Ending stigma in mental health: evidence to action

A freshly-published Lancet Commission tends to generate excitement. Evidence paired with incisive recommendations—all aimed at transforming a particular branch of health—is an appealing proposition.

But how much change is made once the ink is dry? What is the lasting impact of a Lancet Commission?

“Progress in the first year since publication of the Lancet Commission [on ending stigma and discrimination in mental health] is very encouraging”, state Graham Thornicroft and colleagues in a detailed account of activities post-launch.

The 2022 report’s main finding was dismaying: “Stigma and discrimination can be worse than the impact of the mental health condition itself.” Authors and people with lived experience—important contributors to the work—referenced self-stigma, discriminatory legislation, barriers to accessing mental health care, and more.

“People see [a mental health condition] like it is some form of weakness that comes from you. You are avoided like it is contagious. It is seen like it is not a serious problem and you can snap yourself out of it”, said one anonymous individual from Nigeria.

“Stigma and discrimination can be worse than the impact of the mental health condition itself.”

Resolute in its mission, the Commission called on the health community and beyond to help end all forms of stigma and discrimination against people with mental health conditions. Alongside a key message—that forms of social contact are effective in reducing stigma—eight recommendations were put forward. The Comment by Thornicroft and colleagues addresses them all, and we’ve selected a few highlights below ??

1. World Health Organization (WHO) anti-stigma toolkit and indicators: A new toolkit will offer practical information on designing and implementing anti-stigma programmes; it is planned for launch in mid-2024. WHO has also committed to adding new stigma-related indicators to its 2024 WHO Mental Health Atlas to track global progress.
2. Training for health-care staff: The World Psychiatric Association (WPA) and the International Council of Nurses (ICN) will support and monitor the provision of anti-stigma training. In 2023, the ICN issued a Charter for Change, with “mental health protections” listed as a priority, and WPA organised a series of six webinars on stigma in Asia, Latin America, and Africa.
3. Workplace interventions: The workplace was suggested as “an important locus of stigma in promoting social exclusion” in the Commission report. In 2022, WHO published its Guidelines on Mental Health at Work, along with an accompanying WHO and International Labour Organization policy brief.
4. Media partnerships: United for Global Mental Health (UnitedGMH) has led media roundtable discussions, and their Media Manifesto for action against stigma has been shared with several media associations. UnitedGMH is also building partnerships with media groups that, together, represent over 600,000 media professionals.

“The evidence base is clear [...] The challenge now is to implement these stigma-reduction methods in flexible, feasible, and sustainable ways across sectors, across countries, across continents, and over time.”

While changes in health policy and attitudes can be hard-won, progress is progress, and should be celebrated. The actions that have taken place in a little under a year are a testament to the drive of the Commission, mental health advocates, and the readership of The Lancet.

?? Read the Comment in full.

Related content:

??Building on the recommendations of the Commission, The Lancet hosted a webinar on “Context and culture in mental health” for World Mental Health Day. The event brought together researchers, policy makers, government officials, and other subject experts alongside Lancet editors. Watch the replay.

??In 2023, our #Lancet200 campaign zeroed in on Mental Health as one of five Spotlights. Explore a collection of related articles and multimedia.

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