5 Takeaways for Business & Funders: The Lancet Commission to End Stigma & Discrimination in Mental Health

Today the Lancet Commission on Ending Stigma and Discrimination in Mental Health (“the Commission”) has been published.

It has been developed by over over 50 global experts, and I have been honoured to be included as one of the Commissioners. It has been co-produced by people with lived experience of mental health conditions, and includes powerful quotes, poems and testimonies that bring this issue to life, with some of these included below.

The Commission makes a compelling and clear case for us all to act, including private sector actors.

Below are our five key takeaways for private sector actors:

1. The consequences of stigma and discrimination violate basic human rights
2. The workplace is a key setting for stigma and discrimination
3. Key recommendations to reduce stigma for employees include: manager training, reasonable accommodations and social contact?
4. Action needs to be taken across the whole of a business: People & Policies, Products, Promotion, Philanthropy, and Power.
5. The media (including social media) is called out in particular to act??

Read below for more detail on each.

1. The consequences of stigma and discrimination violate basic human rights

Mental health at work has gained increasing prioritisation in the workforce for key reasons including productivity, customer demand, and retention.? These are all important to business, however, so too are human rights.?

“Human rights are the foundation of a healthy society & sustainable business”?- Paul Polman ?

As part of the research for the publication a global survey of people with lived experience of mental health conditions was undertaken, led by Charlene Sunkel and the Global Mental Health Peer Network , finding "stigma is often worse than the condition itself".?

People with mental health conditions, especially those without adequate support, experience increased social isolation and denial of basic human rights, such as job and education opportunities and access to healthcare, including access to the mental health care they need to recover.??

You can hear more of these stories here:

So, while it is important for companies to prioritise the promotion of good mental health and prevention of the onset of mental health conditions, it is also critical for companies, philanthropists and investors to focus on reducing the stigma and discrimination experienced by those who experience a mental health condition.?

2. The workplace is a key setting for stigma and discrimination

“The most difficult for me in the period as I was ill, was how the people at work treat me.”? - Person in Spain

The global lived experience survey also highlighted the workplace as a place where stigma and discrimination is not only experienced, but can have significant knock-on impact. The fear of being perceived as being “unable to work or unstable”, bullying, not being offered equal job opportunities, fear of job loss, and being refused time off work for healthcare appointments are just some of the key issues to be addressed and overcome.

There was also a recognition that some companies who have said to be addressing stigma are doing so in a superficial way.?

However, as outlined in the World Health Organization Guidelines on Workplace Mental Health released last week, work has the opportunity to have a positive impact on mental health where it “contributes to a person’s sense of accomplishment, confidence and their earnings, and contributes to recovery and inclusion for people living with psychosocial disabilities”.

So, action from employers themselves in creating a safe and supportive environment for people with mental health conditions is critical to end stigma and discrimination in the workplace.

3. Key recommendations to reduce stigma for employees include: manager training, reasonable accommodations and social contact?

The recommendations made in the Commission echo those made in the recently released WHO Guidelines on Workplace Mental Health, and Policy Brief in collaboration with the International Labour Organization .?

As in these guidelines, the Commission also highlights that much more research is needed; specifically in measuring structural stigma, and general research on LMIC-based workplaces (of which the Commission found no evidence for).?

However, the recommendations that are made include:

• Manager training. “Training managers to understand and support the mental health needs of employees is effective in improving mental health related knowledge, non-stigmatising attitudes, and self-reported supportive behaviour”
• Positive discrimination through reasonable accommodations at work. This is defined as “necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms”
• Social contact. Social contact (in person or remotely) between people who do and who do not have lived experience of mental health conditions is the most effective evidence-based way to reduce stigma and discrimination.

The final recommendations highlights a fundamental challenge for progress:

“There’s a catch-22 ... speaking out about your own mental health condition and lived experience can be powerful and collectively help to reduce the stigma; however there is still the very strong notion that doing so will hurt your job opportunities, personal standing etc”

- Anonymous

This is a lot to ask of anyone living with a mental health condition.

This demonstrates so clearly how and why employers, and the investors that invest in them, need to commit to reducing mental health stigma and discrimination at work with meaningful action that protects and supports people experiencing a mental health condition for progress to be made.

4. Action needs to be taken across the whole of a business: People & Policies, Products, Promotion, Philanthropy, and Power.

The recommendations the Commission provides is helpful for taking action across all areas of business.

At Prospira Global we break this down into the 6 P’s, and some key suggestions as they relate to each are provided below:

4a. People & Policies

As above, all employers need to enact the recommendation of the Commission and “promote full access to educational opportunities, work participation and return-to-work programmes for people with mental health conditions.”?

4b. Products

While there is little focus in the Commission on products offered by companies to their customers, there are findings which could (and we argue, should) be applied to a company's products.? Few industries are examined in detail in the Commission, implications can also be drawn from the Commission for any company, from the language used of CEOs to customer service providers, or examining if products cause discrimination in and of themselves.??

For instance, a study from Finland released this year highlights discrimination often present in the product offerings of insurance companies.? Professor Hasse Karlsson , Professor of Integrative Neuroscience and Psychiatry at the Turku University of Applied Sciences (note: study not included in the Commission), found that mental health issues do not automatically pose a higher insurance risk , and yet are often still included as an exclusion clause, preventing people with mental health conditions from accessing insurance, or increasing premiums.?

4c. Promotion

Language is critical. From using the term ‘mental health’ in the positive sense it should be, to avoiding language that reinforces negative attitudes, all companies should be aware of what language to use - and not use - in their communications both internally and externally.?

The Commission recommends:

• "Using ‘person-first’ language, rather than ‘identity-first’, i.e., we recommend using the term ‘person with a mental health condition’, or ‘person with lived experience of a mental health condition’; but
• Ultimately decisions about which terms to use should be made by the people directly affected (especially as some language can be stigmatising in different languages)"

4c. Philanthropy

Companies and philanthropists alike are thankfully increasing their philanthropic spend to mental health.? A large focus of this spend is on anti-stigma programmes. The recommendations outlined in the Commission provide a helpful guide for funders to evaluate and support partners in designing and evaluating the success of anti-discrimination and stigma reduction programmes.?

4d. Power

The number of brands looking to use their platforms to advocate for change is also increasing, both public awareness and political advocacy.? Again, the Commission provides an invaluable resource for every company or funder undertaking stigma reduction work, ensuring investments and campaigns for change are grounded in what actually works.

5. The media (including social media) is called out in particular to act??

The media is identified as an industry that has power to influence public attitudes and behaviour - positively and negatively. As a result, a whole chapter is included in the Commission, and the media is called to “systematically remove stigmatising content and issue policy statements and action plans on how they will actively promote mental health and consistently contribute to reduction of stigma and discrimination in mental health”.???

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Thank you to everyone who has worked to develop and publish this seminal piece of work, which will be helpful for anyone seeking to reduce stigma and discrimination of people living with mental health conditions.

We’d like to thank Professor Sir Graham Thornicroft, and Charlene Sunkel (Global Mental Health Peer Network) for your leadership, The Lancet , all the Commissioners and partners for making this possible.

Prospira Global has been created to support global companies, philanthropists and investors who want to understand their mental health risks, and opportunities for impact, including stigma and discrimination reduction across your whole business.?

If you need support with this work, please do get in touch.