Milica Pejović Milovančević 1 ,
Miroslav Pavlović 1 ,
Lazar Tenjović 2 ,
Dusica Lečić Toševski 1,3

1 Insttute for mental health,Belgrade,37 Palmotićeva street
2 Faculty of Philosophy,Psychology Department,Belgrade
3 National Commitee for Mental Health,Health Ministry of Republic of Serbia  

THE CHANGE OF DISCRIMINATORY AND NEGATIVE ATTITUDE TOWARDS MENTAL DISEASES WITH SCHOOL CHILDREN

  SUMMARY

The field of interest and effect of this preventive programme is the discrimination of the young with mental disorders. There are many practical ways for working on this problem - through the reformation of services and institutions of the system, representing of anti-discriminational polices and laws, acting through media and through educational programmes in medical institutions dealing with the problems we are set on.
The first part of the work determines the notions of stigma and discrimination and shows the percentage of mental disorders with the young.
In the second part we described a pilot programme realized in a Belgrade grammar school, we presented the reasons for its conveyance, the method and the results we obtained.
The key words are: stigma, discrimination, mental disorders.

INTRODUCTION-The basic definitions of the term " stigma"

It is considered that one out of five people experience mental disorders during his or her life , either through their own or an experience of a close member of the family. According to the latest data of the World Health Organization one fifth of the young to the 18 years of age has some sort of development, emotional of behavioral problems. There is a mental disorder with 3-12 % of the young and according to some predictions it is considered that the incidence of mental disordersof the young will have grown for 50% by the year 2020. With a well-chosen therapy approach, most of the young recovers quickly, and their recovery does not necessarily imply hospitalization or the use of drugs.

Mental diseases are traditionally connected with the rejection of the society. fear and stigma. Due to stigma the young with mental disorders and their families suffer the consequences of such state for years avoiding the institutions for mental disorders, treatements and the support of experts. People are simply afraid of being discriminated by the fact that they suffer from a mental disease.

Adolescence is a period of intensified growth, both physical and emotional. The opinion of an age group in this period strongly models the personal image of the young and the estimate of their own values.The young with mental disorders not only have the challenge to get to know themselves but also to find the ways of fighting against stigma which automatically appears in this sensitive moment of the acqisition of personal identity. How does stigma appear?How do friends, teachers, experts on mental health understand the significance of the same and its unmeasurable consequences to the recovery of the young with mental problems?

Stigma is a word with different meanings and definitions.Since ancient Greece stizein (tatoo or mark) it has signified a recognizable sign made by burning or cutting of a part of the skin of a less valued member of the society with an aim of distinguishing him from the rest of the members.In the Christian world the word stigmata was used for a certain sign which represented the so-called Christ's spot if a person had a blister on the palm of his hand or on the foot.

Stigma is a mark of shame, disaccordance, repulsion or rejection by others. It appears when a person feels unpleasant or ashamed to speak of his/her own behaviour which is accepted in a different manner. Due to mental illness stigma is so strong that it raises a wall of silence around this problem. Stigma is something not only people with mental disorders suffer from-very often their families or friends also suffer its effects.

The concept of stigma gained its popularity in social sciences through the work of Erwing Goffman.In 1963 he published the book "Stigma : Notes on the Management of Spoiled Identity" . According to Goffman, stigma is a deeply discrediting attribute and a stigmatized person is less valued or "spoiled" by stigmatizing process in three ways: the abnormalities on body such as physical deformities, "tribal" identity such as nationality, gender or religion and "specific individual character" such as mental disorders or unemloyment. This passive concept was later widened so today stigma is seen as recognition of different signs and subsequent devaluation of the one carring it. Therefore, stigma is a rational construction based on attributes.

Link and Phelan think that stigma is a product of four social processes.First of all, people are different and they define the differences. Secondly, the prevading cultural beliefs give people negative characteristics which are tightly connected with negative stereotypes. In social processes, which come third, marked people are in categories which differentiate "us" from "them". In the fourth process marked people lose their status and so become definately discriminated.

Stigma, prejudice and discrimination of people with mental disorders pervade every social group to the degree that it worsens the basic mental illness and makes it even more unbearable and more difficult.Generally, people with mental diseases are presented through media, films through stereotypically created heroes or are easily ascribed attributes to and made into guilty ones for most difficult criminal acts.Unfortunatelly, the media usually give a twisted image of people with mental disorders showing them as unpredictable,violent,dangerous and films , throughout the history of cinematography, usually follow the stereotypic portrait of "psyco-killers". Connecting of a mental disease with violence deepens the stigma and the discriminating behaviour towards people suffering from the same even more.

