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STIGMA What is Stigma? The topic we chose to look at is stigma. The first thing we do when trying to answer a question like 'What is Stigma" is to look in a dictionary. The Oxford English Dictionary describes stigma as a 'mark of disgrace', 'condemnation' or 'a branding' (OED, 1989). Another definition is "a shameful reputation that a particular behaviour has because many people disapprove of it" (White, 1999, p.27) Stigma exists in nearly all social interactions. Australia has an idea of what is 'normal' and acceptable to them. Things that can be used as determinants of normality are ethnicity, socio-economic status, types of employment, age, gender, and sexuality (Meadows & Singh, 2004, p.12). Mental health is just another area where people can be stigmatized. When a small group of people have a unique characteristic, it is easy for a majority to impose their beliefs on society. (Meadows & Singh, 2004, p.12) It is often that people attach a certain stigma to other people with a mental illness. This is not necessarily to be malicious, but because we do not understand their experience or condition. (Canadian Mental Health Association, 2006) Within mental health the word stigma is related to an involuntary labeling of individuals affected by a mental disorder to stereotype their character and personality. (Meadows & Singh, 2004, p.12) Unlike other health issues such as heart disease and cancer, people still feel uncomfortable about mental health. (Canadian Mental Health Association) A fear of the unknown and a fear of difference lead people to label people with a mental illness in an attempt to control their fears. (Meadows & Singh, 2004, p.12) Some consequently believe that these people are of weak character and potentially dangerous. (Canadian Mental Health Association, 2006) There can also be a conception that people with a mental disorder are intellectually disabled, untrustworthy, or brain damaged. These are myths that have arisen because of a stigma. Truth be known 95% of people who do have a mental illness are no more likely to be violent than the general population (Northern Territory Department of Health and Community Services, 2006). This stigma is practiced, shared, and perpetuated by culture causing more marginalisation between society and this group. (Meadows & Singh, 2004, p.12) Stigma is something can be ingrained as a child if a belief already exists about a group within a particular culture. Beliefs may then be subconscious and discrimination occurs without intent. It is therefore important to raise awareness and narrow the existing divide. Stigma is not a new concept. We will now look at the history of stigma associated with mental health issues. Stigmatization is a particularly effective social sanction that has been used throughout history. The principal effect of using stereotypical conceptions to label and categorise a person is to dehumanise that person. Dehumanisation through stereotyping and labelling is inflicted on those groups and individuals perceived as threatening to the physical and emotional stability of society (Meadows & Singh, 2004, p12). In the dark ages the stigma attached to mental health disorders arose from the belief that ‘madness’ was evidence of demonic possession. Society was scared of demons and held the belief that the person was ‘lost’ and not able to be recovered; the demon had taken over their physical body. The only concern was for society, so people displaying outward signs of mental illness were removed from circulation, held in cages, beaten & burned (Meyers, 2002). The classical Greek philosophers believed that for a society to be healthy all of its inhabitants had to maintain perfect physical, mental and spiritual balance. Therefore any person displaying mental illness was a risk to the well being of the society as a whole. If the wealthy were afflicted with a mental illness they were kept away from the rest of society by being detained in their homes, where many committed suicide. The rest – the lower classes were imprisoned in chains, underfed & isolated (Meyers, 2002). In the Middle Ages people believed madness was caused by spiritual possession. This differs from demonic possession in the belief that the ‘good’ person was still inside & every attempt was made to save them. Surgical procedures were tried – they removed people’s blood & replaced it with animal blood, they were castrated, they tried removing lengths of intestine. Until the last 2 centuries the stigmatisation of mental illness has allowed for the disempowerment of the individual and provided the social sanction to remove them from society, housing them in zoo-like conditions (Meyers, (2002). In the 19th Century people began to believe that all mental illness had a biological cause, and professionals wanted to find a cure. This provided the impetus for much-needed reform and concession was given to the important role psychological factors played in mental illness. In the 1950’s they introduced anti-psychotic medication which proved successful in rapidly controlled the positive symptoms of psychosis. This led to de-institutionalization in the 1970’s (Hegarty, Baldesarini, Tohen, Waternaux, & Oepen, 1994). “However de-institutionalization was not wholly welcomed due to the misconceptions and prejudices at work. Residents would band together to prevent the introduction into their neighbourhood of services or accommodation for those suffering from mental illness (Meadows & Sing, 2004, p14). The mass media (film, television, print, and radio) have contributed to the perpetuation of this institutionalized