CanJPsychiatry 2014;59(10 Suppl 1):S4–S5
Commentary
Opening Minds in Canada Norman Sartorius, MD, PhD, FRCPsych1 1
President, Association for the Advancement of Mental Health, Geneva, Switzerland. Correspondence: Association for the Advancement of Mental Health, 14 Chemin Colladon, 1209 Geneva, CH; [email protected].
O
ne of the key people in the OM program in Canada is Professor Heather Stuart, who was, together with Professor Julio Arboleda-Flórez, responsible for the Canadian site of the Open the Doors program,1 a global anti-stigma initiative involving some 20 countries differing in their levels of socioeconomic development, climate, lifestyle, language, religion, and history. The Canadian site in Calgary made a significant contribution to the Open the Doors program, which demonstrated that it is possible to reduce stigma and discrimination in all the settings and countries in which the program was conducted. One of the hopes woven into the fabric of the Open the Doors program was that what was started internationally will be extended nationally using the experience gained in the international setting yet adjusting and expanding activities in harmony with the characteristics of the specific settings, expectations, and possibilities of the countries that participated in the joint effort. The demonstration that an international program can be useful in a major national program made me read the accounts of the excellent achievements of the work in the Canadian OM program with even more pleasure. I have no hesitation in recommending the model of work against stigma undertaken in Canada to other countries. Several features of the program make me say this. First, the program was undertaken by a governmental agency that was established to improve mental health care in the country. It was thus an integral part of the agency’s work rather than a separate campaign; its results were reported to the agency that was to plan and implement the national program; and its evaluation served to improve not only the quality of work against stigma but also the contribution of this effort to the overall national effort to decide on the focus of work in the field of mental health and provide leadership for it. Second, the program was thoroughly evaluated by a consortium of experts from 5 universities: the evaluation was a joint effort intended to serve as a formative influence on the future
Abbreviations MHCC Mental Health Commission of Canada OM
Opening Minds
S4 W La Revue canadienne de psychiatrie, vol 59, supplément 1, octobre 2014
developments of the program. Third, the program provided information through personal contacts between people who have experienced a mental disorder (and either recovered or found a way to live with the impairments resulting from the mental disorder) with population groups whose opinion and behaviour were to be changed. Fourth, the program abstained from media campaigns and blunderbuss approaches because the evaluation of the effect of a media campaign done early in the life of the program did not indicate that the campaign changed opinions and, even less, behaviour. Fifth, work started focusing on 2 well-defined groups—youth and health care providers. The first of these groups was selected because it has a heightened risk of mental disorders that might not get treated because those who fell ill would not come forward to seek help fearing stigmatization, and the second because health care staff— including those working in mental health services—is both contributing to stigmatization and behaving badly with people who come seeking help because of it. Work with these 2 groups was decentralized and widely spread, thus opening avenues for future work in different parts of the country. The laudable features of the program to which I refer have shown their usefulness in other countries participating in the Open the Doors program.1 They sometimes attract criticisms because they are not spectacular and because they indicate that fighting stigma takes a lot of time and effort. The logic of the development of the program, by gradually increasing the number of groups whose attitudes and behaviour have been changed, is that the effort is slow in the beginning and gains speed with the increase in the number of groups reached. The 10 years which were offered to the MHCC, under whose aegis the anti-stigma activities are undertaken, will not be sufficient to remove stigma, and it is to be hoped that the government will ensure that anti-stigma efforts continue until the critical mass of those who are no longer stigmatizing or accepting stigma and discrimination because of mental illness is reached. Many of the anti-stigma programs have been launched without arrangements that would guarantee that the effects of the program are measured and made available in time www.LaRCP.ca
Opening Minds in Canada
for their use to steer the program. In OM in Canada, the evaluation has been given remarkable attention. The results of the evaluation are interesting and encouraging; what is more, they have been obtained on time to influence the program’s directions. They have been developed in collaboration with several universities and seem suitable for use in other settings and for other anti-stigma activities. One of the lines of evaluation—the evaluation of the economic impact of anti-stigma activities showing that it would be possible to make the anti-stigma program pay for itself in the workplace by reducing the negative consequences of mental illness—will be of particular interest to the many who are facing the growing emphasis on the need to invest wisely in the field of health. It remains for me to congratulate the Government of Canada and its MHCC who have decided to include the
www.TheCJP.ca
examination of the stigma of mental illness (and of its many negative consequences), as well as action to prevent or reduce it into their plan of work as one of its essential elements. Experience from all over the world proves that it is not possible to build satisfactory mental health programs without a serious and continuous effort to reduce or prevent stigmatization of mental illness. Canada has not only done the right thing for its mental health program: it is also offering a model of work in this area to other countries. We should be very grateful for this and thank both the MHCC and the many who have been involved in the design and implementation of the OM program.
Reference
1. Sartorius N, Schulze H. Reducing the stigma of mental illness. A report from a global programme of the WPA. Cambridge (GB): Cambridge University Press; 2005. p 238.
