King's College London, London, United Kingdom.
Front Public Health. 2021 Jan 8;8:569539. doi: 10.3389/fpubh.2020.569539. eCollection 2020.
Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.
采用知识-态度-行为实践(KABP)模式,专业人员专注于用生物医学解释来教育公众了解精神疾病。特别是在高收入国家,基于教育的宣传活动现在通常包括某种形式的社会接触,并针对关键群体进行量身定制。然而,尽管有 20 多年的高调全国性宣传活动(例如,英国的“改变时间”;澳大利亚的“超越忧郁”),但研究表明,公众仍然会将那些有心理健康问题经历的人视为异类。此外,对反污名化项目的评估发现,这些项目的长期效果微弱甚至没有显著效果,并且对其可能产生的意外后果也提出了严重关切。因此,本文批判性地重新审视了相关文献。我们的证据表明,在问题概念化方面一直存在系统性问题。即,KABP 模式无法回应每个生命中所体现的多种形式的知识,而这些知识往往是在无意识的情况下存在的。此外,我们强调了如何将解决公众对专业化知识的感知缺陷的单一焦点,维持了将“我们”和“他们”分开的公众实践。此外,我们表明,从业者尚未充分理解将具有精神疾病经历的个体视为异类的社会过程,也不了解这些过程如何促使公众与那些被认为体现这种被贬低的社会身份的人保持距离。最后,我们提出了一些方法工具,这些工具将使公共卫生专业人员能够充分探索这些与身份相关的社会过程。尽管一些读者可能会对本文缺乏明确解决方案感到沮丧,但鉴于反污名化宣传活动的严重意外后果,我们告诫不要简单地说明如何纠正公共卫生宣传活动。相反,本评论应被视为一种行动呼吁。我们希望通过充分探索这些过程,我们可以开发新的干预措施,这些干预措施植根于公众理解心理健康和疾病的方式。