Promoting social change to overcome the stigma of mental disorders : aspirations, cooperation and commitment to collective mental health advocacy

Abstract

A significant body of research demonstrates that people with mental disorders face prejudice and discrimination from other people in society and the health professions as well as systemic and structural disadvantage. Although this structural stigma is recognised as a significant problem for people with mental disorders in the psychological literature, the methods for reducing stigma overwhelmingly focus on changing the attitudes and behaviours of individuals, thereby failing to address the structural disadvantage that perpetuates that stigma. In this thesis, I argue that in order to develop methods that will be effective in reducing stigma, these methods must also produce movement towards positive social change to overcome systemic disadvantage. I propose this change can be achieved by cooperation between people who support mental health advocacy and in particular cooperation between people with mental disorders (and carers), health providers and other members of the public (including government officials) who hold a shared group membership, in what we have termed a cooperative community. This thesis presents five studies to explore aspirations for cooperation among people committed to the aims of mental health advocacy. Studies 1, 2 and 3 (Chapter 4), utilising nominal supporters of the aims of mental health advocacy, demonstrate there is strong commitment to mental health advocacy among people who are not active advocates for mental health but who nonetheless identify as members of this group based on shared opinion. Additionally, this opinion-based group identity is strongly associated with an ideology of endorsing cooperation as the most desirable and effective method for reducing stigma and achieving positive change. This ideology adds unique prediction to non-stigmatizing individual practices (positive beliefs and social interaction intentions) and intended socio-political action. Studies 4 and 5 (Chapters 6 and 7) then explored aspirations for cooperation among active advocates for mental health. Document analyses and interviews with members of two different mental health advocacy organizations demonstrate that advocates strongly value partnerships in the mental health sector, work to develop collaborations to advance mental health advocacy and view cooperation between people with mental disorders and carers, health providers, members of the public and government officials as vital collaborations in making a positive difference for people with mental disorders and the mental health sector. Findings are therefore consistent with those of Studies 1-3 in indicating that people committed to the aims of mental health advocacy, whether nominal or active supporters, strongly aspire to a cooperative community. Taken together, results of the research presented in this thesis provide evidence to support the proposal that (a) social identification as a supporter of mental health advocacy (i.e., an opinion-based group identity) and (b) a shared group ideology that endorses aspirations for cooperation are both strong drivers for stigma-reducing practices to advance the cause of people with mental disorders. The current research also adds to understanding about opinion-based group identities in mobilising collective action and the role of group-based ideology in providing a shared orientation for group actions. Implications for training and community programs are discussed.