The cultural estimate of a mental disease can be associated with the strong influence on the mental health of the society, because mental disease causes two kinds of fear in people: the fear of physical attacks which might be caused by people with mental diseases and the fear of contamination (in the sense that being near a person with mental disease can mean that we have a problem ourselves or that the problem will conquer us).People with mental disorders are stereotypically seen as lazy, unable to cooperate and contribute , on the burden of the system. According to a study ,the most often misconception connected to mentally diseased is that they are dangerous and violent(88%), that they have a low IQ and that they are handicapped in development(40%),that they cannot function ,keep an employment or contribute in any way (32%),that they lack will i.e.that they are weak and lazy(24%), that they are unpredictable(20%) and that they themselves are to be blamed for their condition(20%).

The ways of overcoming the problem of stigma

There are more practical ways with the help of which you can fight the discrimination of mentally diseased people - by reforming the institutions ,presenting anti-discriminational and un -discriminational laws, improving and educating the carer, using the media campaigns with monitoring and training the journalists ,as well as the help of programmes for improving the knowledge and skills in the field of mental health.The general attitude that only the strategies based on combined approaches tending to change the social structures and culture(which deal with education of individuals and providing better standards for the life of the discriminated) are basic in the help of overcoming the discrimination.

Also there are numerous conceptual views on the way in which the discrimination can be reduced.Should people be told that mental diseases are similar to any other , with which they would actually follow the medcal model?Or should we fight for discarding the title such as mental disease or schizophrenia and focus on life experience through the spectar of emotional conditions and by doing that actually take a wider socio-cultural attitude?Or should we accept that inability or invalidity present an inclusional level where equal rights exist and on which anti - discriminational activities are based?It is true that we don't know yet what is best when discrimination is in question.

During 1996 the World Psychiatric Association (WPA) began the international programme for the fight against stigma and discrimination due to schizophrenia, one of the most difficult of mental diseases.It is very clear that stigma causes a chain of alienation and discrimination which leads towards isolation ,work inability,maluse of alchocol and drugs, homelessness , longlasting hospitalization , which ,all together, contribute to the diminishing of recovery chances.

After being formed by the Health Ministry of Government of Serbia, one of the basic tasks of the National Commitee for Mental Health was working on problems of discrimination of people with mental disorders.With public panels, education of citizens and professionals a very intense work is being done on stopping the stigma and its consequences.

In order to diminish the stigma and discrimination it is necessary to change the attitude of people through education and different programmes and also by changing the law in the sense of diminishing the discrimination and improving the legal protection of those with mental disorders.As far as adolescents are concernrd , one of the most important factors in the process of psychologic and social functioning is, of course, the age group. The age group accepts or rejects the individual and the consequence of such attitude can be far-reaching.

The programme

In order to overcome the problem of stigma we organized a programme called "Antistigma programme for high schools" which aims to achieve the positive changes of attitudes of high school students towards friends of the same age with mental health problems in the sense of accepting and giving active help and support to such young people from their environment.

The basic aim of this programme was raising the level of information and education of high school students about the problems of mental health of the young.The basic notions connected with mental health and its problems were presented to students of the first grade of a belgrade grammar school , and personal attitudes and emotions concerning the topic were questiont in workshops.It was expected from the young to experience and deal with some of the basic emotions connected to problems of stigma and other relevent problems.The estimate of the efficiency of the programme was done at the end.

The long-term aim of the programme was to change the attitude and behaviour of the young to the people of the same age with mental problems using the existing knowledge and positive changes acquired during the education.The programme was a pilot project and its further implementation is being considered.

The programme was conducted in six consecutive weeks , in the periods planned for extracurricular activities, in two classes of first grade in a grammar school in Belgrade.Students, teachers,pedagogue and school psychologist, as well as pedagogue and child psychologist of the Institute for Mental Health took part in the same.Sixtythree students attended the programme and the participation was voluntary with a formal agreement of parents ,who gave their aproval on a specially prepared form.Children of the age of 15 are considered convenient for the young on that development level are able to understand and accept the workshops, but also to understand the significance of connecting the theory with applied practical tasks , as well as the significance of application of gained experience in social environment.

Each meeting lasted 60 minutes ,15 of which was dedicated to theoretical discussion of the problem and the remaining 45 was for the workshop.The basic aims were separated in six theory wholes and each meeting ended with a short summary of the aims.

