Lancet Commission Calls for Ending Stigma, Discrimination Around Mental Health

Evidence-based strategies should be implemented to eliminate the stigma and discrimination around mental health conditions, according to an extensive report from The Lancet Commission.

The Commission’s recommendations are intended for a broad cross section of stakeholders, including governments, international organizations, schools, public and private employers, and healthcare workers and their organizations, noted co-chair Graham Thornicroft, PhD, of King’s College London, and more than 50 global colleagues in The Lancet.

They outlined six goals, which encompass eight more detailed recommendations, including:

• Issuing international guidance that states that all forms of stigma and discrimination towards people with mental health conditions are unacceptable
• Implementing governmental policies to support the end of stigma and discrimination
• Eliminating workplace stigma and discrimination against people with mental health conditions
• Implementing national curricula and vocational training for all healthcare and social-care professionals that should include mandatory components on the needs and rights of people with mental health conditions and should be co-delivered by people with lived experience of mental health conditions
• Removing stigmatizing content from the media
• Supporting people with lived experience of mental health conditions

People with mental health conditions often experience a “double jeopardy” that includes the effects of living with their condition while also experiencing “the severe consequences of stigma,” Thornicroft’s group pointed out.

“Many people with lived experience of mental health conditions describe stigma as ‘worse than the condition itself,'” Thornicroft said in a press release. “There is now clear evidence that we know how to effectively reduce, and ultimately eliminate, stigma and discrimination.”

The authors explained that mental health-related stigma and discrimination can lead to individuals being excluded from their communities and being denied basic human rights, such as employment, educational opportunities, and even access to healthcare.

Of note, stigma and discrimination by healthcare workers can have negative effects on patients, including “worsened health outcomes and physical health care because of diagnostic overshadowing, in which physical symptoms are misattributed to mental health conditions,” Thornicroft and colleagues wrote. The effects of stigma by healthcare workers can also contribute to reduced life expectancy in this patient population, they added.

The authors also called for changes to laws and policies, including for controversial tactics such as conversion therapy and involuntary detention, as well as investment in mental health support, especially at the community level.

In the report, the Commission also reviewed the evidence on interventions to reduce stigma and discrimination, noting that social contact between those who have lived experience of mental health conditions and those who do not is the most effective way to reduce stigma and discrimination. Moreover, people with mental health conditions should be strongly supported to lead or help to lead interventions that use social contact.

“We found that social contact, where the lived experiences of people with mental health conditions were shared with people who did not have such conditions, successfully reduced stigma when appropriately adapted to different contexts and cultures,” said co-author Petr Winkler, PhD, director of the WHO Collaborating Center for public mental health research and service development, in the press release. “It is crucial that we see more organized social contact, whether via in-person discussions, video calls, or through theatre or film, between people with and without lived experiences of mental health conditions if we are to end stigma and discrimination.”

In an accompanying comment, Melvyn Freeman, MA, of the University of Stellenbosch in South Africa, and Nkeng Evah Mulutsi, of Tshwane District Health Services in Pretoria, South Africa, noted that the “Lancet Commission emphasizes the importance of centering people with lived experience in movements to end stigma and discrimination in mental health. This principle has been well established in the disability sector and in the struggles for equity of racially minoritized populations, women, LGBTQI+ persons, and others.”

“The Commission rightly underlines the importance of intersectionality, since ending stigma and discrimination is not a single-issue endeavor. Crucially, efforts to end stigma and discrimination against people with lived experience of mental health conditions need to be embedded in general anti-discrimination programs,” they concluded.