would recommend a fellow teacher to work with the
subject mental health problems
• 48% students stated it was ”interesting” to work on the assignment
• 100% teachers and 75% students have gotten a better
understanding of the significance of more openness about mental
health problems
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The public and the media
The Sad Viking
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The public and the media
Cooperation with
The Danish Broadcasting Coporation (DR)– Denmark’s public service institution comprising television, radio and
online services
• The TV-program ”How Mad are You?”,
May 2012
• DR-campaign ”Invisibly Ill” Spring 2014,
including ”The World’s Maddest Job
Interview” – 2,7 mil. Danes watched at
least one tv-program, high quality score
• ONE OF US advice and assist in recruiting
for programs in 2015 about loneliness,
forensic psychiatry and suicide respectively
• ONE OF US-ambassadors as cases for
radio- and tv-programs, online news stories
etc.
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The public and the media
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0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Meget enig Enig Delvis enig Delvis uenig Uenig Meget uenig
18. The tone at the work place and the way we speak about
patients affect our perception of their possibility of recovery.
Professionals in the health and social sectors
Added item: Cultural sensitivity
Strongly Agree Partly Partly Disagree Strongly
agree agree disagree disagree
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Professionals in the health and social sectors
Aim of the tool kit
• To create awareness of communication
• To motivate professionals to a dialogue on respectfullanguage and acknowledging culture and social conventions
• That the professionals work in a more goal-directed manner to promote anti-stigma
Translation:
The Dialogue Starter
– bring anti-stigma into focus
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Professionals in the health and social sectors
Inequity in somatic health:
The mind is also part of the body
• 15-20 years shorter life expectancy for people with severe mental illness
• Discrimination survey 2015:
32% experienced discrimination in the somatic health system
• Panel survey: 53% experienced physical symptoms being dismissed as mental
• Survey among somatic health professionals: 47% feel like they don’t have
enough knowledge about mental illness
• Stigma seems to play a big part in somatic illness not being treated,
undertreated or overlooked
• Currently ONE OF US is preparing an intervention targeted health professionals
• Momentum!
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Professionals in the health and social sectors
Inequity in oral health:Mental health problems should not be tooth problems
• A well-known side effect of a lot of
psychiatric medicine is dry mouth →
dental problems and potentially serious
health problems
• A lack of information and awareness
among professionals
• ONE OF US tooth campaign launched
2018
– Materials: Dental kit, poster, pamphlet,
website
– Visit by ONE OF US including
ambassador to mental health and
psychosocial rehabilitation services
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Evaluation tools
• Internationally validatedscales
• Activities registered on website and in internalmodule
• Population surveys
• ONE OF US panel surveys
• Media watch and analysis
• External evaluations
• Statistics and analysis of activity on social media
• Ambassador survey
0
2.000.000
4.000.000
6.000.000
8.000.000
10.000.000
12.000.000
14.000.000
16.000.000
18.000.000
0
10
20
30
40
50
60
70
80
90
JanFebMarAprMajJunJulAugSepOktNov
LÆSERTAL/ UNIKKE
BRUGERE
ANTAL
Infomedia: ONE OF US mentions in the media 2014
OBS: DR’s Invisibly Ill March-May
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• Cultural adaptation of organisation and campaigning is vital
• Important to have visions and missions. But plans should allow
for flexibility and grabbing the moment when opportunities arise
• Social contact/ambassadors has great effect – also for recovery
• Communication training of ambassadors important
• Involvement of relevant stakeholders takes time, patience and
effort but increases quality and ownership
• Identifying relevant criteria for success and documentation of
long term effect is a challenge
Lessons and learning
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The Dialogue Kickstarter- one of four films with ambassadors