Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between “us” and “them.” In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.

Mental illness has recurrently been found to be Othered by the lay public, although few researchers have examined the affective and implicit processes involved. To explore this, we triangulated facial electromyography (EMG), self-reports, and individual interview data, finding participants to Other mental illness, a process that involved disgust, fear and pity. Furthermore, mental illness was considered to have the potential to permeate, posing a contagious threat. This research highlights the need to fully explore the forms of understanding, which maintain mental-health related stigma, including beliefs about contamination, and the implications this may have for the design of anti-stigma campaigns.

Efforts to challenge mental health‐related stigma have been limited by an insufficient conceptualization of the problem space. As is common in health communication, practitioners have neglected the multiple tacit understandings the public embody in everyday life. Using the example of our recent research into the public’s social representations of mental health and illness, in this paper, we will work through the theoretical‐methodological considerations involved in how we approached expanding the problem space. Using social theory, we tailored thematic analysis and natural language processing techniques to examine the public’s polyphasic sense‐making processes. The approach is novel, as it diverges from standard methods in understanding health communication and the possibilities for behaviour change. Instead, we root our approach in a dynamic and relational epistemology to iteratively reveal in greater complexity some of the contents and processes that sustain mental health‐related stigma.

Objective. This paper reviews the decline in numbers in inpatient psychiatric care in Ireland over the past half century.Method. The relevant policy publications advocating de-institutilisation have been examined. Change has been monitored through successive census reports of the Medico-social Research Board and the Health Research Board.Findings. Ireland has moved from having the highest hospitalisation rate of any western country to a position of equality with other comparable countries in the quantum of inpatient care provided. In the public sector virtually no patients remain in 19th century mental hospitals with acute care being provided in general hospital units. Numbers have also decreased in the private sector but to a lesser degree and acute private care is still delivered in stand-alone psychiatric hospitals.

Mental health-related anti-stigma strategies are premised on the assumption that stigma is sustained by the public’s deficiencies in abstract professional knowledge. In this paper, we critically assess this proposition and suggest new directions for research. Our analysis draws on three data sets: news reports (N = 529); focus groups (N = 20); interviews (N = 19). In each social context, we explored representations of mental health and illness in relation to students’ shared living arrangements, a key group indicated for mental health-related anti-stigma efforts. We analysed the data using term-frequency inverse-document frequency (TF-IDF) models. Possible meanings indicated by TF-IDF modelling were interpreted using deep qualitative readings of verbatim quotations, as is standard in corpus-based research approaches to health and illness. These results evidence the flawed basis of dominant mental health-related anti-stigma campaigns. In contrast to deficiency models, we found that the public made sense of mental health and illness using dynamic and static epistemologies and often referenced professionalised understandings. Furthermore, rather than holding knowledge in the abstract, we also found public understanding to be functional to the social context. In addition, rather than being agnostic about mental health-related knowledge, we found public understandings are motivated by group-based identity-related concerns. We will argue that we need to develop alternative anti-stigma strategies rooted in the public’s multiple contextualised sense-making strategies and highlight the potential of engaging with ecological approaches to stigma.