October 2-8, 2016 is Mental Illness Awareness Week(MIAW) in Canada. This week was established in 1992 by the Canadian Psychiatric Association and is now coordinated by the Canadian Alliance on Mental Illness and Mental Health (CAMIMH). The MIAW is a week held annually to raise awareness in Canada about mental illness and its impact on those who suffer from a mental illness and on those who love and care for them.
At the time it was introduced in 1992, stigma was still firmly entrenched in Canada, with attitudes toward those with mental illness still influenced by misconception and myth and not science or fact. This history of battling stigma in Canada can be found in this review by Heather Stuart, published in 2005.
The review traces the history of anti-stigma initiatives to the work of a Saskatchewan couple in the 1950’s. The Cummings developed an extensive program based on the health education approaches of the time to address the negative attitudes of the citizens of a Saskatchewan community toward the mentally ill. The program, however, had exactly the opposite effect to what was hoped for by the Cummings. According to the report,
“As the program grew in momentum, community reactions changed from interest, to anxiety, to outright hostility. It became apparent that people held fixed ideas about the causes of mental illness, the appropriate way of dealing with those with a mental illness, and the correct amount of social responsibility to assume.”
The report goes on to tell us that twenty years late, in the 1970’s, when other studies were beginning to show that Canadians were becoming more knowledgeable about mental illness and more accepting of those with mental illness, replicating the study done by the Cummings in the same small community showed no change in attitudes at all.
Progress on the frontlines of the anti-stigma campaign continued to be slow – a study in Quebec in 2001 found that 54% of those surveyed believed that people with Schizophrenia were “violent and dangerous”.
In the last fifteen years, those of us who work in mental health believe that we have seen positive developments in the anti-stigma campaign. For us, the proof is that more and more people are coming forward courageously to tell their personal stories of mental illness. When athletes like Clara Hughes and public figures like Margaret Trudeau describe their mental health struggles, some of the myths and misconceptions about mental illness can be broken down.
With a change in attitude, however, comes an increased demand for treatment and support. However, our health human resources still are not ready for this change. Many of us were trained at a time when our career choices were as denigrated as our patients’ illnesses. In fact, there are many who still characterize psychiatrists as not being “real doctors” and mental health workers in various professions earn less than their counterparts in other areas of medical practice. For example, Emergency Room Nurse Practitioners earn in the $100k range while Psychiatric Nurse Practitioners earn an average of $15k per year less. Psychiatrists make less than other physician specialties. There are many reasons to consider careers in other areas of healthcare.
At this point, in 2016, having been able to change some peoples’ attitudes toward mental illness, might it be reasonable to take a long, hard look at how we support those with mental illness? If people require Cognitive Behaviour Therapy every few weeks, should they have to require a letter for their employer? I don’t believe you’d need this if you were being treated for Diabetes or Heart Disease. Might we begin to think about prevention, since it’s well-established that there are conditions and circumstances that foster improved mental health?
Is it possible yet to move from awareness to action? Or will that take over sixty years also?