Definiciones operacionales

Before considering some o f the ways in which stigma, discrimination and social exclusion might be reduced it is important to consider what the goal for this work would be. Sayce (2000) proposes that whilst most mental health stakeholders probably agree on what shouldn’t exist, there is little agreement about what should replace it. Clarke et al. (2005) interviewed people with learning disabilities and found that most had experienced social exclusion during their lives. The authors state that those who did not report this experience, whilst, not feeling excluded could not be considered fully integrated into their communities. They suggest that the aim should not be to reduce social exclusion by focussing on an externally determined set of needs, but rather to increase social coherence by placing the focus on the individual and their social context. A similar view was recently expressed by Naomi Eisenstadt, former Director of the government’s Social Exclusion Task Force, in an interview with Davis (2010): ‘Inclusion is not simply the

Academic Dossier - Professional Issues Essay

opposite o f exclusion, nor is it just improving access to services. We also have to facilitate the inclusion o f excluded people into capable communities (...)' (p.22).

Differing agendas and interests influence what is considered the goal for this work, but it also depends on the way learning disability and mental illness are conceptualised. It is beyond the scope of this essay to outline all the various models and their implications, but clearly the messages o f an anti­ stigma campaign based on the assumption that mental illness is purely biological or genetic would be very different to one based on the assumption that mental illness is something that is socially constructed. The same would be true for learning disabilities; a campaign based on the inclusive premises outlined in Valuing People (Department of Health, 2001) would look very different to one based on the more traditional ideas that people with learning disabilities were better provided for in specialised units.

This relates to the earlier point of what language is used to talk about these issues. It seems that currently there is no agreement across disciplines about what exactly is being addressed, whose ‘problem’ it is or what the aims of this work should be. This is an area which needs consideration. Although I have not yet formed an opinion regarding many of these complexities, regarding where the responsibility for change lies, I feel strongly that efforts should concentrate on changing attitudes towards mental illness, rather than concentrating on changing mental illness. Whilst I am not suggesting that work to reduce stigma, discrimination and social exclusion should wait until the complexities above have been resolved (a potentially unrealistic aim) I do think it is worth considering what the potential implications could be of running campaigns with very different and possibly contradictory messages. Sayce (2000) also highlights the importance of considering whether to aim for a change in the behaviours, attitudes or both, o f the people who

discriminate. I would advocate for attempting to change both. Having had the experience of deciding whether or not to disclose past depression when applying for jobs; I know I personally I would feel saddened if the potential employer endorsed either stigmatising attitudes or behaviours which affected whether or not I got the job.

To date strategies to reduce stigma, discrimination and social exclusion have tended to follow one of three methods; protest, education and contact. Although these strategies have empirical support, they do not seem to be developed from or even closely aligned to any of the theories regarding stigma. Protest strategies tend to use a moral message about the injustice of stigma and discrimination to appeal for people to change. Evidence for the effectiveness o f this intervention is mixed with many studies showing no change or even worsening o f attitudes (Corrigan et a l, as cited in Watson & Corrigan, 2005) and others suggesting that protest can change some behaviours (Wahl, as cited in Watson & Corrigan, 2005).

Educational approaches foeus on providing the public with accurate information about a topic with the aim o f replacing stigmatised beliefs with accurate ones. Evidence cited in Sayce (2000) is mixed as to the effectiveness of these approaches; it has been seen that people are more likely to attend to information that fits a stereotype, rather than contradicts it (Fyock & Stangor, cited in Watson & Corrigan, 2005) although evidence does suggest that people are able to inhibit stigmatising stereotypes with a cognitive response when given alternative, more accurate information (Devine, cited in Watson & Corrigan, 2005).

Contact strategies, provide opportunities for people to spend time with people from the discriminated group. A meta-analysis (Pettigrew & Tropp, cited in Watson & Corrigan, 2005) provides good support for the effectiveness of these strategies, but there are certain conditions which have

Academic Dossier - Professional Issues Essay

been found to increase this effectiveness; equal status between target group and stigmatised group, common goals, no competition between groups and an official sanction o f the strategy (Watson & Corrigan, 2005). It seems that the fact that iatrogenic stigma exists is evidence against the effectiveness o f the contact strategies. These practitioners are knowingly exposed to people with mental health difficulties regularly during their work, yet evidence suggests that they maintain stigmatising and discriminatory attitudes and practices. However, I would imagine that the conditions highlighted above for contact to be successful, namely equal status and common goals, are not present between many practitioners and the individuals they work with. Additionally contact strategies rely on people to disclose; if people feel too stigmatised to disclose then contact methods cannot be used.

One of the biggest challenges for strategies to reduce stigma, discrimination and social exclusion is accurately evaluating them, particularly the larger scale, national initiatives. Additionally whilst it might be relatively easy to measure change in attitudes through the use o f questionnaires (which are of course susceptible to issues of socially desirable responding) it is very difficult to evaluate the ecological validity o f these studies, i.e. does attitudinal change relate to long standing, real life, behavioural change.