Mental illness stigma still a big problem in the Czech Republic

The National Institute of Mental Health has launched a campaign aimed at fighting the stigma attached to mental illnesses which still plagues thousands of patients and prevents many others from seeking the help that they need. To find out more about the problem I invited Miroslava Janoušková from the National Institute of Mental Health to the studio and began by asking how serious the discrimination of people with mental illnesses is.

Miroslava Janoušková, photo: archive of National Institute of Mental HealthMiroslava Janoušková, photo: archive of National Institute of Mental Health “I can say that in the last ten years the attitude of the public towards people with a mental illness has been quite negative. For example there was a research on social distance, in which people were asked whether they would like to have a neighbour from a particular group – and the people with mental illnesses were the fourth least popular group –after people with a drug addiction, alcohol dependency and a criminal history.”

In the past people were reluctant to see a psychiatrist or reveal that they were seeing one even to close family and friends – is that still the case?

“Yes, unfortunately it is. People with a mental illness are stigmatized by the society which leads to discrimination and also to self-stigmatization. People are afraid to speak openly about their problem and seek help.”

Why is that the case? For instance in the United States it is considered perfectly normal to have a psycho-analyst? So why not here –why do people here regard it as something terrible?

“There are differences among the various diagnoses. For example depression is much more accepted by the society. On the other hand, people with schizophrenia are often afraid to seek help, although they need it very much.”

So it has these negative consequences – people not getting medical attention when they need it?

“Yes, and also there is a problem with uneducated health care staff – for example GPs often do not have sufficient knowledge how to recognize serious mental illnesses.”

You conducted a study among medical students and I believe you found that the prejudice extends to future members of the medical profession as well?

“Our project was targeted at nursing students and we found that even these young people have negative attitudes towards people with mental illnesses that they would not want to work in a psychiatric ward, which could be a problem since as health care workers they will still be in daily contact with people who have such problems.”

“People are afraid to speak openly about their problem and seek help.”

So what is it they are afraid of?

“They are influenced by the media and movies and they see people with mental illnesses as dangerous, unpredictable and irresponsible. Moreover, they do not come into daily contact with such people because these people hide their diagnosis. So it is a vicious circle.”

You have launched a campaign to try to break that vicious circle …can you explain what it is?

“We have tested three interventions designed for young people. We organized seminars with a speaker who has experienced a mental illness; we prepared three video slots and also a leaflet. We found that the personal contact was the most effective method, because when students see a person face to face, ask questions and hear his or her story they see that this person lives a normal life, has family, friends and work, but is suffering from discrimination and negative attitudes that makes their life hard. It is very effective, but at the same time it is quite an expensive tool so we made those three videos that will reach more people through the social media and we were quite successful because they got more than half a million viewings on Facebook.”

Was it difficult to get patients to come and tell their story?

“It was. However we have co-workers with personal experience with mental illnesses and they cooperated in the seminars for schools project. They are used to speaking in public about their problems, but not everyone is –or has the courage to do so.”

Are we talking about researchers who have personal experience with a mental illness?

“Yes, we are employing (in our department of the National Institute of Mental Health) people who have personal experience with psychosis and they are very valuable members of our team. We are skilled in conducting research but they have experience with the illness and the stigmatization and discrimination accompanying it.”

When you say that the campaign was effective – to what extent did it influence the student nurses?

“The attitudes of the students changed after they watched the video slots and attended the seminar.”

Photo: Štěpánka BudkováPhoto: Štěpánka Budková Yes, but would they be willing to work in a psychiatric ward?

“Yes, their willingness increased and their attitude improved.”

Is there a way of reaching the broader public with this message?

“Yes, although we prepared the videos specifically for young people – we used young actors and chose a story we thought would appeal to the young – they were very successful and got more than half a million viewings not only by teenagers but also by adults and we received very positive feedback.”

But is there a plan to launch a broader campaign that would impact the public – on national TV and radio and so on?

