In a report issued Oct. 9, The Lancet Commission on Ending Stigma and Discrimination in Mental Health issues a call to action to “act now to stop stigma and to start inclusion.” The report summarizes extensive research around the world, highlights the results of an international survey, and provides recommendations for actions by a range of stakeholders.

"People with lived experience of mental health conditions are the key change agents for stigma reduction."

The Lancet Commission

Importantly, the report incorporates and highlights the voices and perspectives of people with lived experience of mental health conditions. The report was the work of more than 50 people led by Graham Thornicroft, Ph.D., and was published online in The Lancet* in early October. “It is time to end all forms of stigma and discrimination against people with mental health conditions, for whom there is double jeopardy: the impact of the primary condition and the severe consequences of stigma,” the report urges.

Harmful Effects of Stigma

The report summarizes the negative impact of stigma and discrimination which “contravene basic human rights and have severe, toxic effects on people with mental health conditions that exacerbate marginalization and social exclusion, for example by reducing access to mental and physical health care and diminishing educational and employment opportunities.”

The report also points to the role of the media in both perpetuating and potentially decreasing stigma. The media contributes to further stigmatization, for example, by reinforcing stereotypes such as the dangerousness of people with mental illness. The media can also play a positive role, for example, when following accepted guidance on how to report on suicides. p

Addressing Stigma

Based on an umbrella review of more than 200 articles, the Commission found that stigma is most effectively addressed through interventions based on social contact — including in-person, virtual or indirect — that have been adapted for the culture and context. Anti-stigma programs were most effective when

• They involve people with lived experience of mental health conditions in all aspects.
• Target groups are consulted on content and delivery.
• Efforts are sustained over the long term.

The report proposes a series of goals and recommendations for action by different sectors, each with specific targets and indicators. They are:

• International non-governmental organizations should issue guidance that all forms of stigma and discrimination towards people with mental health conditions are unacceptable.
• Governments of all nations should implement policies to support the end of stigma and discrimination against people with mental health conditions.
• Employers should ensure that stigma and discrimination against people with mental health conditions in the workplace are eradicated.
• Healthcare and social-care sectors should include mandatory sessions (co-delivered by people with lived experience) on the needs and rights of people with mental health conditions in national professional and vocational training curricula.
• Media organizations should systematically remove stigmatizing content.
• People with lived experience and local communities should be strongly supported to reduce stigma and discrimination.

New National Anti-Stigma Initiative

A new national initiative, launched by Huntsman Mental Health Institute in collaboration with many other organizations, aims to end the stigma of mental illness and substance use disorders. On World Mental Health Day, October 10, more than 180 leaders from across the country gathered in Utah to develop strategic actions for the 10-year Stop Stigma Together campaign. The goal of the effort is “to pose a grand challenge to our friends, family, employers, health care providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being.” It will involve:

• Establishing metrics and sustainable funding models.
• Building infrastructure to coordinate and communicate evidence-based best practices.
• Creating outreach plans to connect to hard-to-reach and underserved communities and populations.
• Hosting pilot projects and gathering evidence to identify new success models.

* The Lancet is a two-century-old widely respected medical journal. Its commissions, made up of global experts, publish research and comments on important issues in medicine.