discrimination through their portrayal of people with a mental illness. The crazed psychotic killer is a staple of films and television programs, and while over the past decade some programmes have attempted to present a more balanced representation, the dominant myth persists. News media nurture the myth by highlighting violent events in which there is some (often tenuous) link with mental illness because it sells their product. Unfortunately the continuing link between mental illness and violence reverberates in the public mind, which we need to remember, includes those with a mental illness” (Meadows & Sing, 2004, p14). More recently parents were held responsible and blamed for their children’s mental health problems. Even health professionals held this attitude which helped to keep mental illness in the closet as a family issue. There were increased feelings of guilt and isolation, increased reluctance to talk about matters considered shameful, and a consequent strengthening of social taboos around the whole subject (Meadows & Sing, 2004 p12-18). Throughout time all individuals making up society have held and participated in the cultural attitudes of the general population, its expectations, aspirations, beliefs and fears. When these expectations are disappointed, personal grief and anger needs to be worked through. In the past families could express their feelings through few safe outlets. Even now there is still a reluctance to talk about mental illness ‘in the family’ because of the attendant shame. This shame is actually a mixture of guilt and disappointment and is a response to stereotypical community attitudes towards mental illness & its causes. We will now look at the impact of stigma on the individual and on society. If you became ill you would go to a doctor. Once you got better, you would expect to get on with life as usual. However life does not always fit back into place for people who have mental health issues. Everyone has the right to fully participate in their community; however, individuals struggling to overcome a mental health issue find themselves facing a constant series of rejections and exclusions. Individuals with a mental health issue and their relatives have reported that increased isolation and loneliness followed the diagnosis of their mental health issue. The typical reaction encountered by someone with a mental health issue is fear and rejection. Individuals with a mental health issue experience stigma in all areas of their life; some have been denied adequate housing, loans, health insurance social benefits and jobs due to their history of mental health issues. (Canadian Mental Health Association, 2006.) Often individuals with mental illness find that after hospitalisation they are evicted even though rent has been paid in full and on time. Others with illnesses such as non-specific psychosis do not meet eligibility criteria for disability support pensions because they have no crutches, no wheelchair, no burn marks, so they have no problems. (Meadows and Singh, 2001) Due to the stigma associated with mental health issues many people have found that they lose part of their self-esteem and have difficulty making friends. The most damaging effect of stigma is the unwillingness of people to seek help. Spouses may be reluctant to define their partners as having mental health issues, while families may delay seeking help for their child because of their fears caused by the stigma placed on people with mental health issues. (CMHA, 2006.) Often when we mark, label, and identify individuals, it is an attempt to control our fear of otherness, or our fear of difference. (Meadows and Singh, 2001) How do the mentally ill lose from such a stigma? The obvious first point is that they lose -- or suffer is perhaps a more accurate word - from a loss of self esteem. If one is told often enough by many people that they are not good, not contributing, weird, dangerous and abnormal, then one will start to believe it. Even the individual with the strongest sense of self will finally believe what others say about him if it is said often enough. The mentally ill individual usually does not have a strong positive self image or belief that they are a good, contributing member of society. So when they are portrayed time and again with the stigma it does not take them long to start believing what is said. Indeed it is not just what is said but also what is done, or not done. It would be safe to say that the majority in society are kind and considerate and want the best for others. Most of us would not want mentally ill people to feel marginalized, to feel inferior and to feel bad about themselves. Unfortunately when the stigma is stated, whether that be in private statements by individuals, public portrayals in the media, or by the looks and avoidance behaviour of the general public, these tend to get noticed and remembered. The minority of the general public who for whatever reason need to deprecate the mentally ill tend to get heard and the majority who want the best for the mentally ill tend to remain silent. So the stigma is perpetuated as much by silence as by prejudicial comments. This silent majority may seem like a nice, good group of people and members of this group may even gain solace for themselves in that belief. They may even attempt to reassure themselves that they are not biased or bigoted against the mentally ill. That may even be true but there remains one other fact which they cannot deny. The majority of the silent majority play the bystander role, or they would not be silent! Their thoughts and actions go along the lines of, I myself do not think