Reducing stigma in mental health through communication campaigns? A literature review

Objective. - Fight against discrimination and stigmatization of people living with mental health disorder has become one of the most important political public health objectives. It has been identified as one of the five priorities of the 2008 European Pact for Mental Health and Well-Being. Stigmatization impacts the quality of life and jeopardizes the social integration. It has been shown that compliance to medical care was also impacted by individuals' perception of their stigmatization. Numerous international programs targeting general population have been elaborated since the last decades, but those communication strategies haven't raised the interests of researchers and academics. Hence, very few data are available to set new objectives to lower the social impact of stigmatization in people living with mental health condition. Material and methods. - This paper examines the rational and effectiveness of different anti-stigma campaign targeting mental health. By reviewing the scientific literature and policy documents on different strategies to address and lower stigmatization, we identified a typology of stigma-orientated actions and policies. Communication campaigns are the most common instrument used to address stigmatization. They are sometimes associated with communication programs targeting representations in general population through campaigns as well as representations in subgroups, through local and/or national actions. Specific information and training for journalists have also been experienced. Results. - Very few researches have observed convincing effects of anti-stigma campaigns in general population. Evaluations of the communication campaigns have revealed that they had a limited impact on representations. Attitudes towards people living with a mental disorder were still negative 5 years after the Changing Mind campaign, although there was an impact on the perceived distance by the respondents (how people living with mental health condition feel different from us). Actions targeting media and journalists led to ambivalent results, with a rise of positively connoted journal articles as well as negatively connoted papers. Conclusions. - Campaigns targeting general objectives have not been proven to be effective. Some authors' state that they should be replaced by local actions and programs, orientated to specific subgroups and should (a) associate the psychiatric services users and their families, (b) empower people living with mental health conditions, (c) be developed upon the experience of people who are been stigmatized. The rational of past communication campaigns as well as global communication programs were impaired by the absence of an operational definition of the problem addressed (discrimination, stigma, and stigmatization). Lack of empirical data on stigmatization jeopardizes the effects of these campaigns and their potential development. Conflict of interests in people managing the campaigns and the absence of systematic evaluation are also pointed as limitation for future developments. (C) 2012 Elsevier Masson SAS. All rights reserved.