Inclusive Dialogue: The Way Forward in Anti-Stigma Education?

Yesterday saw the publication of a new article of mine in the Journal of Public Mental Health. It’s titled ‘Inclusive Dialogue: The Way Forward in Anti-Stigma Education?’ Inclusive Dialogue is an educational technique I developed during my PhD research, and the article discusses the impact it had on the young people taking part. As you need subscriber access to view the full PDF, I’ll use this blog post to give you a flavour of the piece.

Reducing the stigma of mental illness is a major public health issue.  Historically, the anti-stigma agenda has been largely controlled by those holding most power in the field – predominantly psychiatrists. This has led to anti-stigma initiatives drawing primarily on a biomedical model, emphasising similarity between mental and physical illness, stressing that mental illness can happen to anyone and that it should be treated with medication. However, there is a growing body of evidence that the biomedical approach to reducing stigma is not only ineffective, but can actually increase the very phenomenon it aims to ameliorate.

My work on inclusive dialogue aimed to develop a viable alternative approach to education about mental illness. The inclusive dialogue process consisted of a series of discussion workshops with a group of seven young people aged 14-15. The aim was to encourage participants to share and explore understandings relating to mental illness. I intentionally avoided being didactic, but rather set out to give young people opportunities to share and explore their own existing ideas and to reflect on their responses to stimulus material. 

 I intentionally avoided being didactic, but rather set out to give young people opportunities to share and explore their own existing ideas and to reflect on their responses to stimulus material.

I used a number of springboard techniques from which to launch conversations, including the use of photo-vignettes, a narrative building exercise, language audit, media-based activities and exploration of first-hand narratives of mental illness.

All of the activities aimed to foreground personal experiences of mental illness rather than to consider the concept in the abstract, or purely in terms of diagnostic categories. The young people taking part were encouraged to take an active role, bringing their own experiences and understandings to the discussion.

The approach was informed by the principles of constructivist education. The aim of constructivist education is personal autonomy – to enable young people to be governed by themselves, and to think logically about any subject or issue, drawing on their own resources to form both understandings and opinions. Inclusive dialogue represents an attempt to apply this philosophy to the delivery of education about mental illness, guided by two broad aims. First, to enable young people to look at the issue from a number of different perspectives, and second, to equip them with the resources to construct open and positive positions towards other who are experiencing or have experienced mental illness.

At the end of the inclusive dialogue process, I interviewed the young people who had taken part to find out how they felt it had affected them. The young people reported that as a result of taking part they had become more confident and comfortable in being able to talk about mental illness. They discovered a number of things that they had not previously appreciated, including that there can be positive aspects to having mental illness, and that having a mental illness does not necessarily mean a person will have a substandard life.

They felt they would be less scared if faced with a friend or family member experiencing mental illness and that they would have the resources to know how to respond. They also reported increases in knowledge and understanding, along with having more resources to be able to empathise with the experience of mental illness.  Most importantly, they seemed to enjoy the process, as this comment from a member of the group demonstrates:

“The best thing I did in school all year was that thing you did with us where we had to choose a picture and decide on what the person would be like and stuff, if they had a mental health problem.”

My work was encouraging, in that it showed inclusive dialogue has the potential to be a viable alternative to biomedically-based anti-stigma work, and that it can help to shift young people to being more open, empathic and supportive towards others with experience of mental illness. Given that mental health issues are an unavoidable feature of the landscape of the social worlds young people inhabit, the need to promote greater understanding of mental illness in society becomes ever more pertinent. The study I conducted adds to the body of evidence that there is a place for education about mental illness in adolescents’ lives and I would be delighted to see more teachers broaching the subject with their pupils.