mentally ill people are strange and a drain on society, but I do not do anything about it. They stand on the side and do nothing. If the silent majority stopped being silent, the stigma against the mentally ill would quickly vanish. But they do not, they remain as bystanders, and bystanders support prejudice and ridicule by inaction. It seems safe to conclude that if they really wanted to do something about the stigma then they would not be a silent bystander. So society does have a stigma about the mentally ill. That seems beyond question. It is however a double edged sword. This unfair discrimination is indeed unfair. But what does the mentally ill individual, and those around them, do with that knowledge? It can be used to motivate action to fight the stigma both at a political level and at an individual to individual level. On the other side it can lead to the mentally ill individual taking on the victim position. ‘Poor me’ or ‘Ain't life awful’ are easy positions to fall into for the mentally ill. It is a safe position, as one can easily use it to justify their inaction, or their giving up on life. They can believe - What is the point of doing anything if society thinks I am no good. It is an unfortunate reality of life that in the human species it is the politically strong that get treated best and get the most resources. Throughout the history of mankind I do not know of any politically weak group in any society who has fared well in the long term. The mentally ill certainly have not. As a result of their illness they have always been political infants. Throughout history societies have essentially dealt with the mentally ill by putting them away somewhere. Keeping them out of sight. Long term favourable and fair treatment has been rare for this group over history. To hope that this aspect of human nature is going to be different in our lifetimes or even the next few generations is false hope. We can even think that it should be different, and that it is not fair. Indeed it is not fair and it should be different, but that is how it is and how it is going to remain at least in the near future. The mentally ill and those around them need to actively avoid the victim standpoint. To feel maligned or hard done by as a result of the stigma will do no good, in fact it will harm. The stigma is there, it must be recognized for what it is, it needs to be confronted at a societal or political level, but as importantly it is each individual mentally ill person who must fight for their own self image and demand respect from others. This is what will really, finally, bring the long term demise of the stigma against mentally ill people. (White, 1999) So how does this affect society? Today, those who experience mental health problems endure the shame and disgrace placed on them by modern society. The life opportunities of many people are frequently undermined by stigmatizing attitudes and discriminatory behavior (CCSR, 2006). Stigma against those with mental illness cut across all classes and social groups, and, to the extent that many mental conditions are chronic and incapacitating, those affected can hardly migrate out of the grip of negative social attitudes. The result is social annihilation that constricts the lives of those with mental illness, preventing them from fully reengaging in their communities and participating in the social activities of their groups of reference. (CPA, 2005). Mental health patients who show visible signs of their conditions because either their symptoms or medication side effects make them appear strange, who are socially construed as being weak in character or lazy are stigmatised. By a process of association and class identity, all persons with mental illness are equally stigmatized: regardless of impairment or disability level, the individual patient is lumped into a class, and belonging to that class reinforces the stigma against the individual. Individuals have reported that they have been dismissed or forced into redundancy due to their mental disorder. Fear of discrimination also has prevented people from disclosing details of their mental health history in social settings, on application forms (e.g. for employment and insurance).www.mentalhealth.org. Mental illness can be called the invisible illness. Often, the only way to know whether someone has been diagnosed with a mental illness is if they tell you. The majority of the public is unaware of how many mentally ill people they know and encounter every day. As a society, we are bombarded with negative images of people with mental illnesses The media and entertainment industries overwhelmingly present people with mental illnesses as dangerous, violent and unpredictable individuals. These inaccurate and unfair portrayals shape the public’s perception of those who suffer from mental disorders as people to be feared and avoided. Newspapers, often stress a history of mental illness in the backgrounds of people who commit crimes of violence. Television news programs frequently sensationalize crimes where persons with mental illnesses are involved. Comedians make fun of people with mental illnesses, using their disabilities as a source of humor. Also, national advertisers use stigmatizing images as promotional gimmicks to sell products. Television or movie characters who are aggressive, dangerous and unpredictable can have their behaviour attributed to a mental illness. Mental illness also has not received the sensitive media coverage that other illnesses have been given. We are surrounded by stereotypes, popular movies talk about killers who are "psychos," and news coverage of mental illness