DR. UMME KULSUM

MD (Psychiatry),

RESIDENT, PHASE A

* JOURNAL PRESENTATION

*TITLE

*Experience Of Discrimination Among People Using Mental Health Services In England (2008 - 2011)

*Source

*British Journal of psychiatry

*September,2013

*Volume 202, Page 58-63

*Type of article- original

*AUTHORS

* Elizabeth Corker, Msc,Institute of Psychiatry,London

*Sarah hamilton,Ma,Rethink Mental Illness,London

*Clairy Handerson,Phd,KING’S College, London

*Craig weeks, Bsc

*Diana Rose, Phd

Background

*Research suggests that level of discrimination against people using mental health services are high.

*However, report of these people’s experiences are rare.

Objective

*To determine whether the time to change (TTC) programme target of 5% reduction in discrimination has been achieved .

*Introduction

*Stigma and discrimination can significantly compound difficulties facing people with mental health problem. In England public attitude towards mentally ill people had not improved prior to TTC programme in 2008 inspite of greater understanding about causes of these problem.

*Introduction

*TTC (Time to change) was a programme launched in England in between 2008 to 2011.

*A target set by mental health charities Mind and Rethink Mental illness was to achieve a 5% reduction in discrimination experienced by people of mental health problem.

*Introduction

*Purpose of this study was to determine whether this target had been met .

*Method

*Separate sample of people using mental health services were interviewed annually using discrimination and stigma scale to record instances of discrimination.

Method

Each year 5 NHS mental health trust across England selected to take part.

Staff in IT use central patient database to select random sample of people receiving mental health service.

*Method

*Sample checked by clinical care team for eligibility

*Invitation pack mailed to participant ( with consent form)

*Method

*View point survey

*Different sample for each year

*Age-18 to 65 years

*DISC is interviewer administered

*Method

*Overall score calculated as number of instances of reported discrimination divided by number of questions answered and multiplied by 100 to give percentage of item

*Method

*Study received ethical approval from Riverside NHS ethic committee.

*Result

*Total participant - 3579

*2008- 91% dicriminations

*2011- 88% discrimination

*2008-75% conceal mental illness

*2011-72% conceal mental illness

*Result

*Response rate

*7% in 2008,11% in 2011

*Significant difference –ethnicity,gender. employment status.whether admitted to hospital involuntarily.

*17 out of 21 area-less discrimination in 2011

*Result

*Increased discrimination in area-family, friend, social contact, general aspect being avoided.

*Reduction of discrimination not sustained in 2011 in finding a job, keeping a job,education, police, starting a family .

*Discussion

*Proportion of people using mental health services who experienced no discrimination increases over the course of TTC by 2.8% which is less than target 5%.

*Discussion

*Although we have detected clear positive change, experience of discrimination is extremly common in England.

*Most common source of negative discrimination were with family and friends which also showed greatest reduction.

Limitation

Low response rate

Database by NHS may not be accurate or up to date

Response bias due to overpresentation

Increase response in 2011 due to offer of voucher

*Comment

*Mentally ill people are just like other beloved creation of Almighty. Their helpnessness should not be a subject of discrimination rather should draw our sympathetic attention.

*Conclusion

*Stigma and discrimination can influence outcome of person’s illness. It causes reluctance to seek help and lack of treament adhererance. So further research is necessary to evaluate how people are affected by different level of discrimination.

*Thank You