Is anti-stigma the new stigma?

The 'Time to Change' campaign challenges stigma and discrimination against people with mental health conditions. Time to Change is helping groups and individuals organise activities which actively cooperate in challenging discriminatory attitudes and behaviours.

Challenging discrimination is achieved primarily through engaging in mainstream as a contributor, a consumer or a provider. Many people with mental health conditions access mainstream activities, making their own choices as to whether to disclose or not. The greatest impact in challenging mainstream can be achieved by prioritising individual goals and aspirations. Support is also available to access mainstream from mental health organisations and bridge builders or through personalisation and direct payments.

'Time to Change' seems to insist that all people with mental health conditions wish to disclose as part of their eligibility for mainstream life. In a recent campaign video the broadcaster and service user Stephen Fry asserts that stigma and the attitudes of society in general are the main roadblocks that hinder the self-development of people with mental health conditions.

But many individuals with mental health diagnoses are accessing mainstream life without stigma, whether they choose to disclose or not. Disclosure is really up to the individual and far from discouraging service users to use mainstream, many organisations are open to all and are accessed by people with mental health conditions every day of the week. These are not simply voluntary organisations or groups limited to the health or charity sectors. These are consumer providers of all kinds - art galleries, libraries, recording studios, performance venues, gyms, sports centres, retail outlets and many more. To assert these these organisations are discriminating simply isn't fair on these groups, nor is it a realistic assessment.

Where people with mental health conditions may lose out is in having the initial confidence to set on the journey back to mainstream. This is particularly true of those who have been in secondary care and who may have become habituated to the life that Pat Deegan calls 'a career in mental health'. Dr. Deegan is referring to the lack of hope, aspiration and goals that can set in with hospitalisation or a long-term condition.

People who play football who happen to have mental health conditions are footballers. They aren't required to be 'positive mental health footballers'. People who play guitar who happen to have mental health conditions are guitarists, not mental health guitarists. People who are arts tutors who have a mental health condition are arts tutors. By continuing to tag mental health on mainstream activities and aspirations there is a danger of recycling stigma and not allowing people to move into valued social roles.

Could anti-stigma be the new stigma?

Discussing Mainstream

Bridge building for mainstream is now incorporated into the care pathway for people recovering from mental health conditions.

Community mental health teams, occupational therapies, psychiatrists are all aware of the value of mainstream bridge building. Many community mental health teams actively promote mainstream as part of their in-house practice with clients. Service-user led initiatives are also widely encouraged.

Where mental health teams may not always the time and resources to promote mainstream fully, there are many outside organisations working alongside the teams. The benefits of referral to an outside non-clinical team can be considerable.

Mental health teams can often discuss mainstream with clients in a clinical or home setting. An outside organisation has more time and capacity to draw clients out into mainstream settings where a conversation can begin. This may well be and should be - a conversation about the client's hopes, dreams, goals and aspirations.

One of the bridge builder's roles is to help facilitate this conversation. Another role is to be clued-in with what mainstream has to offer. For example, a bridge builder specialising in arts and culture needs to know what outlets there are both locally and further afield. A client who wishes to develop skills in music production should be introduced to the mainstream venue or venues where this opportunity takes place.