only when it related to violence. We also often hear the causal use of terms like "lunatic" or "crazy," along with jokes about the mentally ill. These representations and the use of discriminatory language distort the public’s view and reinforce inaccuracies about mental illness (MHW, n.d.). The Canadian paper, by Dr Heather Stuart, deals with the problem of media reporting. It evaluates a media-intervention program carried out in Calgary within the activities of the Open the Doors pilot program, which aimed to combat stigma and discrimination toward persons with schizophrenia. This paper highlights both the importance of media reporting on sensational crimes supposedly committed by persons with mental illness and how broader social situations can influence media reporting. A conclusion to be drawn from this paper is that, while the media have a responsibility to inform the public, mental health service providers, relatives, and consumers alike also have a responsibility to ensure that patients are properly treated and adhere to acceptable treatment protocols to minimize or eliminate violent incidents caused by mentally ill persons. One single case of violence is enough to undermine any good work to combat stigma and discrimination(www.cpa-apc.org). Recent research has also demonstrated that the fear of mental illness is not related just to the behaviour sometimes demonstrated by affected persons. It is also related to the label itself and to the consequences that flow from the illness. Ironically, the media also offers our best hope for eradicating stigma because of its power to educate and influence public opinion. Mindframe Media and Mental Health is an Australian project that is designed to ensure proper reporting of suicides. See: http://www.mindframe-media.info/" title="http://www.mindframe-media.info/" target="_blank"http://www.mindframe-media.in... The Mindframe-media website, based on the print resource 'Reporting Suicide and Mental Illness', provides practical advice and information to support the work of media professionals by informing them about sensitive and appropriate reporting of suicide and mental illness. The Mindframe Media and Mental Health (MMMH) project is one of a suite of projects on suicide, mental illness and the media developed as part of a national media strategy. The MMMH project is coordinated by the Hunter Institute of Mental Health in partnership with the Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet), SANE Australia and two Indigenous consultants. MMMH aims to build a collaborative relationship with the Australian media and mental health systems to enable a more accurate and sensitive portrayal of suicide and mental health issues across all news media in Australia. Successful treatment and community management of mental illness relies heavily on the involvement of many levels of government, social institutions, clinicians, caregivers, the public at large, consumers, and their families. Successful community reintegration of mental health patients and the acceptance of mental illness as an inescapable element of our social fabric can only be achieved by engaging the public in a true dialogue about the nature of mental illnesses, their devastating effects on individuals and communities, and the promise of better treatment and rehabilitation alternatives. An enlightened public, working in unison with professional associations and with lobby groups on behalf of persons with mental illness, can leverage national governments and health care organizations to provide equitable access to treatment and to develop legislation against discrimination. With these tools, communities can enter into a candid exchange of ideas about the causes of stigma and the consequences of stigmatizing attitudes in their midst. Only these concerted efforts will eventually dispel the stigma associated with mental illness (CPA, 2005). We will now look at the relevant policies at National and State levels, as well as the involvement of Non-Government Organisations. The National Mental Health Strategy is a commitment by the Australian and State and Territory governments to improve the lives of people with a mental illness. The National Mental Health Strategy aims to: - Promote the mental health of the Australian community
- To, where possible, prevent the development of mental disorder
- Reduce the impact of mental disorders on individuals, families and the community
- Assure the rights of people with mental illness.
It is estimated that mental health problems and mental illness will affect more than 20% of the adult population in their lifetime and between 10-15% of young people in any one year. Many will recover spontaneously and, of the remainder, the vast majority can be treated and will fully recover. However, a smaller number of people will experience longer periods of distress and disability.
Despite the suffering and the great personal and financial costs resulting from mental illness, the community has not always recognised the needs of people with a mental illness, or their right to live independent lives. People with a physical illness evoke community concern and sympathy, and we readily recognise their needs. People with a mental illness are not usually so fortunate.
In the past, the more severely affected people were isolated and treated in psychiatric institutions, and had little opportunity to participate in the life of the community.
Recently, things have changed and, although some people with severe mental illness will still require hospitalisation, the emphasis is now on treating and supporting people with a mental illness in their own communities.
