The urgent need to talk about mental illness

The taboos around mental health can be isolating Keystone

In Switzerland, as elsewhere, mental illness remains a taboo - despite the country having one of the highest number of psychiatrists per capita in the world. Campaigners argue that it is time to break down this culture of silence.

Would you hire someone who was mentally ill? Would you let them babysit for you? Only 38% would do the former, with just 14.2%, doing the latter, according to a survey of attitudes to mental illness which was presented at the launch in Zurich, in early October, of Switzerland’s first national campaign targeting the taboos around mental illnessExternal link. (See infobox)

“European societies have opened their minds towards mental illness but mostly on a certain level: you may be in favour of taking certain measures generally, but if it comes to actually employing someone who is mentally ill, then that makes things different,” said Wulf Rössler, the former director, now retired, of the Psychiatric University Hospital Zurich, who presented the overview.

“With a babysitter, that’s really sensitive, people want to defend their children. Then it becomes really obvious what people think about the mentally ill.”

Which was, the survey found, that some people thought that they were “dangerous”, “unpredictable” and their illness was “their own fault”. Even professionals in the field can sometimes have certain prejudices, added Rössler. This is why an anti-taboo campaign is so important, he said.

“Mentally ill people have the same life aspirations as everybody else: they want to work, have a family, be integrated and earn their own living,” Rössler said.

How are you, really?

Franca Weibel, from mental health organisation Pro Mente SanaExternal link, one of the campaign’s backers, has firsthand experience of prejudices. Her daughter was just 17 when she was diagnosed with schizophrenia and has been in and out of clinics. She has also attempted suicide. Her isolation from society is what prompted Weibel to speak out.

A person with schizophrenia would also like some respect, like someone who has a more “visible” illness like cancer, she argues. “And to be allowed to tell people what it’s like when someone asks how you are.”

Indeed, “Wie geht’s DirExternal link (how are you?) is the motto of the campaign, which is also backed by the cantons of Zurich, Schwyz, Bern and Lucerne as well various health associations, including some from the French-speaking Switzerland.

Posters (see gallery), a brochure and a website give tips on talking about and information on mental illnesses. It is the first time that the issue has been addressed on a coordinated, national level (previously it was up to the cantons).

The need to take action seems all the more pressing as, according to Pro Mente Sana, one in two people in Switzerland will suffer from a form of mental illness during their lifetime. And there are costs: in-patient psychiatric care came to CHF2.1 billion ($2.2 billion) in Switzerland in 2010, or 3.4% of health costs, says the organisation. Out-patient doctor psychotherapy care cost CHF212 million.

A land of psychiatrists

Switzerland has a very differentiated mental health care system, with a lot of specialised resources, said Niklas Baer, a consultant for the Organisation for Economic Co-operation and Development (OECD)External link, who works for the psychiatric services in canton Basel CountryExternal link.

“We have the highest rate of psychiatrists per population in the whole of the OECD. The second best country [Iceland] has half as many psychiatrists, so we have huge resources. Additionally we rate very highly in specialised in-patient mental health care, we have a very high rate of specialised beds and hospitals and many out-patient psychiatric services,” Baer told swissinfo.ch.

The high number of psychiatrists might be explained by fact that Swiss psychiatrists have different task than their counterparts in other countries. Whereas the latter are often extremely specialised, doing lots of diagnoses, Swiss psychiatrists are more like family doctors, providing long term treatment and basic mental healthcare, Baer explained.

But, nevertheless, “stigma and taboo is a worldwide phenomenon and Switzerland is no exception,” he cautioned. “It’s interesting that mental healthcare has strongly expanded in the past decades but the stigma has not reduced. It’s a deeply rooted thing.”

Nobody likes talking about mental health problems, so a campaign is a good thing, he said, but he is “a bit sceptical about how long lasting such potential effects will be”. “Moreover, not all barriers are related to stigma: in employees, for example, even moderate mental health problems cause a lot of real productivity losses at work. This is not due to stigma but caused by mental ill-health. If there were no stigma anymore, a lot of problems would still remain,” he added.

Anti-stigma research shows contact with mental illness sufferers to be productive for countering taboos, for example at the workplace, Baer said. The OECD recently published a reportExternal link, in which Baer was involved, saying Switzerland should improve its approach in this area – above all by improving the contacts between employers and treating psychiatrists.

Mainstreaming

Shekhar Saxena, Director of the Department of Mental Health External linkand Substance Abuse at the World Health Organization (WHO) in Geneva, looks at mental health issues from a global perspective. He says it is hard to change attitudes and behaviours through information alone.

“The best reduction of a system of stigma and discrimination of mental illness is that it be mainstreamed in hospital system and society in general,” he told swissinfo.ch.

Many countries still have separate mental hospitals, but it is better to treat patients in a general hospital, which also treats patients with other illnesses. The WHO also supports more care in the family and community, an area in which Switzerland could do more, he said.

Like Baer, he underlined how getting people back into work and society was important, citing the  example of the former Norwegian prime minister Kjell Magne BondevikExternal link who took a leave of office to be treated for depression and then resumed his duties, eventually being re-elected. The case strikes at the heart of many mental health myths, he said.

“The attitude around the world is that people with mental illness are inferior, that they can’t ever be ok and it’s best to let these people be isolated,” said Saxena. “All these premises are wrong.”

Swiss campaign

The Swiss national campaign was launched on October 10, 2014, World Mental Health Day, by mental health organisation Pro Mente Sana and Canton Zurich. It also has the backing of the cantons of Schwyz, Bern and Lucerne, and health organisations in French and German-speaking Switzerland.

The idea is to tackle taboos in society and make people talk more and find out more about mental health problems.

Posters highlight four conditions, including bulimia and depression. At the launch, there was some criticism that there were no young men in the posters, a group known to have a higher risk of suicide. When asked about this by swissinfo.ch, Pro Mente Sana president Thomas Ihde said that young men were not yet included, but “we started with 4 posters, the idea is that we will have 100”.

The campaign will last into 2016, and be extended not only thematically but also geographically to other cantons. Campaigners are hoping to bring partners from the business world on board as well.