 Mae adnod i'i argynno'r rhesuig ymlaen i'r Unedig Ymlaen i'r Llyfrgell yn y Gweithgrifol yng Nghymru. Mae arlaen i'r adnod o argynno'r gesuig ymlaen i'r Ymlaen i'r gwahodau. Mae angen i'r adnod i'r adnod i'r adnod i'r gweithgrifol yw'r reiswyr, rydyn ni'n gwybod i'r grond i'r ffordd i'r llwythion o'r argynno'r bwysig, dyma eich bod yn ymlaen i'r gweithgrifol, iawn i'w gwaith yng Nghyrch Llywodraeth Sdigma a'r ysgwrs. A dyna, Jessica Irwin a'r drwy'r dr campsur o'r ddysgu'r digon현 i'r darllwn o'r corrections cerddio gwaith, ac y gallwn gymryd. Yn gyfer beth, dyma'n edrych i'n mynd i'w ysgwrs. Oes ystod, yr Osud orwaith Sdigma yn y ddyl여ng fathers, dwi'n olygu yn gwybod y dynol, sydd yn yr UK, dwi'n olygu yn ei gweithio sydd wedi'i bod yn ystod ples bwrdd sdigma. gallwn i'n ymlaen i amlwg ac i gael presbytyno ar gyfer Yndygol. What do we mean by stigma? But the term is very much said to come originally from the ancient Greeks who talked about stigma as something you physically branded on somebody to make them visibly undesirable to other people. So you mark them out as somehow being different to the rest of society. This was used for slaves, for criminals and other people seen as undesirable. Okay? Now that term was picked up in the social science, particularly in sociology, by Irving Goffman. a very, very influential North American. He published this book, stigma on the management of spoiled identity. What he said, which I think immediately became obvious in the short excerpts there, is that stigma is an attribute that is deeply discrediting, so in this case, struggling with a mental health difficulty, and that reduces the bearer from a whole and usual person to a tainted, discounted one. Nothing Jessica talked about that very powerful, how people suddenly started to see her differently to the Jessica she had been for nine years. To other very influential thinkers, Bruce Link and Joe Phelan said stigmatisation exists first of all when an individual attribute is labelled, so this might be mental health problems generally or autism, depression, anxiety, substance misuse and so on. The individual attribute is labelled, it is evaluated negatively by society and the community, and people who carry that label experience status loss and discrimination, so it's not just about being seen as different, but it's about actually the process of being somehow devalued and losing status and becoming vulnerable to discrimination. The third person who's been very influential in the field of mental health stigma is a colleague from London, Sir Graham Thornycroft, and he talks I think in a much more accessible way about stigma being a problem with three aspects, and the first one is a problem of what he says ignorance, a problem of knowledge that people don't understand and there's a lot of misinformation around, a problem of attitudes which in the world of psychology we generally call prejudice, and then a problem of behaviour, so this is what actually happens as a result of stigma which is discrimination. Now there's been quite a lot of research about this relationship between knowledge, attitudes and behaviour, and I think interestingly there are big campaigns in many many many countries to try and reduce mental health stigma, and one of the things is we find in relation to many conditions as people understand them better, and there's much wider attempts to tackle misinformation, people's attitudes become more positively, so there've been some longitudinal, some over many years studies around depression for example, as the general population understands more about depression people's attitudes become more positive, but that does not apply everywhere, so particularly in relation to schizophrenia, psychosis but also substance misuse, negative attitudes really persist, and I think one important aspect is negative and sensationalist media reporting, it's probably not the own aspect but it certainly has a very important role to play. I don't know what it's like in the Netherlands but usually you will only hear about schizophrenia or psychosis when something terrible has happened, there's been perhaps an attack in public on somebody, by somebody who was experiencing paranoid delusions or hallucinations, with no mention at all that people with schizophrenia are actually more likely to experience violence themselves to be the victims of other people's actions. So simply educating the public is not the whole solution, it's very important. And what are the effects of stigma? We've already heard quite a bit about it, but a colleague from the US, one of the key figures in the mental health stigma field, Pat Corrigan said many years ago, mental illness strikes with a double edged sword, and what he means, I think for me there's always been a really important sentence, on the one hand if somebody starts to experience a mental health problem, they need to struggle with the symptoms, they need to take medication which very often has side effects, they need to engage in treatments and decide what they tell other people about these. But the other side, the other edge of the sword is other people's perceptions, the responses somebody experienced. And he says, and very much from personal experience, Pat Corrigan is a professor, distinguished professor of psychology in Chicago, he's also very open about his longstanding experience with bipolar disorder himself. So he's been in a mental institution, he's experienced all the effects of being on lithium experiencing discrimination and so on. And in his view, and many people he's worked with, very often the stigma side of the sword is much worse than the actual symptoms and lasts for a very, very long time. Some of the other effects of stigma, I'm sure you're probably aware of those, but I thought I'll simply summarise them. Are that people experience discrimination in employment, housing is another really important area. There's quite a lot of research that shows people mental health problems, often problems accessing good housing or keeping good housing and discrimination in healthcare. People are very often excluded from activities, relationships and communities and many of the sort of activities we regard as making up a valued life and helping to most other people. They very often lose relationships and valued roles other people have access to. Even though I think things are changing quite substantially, there certainly is a big concern about, for example, parenting. What is the impact on me being able to parent my children, will social services become aware and get