Morgan Amy J, Wright Judith, Reavley Nicola J
Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
Int J Ment Health Syst. 2021 Jan 18;15(1):10. doi: 10.1186/s13033-020-00423-1.
Australian national mental health policy outlines the need for a nationally coordinated strategy to address stigma and discrimination, particularly towards people with complex mental illness that is poorly understood in the community. To inform implementation of this policy, this review aimed to identify and examine the effectiveness of existing Australian programs or initiatives that aim to reduce stigma and discrimination.
Programs were identified via a search of academic databases and grey literature, and an online survey of key stakeholder organisations. Eligible programs aimed to reduce stigma towards people with complex mental illness, defined as schizophrenia, psychosis, personality disorder, or bipolar disorder; or they focused on nonspecific 'mental illness' but were conducted in settings relevant to individuals with the above diagnoses, or they included the above diagnoses in program content. Key relevant data from programs identified from the literature search and survey were extracted and synthesized descriptively.
We identified 61 programs or initiatives currently available in Australia. These included face-to-face programs (n = 29), online resources (n = 19), awareness campaigns (n = 8), and advocacy work (n = 5). The primary target audiences for these initiatives were professionals (health or emergency), people with mental illness, family or carers of people with mental illness, and members of the general population. Most commonly, programs tended to focus on stigma towards people with non-specific mental illness rather than on particular diagnostic labels. Evidence for effectiveness was generally lacking. Face-to-face programs were the most well-evaluated, but only two used a randomised controlled trial design.
This study identified areas of strength and weakness in current Australian practice for the reduction of stigma towards people with complex mental illness. Most programs have significant input from people with lived experience, and programs involving education and contact with a person with mental illness are a particular strength. Nevertheless, best-practice programs are not widely implemented, and we identified few programs targeting stigma for people with mental illness and their families, or for culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities and LGBTIQ people. These can inform stakeholder consultations on effective options for a national stigma and discrimination reduction strategy.
澳大利亚国家心理健康政策概述了制定全国协调战略以应对耻辱感和歧视的必要性，特别是针对社区中理解不足的复杂性精神疾病患者。为了为该政策的实施提供信息，本综述旨在识别和考察澳大利亚现有旨在减少耻辱感和歧视的项目或举措的有效性。
通过检索学术数据库和灰色文献以及对关键利益相关组织进行在线调查来确定项目。符合条件的项目旨在减少对患有复杂性精神疾病（定义为精神分裂症、精神病、人格障碍或双相情感障碍）患者的耻辱感；或者它们侧重于非特定的“精神疾病”，但在与上述诊断个体相关的环境中开展，或者在项目内容中包括上述诊断。从文献检索和调查中确定的项目的关键相关数据被提取并进行描述性综合。
我们确定了澳大利亚目前可用的61个项目或举措。这些包括面对面项目（n = 29）、在线资源（n = 19）、宣传活动（n = 8）和宣传工作（n = 5）。这些举措的主要目标受众是专业人员（卫生或急救人员）、精神疾病患者、精神疾病患者的家属或护理人员以及普通民众。最常见的是，项目倾向于关注对非特定精神疾病患者的耻辱感，而不是特定的诊断标签。普遍缺乏有效性证据。面对面项目得到了最充分的评估，但只有两个采用了随机对照试验设计。
本研究确定了澳大利亚当前减少对复杂性精神疾病患者耻辱感做法的优势和劣势领域。大多数项目都有来自有亲身经历者的大量投入，涉及教育以及与精神疾病患者接触的项目是一个特别的优势。然而，最佳实践项目并未得到广泛实施，我们发现针对精神疾病患者及其家属、或针对文化和语言多样化社区、原住民和托雷斯海峡岛民社区以及性取向和性别认同多元群体的耻辱感的项目很少。这些可为利益相关者就减少耻辱感和歧视的国家战略的有效选择进行的磋商提供参考。