The Canadian Journal of Psychiatry, Vol 59, Supplement 1, October 2014 W S5
Commentary
Opening Minds in Canada Norman Sartorius, MD, PhD, FRCPsych1 1
President, Association for the Advancement of Mental Health, Geneva, Switzerland. Correspondence: Association for the Advancement of Mental Health, 14 Chemin Colladon, 1209 Geneva, CH; [email protected].
O
ne of the key people in the OM program in Canada is Professor Heather Stuart, who was, together with Professor Julio Arboleda-Flórez, responsible for the Canadian site of the Open the Doors program,1 a global anti-stigma initiative involving some 20 countries differing in their levels of socioeconomic development, climate, lifestyle, language, religion, and history. The Canadian site in Calgary made a significant contribution to the Open the Doors program, which demonstrated that it is possible to reduce stigma and discrimination in all the settings and countries in which the program was conducted. One of the hopes woven into the fabric of the Open the Doors program was that what was started internationally will be extended nationally using the experience gained in the international setting yet adjusting and expanding activities in harmony with the characteristics of the specific settings, expectations, and possibilities of the countries that participated in the joint effort. The demonstration that an international program can be useful in a major national program made me read the accounts of the excellent achievements of the work in the Canadian OM program with even more pleasure. I have no hesitation in recommending the model of work against stigma undertaken in Canada to other countries. Several features of the program make me say this. First, the program was undertaken by a governmental agency that was established to improve mental health care in the country. It was thus an integral part of the agency’s work rather than a separate campaign; its results were reported to the agency that was to plan and implement the national program; and its evaluation served to improve not only the quality of work against stigma but also the contribution of this effort to the overall national effort to decide on the focus of work in the field of mental health and provide leadership for it. Second, the program was thoroughly evaluated by a consortium of experts from 5 universities: the evaluation was a joint effort intended to serve as a formative influence on the future
Abbreviations MHCC Mental Health Commission of Canada OM
Opening Minds
S4 W La Revue canadienne de psychiatrie, vol 59, supplément 1, octobre 2014
developments of the program. Third, the program provided information through personal contacts between people who have experienced a mental disorder (and either recovered or found a way to live with the impairments resulting from the mental disorder) with population groups whose opinion and behaviour were to be changed. Fourth, the program abstained from media campaigns and blunderbuss approaches because the evaluation of the effect of a media campaign done early in the life of the program did not indicate that the campaign changed opinions and, even less, behaviour. Fifth, work started focusing on 2 well-defined groups—youth and health care providers. The first of these groups was selected because it has a heightened risk of mental disorders that might not get treated because those who fell ill would not come forward to seek help fearing stigmatization, and the second because health care staff— including those working in mental health services—is both contributing to stigmatization and behaving badly with people who come seeking help because of it. Work with these 2 groups was decentralized and widely spread, thus opening avenues for future work in different parts of the country. The laudable features of the program to which I refer have shown their usefulness in other countries participating in the Open the Doors program.1 They sometimes attract criticisms because they are not spectacular and because they indicate that fighting stigma takes a lot of time and effort. The logic of the development of the program, by gradually increasing the number of groups whose attitudes and behaviour have been changed, is that the effort is slow in the beginning and gains speed with the increase in the number of groups reached. The 10 years which were offered to the MHCC, under whose aegis the anti-stigma activities are undertaken, will not be sufficient to remove stigma, and it is to be hoped that the government will ensure that anti-stigma efforts continue until the critical mass of those who are no longer stigmatizing or accepting stigma and discrimination because of mental illness is reached. Many of the anti-stigma programs have been launched without arrangements that would guarantee that the effects of the program are measured and made available in time www.LaRCP.ca
Opening Minds in Canada
for their use to steer the program. In OM in Canada, the evaluation has been given remarkable attention. The results of the evaluation are interesting and encouraging; what is more, they have been obtained on time to influence the program’s directions. They have been developed in collaboration with several universities and seem suitable for use in other settings and for other anti-stigma activities. One of the lines of evaluation—the evaluation of the economic impact of anti-stigma activities showing that it would be possible to make the anti-stigma program pay for itself in the workplace by reducing the negative consequences of mental illness—will be of particular interest to the many who are facing the growing emphasis on the need to invest wisely in the field of health. It remains for me to congratulate the Government of Canada and its MHCC who have decided to include the
www.TheCJP.ca
examination of the stigma of mental illness (and of its many negative consequences), as well as action to prevent or reduce it into their plan of work as one of its essential elements. Experience from all over the world proves that it is not possible to build satisfactory mental health programs without a serious and continuous effort to reduce or prevent stigmatization of mental illness. Canada has not only done the right thing for its mental health program: it is also offering a model of work in this area to other countries. We should be very grateful for this and thank both the MHCC and the many who have been involved in the design and implementation of the OM program.
Reference
1. Sartorius N, Schulze H. Reducing the stigma of mental illness. A report from a global programme of the WPA. Cambridge (GB): Cambridge University Press; 2005. p 238.
The Canadian Journal of Psychiatry, Vol 59, Supplement 1, October 2014 W S5