involved and so on. Very often financial insecurity as a result of not being able to find work or maintain a job. And then something that a lot of research focuses on the effect on the person themselves, how they think about themselves, how they see themselves, which is what we refer to as a self stigma. So, very often people will blame themselves for their difficulties, will think, well, somehow it's my responsibility that I'm struggling if only I done things differently or why can't I get better. Very often a lot of shame, which I think is something that's talked about much less because it's very difficult to talk about the sense that I'm somehow, I'm faulty, there's something not quite right with me, that's sort of the tainted, which Urban Government is talking about, and the anticipation or the actual rejection. So it may be that somebody fears other people will reject them like Jessica was talking about, or it may just be the feel that what do I do, what will other people see me differently. And those in turn can have a very, very profound effect on how somebody excesses both informal support. So support and help from other people, from friends and family, but also whether they excess professional help, whether they excess psychiatric services, mental health treatments, counseling, and so on. And whether they possibly seek support in a work environment. And together those things obviously can have a very negative effect on people's recovery if they don't excess the help they are entitled to. In terms of anti-stigma interventions that are out there, so a lot is being done to try and tackle mental health stigma, and I think we can broadly categorise them into interventions at three levels. So first of all there's obviously very, very importantly interventions at societal level. So there's putting laws in place, making sure that people's rights are protected, trying at societal level to tackle stigma through big anti-stigma campaigns and so on. Then there are a lot of activities at the level of the stigmatiser. This is other people who hold stigmatising attitudes and to may discriminate against people mental health difficulties. Something we also call public stigma or external stigma. So there's attempts to educate either the general public or to do to work with specific target groups. So there's a lot of work going on in schools. There are a lot of interventions for particular key groups, teachers, healthcare providers, employment advisors and specialists, the police, legal services and so on. People who are much more likely to come into contact with people mental health difficulties to try and educate them and sensitise them to the risks of stigma. And then finally, the third group, there are interventions for people themselves and they really target two things. There are quite a lot of work going on to try and either reduce the risk that people self-stigmatise, that they experience negative thoughts and feelings about themselves or that they think very carefully about what we call disclosure decisions. And it's the second bit I wanted to tell you a bit more. There's a lot of work going on locally at Transo thinking around disclosure. One of the early reviews around this, which is very helpful is by some colleagues in London, which looked at beliefs, behaviours and influence factors associated with disclosure of a mental health problem in the workplace. And basically the picture they painted, it is pretty complex and complicated. There are a lot of factors and I think we already saw that. The lady at the end who made a careful decision to actually not tell people and to justify that to herself whereas her boyfriend hadn't even talked about it until it was obvious that something was going on. We produced a parallel review to look at disclosure outside the workplace, so in personal settings, but obviously today you're very much thinking about the workplace. And what that tells us in very simple terms, when people make this decision, it's a pretty difficult decision, very often it may be quite a snap decision or something they don't think about very carefully. But some of the things that go in favour of what we might call self-disclosure, so sharing aspects of one's experience or in the case of Alwyn's diagnosis of autism might be the knowledge that there are legal protections in place that one is entitled to access to support and to reasonable adjustment. So these are some of the things in favour of actually telling somebody in a workplace, telling the employer. There's a whole, and I could probably put a big stack on there, things that actually lead people to decide against self-disclosure, whether they think about it carefully or just an instinctive decision. And I think Jessica's decision seemed to be quite, no it wasn't Jessica, sorry, the third lady whose name I don't recall, was quite a quick decision of just I think they might discriminate against me with a long history of substance misuse and 10 years out, so I'm just not going to tell them. But some of the key factors we know from research are the fear of being found out and everything else that comes with that, but others will see me negatively or certainly they will see me differently. They may not any longer invite me along to whether it's after work outings, whether it's more social gatherings, they may behave a bit differently in the coffee room, whatever it may be, and the fear about career prospects. And we heard some clear examples there of being passed over for promotion. And very often it's very difficult to know, well is it a fear of, or is this what actually really happens? And many people are swayed by the fear things they've heard from other people, but also perhaps the sense that there's something a bit wrong with me and decide against telling a work. I think we're seeing quite a shift and I think the pandemic has moved this along further. I think certainly in the UK and I imagine in the Netherlands, it has really, really opened up conversations about workers well being mental health problems. And I think there's quite a lot more sympathy, but we shall see how it goes over the years. So, understandably then, quite a lot of work and I think you'll hear a lot more today about the work of Transo locally around how do we support people in making these careful decisions around whether they might share their mental health difficulty or not and how they might go about that. There are two particular interventions and treatment programmes, if we may call them that, that have gained a lot of attention internationally. The