Dr. Heather Stuart, a professor of Community Health and Epidemiology, was recently named the first Bell Mental Health and Anti-Stigma Research Chair – the first of its kind in the world. Writer Ned Dickens recently spoke with her to learn about her research.
Q: What sparked your interest in mental health issues?
HS: I grew up in Guelph, Ontario, where we lived on the grounds of what was then called the Homewood Sanitarium. Summers and part-time during high school I worked in virtually every department.
Q: How did you become involved with stigma research?
HS: About 15 years ago, Professor Norman Sartorius, who was the President of the World Psychiatric Association at the time, figured out that if we didn't do something about stigma – that is, the negative public stereotypes about people with mental health issues – psychiatry was up against the wall. Even if we could provide better services, people wouldn't access them because they were afraid of being labeled and of the discrimination that goes along with stigmatization. People who have mental illnesses are denied social rights and entitlements that the rest of us have and we all take for granted.
Q: Such as?
HS: Basic health care. I just had a fellow tell me the other day that he went to an [emergency ward] with a badly injured knee and they saw a psychiatric diagnosis on his chart. The first thing they did was to put him in a room and await a psychiatric consult. People are afraid of people who have a mental illness. We buy into all of the media stereotypes that "people like that" are dangerous and unpredictable.
Q: Aren't psychiatric patients more likely to be the victims of crime than the general population?
HS: Yes. Think about why. They are living in the worst parts of most major cities because those are the only places where they can get a landlord to rent to them, where they are at huge risk of being assaulted, teased, bullied or robbed.
Q: How widespread is stigmatization?
HS: We have lots of anecdotal evidence that it's widespread, but there's been no epidemiology to actually quantify the extent of it. In order to get funding for programs to address it, you have to have persuasive evidence that the program works. So stigma research is not something that's been funded because we haven't had any evidence to show how important stigma prevention is.
Q: What do you aim to accomplish in your research?
HS: We have to fill the holes in the evidence. First, we worked out an instrument – a survey that allows us to gather consistent information from people about their attitudes about people with a mental illness. We had a little bit of information to start with, but our surveys made it clear that stigma experiences are huge problems for people.
Q: What's next?
HS: What we really need now is more population-based data, because what we've got so far is from individual programs and we need to know about the rest of the world. We've worked with Statistics Canada and the Mental Health Commission of Canada to develop a stigma research module, and for the first time Statistics Canada will include it in their 2012 Mental Health Survey.
Q: You have said that it is more important to change behaviours than to change attitudes. Can you explain that idea?
HS: The little research we do have suggests that you can change people's attitudes and it makes absolutely no difference to the way they act towards people with a mental illness. We can be told lots of things about mental illnesses. We can even feel sympathy. But the attitude is still "I really feel for these people, I think society should do more for them, but there's no way I'm letting my daughter marry one." The fear is still there.
So what we're saying is that when we do these anti-stigma programs, it's not enough to show that they produce changes in knowledge. That's easy. It's not even enough for us to show attitude change. We want to change behaviours. We hear people [with mental health issues] saying, "Frankly, I don't care what you think about me, keep your opinions and attitudes to yourself. But, you're going to treat me fairly."
Q: But, as you say, that's still anecdotal evidence.
HS: Exactly. If we're ever going to really tackle the serious problem of stigma we have to have the evidence to know accurately what the problem is, where it is and under what circumstances, and what works in the fight to beat it. To know that, we need solid research, and that costs money. Somebody had to take the risk and say this is important, and that's what Bell has done.