The impact of lived experience on health care workers' knowledge, attitudes and behaviour regarding mental illness

Background/Aims The literature suggests that many health care workers hold stigmatising attitudes towards mental illness. This study aimed to ascertain information regarding the impact of lived experience on health care workers' knowledge about mental illness, attitudes towards mental illness and intended behaviours towards people who experience mental illness. Methods This quantitative study used a questionnaire survey of health care workers employed in four National Health Service Trusts (n=2073). Statistical analyses were conducted. Results Lived experience of a mental illness (self or family member) was associated with more favourable knowledge about mental illness, attitudes towards mental illness and intended behaviours towards those with a mental illness. Conclusions The lived experience of mental illness among health care workers could be harnessed as a resource to improve service delivery. There should be a long-term commitment to capitalising on the benefit to patient care of lived experience among health care workers.

Changes in newspaper coverage of mental illness from 2008 to 2016 in England

Aims Since 2008 England's anti-stigma programme Time to Change has lobbied media outlets about stigmatising coverage and worked with them to promote accurate and non-stigmatising coverage. While this may have an impact on coverage and hence attitudes, it is also possible that coverage can change in response to improving attitudes, through the creation of a market demand for less stigmatising coverage. This study evaluates English newspaper coverage of mental health topics between 2008 and 2016. Method Articles covering mental health in 27 newspapers were retrieved using keyword searches on two randomly chosen days each month in 2008–2016, excluding 2012 and 2015 due to restricted resources. Content analysis used a structured coding framework. Univariate logistic regression models were used to estimate the odds of each hypothesised element occurring in 2016 compared with 2008 and Wald tests to assess the overall statistical significance of the year variable as the predictor. Results The sample retrieved almost doubled between 2008 (n = 882) and 2016 (n = 1738). We found a significant increase in the proportion of anti-stigmatising articles (odds ratio (OR) 2.26 (95% confidence interval (CI) 1.86–2.74)) and a significant decrease in stigmatising articles (OR 0.62 (95% CI 0.51–0.75)). Reports on all diagnoses except for schizophrenia were more often anti-stigmatising than stigmatising. Conclusions This is the first clear evidence of improvement in coverage since the start of Time to Change. However, coverage of schizophrenia may be less affected by this positive shift than that of other diagnoses. The increase in the level of coverage identified in 2016 requires further investigation, as it may also influence public conceptualisation of what constitutes mental illness, attitudes to mental illness in general and/or specific diagnoses. While most anti-stigma programmes are not diagnosis specific, we suggest their evaluation would benefit from a diagnosis specific approach to allow fuller interpretation of their effects. This could include media analysis driven by hypotheses based on diagnoses to ascertain whether variations by diagnosis over time occur both in the nature and in the proportion of coverage.

A Confederacy of Dunces: mental illness in the life and work of John Kennedy Toole

SummaryThis article examines the life and work of John Kennedy Toole, focusing on his 1981 Pulitzer Prize winning novel A Confederacy of Dunces. Toole finished the novel in 1966 and, after failing to rework his manuscript to his editor's satisfaction, he shelved the project. Following this, he displayed symptoms typical of paranoid schizophrenia and he took his own life at the age of 31. In his novel, Toole parodies both psychoanalysis and the practice of psychiatry at the time, with a strong overlap with the emerging perspectives critical of psychiatry popularised by figures such as Szasz, Laing and Foucault. Toole's life and work have relevance for psychiatrists interested in the relationship between creativity and mental illness, attitudes towards psychiatry in the 1960s, and the interplay between societal values and judgements of mental health.