Public attitudes and the challenge of stigma

People with mental illness frequently face challenges related to knowledge, attitudes, and behaviour. These challenges are more commonly known as stigma and discrimination, and appear universally with local and regional variations in their content and manifestations. They display in low levels of mental health literacy among the general population (ignorance/knowledge), negative affect towards people with experience of mental illness (prejudice/attitudes), and social exclusion and diminished citizenship for people with mental illness (discrimination/behaviour). This chapter looks at how people with mental illness are impacted by stigma and discrimination, considering the evidence of the implications of these knowledge, attitudes, and behaviour, and summarizes the literature on what can be done to effectively reduce stigma and discrimination. Increasingly strong evidence suggests that personal and social contact methods, including filmed/virtual contact, are the most strongly evidence-based method to reduce stigma and discrimination. Yet, most evidence is from high-income countries and tested for short- to mid-term efficacy. This evidence gap increases the need for more evidence from low- and middle-income countries and validation of sustainability in more long-term studies. In summary and for future research and interventions, service users will the key partners in anti-stigma programmes, and interventions specifically locally and culturally adapted for use in low- and middle-income countries are a pressing priority.