For community-based treatment of people with an ongoing illness to be effective, they may need access to a range of different services: specialised mental health services that recognise their rights and respect their dignity; general medical services, housing, accommodation support, social support, community and domiciliary care; and income security, employment and training services that can all have a significant impact on the capacity of a person with a mental illness or psychiatric disability to live in the community, free from discrimination and stigma. As a result, all levels of Australian government have recognised that they need to work together to reform services and mental health policy to ensure that, wherever possible, people with a mental illness are able to enjoy the same opportunities as other Australians. (Australian Government: Department of Health and Ageing, 2006)
The section in the National Mental Health Plan 2003-2008 that is relevant to the topic of stigma can be found under the section: Promoting mental health Mental health promotion aims to protect, support and sustain the emotional and social wellbeing of the population, from the earliest years through adult life to old age. It should address people who are currently well, those at risk of developing a mental health problem, and those experiencing mental health problems or mental illness. A range of factors influences mental health. Public policies in sectors such as health, housing, welfare, education, employment, justice and corrections, art, sport and recreation, and the media impact on mental health. Supportive social, economic, educational, cultural and physical environments provide a basic framework for developing and maintaining mental health, particularly for children and adolescents whose early experiences shape their later mental health. Communities that recognise and accept diversity also contribute to social and emotional wellbeing. Communities in which people feel involved, included and empowered to influence decisions that affect them are supportive of mental health. Knowledge about risk and protective factors for mental health, symptoms of mental health problems and mental illness, and sources of help and self-help contribute to emotional resilience. Such knowledge is also essential in order to dispel the stigma of mental illness. The media have a major role to play in community education regarding mental health, but there are opportunities for all sectors to contribute to improving the mental health knowledge and skills of individuals, groups and communities. Settings such as schools, workplaces, primary care and community organisations are particularly suitable for such education. Much of the activity in mental health promotion needs to occur beyond the system of direct mental health service provision, in other sectors that impact on the daily lives of individuals and communities. However, those who work in mental health have an important role to play in engaging these other sectors and alerting them to their capacity to impact positively upon mental health. Mental health services need to embrace mental health promotion in their own settings, by adopting a recovery orientation for consumers. Furthermore, mental health services should consider their wider role in terms of promoting mental health. Attitudes of the mental health workforce can perpetuate the stigma of mental illness. Improved attitudes towards consumers, their families and carers, along with continuous professional development that emphasises the priority of consumer rights and participation, are urgently needed. Outcome 3 in this section of the National Mental Health Plan 2003-2008 looks at stigma specifically. Outcome 3: Increased levels of mental health literacy in the general community and in particular settings, and decreased levels of stigma experienced by people with mental health problems and mental illness Key direction 3.1: Build on initiatives aimed at raising community awareness about mental health, mental health problems and mental illness Key direction 3.2: Develop new and innovative programs and continue to support existing programs aimed at increasing mental health literacy and resilience, delivered in specific settings Key direction 3.3: Further promotion of accurate portrayal of mental health problems and mental illness in the media Key direction 3.4: Support antidiscrimination initiatives aimed at identifying and combating the impact of racism on the wellbeing of Aboriginal and Torres Strait Islander populations, and people from culturally and linguistically diverse backgrounds (Australian Health Ministers, 2003)
State policy In order to eliminate stigma associated with mental illness there is a need for policies to be put in place. New South Wales has four mental health strategies. That guide care of people who have mental illness. There are also a number of smaller policies that provide specific detail about care with individuals. The four strategies are: - Caring for mental health: a framework for mental health care in NSW
- Making mental health better for children and adolescents: NSW Strategy
- Getting in early: A framework for early intervention and prevention in mental health for young people in NSW
- Suicide: we can make a difference. NSW Suicide Prevention strategy
With in the strategy "Caring for mental health: a framework for mental health care in NSW" there are four objectives which are: - Developing partnerships, particularly with General Practitioners and non government agencies
- Emergency mental health response Prevention, promotion and early intervention
- Providing better mental health care
- Quality and effectiveness
(NSW Department of Health, 2005) The first one there, "developing partnerships" means that the NSW health initiatives are using partnerships to consolidate new promotion strategies. These partnerships exist between - Governments,
- Other mental health services,
- All health services,
- The department of education,
- The department of community services and
- Non government organizations.
