Wednesday, 25 August 2010

Empirical data for anti-stigma programmes

This thought comes from a Rachel Perkins interview for The Guardian.
http://www.guardian.co.uk/society/2010/aug/25/mental-health-treatment-rachel-perkins-mind

She's obviously woken up on the wrong side of the bed before the
interview. It's a rant I'd be proud of.

I could take exception with many bits of the piece but I'm letting the
end of the piece be a trigger for some thinking.

Here's her lashing out at anti-stigma programmes
"
In particular, Perkins gives short shrift to anti-stigma campaigns,
which have attracted substantial funding in recent years. "I don't have
any evidence that they [work]. I prefer not to use the term stigma,
because it attaches to the person. We don't talk about the stigma of
race. We talk about racism. The problem with anti-stigma campaigns is
that they identify the class of people by their impairment," she says.
"I want to see some empirical data [that they help people to get] a home
and a job. The bottom line [is] I want to change behaviour."
"

There's two bits I'm going to pick on. The second is the bottom line
described in the last line. She sounds like a tyrant but she's totally
right in her honesty in what the mental healthcare system wants to do.

I'm not surprised she hates anti-stigma programmes - and what she's
talking about is Time to Change. They are the opposite of conventional
mental healthcare. They make people less 'ill' by changing society's
expectations of mental illness. They reduce stigma thereby reducing
distress. They do not work on the disorder spectrum though they may
impact on it because reduced distress may lead to reduced mental
disorder. A person at peace is less undesireable or socially ugly
compared to a person in mental pain. T2X represents the antithesis of
her bottom line.

She's totally wrong about the lack of empirical data but it's here where
it gets interesting. T2C is evidence-based and it is a sort of
experiment. They hypothesis is anti-stigma programmes to do work. The
measures are the DISC scale developed by Professor Graham Thornicroft.
It's been through several revisions - I think it's on version 9 or 10 -
and it's been validated as a meaningful scale. T2C is having a
measureable effect on discrimination and stigma though it may not meet
its targets of 5% changes in stigma and discrimination.

Rachel Perkins would have T2C measured on psychiatric measures. In her
grumpy statement she wants bheaviour controlled, not accepted. She wants
the individual to be turned into an automoton for the modern (and now
becoming traditional) factory ethic rather than valued as they are.

T2C is not driven by the same measures that are becoming an imperative
but historically weren't: employment. It's driven by compassion and an
understanding that society is unequal, and continued behavioural
modification practices will not solve this.

What are the measures though? Prof. Graham Thornicroft is the UK's
expert but he's one of few research psychiatrists looking at the great
leap in mental healthcare: the change of society rather than the
individual. There is a lot of work to be done in the area of measurement
of the three areas he identified: ignorance, prejudice and
discrimination. There's even more to be done to heal society.

Empirical measures will take the finest minds available. Measuring
people takes the finest minds and measuring society is even harder.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"