DESARROLLO DEL PROTOTIPO
4.6 Evaluación de diseño
Mehta and Amerigo’s study122
of the effects of the disease model found that the public felt that it must be kind to people whose mental illness is conspicuous but that it actually treats the person more harshly if their illness is described in disease terms.123 This contradiction between what is felt and what is done is not apparent if the illness is described in psychosocial terms. This mirrors the findings in the Rothaus employment interview study 35 years earlier.124 The disease view tends to
116
Ending Stigma and Achieving Parity in Mental Health: A Physician Perspective, Summary of Presentations and Key Emerging Themes, Toronto, Canada, September 2010,
<http://www.mooddisorderscanada.ca/documents/Advocacy/Stigma%20Workshop%20Report.pdf>
117 David Goldberg and Peter Huxley, Common mental disorders a bio-social model' (Routledge, 1992). This
statistic initially was taken from a large scale study published first in 1980, then updated again 1992. Also see United Kingdom Office for National Statistics, ‘Psychiatric Morbidity Report’ (Report, 2000)
<http://www.ons.gov.uk/ons/rel/psychiatric-morbidity/psychiatric-morbidity-among-adults-living-in-private- households/2000/index.html>.
118
United States Department Of Health And Human Services, ‘Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings’ (Report, 2010)
<http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm>. See also Australian Bureau of Statistics, ‘National Survey of Mental Health and Wellbeing: Summary of Results’ (Report, ABS, 2007) <http://www.abs.gov.au/ausstats/[email protected]/Latestproducts/4326.0Media%20Release12007?opendocument&tab name=Summary&prodno=4326.0&issue=2007&num=&view=>.
119
Defined by the Victorian government as ‘mental health problems’ Victorian Government,
<http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mental_health_problems_early_care_helps>.
120 Stollznow Pfizer Health Report Wave 2 - Views and Understanding of Schizophrenia and Bipolar Disorder
in Australia, October 2010,
(<http://www.pfizer.com.au/sites/au/news_and_media/media_releases/Pages/Stigmaofseverementalillnessescon tinuestoriseinAustralia.aspx>
121
‘Cosmetic anti-stigma campaigns miss the point’ (2012) 4 NSSS Advocacy Bulletin
<http://www.northshoreschizophrenia.org/images/2012%20Feb%20Advocacy%20Bulletin.pdf>.
122 Mehta and Amerigo, above n 57. 123
Ibid, 415.
124
engender awareness that there should be generosity of thought directed toward the person but produces the concurrent awareness that the person is ‘set apart from the rest of humanity.’125
They are perceived to be different from ‘us’ and this sense of difference, or ‘Otherness’, is central to the description of mental illness.126
Attitudes based on difference create an image of an inferior person standing outside normal standards of human interaction.
Promoting a disease view of mental illness reminds the public of its susceptibility to a chance in which one in five healthy people will become ‘mentally ill’ at
anytime.127 Feeling under constant threat can prompt the harsh treatment of those who have already succumbed to mental illness as they are seen as perpetual reminders of the public’s vulnerability.128
Mehta and Amerigo’s study found little support for the position that regarding mental illness as a sickness would ‘promote greater acceptance and more favourable treatment’.129
In fact, it may cause the adoption of a patronising attitude where the person is not blamed for their socially unacceptable behaviours but is simply thought to require firm, disciplined, thereby harsher, treatment to control the output of unacceptable behaviours. By viewing the person as diseased, they are identified as different which can engender
callousness130 within thought and lead to harsh actions.131 These negative attitudes and unfair behaviours are apparent in the parenting decisions that are discussed in Chapter Six.
3.6 Violence
Phelan established that the public of the 1950s had an unscientific understanding of mental illness; was unable to identify individuals as having a mental illness unless their behaviour was extreme, namely psychotic; was unskilled in distinguishing mental illness from ordinary unhappiness and anxiousness; and feared the mentally
125
Mehta and Amerigo, above n 57, 416.
126
Juliet Foster, ‘Unification and differentiation: A study of social representations of mental illness’ (2001) 10
Papers on Social Representations 1.
127 One in five Americans, or 45 million adults, experienced some form of mental illness in 2009. Source: 2009
National Survey on Drug Use and Health: Volume I. Summary of National Findings released in November, 2010, <http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm>
128
Mehta and Amerigo, above n 57, 416.
129
Ibid 417.
130
Ibid 416.
