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Anti-stigma campaigns: Time to change

  • Michael smith (a1)
Summary

This evaluation of the Time to Change anti-stigma campaign in England represents a milestone in international stigma research. While showing some positive outcomes, the overall picture is mixed and falls short of the wholesale shift in attitudes that is needed. A new approach is proposed for the coming decades.

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Copyright
Royal College of Psychiatrists, This paper accords with the NIH Public Access policy and is governed by the licence available athttp://www.rcpsych.ac.uk/pdf/NIH%20licence%20agreement.pdf
References
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3 Henderson, C, Williams, P, Little, K, Thornicroft, G. Mental health problems in the workplace: changes in employers' knowledge, attitudes and practices in England 2006-2010. Br J Psychiatry 2013; 202 (suppl 55): s706.
4 Thornicroft, A, Goulden, R, Shefer, G, Rhydderch, D, Rose, D, Williams, P, et al Newspaper coverage of mental illness in England 2008-2011. Br J Psychiatry 2013; 202 (suppl 55): s649.
5 Friedrich, B, Evans-Lacko, S, London, J, Rhydderch, D, Henderson, C, Thornicroft, G. Anti-stigma training for medical students: the Education Not Discrimination project. Br J Psychiatry 2013; 202 (suppl 55): s8994.
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7 Evans-Lacko, S, Henderson, C, Thornicroft, G, McCrone, P. Economic evaluation of the Time to Change anti-stigma social marketing campaign in England 2009-2011. Br J Psychiatry 2013; 202 (suppl 55): s95101.
8 Corker, E, Hamilton, S, Henderson, C, Weeks, C, Pinfold, V, Rose, D, et al Experiences of discrimination among people using mental health services in England 2008-2011. Br J Psychiatry 2013; 202 (suppl 55): s5863.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Anti-stigma campaigns: Time to change

  • Michael smith (a1)
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eLetters

Stigma caused by the stigmata of antipsychotic use (corrected version)

Prasanna N. de Silva, Consultant Old Age Psychiatrist
10 April 2013

Having worked in a semi rural settled community for 15 years, my understanding of perceived stigma among the general population is slightly more nuanced than the this editorial and the accompanying evaluation (1) suggests. The people in my locality are extremely protective of actively psychotic individuals and make (sometimes heroic) attempts to prevent harm. They are also prompt in passing concerns to our local CMHT, which has a good reputation in the community.

However, I have received persistent negative responses from the community about treatment effects on patients, especially psychomotor slowing, obesity and various parkinsonian features. The suggestion is thatthese people have been over treated, thereby preventing social and employment integration. Getting back to work (at least in a voluntary capacity) is seen as a measure of success in treatment.

This opinion is surprisingly consistent with what I have been told bymy many juniors from overseas, especially from India, who have commented on much less stigma towards the longer term mentally ill, partly due to 'low and slow' antipsychotic dose escalation, minimal dosage in the convalescent stage (6 months to 2 years) and active involvement of the family in rehabilitation. In the UK, rehabilitation services, if anything,are being downgraded in favour of the all encompassing 'Psychosis Pathway'.

I find these concerns about over treatment hard to argue with, as I am aware of the Glucose Transporter (GLUT) blocking property of all known antipsychotics, which does cause psychomotor slowing, obesity, and the metabolic syndrome (including fatty liver). This blockade is most potent among the atypicals, and has been known about by the main antipsychotic producers over the last 20 years (2), (3).Perhaps we need to look towards our practice to improve public concerns about the treatment effects of mentally ill people.

References1. Claire Henderson and Graham ThornicroftEvaluation of the Time to Change programme in England 2008-2011 BJP April 2013 202:s45-s48; doi:10.1192/bjp.bp.112.112896 2. Dwyer DS, Lu XH, Bradley RJ. Cytotoxicity of conventional and atypical antipsychotic drugs in relation to glucose metabolism. Brain Res 2003; Vol9711: pp31-9.3. Dwyer DS, Donohoe D. Induction of hyperglycemia in mice with atypical antipsychotic drugs that inhibit glucose uptake. Pharmacology, Biochemistry and Behaviour: 2003; 75(2):255-60.

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Conflict of interest: None declared

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