Paradigms Lost

Heather Stuart has been working in the field of stigma research for almost 15 years and is the co-founder and current Chair of the Scientific Section on Stigma and Mental Disorders for the World Psychiatric Association. Dr Stuart is Director, Masters of Public Health Program, Department of Community Health & Epidemiology and Associate Director, Queen's/Pan American Health/World Health Organization Collaborating Centre for Training in Psychiatric and Behavioural Epidemiology, both at Queen's University, Ontario, Canada. Dr Stuart is also the Senior Consultant for Canada's Opening Minds national anti-stigma/anti-discrimination initiative.Julio Arboleda-Flórez is Emeritus Professor, Departments of Psychiatry and of Community Health and Epidemiology and the Inmediate Past Head and Chief-of-Psychiatry at Queen's University in Ontario, Canada. Dr Arboleda-Flórez is a leading authority on legal psychiatry and human rights of the mentally ill. He is the Honorary Chair of the Forensic Section and a longstanding member of the Ethics Committee of the World Psychiatric Association, an Honorary member of several national psychiatric associations. Norman Sartorius was Director of the World Health Organization's mental health programme from 1977 - 1993, President of the World Psychiatric Association from 1993 - 1999 and has been President of the European Psychiatric Association since 1999. Dr Sartorius holds professorial appointments at the Universities of London, Prague and Zagreb and is Senior Associate of Faculty at Johns Hopkins University in Baltimore, MD. Dr Sartorius is among the world's leading authorities on fighting stigma, co-morbidity of mental and physical illness, public health aspects of psychiatry and psychiatric education.

• Preface ; -Part I Eroding Paradigms ; Chapter 1 ; Introduction - The nature and nurture of stigma ; The origins and meaning of stigma ; Consequences of stigma for people with a mental illness ; Consequences for family members ; Consequences of stigma for mental health systems and societies ; Anti-stigma initiatives are growing ; Chapter 2 ; Paradigm 1: Developed countries have eradicated systemic discrimination on the grounds of mental illness ; Mental health development ; Employment inequity ; NIMBYISM, homelessness, and the inverse care law ; Media depictions and public tolerance ; Chapter 3 ; Paradigm 2: In developing countries, people with mental illnesses are not stigmatized ; Exploding the myth ; Stigma in other cultures ; Islamic cultures ; Chinese culture ; Indian culture ; Chapter 4 ; Paradigm 3: The fight against stigma must be based on well-developed long term specific and comprehensive plans ; A case for enlightened opportunism ; Networks of practice ; Network governance and leadership ; General principles, rather than specific plans guide anti-stigma activities ; Chapter 5 ; Paradigm 4: Scientific evidence will best define the targets of anti-stigma work ; Evidence-based advocacy ; Evidence is in the eye of the beholder ; To be successful, programs must target local needs ; To be successful programs must build better practices ; Chapter 6 ; Paradigm 5: Mental health professionals should lead anti-stigma programs ; Mental health professionals are worthy targets of anti-stigma programs ; Stigma in general health care settings ; Mental health systems as agents of social control ; What can mental health professionals do differently? ; Chapter 7 ; Paradigm 6: Improving knowledge about mental illnesses will reduce stigma and discrimination ; The nature of prejudice ; Can prejudice respond to nuggets of knowledge? ; What about mental health literacy? ; Anti-stigma programs as purveyors of medical knowledge ; Chapter 8 ; Paradigm 7: An anti-stigma program is successful if it changes attitudes ; The knowledge-attitude-behaviour continuum ; 'What we dont know about prejudice reduction ; How much change is change? ; When are anti-stigma programs successful? ; Environments are not just containers ; Chapter 9 ; Paradigm 8: Community care for the mentally ill will destigmatize mental illness and psychiatry ; Stigma as a consequence of institutionalization ; Stigma as a consequence of community care ; Stigma as a social barrier to recovery ; Chapter 10 ; Paradigm 9: Campaigns are an excellent way of reducing stigma ; The cause de jour ; Can social inclusion be sold like soap? ; Chapter 11 ; Paradigm 10: Anti-stigma programs should be built on the premise that mental illness is like any other illness ; Forced confinement and treatment ; Anti-psychiatry sentiments ; Violence and unpredictability ; An illness like any other? ; Chapter 12 ; Paradigm 11: The stigma of mental illness is too deeply ingrained to prevent or reduce it ; The importance of fighting back ; -Overcoming NIMBYISMthe Not in My Backyard Syndrome ; Changing the way emergency departments do business ; Connecting with teachers and students ; Engaging the police ; Engaging the media ; Can community projects make a population difference? ; -Chapter 13 Summary of Part 1 ; -Implications for anti-stigma programming paradigms lost ; -Part II Building Programs Against Stigma and its Consequences ; Chapter 14 - Getting going ; Introduction ; Developing a program committee ; Creating an advisory committee ; Setting clear goals ; Creating interes ; Acquiring and monitoring resources ; Writing a successful funding application ; Chapter summary and chapter checklist ; Chapter 15 - Identifying program priorities ; Identifying program priorities through qualitative investigation ; Focus groups ; Steps in conducting a focus group ; Troubleshooting in focus groups ; Analysis of focus group data ; Identifying program priorities using semi-structured interviews ; Identifying program priorities using surveys ; Chapter summary and chapter checklist ; Chapter 16 - Program development ; Picking target groups ; Journalists ; Youth ; Health professionals ; Members of community neighbourhoods ; Police ; Policy makers and legislators ; Choosing a program approach ; Creating a program logic model ; Including people who have experienced a mental illness in program delivery ; Families ; Using media wisely ; Working with external media experts ; Working with television ; Working with radio ; Working with the arts ; Pilot testing ; Chapter summary and chapter checklist ; Chapter 17 - Program monitoring and evaluation ; Using qualitative data to monitor program implementation ; Assessing change ; Specification of program outcomes ; Setting performance targets ; Devising and implementing a data collection plan ; Data management and analysis ; Identifying lessons learned ; Ethical issues in evaluation ; Communicating results ; Chapter summary and chapter checklist ; Bibliography and Suggested Readings ; The Nature of Stigma ; Evaluation Methods ; Works Cited ; Appendix: Inventories of Stigma Experiences ; Personal Experiences with the Stigma of Mental Illness ; Family Experiences with the Stigma of Mental Illness ; Appendix ; Index

' Paradigms Lost is simply excellent. The chapters are clearly written and well organized and the material is relevant to the aim of the book, i.e., to inform those wishing to undertake anti-stigma programmes. I am sure that it will be a vitally important contribution to the field.'