Making sense of mental illness: The importance of inclusive dialogue

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Abstract

People with diagnoses of mental illness have been described as the last minority group against whom it is socially acceptable to discriminate. Challenging the stigma of mental illness is a major social issue and public health concern. Despite a range of anti-stigma efforts being conducted in recent years, the problem persists. It has been argued that a good place to start when changing social attitudes is with young people, whose attitudes are in a state of flux, making them more open to alternative ways of thinking. However, school based educational approaches designed to address this issue are in their infancy. To date, the mental health stigma reduction agenda has largely been drawn up by those who hold most power in the field – predominantly psychiatrists. This has led to anti-stigma initiatives drawing primarily on a biomedical model. There is a growing body of evidence that this approach is not only ineffective, but can actually increase stigma. There is therefore a need to investigate and test alternative approaches. Furthermore, previous research investigating young people’s knowledge of and attitudes about mental illness has been constrained by being conducted within the terms of the dominant discourse.This research set out to investigate how young people construct their positions in relation to mental illness. A primary aim was to understand how they negotiate the ambiguities of the mental health discourse. In addition, it has looked at the impact of engaging in ‘inclusive dialogue’ about mental illness on young people’s sense making. Mental illness is itself an essentially contested concept. Inclusive dialogue is an approach which takes seriously the variety of competing concerns which make up the ways in which mental illness is approached in day to day life, aiming to embrace the complexities and encourage people to grapple with them, bringing their own experiences and beliefs to bear. The underlying purpose of the inquiry was to consider whether there is potential for educational initiatives to help young people adopt non-discriminatory stances in relation to mental illness. The research was conducted qualitatively, and engaged a group of seven year 10 pupils in a series of discussions, which took place over the course of a half term. In addition, individual interviews and follow up group sessions were carried out later in the academic year.The results of this study indicate that engaging young people in inclusive dialogue is beneficial across a range of domains. The young people said that the discussions left them more comfortable in talking about mental illness and confident about their ability to respond to mental illness in people around them. The study revealed that context and the specific details of each situation are crucial in determining whether young people take up stigmatising or supportive positions towards people with a mental illness. Stepping outside the terms of the dominant discourse reveals that far from being the product of poor comprehension of biomedical psychiatry, ‘stigma’ may in fact be just one of a set of responses to people with mental illness. People who are mentally ill sometimes behave in ways that are disturbing and frightening, and it is vital that education accepts, rather than sidesteps, this reality. The findings of this investigation suggest that what is needed to improve social responses to mental illness is a reframing of the issues; a conceptual shift, wherein the notions of ‘knowledge’ and ‘attitude’ are not taken for granted and the aim of ‘reducing stigma’ is left behind in favour of the positively framed target of increasing solidarity.

Keyword(s)

Education; Inclusive dialogue; Mental illness; Narrative; Stigma; Young people

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