131 Nicholas G Procter, ‘‘They first killed his heart (then) he took his own life': Reaching out, connecting and
responding as key enablers for mental health service provision to multicultural Australia’ (2006) 5 Advances in Mental Health 81.
ill as dangerous and unpredictable.132 By the latter part of the 1990s, the public largely attributed mental illness to a combination of biological abnormalities and vulnerabilities and social and psychological stresses; was able to define mental illness; and could separate mental illness from life’s ordinary, albeit, distressing experiences.133 However, only 13% of people surveyed in the 1950s134 linked violence to mental illness. The percentage had increased to 31% by 1996.135
The ‘British Attitudes to Mental Illness 2007’ survey found that there had been an increase in prejudice across a wide variety of indicators including the belief that people with mental health problems are 'prone to violence' and that younger people are more likely to hold negative attitudes. 136 The 2010 follow up survey found that agreement with the statement that ‘We need to adopt a more tolerant attitude
towards people with mental illness’ had fallen from 92% in 1994 to 87%.137
Also in 2010, Pescosolido et al. published the results of their 10-year comparison of public endorsement of treatment, and prejudice. 138 They found that the majority of respondents reported that a person with schizophrenia was likely to be violent towards others, and that significantly more respondents in the 2006 survey than the 1996 survey reported an unwillingness to have someone with schizophrenia as a neighbour.
A major finding of the study was that ‘… holding a neurobiological conception of mental illness either was unrelated to stigma or increased the odds of a stigmatizing reaction…. In no instance was a neurobiological conception associated with
significantly lower odds of stigma.’139 In his study assessing the efforts to reduce stigmatisation by providing specific information regarding the relationship between mental illness and violence, Penn concluded that some information such as the role
132
Phelan et al., above n 16.
133
Mental Health, Report of the Surgeon General, 1999, Chapter 1, <http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html>
134
Phelan et al., above n 16.
135
Ibid
136
Attitudes to Mental Illness 2007 Research Report, June 2007. The report presents the findings of a survey of attitudes towards mental illness among adults in England. The survey was commenced in 1994 and were initially carried out annually, then every three years from 1997-2003, and again annually since 2007. The aim of the surveys is to monitor public attitudes towards mental illness, and to track changes over time <
http://webarchive.nationalarchives.gov.uk/20120406161400/http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsStatistics/DH_076516>
137
Attitudes to Mental Illness, 2010 Research Report, March 2010 .p.4. <
http://webarchive.nationalarchives.gov.uk/20120502171823/http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsStatistics/DH_114795>
138
Pescosolido et al., above n 69.
139
that acute symptoms has in initiating violent behaviour can have a deleterious effect on the public’s perceptions of dangerousness, and increase the fear of people with schizophrenia.140 In 2010, an Australian survey of more than two and a half thousand Australians found that 47% of respondents believed that schizophrenia meant ‘having violent tendencies’ which was a dramatic rise from the reported 32% in 2006.141 The perceived danger associated with people experiencing mental illness has not decreased significantly, although a neurobiological conception was found to increase the likelihood of support for treatment but this was generally unrelated to stigma.142
The evidence suggests that while the public demonstrates a greater scientific understanding of mental illness than in the past, this newly found knowledge has not defused social stigma, which remains at high levels143, and with some variables such as the apprehension of violence having increased appreciably.144 Where there was an association, ‘the effect was to increase, not decrease, community
rejection’.145
Generally, the perception of mental illness has become more negative, statistically increasing four-fold, due primarily to the association of mental illness with violence.146 It is unlikely that the politicians, judges, prosecutors, lawyers, child protection and probation and parole officers and clerks that are the mainstay of the legal system are immune from the increases in the public’s perceptions of violence associated with mental illness.
The legal system reports large increases in violence with one Victoria Legal Aid branch indicating an overall funding assistance increase of 20% for family violence matters in 2011-12 compared to the previous financial year.147 ‘There is a well- established relationship between the experience of intimate partner violence and
140
Penn et al., above n 51.
141
Stollznow Pfizer, above n 120.
142
Pescosolido et al., above n 69, 1321.
143
Pescosolido et al., above n 19. See also Bernice A Pescosolido et al., ‘“A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence’ (2010) 167
American Journal of Psychiatry 1321, 1325. See also George Schomerus, ‘Evolution of Public Attitudes about Mental Illness: A Systematic Review and Meta-Analysis’ (2012) 125 Acta Psychiatrica Scandinavia 440. See also Andrew R Payton and Peggy A Thoits, ‘Medicalization, Direct-to-Consumer Advertising, and Mental Illness Stigma’ (2011) 1 Society and Mental Health 55.
144
Phelan, above n 16.
145
Pescosolido et al., above n 69, 1321.
146 Ibid 1325. 147
Clark Quirk, ‘Family violence court cases rise 20 per cent’, The Standard (online), 12 November 2012 <http://www.standard.net.au/story/967113/family-violence-court-cases-rise-20-per-cent/>.
mental health problems’.148
There is also evidence that the fear/risk of violence associated with parents with a mental illness is a key factor in the parenting order decisions (see Chapter Six) and in regard to preventative detention (discussed below), but there needs to be much more research undertaken regarding the extent to which the legal system disadvantages parties with a mental illness because the association mental illness has with violence.