Outcome of a Knowledge Contact-Based Anti-Stigma Programme in Adolescents and Adults in the Chinese Population

Introduction Barriers to Treatment of Mental Disorders One of the barriers to treatment of mental disorders is low mental health literacy, that is, the poor ability to recognise specific mental disorders, the lack of knowledge about causes and interventions, and attitudes that hinder appropriate help-seeking behaviour. (1) Low mental health literacy makes early recognition of and appropriate intervention in mental disorders difficult. (2,3) Another barrier to treatment of mental disorders is public stigma--the reaction of the general public to people with mental illness. When people agree to the stereotype that individuals with mental illness are dangerous, incompetent and dependent, unpredictable, flawed in character, at fault for their illness, and/or unlikely to recover, (4,5) they become prejudiced. This leads to negative emotional reactions (e.g. fear, anger) and discriminatory behaviour, such as avoidance and withholding help or opportunities. (4) As a result of public stigma, people with mental illness are denied rightful opportunities related to work and other important life goals, (6) undermining their quality of life. (4) Moreover, when public-held stereotypical beliefs are also endorsed by the individuals with mental illness, self-stigma ensues and leads to other problems such as avoidance and non-adherence to treatment, thereby limiting the prospect of recovery. (7,8) Levels of Mental Health Literacy and Stigma in the General Public in Hong Kong There is still room for improvement in the level of mental health literacy of the general public of Hong Kong. Some individuals wrongly attribute the cause of mental illness to supernatural powers, such as punishment for sins by ancestors or imbalance of 'Yin-Yang forces'.9 Even after 10 years, a study by Siu et al (10) found that about 10% of those surveyed wrongly attributed the cause of psychosis to disturbance by supernatural forces, about 20% wrongly believed that depressive symptoms were not indicative of psychiatric disorder but a 'normal' reaction to setbacks, and 7% thought that seeking professional help would increase suicide risk. Further, the youngest respondents (15-19 years) achieved the lowest knowledge score. (10) In 2011, a survey in Hong Kong by the Equal Opportunities Commission found that people with mental illness were consistently among the most stigmatised and avoided groups in various areas of life, including housing, public services, and education. (11) More than half of those surveyed said they did not want people with mental illness to live in their neighbourhood, while nearly 70% disagreed that integrative schooling is preferable for children with mental illness. (11) There continues to be local opposition to the setting up of integrated community centres for mental wellness in various districts. (11) We still have a long way to go to reduce the stigma associated with mental health. (11) Knowledge Contact Approach as a Way to Reduce Barriers to Treatment A method suggested by the World Health Organization (3) to remove barriers to mental health treatment was to launch public awareness and education campaigns based on the knowledge contact approach. (12) Educating the public about mental illnesses, especially dispelling myths about mental illness and replacing them with facts, can help to improve mental health literacy, (4,12) and even improve attitudes towards people with mental illness. (4) Education programmes have been found to be effective for children, (13) adolescents, and adults. (4) Education that targets young minds is especially important; research has found that negative attitudes towards mental illness expressed by adults have their roots in early childhood. (5,14) As well as increasing knowledge, facilitating contact between participants and people with mental illness can further reduce stigmatising attitudes. (15,16) The optimal conditions for contact include: an equal status of the participants, common goals, no competition, institutional support for contact (i. …