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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Anti-Stigma Programmes

Time to Change is an anti-stigma campaign run by leading mental health charities in the UK ( This campaign conducts an annual survey of the English population to investigate the attitudes and behaviours that are directed towards people experiencing mental health difficulties. The biggest improvement in public attitudes to date took place during 2013, with a 2.8% improvement being observed between responses to the 2012 and 2013 surveys. Since Time to Change began in 2007, the overall improvement has been 6.4%. Since the launch of the second phase in 2011, there has been a 4.8% improvement. Although a range of similar anti-stigma campaigns to Time to Change have been rolled out in other HICs [e.g. in Denmark (One of Us), New Zealand (Like Minds Like Mine) and Canada (Opening Minds)], there is a marked scarcity of national campaigns in LMICs (Sartorius and Schulze 2005; Mascayano et al. 2015).

Reducing Stigma in Low- and Middle-income Countries

Quinn and Knifton (2014) pointed out that ‘most approaches towards stigma have been developed in the context of high-income countries using Western constructs of mental health’ (p. 555). Reflecting on their research in Uganda, Quinn and Knifton (2014) warn that the scaling up of global anti-stigma that lack cross-cultural validity could potentially cause harm in LMICs because of a lack of cultural fit. These concerns in combination with the equivocal findings in relation to national campaigns in HICs (Link 2013) and the high costs of these campaigns (Mascayano et al. 2015) highlight the need to engage in careful consideration about how best to address mental health-related stigma in LMICs. Mascayano et al. (2015) pointed out that an overall lack of political will to prioritize mental health in LMICs will also detract significantly from efforts to tackle mental health-related stigma in these contexts.

Reflecting on the paucity of published research relating to the efficacy of stigma reduction initiatives in LMICs, Semrau et al. (2015) noted that in particular there was an absence of studies with long-term follow-up. It was concluded that there was insufficient evidence to determine which types of intervention may be both feasible and efficacious in LMICs (Semrau et al. 2015). No firm conclusions were made by the authors about the extent to which intervention programmes developed in HICs needed to be tailored to local contexts to be acceptable for implementation at scale in LMICs (ibid.). Emphasizing the need for pragmatism in the face of inadequate resources and no clear consensus on evidence-based approaches, Mascayano et al. (2015) proposed that to be most effective, anti-stigma interventions in LMICs should draw on existing strengths to reduce stigma and discrimination. Further details of the specific examples of community resource and strength are available from Mascayano et al. (2015) but these include (1) the willingness of communities to accept and protect people in Jamaica; (2) the social solidarity that can be fostered through being offered work opportunities in local businesses in Latin America; (3) opportunities to participate in tradi- tional/religious healing rituals, for example, musical rituals that are characteristic of Sudanese culture; (4) creating flexible job opportunities for agrarian workers in rural China; (5) utilizing family and extended kinship networks, such as the communal support in Ethiopia and Tanzania, to provide support for people with mental health difficulties; and (6) assigning cultural/spiritual importance to psychotic experiences (which could be interpreted as prophetic experiences) in countries such as Uganda.

Mascayano et al. (2015) concluded that efforts to decrease mental health-related stigma in LMICs and beyond will prove most successful if an emphasis is placed on promoting the possibility that individuals with mental health difficulties can fulfil role expectations. This can be contrasted with narrower attempts to undermine or challenge generic stereotypes such as people with mental health problems are incompetent. An example of this kind of approach that Mascayano et al. (2015) highlighted is the What Matters Most programme that was developed for Chinese migrant groups in New York who were experiencing stigma associated with their mental health difficulties (see: Yang et al. 2006, 2014). This approach places specific focus on embracing cultural factors and strengths that exist within particular contexts for tackling the impact of stigma. This could be a helpful template moving forward for addressing stigma in other resource-scarce settings such as LMICs.

Recently, a broad distinction has been made between two approaches that can be adopted in efforts aimed at reducing mental health-related stigma:

(1) ‘Appeals to normalcy’ (based on the assumption that people with mental health difficulties are just like everyone else) and (2) ‘Solidarity’ (calls for the general public to stand together with individuals diagnosed with mental health difficulties) (Corrigan 2016). It is suggested that efforts aimed at promoting normalcy might inadvertently encourage people to conceal aspects of their experience to conform with a hypothetical norm. Corrigan (2016) raises the possibility that celebrating diversity and fostering solidarity around a positive identity of mental health difficulties may be conducive to reducing stigma. Moving forward, Corrigan (2016) suggests that efforts aimed at reducing mental health-related stigma should consider the comparative merits and demerits that the ‘normalcy’ versus ‘solidarity’ approaches have for particular contexts.

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