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Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking.

BackgroundStigma and discrimination present an important barrier to finding and keeping work for individuals with a mental health problem. This paper reviews evidence on: 1) employment-related disclosure beliefs and behaviours of people with a mental health problem; 2) factors associated with the disclosure of a mental health problem in the employment setting; 3) whether employers are less likely to hire applicants who disclose a mental health problem; and 4) factors influencing employers' hiring beliefs and behaviours towards job applicants with a mental health problem.MethodsA systematic review was conducted for the period 1990-2010, using eight bibliographic databases. Meta-ethnography was used to provide a thematic understanding of the disclosure beliefs and behaviours of individuals with mental health problem.ResultsThe searches yielded 8,971 items which was systematically reduced to 48 included studies. Sixteen qualitative, one mixed methods and seven quantitative studies were located containing evidence on the disclosure beliefs and behaviours of people with a mental health problem, and the factors associated with these beliefs and behaviours. In the meta-ethnography four super-ordinate themes were generated: 1) expectations and experiences of discrimination; 2) other reasons for non-disclosure; 3) reasons for disclosure; and 4) disclosure dimensions. Two qualitative, one mixed methods and 22 quantitative studies provided data to address the remaining two questions on the employers perspective.ConclusionsBy presenting evidence from the perspective of individuals on both sides of the employment interaction, this review provides integrated perspective on the impact of disclosure of a mental health problem on employment outcomes.

W La Revue canadienne de psychiatrie, vol 55, no 7, juillet 2010 440Objective: Stigma has been conceptualized as comprised of 3 constructs: knowledge (ignorance), attitudes (prejudice), and behaviour (discrimination). We are not aware of a psychometrically tested instrument to assess knowledge about mental health problems among the general public. Our paper presents the results of the development stage and the psychometric properties of the Mental Health Knowledge Schedule (MAKS), an instrument to assess stigma-related mental health knowledge among the general public. Methods:We describe the development of the MAKS in addition to 3 studies that were carried out to evaluate the psychometric properties of the MAKS. Adults aged 25 to 45 years in socioeconomic groups: B, C1, and C2 completed the instrument via face-to-face interview (n = 92) and online (n = 403). Results:Internal reliability and test-retest reliability is moderate to substantial. Validity is supported by extensive review by experts (including service users and international experts in stigma research). Conclusion:The lack of a valid outcome measure to assess knowledge is a shortcoming of evaluations of stigma interventions and programs. The MAKS was found to be a brief and feasible instrument for assessing and tracking stigma-related mental health knowledge. This instrument should be used in conjunction with other attitude-and behaviour-related measures.Can J Psychiatry. 2010;55(7):440-448. Clinical Implications· Improving public knowledge about mental health can produce a positive impact on stigma, facilitate help seeking, and contribute to a greater proportion of people with mental illness receiving treatment in future. · To our knowledge, the MAKS is the first psychometrically tested instrument to assess mental health-related knowledge at the population level and can be used for longitudinal studies of changing population levels of mental health-related knowledge. · The MAKS is a brief and feasible method for assessing and tracking stigma-related mental health knowledge and can facilitate evaluation of large-scale antistigma interventions, and will allow for better understanding in the future of how knowledge, attitudes, and behaviour interrelate. Limitations· Although online assessment should reduce social desirability, we cannot be certain to what extent social desirability affects participant response. · The MAKS alone is not sufficient for assessing reductions in discrimination or success of an antistigma intervention and should be used in conjunction with attitude-and behaviour-related measures. · Future research is still needed to examine how improvements in these areas of mental health knowledge translate into changes in stigmatizing behaviours.