Jo Mueller investigates how parents could hold the key to tackling mental health stigma.

When it comes to attitudes to mental health, things are getting worse. Despite the high-profile campaigns, stigma and discrimination against people with mental health problems seem to be on the rise. Part of the reason may be that our campaigns are promoting the wrong message. The way we often address stigma is to promote the idea that mental health problems are illnesses. The rationale is noble. Rather than give the impression that someone is weak or blameworthy, isn’t it surely better to say they are sick?

The danger of this is that the idea of something going wrong with people’s brains can be scary and alienating. Put this together with the ‘1 in 4’ idea – that one in four of us will suffer ‘mental illness’ at some point – and it can add up to a frightening message: there’s a dangerous disease out there that might strike at us any time.

However, we all have dark moments, and many argue those are on the same spectrum as the emotional distress that attracts ‘mental health’ diagnoses. As clinical psychologist Anne Cooke said recently, ‘there is no “us and them”, no people who are “normal” and people who are “mentally ill”. We’re all in this together.’

Just as important as the message though, is the question of whether the wide-focus approach of anti-stigma campaigns (posters on the tube, etc.) is the most effective way to go about things. So what messages should we be giving and who are the most important groups to reach?

A study that I and some colleagues have recently published investigated both the message and the people who receive it. In particular, we looked at the importance of communication during key stages of children’s development and we considered how parents talk to their primary-school-aged children about mental health.

Our central finding was that, while parents were happy and open when chatting to their children about mental wellbeing, the exact opposite was true when communicating about mental illness. The more parents thought of a particular issue as being about mental illness, the more they conceptualised it as happening to other people and the less they talked to their child about it. Even when asked directly, parents tended to avoid the subject. Comments often inadvertently reinforced the us and them distinction: ‘He’s met a girl who is bipolar but I don’t think he realised… they look like you and me.’

Interestingly, the parents in the study all said that they wanted to be open and honest with children about mental health problems. The mismatch with what they actually did led to some interesting contradictions. For example, parents believed that their children were understanding and accepting of mental illness. However, they also talked about children’s lack of understanding and the probability of them being upset as reasons to avoid talking about it. Most poignantly, these confusions were even true of parents who had themselves experienced mental health problems:

‘I don’t think you put your head in the sand and pretend it’s not there… I got post-natal depression… and Daisy [name changed] went through that. Now, I’ve never told her I had depression.’

The way parents talked to their children was powerfully influenced by the way that their own parents had talked to them. Often people wanted to be more open than their own parents had been, but didn’t manage it. I wonder if this affects many families. There was a sobering moment halfway through the research when I realised that this issue had been a part of my own childhood. I remember half-explanations, pointed looks, and sad voices when people mentioned a beloved family member who had died before I was born. Much later on, I discovered that they had died by suicide, following a period of intense mental distress. When I plucked up the courage to broach this with my family, I found that my parents hadn’t talked to me about it partly because they felt they hadn’t really understood what had gone on. They put this down to silence on the subject on the part of their own parents. Taboo and lack of understanding had passed down through the generations.

Why is it important to know what messages parents are giving to their children? Our study shows that between the ages of 7 and 11 children receive messages from their parents that divide the world into us and them. This is exactly the age when children’s brains begin to develop the ability to understand mental health issues. It’s also the age when prejudice towards people with mental health problems begins. Our research suggests that parents’ messages are contributing to the development of stigmatising attitudes. It also suggests that unconscious intergenerational patterns of parenting might lead to the persistence of these messages, despite wishing for something different. This process could undermine any beneficial impact of programmes such as Time to Change, targeting as they do explicit opinions and knowledge. It’s clear that these don’t translate into changed messages to children nearly as easily as we might think.

So what could we do differently if explicit messages reinforcing difference are not the best way? Here are a few suggestions:

• Anti-stigma programmes should explicitly target parents of young children. Parents are skilled at talking about mental wellbeing with their children. It follows that an understanding of mental health and distress as part of a spectrum of human experience, is likely to help parents feel more confident in openly discussing mental health difficulties.
• Encourage parents to reflect on what was communicated to them as children might help them think about what they might like to do differently. During my research interviews parents readily began to do this with relatively little prompting.
• Campaigns need to target primary school aged children directly, in the media and also working alongside schools and parents. Campaigns targeting adolescents and adults are too late: fear and prejudice are already ingrained.
• We shouldn’t rely upon campaigns and professionals to begin this sea change. Each of us can start to make changes to how we talk about mental distress within our own families. Take a risk: bring it up. Let’s help our children learn that there is no us and them, only us and us.

About the author

Jo Mueller is a clinical psychologist working with children and families in London. Follow her on Twitter @clinpsydrjo.