(NSW Department of Health, 2003) These partnerships are a way of increasing public exposure to mental illness through as many sources as possible and combining their knowledge base to work collaboratively with each body involved. As the next part of our presentation will explain community forums such those held by Rotary are specifically aimed at enhancing community awareness and perceptions towards mental health to eliminate stigma. The second objective is "Prevention, promotion, and early intervention". In the oxford dictionary promotion is said to be "contributing to the growth of" something (OCED, 1996). If we remember stigma exists because the issue is of a minority and comes about through a lack of understanding. If we are able to grow the area of mental health so it is prominent in society and people possess the knowledge of what is going on stigma surrounding mental health should decrease. The third objective is to "provide better mental health care." Under this objective there is a principle that care for people with mental illness should be delivered through services that are accessible to all patients(Amos, 2005). This aims to eliminate segregation of the hospital facilities and people, to minimize the differentiation because illness and physical illness. Although thought is being given to processes that can decrease stigma there are still some policies that inadvertently add to this problem with stigma surrounding mental illness. One in particular is the policy of "Medical practitioners – use of assumed names on admission to psychiatric units: NSW health". So for quite some time health professionals that have been admitted to psychiatric hospitals have been doing so under alias a name, being treated in secrecy after request to superintendent has been granted. This in itself is demonstrating that they as individuals felt ashamed to be associated with mental health issues. (Brown, 2005) Now for relevant Non-government organisations and their involvement. & nbsp; Established in 1997 the Mental Health Council of Australia (MHCA) is the peak non government organisation (NGO) for mental health in New South Wales. It represents and promotes the interests of the Australian mental health sector, & is committed to promoting mentally healthy communities and reducing stigma & isolation. "As the peak body for NSW, MHCA aims to provide leadership and representation on mental health issues and to improve the mental health of the community by promoting and developing non-government organizations in NSW to provide strong quality services” “The MHCA facilitates effective linkages between the government, non-government and private sectors. The MHCA acts as the liaison body representing the views of its membership." (Mental Health Council of Australia, 2005) MHCA is a registered charity & its members include representatives of mental health service consumers, carers, special needs groups, clinical service providers, public and private mental health service providers and state/territory mental health peak bodies. According to the MHCA website (accessed 3//8/06) the overwhelming perception of those who currently use or provide services is that we have now arrived at a position of 'OUT OF HOSPITAL, OUT OF MIND!'. That is, one of the most chronically disadvantaged groups in this country continues to be ignored. In 2002 the MHCA conducted a survey called 'Out of Hospital, Out of Mind' It asked people in the community to indicate their priority areas of action. Stigma reduction campaigns came in at 10th place. 10. Stigma reduction campaigns: - Support for national stigma reduction campaigns
- Support for development of regional and local stigma reduction campaigns
- Prioritise stigma reduction amongst health care providers
- Support for stigma reduction focusing on psychotic disorders
- Support for stigma reduction focusing on non-psychotic disorders
- Other (e.g. especially among children and adolescents)
Community health support services are increasingly provided by non-government community-managed organisations recognised as providers of necessary components of a comprehensive mental health service. The overall goal is to facilitate and support active consumer participation in living, learning, working, playing, and relating within the local communities. Misconceptions surrounding mental illness have fuelled stigma & legitimised society’s exclusion of consumers. Increased visibility & interaction between consumers & mainstream society should reduce misconceptions that have fuelled stigma & made alienation of consumers morally acceptable. Non-government community health support programs provide consumers with resources, opportunities, knowledge, and skills for participating in, contributing to, and affecting the life of the community (Meadows & Sing, 2004, p.39). The community health support workers are essential elements of the network of mental health services (Meadows & Sing, 2004, p.158). Often community support programs are designed and run with the help of volunteer consumers, in accordance with the Disability Services Act and the Mental Health Standards. (NSCCAHS, 2005. pg 42). Unfortunately, even within the mental health profession there is stigma attached to the role of volunteer community support mental health worker. Health professionals have a tendency to regard volunteer consumer participation as therapeutically rewarding to the volunteer, and therefore the service is doing a ‘favour’ for a less able member of society by allowing them to be involved in service delivery (Meadows & Sing, 2004, p.140). This disregard for the volunteer’s abilities, knowledge, and their unique and important perspective is profoundly disrespectful & is likely to impact on the consumers psychological state as public-esteem and self-esteem are highly interdependent (Yalom (1995, p.57). Our society relies heavily on volunteers but getting paid carries more significance than dollar value; it is an acknowledgment of a person’s value. The lack of financial recognition may impact on a consumer’s self-concept, they’re more vulnerable than the general population due to the loss of self-esteem and self-confidence that often results from the stigma accompanying mental distress (Meadows & Sing, 2004, p.139) Examples of non government community support services for people with mental illness are; Mission Australia, Centacare, & The Yakkalla St Program. We will now look at the possibility of OT involvement at government, society and the individual level. To start of with, at government level. OT involvement in stigma reduction at Government level takes different forms. OT Australia is the peak professional body representing OT’s across Australia. This organisation makes submissions to the Government regarding issues important to its members. As individuals we can petition the Director General who is ultimately responsible for informing public opinion, promoting research into mental illness, and the education of those who deliver mental health services (NSW Institute of Psychiatry, 2003, p.2). OT’s are employed at both Commonwealth and State Government level in initiatives that aim to encourage responsible, accurate and sensitive portrayal of mental illness and mental health in the media. The media has a choice in the way stories are framed and this has serious ramifications for how audiences interpret news. If the right choices are made, the media can help to destigmatise mental illness in our community and improve the lives of many people with mental illness. A project undertaken in 2000 at the Hunter Institute of Mental Health was the ‘Response Ability’ project for Journalism Education. This was a Commonwealth Government Dept of Health & Ageing initiative under the National Mental Health Strategy. It aims to influence tertiary curriculum so that graduates in journalism will be aware of and able to respond to issues relating to mental illness. 