first one is Coral, which stands for concealed or revealed, so do I hide or do I share? Yeah, which is a basically a one session decision aid, which is designed for employee employment specialist employment advisors to work with somebody as they take up a new job to help them think about these decisions. And you will hear more about that later I imagine because that was very much the focus of Kim Jensen's work and some very, very interesting work and research that has been conducted locally in the Netherlands. And the other intervention, which my group has been much more involved in, comes from Pat Collins group in the States and is called Honest, Open Proud or Hope for short. It is very briefly a manualised peer group intervention, so there's a booklet you put it off the shelf and follow what it tells you. It is done with a peer group of other people experiencing mental health problems, and it's designed to support decisions and actions around disclosure. It is nearly always co-delivered by somebody who is a sort of hop trainer and a peer facilitator, so somebody with mental health difficulties is there delivering this, the hop intervention. There are many, many versions now in many parts of the world, so there's a version for high school students, for military veterans, people with Tourette's syndrome at the moment in the UK. We're trying out a version for people with autism and autism suicide attempt survivors because attempting suicide is very, very stigmatised. So people have lots and lots of reasons to think very carefully what they share, how they explain their absence and so on. And it's very structured, so whereas the corral tool is just usually one session integrated with an employment advice, this is much more interactive, it much more brings people together to share their experience and things together. So it's usually three, one and a half or two hour meetings and then a follow up a few weeks later or it can be done as a one or two day workshop. So this is just very briefly the aims of HopR to support people with current or past mental health difficulties or challenges to carefully consider whether they want to share this or not, to reduce the self stigma, the blaming of oneself, the stress that is associated with thinking the whole time will people find out what might happen and disclosure related to stress. So this is the worrying and the anxiety that very often comes with actually thinking the whole time will somebody find out might I need to tell them. So to reduce those things and all of them associate mental health problems and to promote a sense of empowerment to give people much more of a sense that I can make my own choices and I'm in charge. And much more broadly is to challenge stigma within society because of more people choose to talk openly about mental health difficulties. We know that in the long term the effect will be that stigma will be reduced and people will gain a better understanding because it's not just some some strange person they read about in the media but it's actually many people in their workplace who may may have struggled with depression with anxiety and with other conditions. The structure very briefly it's structured as three lessons so somebody firstly thinks very carefully this what I was saying the balancing to actually really think in detail what are the pros and cons and what is important to me because they're not the same for everybody. Then they think about different ways of disclosing because people very often going to thought about this and many, many different ways and I can think very carefully who I choose. I might try out a colleague first somebody who is very sympathetic and holds very positive values before I necessarily talk to my employer. There's very different ways I don't need to tell them everything I can tell them tell them a little bit. So it thinks it through in a lot of detail. And then as a last step if the person decides that they're going to share it actually guides them through sharing their experiences. All the time emphasizing this is a decision you can constantly revisit so it's not a either yes or no you may decide just at this moment in time it's not right for me but it's something I can come back to in the future. And then there's a follow up session. A few weeks later to say well if you decided how how did it go. Did it go as you expected to to help the person and structure this. Now there's been a few trials of of hope conducted and the key conclusion is, it does seem to lead to a reduction in stigma stress. Yeah, so that people worry so much more other people will think and also reduction in in self stigma and a review a matter analysis where lots and lots of different studies are brought together and you look at all the results together by by my colleague Nicholas Rouge and costors concluded that there's initial evidence that hop effectively supports people of mental illness in their disclosure decisions, and in their coping with stigma and there's similarly positive evidence about the corral that can seal or reveal decisions. Okay I'm being shown this the stop sign so just very briefly by way of summary. Summary, they're also obviously there are a lot of interventions at as I said at the interpersonal level so to try and reduce other people's and the key message from those is simply educating people is not effective so providing direct contact is at least twice as effective as just providing education. Yeah, so that always having people with lived experience of mental health problems involved is very important. And I won't talk about other levels but I gather in the Netherlands you've at least got one big campaign together strong without stigma, they're big anti health campaigns happening other countries there's actions in in schools and so on and we've seen. I think really in the last 10 years lots and lots of changes in service structures really thinking about trying to reduce discrimination and how do we support people in the workplace by making adjustments. And there are many things we can do individually thinking very much about our own attitudes and behavior, trying to catch ourselves out because we're all massively influenced by by mental health stigma and thinking very carefully about our words because stigmatizing words are huge partner language so we constantly say things like, oh that was mad and crazy and whatever and and people who've been accused of all those things really really pick that up as very negative and stigmatizing language. And I should stop there. Thank you very much.