“We have plans and ideas for such a campaign, although we do not have the money for it yet. But we hope that the reform of psychiatric care is a promising moment for changes in Czech psychiatry and also for the de-stigmatization of mental illnesses.”

Do you feel that media reporting adds to the prejudice in that usually they are just negative –someone with a mental illness having attacked someone and so on….

“Yes, unfortunately that is the case. From a sociological point of view the media construct reality. And in this case they paint a very negative picture. For example last year there were 155 murders and if I remember correctly only one or two were committed by a person with a mental illness. But it was the latter that the media highlighted. They did not spend so much time reporting on murders committed by so-called normal people. So they create a virtual reality that suggests all people with a mental illness are dangerous.”

There are possibly many people out there who are afraid to seek help because of the stigma, but now within a reform of Czech psychiatry there are plans to set up centres of mental health around the country. One is already operating. Can you explain what kind of aid they will provide?

“They are based on the so-called community care principle which means that the care is provided where people are living, so it is in sharp contrast to the huge psychiatric institutions that are often several hundred kilometres away. They are based on field work and employ a multi-disciplinary team which includes not only doctors, but social workers, nurses, psychologists, therapists who all work together and who also visit a person at home. That means the period of hospitalization can be shortened. ”

“There is also a stigma attached to psychiatry itself as a profession.”

And there is one in operation already?

“Yes, there is one in operation and there should be a network of ten to thirty of them in due time.”

What has the response of the locals been like? Do people actually go there and seek help? Is it proving useful?

“Yes, it is definitely useful and it is especially useful when people are discharged from psychiatric hospitals because that is a very sensitive period for them. They were just informed about their diagnosis and they do not know how to adapt to the new situation. It is a very sensitive period when many suicides happen, most frequently in the two months after discharge.”

Do people with mental problems have an adequate support network in the Czech Republic – at the present time?

“No, at the present time, they do not.”

And in hospitals – do doctors have enough time to talk to patients and address the problem as they would like to or are they overburdened as doctors in other spheres and automatically prescribe medicines instead of trying other forms of therapy?

“I think it depends on each facility, but usually mental hospitals are huge institutions some of them with around one thousand beds and the quality of care is not adequate. For example in the Czech Republic there are 12 psychiatrists per 100,000 inhabitants, which is better than in Poland, where there are 5 to 100,000, but much worse than in Finland where there are 28. And we have feedback from both psychiatrists and patients that they do not have enough time for therapy.”

Does the country have enough psychiatrists – are students interested in this field?

“No, I think that is the problem. Because of the stigma and there is also the stigma attached to psychiatry itself as a profession…”

Why is that?

Photo: Julia Freeman-Woolper / freeimagesPhoto: Julia Freeman-Woolper / freeimages “They are not regarded as proper doctors, for example. Among doctors, psychiatrists are not seen as proper doctors because of the field of study and the patients they care for. So students are not interested in this field, they do not see it as a good career-choice.”

What would you like to see change in the next ten or twenty years?

“I think it is important to improve community services, to decrease the number of beds in big institutions and create smaller facilities that would provide acute care for people with mental illnesses. At the same time I would like to see better conditions for these people in the society –they should have equal opportunities in looking for a job, get the best possible care and live a life without discrimination.”

Do you seek inspiration from abroad in your work?

“Yes, for instance we were inspired by the British campaign Time to Change and when we were preparing our Mindset project we consulted experts from Great Britain.”

Can you say something about the Time to Change campaign –what is the message?

“It is time to change stereotypes and time to talk about mental health problems. They used the media, worked with journalists, created videos and involved celebrities, such as members of the royal family. Celebrities and politicians are very helpful opinion leaders who have the power to change the views of the public, which is unfortunately not happening here in the Czech Republic.”

And is the Czech public ready for change?

“I am optimistic. I believe that the public is ready but I think that politicians and the media should be more responsible – because people with mental illnesses are the weakest in society - so they should be more responsible in their statements regarding them and avoid stigmatization and discrimination.”