Tuesday, October 21, 2014
Combating stigma has been a major priority of the Mental Health Commission of Canada. They have adopted a targeted approach, working with grassroots organizations to: reduce the impact of stigma on children and youth, reduced stigmatization by health professionals (who are not immune from stigma) and to reduce stigma in workplaces. A major summary of this extensive program of research is now available through the Canadian Journal of Psychiatry and can be accessed here. When it comes to reducing stigma by health professionals, six key ingredients are identified: (1) adopting a recovery emphasis, (2) using multiple forms of social contact (this means real communication between people with illnesses and health professionals outside of the typical professional channels, e.g. "Doctor-Patient"), (3) a personal testimonial, (4) myth-busting, (5) teaching of skills and (6) an enthusiastic leader for the intervention. Among 22 anti-stigma studies evaluated, those that incorporated all six ingredients performed better than those that incorporated only some.
In a recent blog posting, Dr. James Coyne provides a detailed discussion of a large clinical trial evaluating the impact of adding psychotherapy (manual based, high quality cognitive behavioural therapy, CBT) to pharmacotherapy. One of the key results of the trial is that a large proportion of those receiving such state-of-the-art treatment continue to experience depressive symptoms. The addition of CBT did not have a dramatic effect over and above the medication treatment. It is best not to interpret this kind of information as if it were some kind of competition between different modalities of treatment (all of which are supported by evidence). The key message is that depression is a long-term issue for many people. Dr. Coyne's blog may be found here.