ruby waxIn recent weeks Ruby Wax and Stephen Fry have once again reminded us that the lives of the famous are not always as perfect as we might think. Not for the first time, these two stars of British TV have publicly discussed their mental health: Wax her depression and Fry his bipolar disorder. Their continued openness furthers a helpful trend among celebrities. But for the vast majority with such conditions, discussion is not the norm.

Stigma and discrimination have long been major barriers to people with mental illness. The true scale of these problems has become apparent only relatively recently. In a global study published last year (The Lancet Study), we showed that 79 per cent of people with depression had experienced discrimination in the previous year. More than 1000 people were interviewed across 35 countries, and a remarkably consistent picture emerged: such experiences are common and may severely limit how far people with mental illness can lead normal lives. 71 per cent said that they wished to conceal their diagnosis of depression from others. 

Although concealment is an understandable reaction to being shunned, it creates a problem. Concealment means that fewer friends, family and colleagues know that the person has a health problem, and so their prejudices may remain unchallenged. Concealment reduces social contact and perpetuates stigma. On the other hand, disclosure also brings real risks of discrimination. Those with mental illness are constantly confronted with this dilemma of keeping quiet or opening up.

The consequences of stigma and discrimination can be severe or even life-threatening. The average life expectancy of people with mental illness is at least 15 years shorter than that of the general population in Europe. This is, at least in part, due to less effective treatment by family doctors and hospital staff of the physical health problems of people who also have mental illness: staff sometimes misdiagnose physical complaints as being “all in the mind”, rather than investigating problems thoroughly. A further challenge is that, in every country where this has been studied, the great majority of people with mental illness do not get any treatment at all for these conditions. In poor countries this is largely because treatment is not available, but it is now clear that another important reason is that people do not seek help because stigma makes them fear loss of reputation.

Given that depression is the third biggest contributor to the global burden of disease – and the leading contributor in middle and high-income countries – anything that helps ease its impact and that of other mental illnesses needs exploring” (Graham Thornicroft and Diana Rose in The New Scientist [2013])

One of England’s most famous comedians discusses the stigma of mental illness in the following talk. Hopefully you will be both amused and awakened!