While working with the young we analyzed the following messages:
•  mental health can be estimated for everyone
•  problems of mental health are frequent
•  problems of mental health are different comparing to problems and difficulties of studing
•  people can recover from mental health problems
•  the feeling of discrimination with people suffering from mental health problems additionally hardens and complicates the recovery of the same
•  every connection between mental health problems and violent behaviuor is a myth.

The basic theme wholes were:
•  What is mental health?
•  What are the problems of mental health?
•  What is the life with mental health problems like?
•  Marking and stereotypes-research of well known examples.
•  The research of the pressures on the young with mental health problems.
•  Getting to know the ways the young react to stress.

The short summary of the work

1.The initial meeting implied the presentatrion of the programme and a short theory background for the question what mental health is. Through modified workshop "I am I, you are you" work was done on getting to know yourself and others,revealing and accepting the differences and similarities.The way the young with mental problems feel was analyzed and also how it affects their life in the same age group.

2.In the second meeting we defined the basic problems of mental health, and we set and defined the individual psychological and physical limits on the modified workshop "Limits". The young got to know the term of personal space,and personal experiences were used to analyze the conditions of those with disturbed personal limits due to a mental illness.

3.After the theoretical explanation of basic problems met by people with mental disorders, discrimination, feeling of shame as well as loneliness the modified workshop " Help me ,friends reject me" had a goal to near the feelings of a rejected individual to the young.An active attitude in finding the strategy of reaction of rejected and "observers" was encouraged.

4.During the fourth meeting we named the basic stereotypes and myths connected to the young with mental problems(violent,lazy,useless,crazy,etc.) and in the workshor "Me and others" we defined the processes of noticing, estimating and forming an impression of others;"the first impression" of the young with psychological problems can be negative ,coloured with prejudice.

5.In the fifth meeting we dealt with the estimate of pressure young people with mental problems are exposed to and the modified workshop "The trial" was demonstrated whose aim was to overcome prejudice we have to people with psychological problems with opposite interventions, putting the participants in the role of defense of the discriminated.

6.During the final meeting we presented the ways of overcoming the stress with young with mental disorders and the ways their friends can help them.The last modified workshop" What I bring along" aimed to evaluate the work ,intergration of acquired knowledge and experience in the social behaviour model without prejudice.Answering what he brought along a young man replied:" I bring the knowledge that people with mental problems need someone, that they feel thigs too and that very often they react differentlybecause of the problems, they should not be discriminated but helped and supported in overcoming the problem".

Evaluation

In order to evaluate the programme we used the questionary Opinion on mental illnesses before and six months after the programme ( further OMI).OMI consist of 51 points concerning the cause,description,treatement and prognosis of mental diseases.The questionary gives scores in five dimensions which refer to personal attitudes of the questionarees and are gained from :authoritarianism(obervation of mentally diseased as inferior and harmful member of society),benevolence(based on humanitarian and religious foundations), ideology of mental hygiene(intentions of mental health expert),social restrictions(observation of thr pacient as a threat to the family and society) and interpersonal etyology (a point that all mental problems stem as a consequence of deprivation in childhood).

The results are shown in the table 1. with average values (and standard deviations) for the group before and after the programme on OMI scale.

The results show that after the programme the young diminished social discrimination and tendency to social restrictions, and that social care for problems of mental health grew.This means that the programme has achieved the changes to positive consideration of young with mental problems.The young have shown the greater need to care of this population , their understanding of basic etyology factors causing mental disorders has improved and a greater readiness to help in social integration.

  The conclusion

We can face stigma when we have knowledge and facts.Everybody sometimes feels depressed, inexplicably furious or excessively excited.We can all go through phases when we think that everything and everyone is against us and that we are not able to deal with it.For someone suffering from a mental disorder such states cause the feeling of complete helplessness additionally complicating the existing condition.The young can feel the burden of stigma even more than the problem itself.

There are different strategies for improving mental health and preventing mental disorders and the starting point will depend on the needs, social and cultural context , and the scale of activities varies from local to national level.The significance of promoting the mental health and the emotional well-being of the young is known worldwide.Hence,the problems of emotional health are put in regular schedules in Great Britain. The most important individual obstacle which needs to be overcome in society is stigmatization and joined discrimination of a person with mental disorder.

We hope that the presented programme will come to life in our society not only through the work with the age groups but as well as with the professionals working with the young (teachers,professors,educators,etc.)

"The fact is that people with mental diseases are different from others, but those differences should be accepted and not pointed out , directing a finger towards those people,staring at them...because it is the least we can do so that they feel less rejected and less different." (Vladimir,15,at the end of the programme)

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