The Response Ability multi-media package for Journalism Education distributed in 2002 As an international postgraduate student I now feel I can more confidently report on issues of suicide and mental health whilst being considerate to society and those directly involved/implicated.
(Student, University of Queensland, April 2005) The Response Ability resource package provides universities and media organisations with a tool to introduce journalists and journalism students to the professional and ethical issues involved in reporting on mental illness. The free package includes CD’s with case studies, media examples and discussion questions. Additional supplementary resources were distributed in 2005 and included issues related to the reporting of violent incidents involving those with mental illness. www.responsability.org accessed 8/09/06. Another example of a Commonwealth Govt initiative with OT involvement is ‘Mindframe for the Mental Health Sector’. The Mindframe project managed by the Hunter Institute of Mental Health in partnership with SANE Australia, Auseinet and Multicultural Mental Health Australia ran between August 2005 and June 2006. Kirsti was the project officer. The aim of Mindframe was to assist the mental health sector in its dealings with the Australian media. We’ve talked about how stories reported by the media tend toward sensationalism if a mental illness is involved or suspected. Mindframe provided a set of principals for the mental health sector to adopt. The principals provide guidance for a sector consistent approach to the provision of information on mental illness to journalists and other media professionals. (www.himh.org.au accessed 9/08/06). A website was set up to enable journalists to access a book and associated quick reference cards that accurately depict latest knowledge surrounding mental health. It poses questions such as ‘Is the person's mental illness really relevant to the story? Should it be mentioned in the headline? It also reminds journalists to be conscious about using appropriate language. Recent research (Pirkis et al (2001) shows that terms such as 'lunatic', 'schizo', 'crazies', 'maniac', 'looney bin', are still used by media. This language stigmatizes mental illness and perpetuates discrimination (www.mindframe-media.info accessed 9/08/06). Now lets look at the society level. Knowing about mental illness isn’t enough to for the community to accept individuals with mental illness. Acceptance needs to come through changes in feelings, behaviours, and attitudes to these people needs to take place through a community education program. The role of the community in stigma is quite large and a lack of knowledge and cultural beliefs about mental illness continue to fuel stigma. Broad community awareness paves the way for providing education strategies, campaigns not specifically aimed at changing attitudes but really to put the issue on the table. As Occupational Therapists we can become involved in broad based community campaigns, which reach lots of people indirectly. Strategies can include; slogans and posters, newspapers and newsletters, radio segments, television interviews and community advertising, and social marketing such as stickers, balloons, badges and pens. We can have a role in finding community representatives called community mobilisers who either had or have mental illness and will openly discuss their personal stories in the media or just well known personalities that will act as a role model with positive attitudes and behaviours towards mental illness. There is very little point engaging in a campaign with specific target groups while the group is distracted on an individual level with their own issues. We can be involved in running or developing Community information sessions that are conducted to address different subjects such as the range of mental illnesses, what services are available in the community, how the mental health service works, who can access services, and how stigma stops people seeking help. Strategies to reduce stigma recognize that there is an array of factors that influence it and aim at removing the notion of blaming the individual. The changes to beliefs, attitudes and behaviours of a community need to be pushed forward at the same time as the changes individually and from the government level, through the environment, education, improved service delivery, and funding.
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