Living with schizophrenia: progress in mental health

1. Living with schizophrenia:progress in mental health John Saunders DirectorSchizohprenia Ireland

2. Disclosures of interest InterestName of organisation Paid positions Director, Schizophrenia Ireland Advisory boards EUFAMI Irish Mental Health Coalition Irish Mental Health Commission Irish Action on Suicide Alliance

3. Mission statement “Schizophrenia Ireland is the national organisation dedicated to upholding the rights and addressing the needs of all those affected by enduring mental illness including, but not exclusively, schizophrenia,schizoaffective disorder and bipolar disorder,through the promotion and provision of high quality services and working to ensure the continual enhancement of the quality of life of the people it serves”

4. Objectives of Schizophrenia Ireland Promoting self help groups To help people with mental illness and their families and carers Rights Influencing policy changers Support Engaging in publicawareness activities

5. Prevalence rates of mental illness in the EU 80 million people All brain disorders 3.7 million people Psychotic disorders 1% in any 12 months 2.4 million people Bipolar disorders 0.8% in any 12 months Wittchen and Jacobi 2005

6. Impact of severe mental illness • One in four (132.4 million) Europeans affected every year • Cost of €436 billion in 2006 – more than twice the GDP of Austria! • Affects most families at some stage GDP, gross domestic product

7. Social and personal impact • Prejudice and discrimination • Less likely to be employed • Less likely to be in a relationship • Great risk of homelessness • More likely to be in contact with criminaljustice system

8. Media coverage of mental illness Global media articles 2005 Mental health receives less media attention than physical illness Factiva media search

9. Two very different approaches to the same story The Irish Times The Sunday Business Post News report on schizophrenia

10. Sensational headlines seen internationally This Morning, Granada TV“Mentally ill kill 40 peopleevery year” CORRIERE DELLA SERAPsicopatico uccide la madrea pugni   “Paranoide mutter muss in die Psychiatrie” “El esquizofrénico que matóa un hombre en Chamartín, condenado a 20 años enun psiquiátrico” No rift over tax grab, sayswicks, “Government issuffering from schizophrenia” “…We are seeing the terrible effects of the Financial Services Authority's ownschizophrenia about risk” “Viele Todeskandidatensind geisteskrank” “Schizophrenic killer caged” “Warningson antipsychotic drugs made tougher in US” EUROPA SUREl fiscal pide 21 años para una mujer que padece esquizofrenia  ABCUn estudio encuentra escasosbeneficios en los fármacos más caros contra la esquizofrenia “We don't want thementally ill here”

11. 1996 1950 13% 31% Patients face stigmatisation from thegeneral public Proportion of respondents in a public survey that describeda mentally ill person as being violent “The perception of people with psychosis as being dangerousis stronger today than in the past” Phelan et al 1997

12. Common myths • People with mental health problems areviolent and dangerous • People with mental health problems arepoor and less intelligent • Mental health problems arecaused by personal weakness • Mental illness cannot be treated effectively

13. Discrimination is experienced constantly Poor understanding of severe mental illness by everyone Increased risk of social stigma Significant risk of relapse and readmission to services Lack of choice and empowerment in care Increased risk of social exclusion Specific issues Increased risk of self harm and suicide Poor access to effective treatments in appropriate settings Increased risk of harm to others froma minority of those affected Significant human rights issues emerging from involuntary detention

14. How to combat stigma? Education Media Talking openly Decreasestigma by Language Quality support and treatment Personal role

15. Mental health expenditure in EEA England Luxembourg Germany Malta Norway Netherlands Sweden Hungary Denmark France Cyprus Ireland Romania Iceland Latvia Belgium Slovakia Catalonia Italy Estonia Portugal Czech Rep. Poland Bulgaria Percentage of total health expenditure Mental Health Economics European Network, 2007

16. Political aspects • Mental health traditionally not seen as a core issue • Few politicians are knowledgeable about mental health • Rarely debated in Parliament • Resource allocation has always been low • Traditional mental health services hid people away • Political thinking is usually short term and responsive to public opinion

17. Ideally should be based on 2 fundamental principles Goal for government policies on mental health • Prevention • Investment in public mental health literacy • Promotion of good mental health practices in schoolsand workplaces • Recovery • Resourcing early intervention resources • Resourcing good mental healthcare services

18. Principles of good service Provision of appropriate housing, education, employment andfamily support Focused community-based mental health teams Good service provision will provide Early identification and treatment of major disorders Emphasis on recovery Good links betweenprimary healthcare and specialist services Hospitalisation as a last resort

19. Promoting the mental health of the population. Towards a strategy on mental health for the European Union European Green Paper consultation on mental health

20. Promoting the mental health of the population. Towards a strategy on mental health for the European Union European Green Paper consultation on mental health

21. What needs to be done? • We all need to do more • to promote communication, research and ‘best practice’ to de-stigmatise mental illness • We need pressure • on governments to prioritise mental health and increase support and funding • from mental health patient groups and health professionals • from mental health awareness campaigns aimed at educating the public and reducing stigma • Educate the media