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People with mental illness are one of the most marginalised groups in society. Stigma and discrimination affect tangata whai ora’s (TWO) quality of life, prevent them from full access to education, employment, and housing, contribute to lower incomes, increase relapse, and result in exclusion from the society. This damaging effect on the person is often persisting even after resolution of the symptoms.
The evidence shows that a combination of approaches and intervention methods at different levels times and in range of settings is the most effective in reducing stigma and discrimination (Gale, 2004). The effective approaches ensuring sustainable change take account of education, promotion, respect, and have to be supported by policy and legislation as essential parts of building a successful, integrated society. (Sayce, 2000)
“Raising awareness and changing attitudes are not enough on their own – because attitudes are not necessarily a reliable predictor of behaviour. Effective approaches also require work to promote social inclusion and empowerment, creating an environment of intolerance to prejudice and ensuring change is sustainable and supported by policy and legislation” (Gale, 2004).
- Public Policy
The New Zealand Government laid its expectation from mental health and addiction services in Te Tahuhu: the second mental health and addiction plan 2005-2015. Te Tahuhu is the policy on mental health and addiction that identifies challenges, ascertains outcome the Government strives to achieve, and provides direction for the continued development of the sector. The main focus is on improvement, recovery and wellness of tangata whai ora. Implementation of the plan, on the other hand, and improving mental health outcomes for TWO is the focus of Te Kokiri. It (Ministry of health, 2006)ascertains specific actions and responsible organisations for achieving them.
“Understanding mental illness and addiction in the general community is critical to reducing stigma and discrimination, both of which can reduce an individual’s sense of belonging and participation in society” (Ministry of health, 2005).
The outcomes include full participation of tangata whai ora in society and have the same opportunities as everyone else. Among Ten leading challenges are inclusion and support on the part of employers and effective support, protection and redress for TWO who are discriminated against. The action plan contains promotion of social inclusion, implementation of the next step of the ‘Like Minds like Mine’ project as part of a multi-agency plan to reduce discrimination, develop activities to address the discrimination by addiction users.
- Mass media campaigns
A well-known anti-stigma and discrimination public education campaign in New Zealand “Like minds, like mine” (Like Minds) started in 1997, funded by the Ministry of Health and the Health promotion Agency, and implemented by 26 regional providers. The campaign is directed at reducing discrimination associated with mental health and increasing social inclusion through advertising, community activities, research, events, education, helpline, newsletters, website, and training.
It has been proven by international research that sustained mental health antidiscrimination programs is the best practice in achieving behavioural change. The National Like minds campaign invested a great deal of time and energy in programs aimed at tackling stigma and discrimination, yield improvement in public attitudes towards mental health. “Advertising involving the stories of well-known and famous people who have experienced mental illness has created significant interest, awareness and improved attitudes among the general public. Local community education and other follow-up activities have also contributed to this success” (Vaughan, G & Hansen, C, 2004).
For years campaign has challenged public stereotypes, attitudes, demonization and alienation of tangat whai ora. The effective approaches that underpinned the campaign are:
- Its nature: robust, multileveled, evidence-based and responding to a changing environment
- The involvement of tangata whai ora in the campaign has been critical to its success. They personally leading the work and dispelling stereotypes and prejudice through their personal experience and knowledge.
- Amplifying social contact with TWO. “Face to face contact and community engagement are often the most effective ways to reduce stigma and discrimination” (Alexander, L.A & Link B.G, 2003).
- Famous and everyday people with mental illness spoke to media and employers about their experience made the campaign human and personal.
- Focus on the positive: emphasising abilities, supporting development of the TWO’s capacity to contribute
- Modelling social inclusion
- Education about human rights
The new National “Like minds, like mine” plan for 2014-2019 states that “the Ministry of Health will continue national efforts to reduce stigma… providing direction for the continuation of the journey towards social inclusion for people with mental illness in New Zealand” (Ministry of Health, 2014). It identified that to this day disrespectful attitudes (stigma) and unfair treatment (discrimination) are among the biggest barriers to social inclusion for tangata whai ora. The role of the programme is to ensure that public demonstrate socially inclusive attitudes and behaviours towards TWO and in so doing, increasing their opportunity to fully participate in community life.
- Health promotion
Mental health promotion refers to the actions taken to strengthen mental health and is a powerful resource with significant potential. Research is showing that its initiatives can have concrete, positive outcomes for the entire population.
Building on strength: A guide for action is a practical mental health promotion document designed for the service providers, communities and government bodies of the country that focuses on wellness, healthy populations and the community taking control. Building on strength promotion is consistent with a vision for recovery and participation. Its aims are to: build (inclusive and supportive) healthy communities; work across sectors (i.e. social services, education, housing, employment, ext.) to address the broader determinants of wellbeing; improving skills of the workforce; leadership through policy; to encourage research, innovation and development that can affect mental health and wellbeing of different population groups.
One of the principles of the New Zealand health strategy is to promote active involvement of tangata whai ora and communities at all strata of policy development. “People who have experience of mental illness have vital contribution to make to our understanding of illness prevention and as advocates for mental health promotion” (Ministry of Health, 2001). A central theme for tangata whai ora is their experience of the stigma and discrimination, and the denial of their rights of citizenship. Hence ‘Building on Strength’ supports participation of tangata whai ora in the development and delivery of programmes and continue to work to eliminate stigma and discrimination.
The examples of mental health promotion given in the Building on strength guide include Te Pae Mahutonga: a model for Mäori health promotion, and the Fonofale Model. Both holistic models highlight views of their respective communities on wellness and relational harmony of different elements.
Te Pae Mähutonga is, the Maori name for the Southern Cross constellation of stars, “used as a symbolic map for bringing together the significant components of health promotion, as they apply to Maori health… Te Pae Mähutonga model suggests that health promotion is about creating a climate within which human potential can be realised” (Durie, 1999).
The four central stars reflect the four key goals of health promotion: Mauriora (security of cultural identity), Waiora (environmental protection and connectedness), Toiora (a shift from harmful to healthy lifestyles), Te Oranga (increasing the extent of participation in society). The two pointers – prerequisites for the effective health promotion – are Nga Manukura (leadership) and Te Mana Whakahaere (the level of autonomy and self-determination).
- Service development and educational measures
Service development measures are intended to improve education and training for people coming into the mental health professional services.
Support workers who are showing respect and kindness towards tangata whai ora, have the right skills, values and attitudes make an enormous impact on their recovery process. The Ministry of Health developed the programme with the focus on putting the TWO’s needs and lives first. Let’s get real: Real Skills for people working in mental health and addiction builds workforce’s resources and knowledge to provide qualitative and effective service delivery.
The framework has seven Real Skills which are underpinned by the essential values and attitudes across the sector to achieve Te Tahuhu outcomes. One of them is challenging stigma and discrimination. “Every person working in a mental health and addiction treatment service uses strategies to challenge stigma and discrimination, and provides and promotes a valued place for service users” (Ministry of Health, 2008). The latest include understanding, recognising, minimising and challenging of the impact of stigma and discrimination on TWO; using non-judgemental language; promoting and facilitating inclusion; modelling non-discriminatory behaviour; and using non-discriminatory practices.
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