De l´autostigmatisation aux origines du processus de stigmatisation. A propos de l´enquête internationale « Santé mentale en population générale: images et réalités - en France et dans 17 pays

The archetype of the �mad� represents the paradigm of the stigmatization process and the history of madness appear as an attempt to make it disappear by their medicalization for the benefit of the concept of �mental illness �. The SMPG international survey results show the failure of the medicalization of madness to reduce stigma. This investigation describes the social representations associated to the archetypes of the �mad�, the �mentally ill� and the �depressed�. Made in France (67 sites) and in 17 countries (20 international sites), she describes the variants and invariants of these three archetypes. It describes the factors of significant stigmatization for the group � mad / mentally ill �: non-responsibility, non-controllability, medicalization, poor prognosis and dangerousness. Regardless of the country, the hard core of representations combining madness and danger is rooted in the collective imagination and the �mentally ill� bears the attributes of a �mad� medicalized. Conversely, the �depressive� label seems more acceptable and less exposed to stigma. Very few people recognize themselves in the collective representation of the �mad� or the �mentally ill�, even those who have diagnosed mental disorders. Therefore, how to exit to the dichotomies madness/reason, us /them that are at the base of the process of stigmatization, if for all the people, and even people who have mental disorders, mad it is the other? This may be the role of the patients themselves to combat the stigma and self-stigma in the years to come.L�archétype du « fou » représente le paradigme du processus de stigmatisation et l�histoire de la folie apparaît comme une tentative de la faire disparaître en la médicalisant au profit de la notion de « maladie mentale ». Les résultats de l�enquête internationale SMPG nous montrent l�échec de la médicalisation de la folie à réduire la stigmatisation. Cette enquête décrit les représentations sociales associées aux archétypes du « fou », du « malade mental » et du « dépressif ». Réalisée en France (67 sites d�enquête) et dans 17 pays (20 sites internationaux), elle décrit les variants et invariants de ces trois archétypes. Elle décrit les facteurs d�une stigmatisation importante pour le groupe « fou / malade mental » : non responsabilité, non contrôlabilité, médicalisation, mauvais pronostic et dangerosité. Quel que soit le pays, le noyau dur des représentations associant folie et danger est enraciné dans l�imaginaire collectif et le « malade mental » porte les attributs d�un « fou » médicalisé. A l�inverse, l�étiquette « dépressif » semble plus acceptable et moins exposée à la stigmatisation. Très peu de personnes se reconnaissent dans la représentation collective du « fou » ou du �malade mental�, même celles qui ont des troubles mentaux diagnostiqués. Dès lors, comment sortir de la dichotomie folie/raison, eux/nous à la base du processus de stigmatisation, si pour tout le monde, et même les personnes qui ont des troubles, le fou c�est l�autre? Ce sera peut-être le rôle des patients eux-mêmes de lutter contre la stigmatisation et l�auto stigmatisation dans les années à veni

Discrimination reported by people with major depressive disorder reply

Comment on Discrimination reported by people with major depressive disorder. [Lancet. 2013]Discrimination reported by people with major depressive disorder. Sarkar S, Gupta R. Lancet. 2013 Apr 6; 381(9873):1180-1. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. [Lancet. 2013] Discrimination reported by people with major depressive disorder. [Lancet. 2013

Older adult’s mental health networks: first results of the ARPA ageing project regarding expectations and needs of health professionals

The European project “ARPA ageing” (co-funded by the Erasmus+ strategic partnerships programme) aims to improve the efficiency of mental health networks for older people. In order to have a better knowledge of the perceived strengths and weakness of these networks, we investigated by a survey the needs and expectations of health professionals such as geriatrists, nurses or nursing assistants. A questionnaire of 24 items with an estimated duration of 20 minutes was published online from the 1 March 2018 to the 1 April 2018 in Belgium, France, and Luxembourg. Preliminary data concern 90 health professionals (main categories: 15.6% of nurses, 10% of psychologists, 7.8% of geriatricians and 7.8% of nursing assistants) in the domain of mental health and/or elder care. Notably due to the fact that not all participants already worked with health networks, levels of “no answer” varied between 24.4% to 33.3 according the questions. First results on the total sample reveal that health professionals globally perceived health networks as beneficial to a holistic care approach and care continuity (both 51.1%), and to care access (48.9%). These networks were estimated as beneficial to the increase of professional knowledge regarding older adults (38.9%) and mental health (34.4%), and to the improvement of professional skills (38.9%). Main reported difficulties working with these networks were the lack of information about these networks (56.7%) and the related health professions (50.1%), the lack of time and financial compensation (both 36.7%), and of coordinating tools (36.7%). This study is being extended to more participants and countries (i.e., Greece and Romania) in order to have a larger and more representative understanding of the European situation and cultural differences regarding mental health networks. This information will guide the next steps of the ARPA ageing project: the development of a European Internet platform and the production of guidelines to facilitate the implementation and monitoring of efficient mental health networks in Europe

Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study

BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students' ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students' knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients' experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed

Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction

Purpose: Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. Methods: This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. Results: READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. Conclusion: This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions