Yom Kipur of the mental health community

Atonement

by Thomas Insel

One of my first meetings when I arrived at NIMH 12 years ago was with board members of the National Alliance on Mental Illness (NAMI). I asked them how NIMH could be helpful. One board member’s request was especially memorable. “Declare a day of atonement,” she suggested. When I saw this same board member last month at the annual NAMI meeting, we both recalled that 2002 meeting with a touch of regret. I wished I had had a better response to her request. And, as she said to me last month, “I wished I had asked for a week.”

As it turns out, Mental Illness Awareness Week this year began with Yom Kippur, the Jewish Day of Atonement. Which begs the question: what do we (in the mental health community) need to atone for? There are so many answers. For some, it may be the culture of blame and shame perpetuated for years by clinicians who explained all mental illness as being caused by trauma and evil parents. For others, it may be the singular reliance on medication and modifying behavior rather than holistic care and the provision of skills. Others will name the paternalistic structure of mental health care, which can undermine rather than empower individuals and their families. The list goes on. Maybe it would take a week, not just a day, to capture the many complaints.

My own favorite atonement issue for Mental Illness Awareness Week this year is the lack of humility in our field. Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods. Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science. That is, so much of mental health care is based on faith and intuition, not science and evidence. On the plus side, we put a premium on listening and compassion. We help people to change through understanding. But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

On the research side, it’s easy to lose humility. The pace of discovery in genomics and neuroscience is ever more rapid—this week’s Nobel Prize in Physiology or Medicine  is a good example of how neuroscience is revealing the fundamentals of brain activity—in this case describing the brain’s “GPS” network. Advances in systems neuroscience, from dissecting circuits to human brain imaging, are unequivocally stunning. But, and this is a humbling caveat, we simply have not been able to translate this revolution in neuroscience to diagnostics or therapeutics for people with mental disorders.

Why the disconnect? Translation takes time. Translation requires replication, regulation, and ultimately reimbursement. Fundamentally, translation is really difficult. For instance, we have thousands of neuroimaging studies but none that has delivered a clinically useful biomarker. For NIMH this is a humbling realization—we still lack biomarkers to identify who should get which treatment. We still lack effective treatments for many aspects of mental illness.

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.

Top 10 selections for 2013 by NIMH director

By Thomas Insel on December 13, 2013

It’s time again for the year’s ten best from NIMH. A year that included a 16-day government shutdown and a 5.2 percent sequester also saw some outstanding scientific breakthroughs and historic changes in policy. Befitting the complexity of the problems, many of the breakthroughs were not individually reported findings but the cumulative results of several groups contributing different pieces of the puzzle. And some of the most historic policy changes are just launching so their impact is unclear. Paring a lengthy list down to “ten best” is both difficult and unsatisfying, but here goes.

10. Nobel Prize—This year’s Nobel Prize in Physiology or Medicine (and Lasker Award) recognized NIMH grantee Thomas Südhof for his discoveries of how neurotransmitters are released from the pre-synaptic terminal. Südhof and his colleagues described the molecular machines that allow vesicles to empty their contents into the synapse and then re-form to collect more neurotransmitters. This process is critical for neurons to communicate efficiently. Recently, Südhof’s work on the post-synaptic compartment has revealed a new world of molecules important for translating these biochemical messages. The genes for many of these protein families (i.e., shanks, neuroligins, neurexins, etc.) are emerging as leading risk candidates for autism and schizophrenia, giving us a new vocabulary for the molecular basis of mental disorders.1

9. Beyond Magic Bullets—Several important new trends emerged this year in non-pharmacological treatments, sometimes from pharmaceutical companies. In April, a Nature commentary that included authors from the pharmaceutical giant GSK described “electroceuticals,” heralding a new era in treatment development focusing on devices to deliver electric signals rather than drugs to alter the activity of neurotransmitters in the brain. Neuromodulation, arguably a better term than electroceuticals, had already been gaining traction with treatment of depression using deep brain stimulation and direct current stimulation. This year neuromodulation was introduced for anorexia nervosa. But neuromodulation was also extended to include approaches beyond electrical stimulation. In September, the cover headline of Nature—“Game Changer”—referred to a study by Adam Gazzaley and colleagues on the impact of cognitive training with NeuroRacer, a video game for enhancement of cognitive control. Not only did older adults (60 – 85 years old) trained on this game surpass performance of untrained 20-year-olds, cognitive enhancement generalized to working memory and other forms of cognitive control, with improvements persisting 6 months later. Cognitive training changed local brain activity as well. The key concept: if mental disorders are brain circuit disorders, then successful treatments need to tune circuits with precision. Chemicals may be less precise than electrical or cognitive interventions that target specific circuits.2,3,4

8. Organoids—It’s been 6 years since the first report of induced pluripotent stem cells (iPSCs). These are cells derived from mature skin cells, induced to become undifferentiated stem cells in a dish, and then differentiated to form mature cells like neurons or heart muscle cells. It’s been a year since this work was awarded the 2012 Nobel Prize in Physiology or Medicine. The excitement of this new technique was the potential to take cells from an individual with a disorder and either regenerate new cells in vitro (imagine new dopamine cells for someone with Parkinson’s disease) or recapitulate the disorder in vitro to define its development and screen for new treatments. This year there were some remarkable reports of using iPSCs to explore the altered development of neurons in children with rare forms of autism. But if autism and mental illnesses are circuit disorders or “connectopathies,” how can individual cells teach us about the altered connections? Amazingly, according to a team from the Austrian Academy of Sciences in Vienna, when neurons are grown in a dish, they self-assemble into circuits that resemble the normal cortex. These “organoids” are not “mini-brains” capable of consciousness but they are functional enough to permit the study of connections. It now appears that iPSCs could be a powerful tool to study circuit disorders.5,6,7

7. DSM-5 and RDoC—For NIMH, probably the year’s most oft-quoted statement was my April blog post about transforming diagnosis. Referring to the pending release of the DSM-5, I said, “Patients with mental disorders deserve better.” To many, this was interpreted as a critique of mainstream psychiatry. In truth, I was complaining that we in the research community have failed to provide the objective measures for diagnosis present in every other area of medicine. The Research Domain Criteria (RDoC) project aims to do just that, by using biological, cognitive, and social information to build more precise classifiers for each patient. RDoC is not a diagnostic system. At this point it is simply a framework for organizing the data. But it is a promise from the NIMH to get beyond diagnostic categories based only on symptoms. Why is this important? For brain disorders, symptoms are generally a late manifestation of a years-long brain process. In medicine, early detection and early intervention have often been the best ways to improve outcomes. RDoC is a first step towards achieving these goals with mental disorders.8,9

6. EP3—A year that began with concerns about school shootings and mental illness saw more mass shootings, many of them connected to serious mental illness (SMI). For this unfortunate reason, there was more media attention on mental illness this year than any time in recent memory. The number of articles about “mental illness” in theNew York Times in 2013 were more than double the average of the previous five years. Among the many recurring themes—access to weapons, access to treatment, incarceration—one prominent one was the need for earlier detection and treatment for SMI. The Early Prediction and Prevention of Psychosis (EP3) program, launched this year at NIMH, is an example of efforts to answer that need. Building on the success of the Recovery After Initial Schizophrenia Episode (RAISE) project, which was implemented this year in New York and Maryland, EP3 will focus on tools for the prodrome, that period prior to psychosis when symptoms are just beginning to emerge and may be most treatable. New studies will build on results from the North American Prodrome Longitudinal Study (NAPLS), just completing 10 years of critical research to develop ways to identify individuals who are at risk for an initial psychotic episode. With a series of new funding announcements and with the success of RAISE and NAPLS, NIMH made EP3 its signature program this year.10,11

5. Psychiatric Genetics—In 2003,Science magazine named the identification of genes for mental illness as its #2 breakthrough of the year (just behind confirmation of the existence of dark energy in the cosmos). It has taken another decade to deliver results that are statistically significant and clearly reproducible. For schizophrenia there are now 128 genetic associations, all common variants found across the genome. None of these alone accounts for much of the risk, but groups of these “hits” point to specific biological pathways. For autism, there are many rare variants emerging, many of these “de novo” or spontaneous mutations not found in other family members. These mutations seem to be most common in children with both autism and intellectual disability. Studies that have looked across disorders find some common genomic associations, with some findings across childhood disorders and others across adult disorders, irrespective of diagnosis. Before concluding anything about the significance of these cross-disorder findings, it will be important to understand the actual variation (which gene is involved) and the functional role, if any, of the variant.12,13

4. Brain Exceptionalism—For me, 2013 will be the year when we began to realize how much the brain differs from other organs. We already knew that cells in the brain express (translate into protein) more of the genome and use more energy than any other organ. But two discoveries this year really made the case for the human brain as not only the most mysterious but the most exceptional of organs. Leveraging new tools for single cell biology, scientists working with Rusty Gage at the Salk Institute and Ira Hall at the University of Virginia reported that the brain has its own genome, with abundant and sometimes profound variation not found in other tissues. In human frontal cortex, they report as many as 41 percent of cells having at least one large mutation, with a million DNA bases either duplicated or deleted. These are mutations not seen in blood cells (which have been the basis for all psychiatric genetic studies) or in neurons elsewhere in the brain. Equally surprising, the brain epigenome also appears unique. The epigenome is a complex of molecules that coat the DNA helix, “silencing” parts of the genome to ensure that certain genes are not translated. The entire DNA strand consists of only four bases: cytosine, guanine, adenine, and thymine. Whereas in most cells in the body silencing occurs where cytosine and guanine are adjacent, brain cells follow a different set of rules with all the base pairs involved. This means that the mechanisms by which experience influence biology are completely different in brain cells compared to blood cells or liver cells. The lesson is that we cannot use peripheral cells to know what is happening in the brain.14,15

3. CLARITY—It may be an inelegant acronym but the results are utterly beautiful. CLARITY = Clear Lipid-exchanged Anatomically Rigid Imaging/immunostaining-compatible Tissue hYdrogel. By replacing the brain’s fat with a clear gel, CLARITY turns the opaque and impermeable brain into a transparent and porous structure. Most important, the hydrogel holds the brain’s anatomy intact. And because the hydrogel is permeable, the brain can be stained to localize proteins, neurotransmitters, and genes at a high resolution. Unlike other recent breakthroughs in neuroanatomy, this one can be used in human brains. And unlike virtually all neuroanatomy of the past century, CLARITY is 3-dimensional. Flying through the tissue in 3-D allows the first comprehensive view of how cells and processes are arrayed across the entire brain. Karl Deisseroth earlier developed optogenetics as a revolutionary tool for studying brain circuits in behaving animals. This time his lab has revolutionized how we will look at the brain post-mortem.16

2. BRAIN—On April 2nd, President Obama in the East Room announced the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. The speech should be read by everyone with a stake in brain research or brain disorders. Calling BRAIN the “next great American project,” he challenged a broad scientific community to explore the brain as we had once explored space. BRAIN will involve several government research agencies as well as several private sector partners. And it complements a large brain project underway in the European Union and projects being developed in Israel, Japan, China, and elsewhere. This global interest in neuroscience reflects both the growing awareness of the cost of brain disorders and the growing recognition that success in the 21st century will depend on a “brain economy” rather than a “brawn economy.” The U.S. BRAIN initiative will launch in 2014 with $110M, of which $40M will be from NIH. Funding announcements for the first wave of NIH projects will be released this month.17

1. Parity—My guess is that in terms of mental health issues, history will remember 2013 not for a scientific finding but for a long overdue policy change: mental health parity. While the Mental Health Parity and Addiction Equity Act was signed into law in October 2008, the final rule providing the guidance to implement this law was only released in November 2013. Most important, the Affordable Care Act, signed into law in 2010, affirmed mental health care as an “essential benefit.” As a result, mental health care must be provided in all health care plans and the provision of care for mental disorders must be on a par with other medical disorders (i.e., same co-pays, deductibles, certification requirements). When you add to these changes the removal of exclusions for pre-existing conditions, the extension of coverage to offspring until age 26, and in some states the expansion of Medicaid, you can see that this is really the most far-reaching change in mental health care since the Community Mental Health Act 50 years ago. And this is coming at an important time. Over the summer, the Global Burden of Disease project reported out on 291 medical disorders, updating its 1990 report with 2010 data. The new report finds mental illness and substance abuse disorders to be the leading source of years lost to disability, with the burden of illness from this group of disorders increasing 37 percent since 1990. Depression and anxiety were the largest contributors among the 20 mental and substance abuse disorders, accounting for 55 percent of the DALYs (disability adjusted life years—a composite measure of disability and premature mortality).

There are many questions about how parity will reduce DALYs: Who will provide the care? What will it cost? Where will mental health care be delivered? What is the dose and duration of psychosocial treatments that will be covered? None of these questions will be answered in 2013, but going forward NIMH can ensure that the best science informs this historic change.18,19

References

1 Südhof TC. A molecular machine for neurotransmitter release: synaptotagmin and beyond. Nat Med. 2013 Oct; 19(10):1227-31. doi: 10.1038nm.3338.

2 Anguera JA et al. Video game training enhances cognitive control in older adults. Nature. 2013 Sep 5;501(7465):97-101. doi: 10.1038/nature12486.

3 Lipsman N et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet. 2013 Apr 20;381(9875):1361-70. doi: 10.1016/S0140-6736(12)62188-6. Epub 2013 Mar 7.

4 Famm K et al. Drug discovery: a jump-start for electroceuticals. Nature. 2013 Apr 11;496(7444):159-61. doi: 10.1038/496159a.

5 Shcheglovitov A et al. SHANK3 and IGF1 restore synaptic deficits in neurons from 22q13 deletion syndrome patients.Nature. 2013 Nov 14;503(7475):267-71. doi: 10.1038/nature12618. Epub 2013 Oct 16.

6 Krev JF et al. Timothy syndrome is associated with activity-dependent dendritic retraction in rodent and human neurons.Nat Neurosci. 2013 Feb;16(2):201-9. doi: 10.1038/nn.3307. Epub 2013 Jan 13.

7 Lancaster et al. Cerebral organoids model human brain development and microcephaly. Nature. 2013 Sep 19;501(7467):373-9. doi: 10.1038/nature12517. Epub 2013 Aug 28.

8 Cuthbert BN, Insel TR. Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med. 2013 May 14;11:126. doi: 10.1186/1741-7015-11-126.

9 Casey BJ et al. DSM-5 and RDoC: progress in psychiatry research?;
Nat Rev Neurosci. 2013 Oct 18;14(11):810-4. doi: 10.1038/nrn3621.

10 Fusar-Poli P et al. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry. 2013 Jan;70(1):107-20. doi: 10.1001/jamapsychiatry.2013.269.

11 Carrion RE et al. Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry. 2013 Nov 1;70(11):1133-42. doi: 10.1001/jamapsychiatry.2013.1909.

12 Cross-Disorder Group of the Psychiatric Genomics Consortium: Genetic Risk Outcome of Psychosis (GROUP) Consortium.Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet. 2013 Apr 20;381(9875):1371-9. doi: 10.1016/S0140-6736(12)62129-1. Epub 2013 Feb 28.

13 Ripke S et al. Genome-wide association analysis identifies 13 new risk loci for schizophrenia.Nat Genet. 2013 Oct;45(10):1150-9. doi: 10.1038/ng.2742. Epub 2013 Aug 25.

14 McConnell MJ et al. Mosaic copy number variation in human neurons. Science. 2013 Nov 1;342(6158):632-7. doi: 10.1126/science.1243472.

15 Lister R et al. Global epigenomic reconfiguration during mammalian brain development. Science. 2013 Aug 9;341(6146):1237905. doi: 10.1126/science.1237905. Epub 2013 Jul 4.

16 Chung K et al. Structural and molecular interrogation of intact biological systems. Nature. 2013 May 16;497(7449):332-7. doi: 10.1038/nature12107. Epub 2013 Apr 10.

17 Insel TR et al. Research priorities. The NIH BRAIN Initiative.Science. 2013 May 10;340(6133):687-8. doi: 10.1126/science.1239276.

18 US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.JAMA. 2013 Aug 14;310(6):591-608. doi: 10.1001/jama.2013.13805.

19 Whiteford HA et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013 Nov 9;382(9904):1575-86. doi: 10.1016/S0140-6736(13)61611-6. Epub 2013 Aug 29.

Are there indeed “Right-Brained” or “Left-Brained” Personality Traits?

Posted By Neuroscience News 

Chances are, you’ve heard the label of being a “right-brained” or “left-brained” thinker. Logical, detail-oriented and analytical? That’s left-brained behavior. Creative, thoughtful and subjective? Your brain’s right side functions stronger —or so long-held assumptions suggest.

But newly released research findings from University of Utah neuroscientists assert that there is no evidence within brain imaging that indicates some people are right-brained or left-brained.

For years in popular culture, the terms left-brained and right-brained have come to refer to personality types, with an assumption that some people use the right side of their brain more, while some use the left side more.

Following a two-year study, University of Utah researchers have debunked that myth through identifying specific networks in the left and right brain that process lateralized functions.

The hemispheric lateralization maps for the nine hubs of the left-lateralized network and 11 hubs of the right-lateralized network are shown in lateral and medial projections. Color scale (t-statistic) shows significantly left-lateralized (warm colors) or right-lateralized (cool colors) to the seed (i.e., hub). A black circle marks the position for each seed. Image and caption credited to Jared A. Nielsen et al in PLOS ONE.

Lateralization of brain function means that there are certain mental processes that are mainly specialized to one of the brain’s left or right hemispheres. During the course of the study, researchers analyzed resting brain scans of 1,011 people between the ages of seven and 29. In each person, they studied functional lateralization of the brain measured for thousands of brain regions —finding no relationship that individuals preferentially use their left -brain network or right- brain network more often.

“It’s absolutely true that some brain functions occur in one or the other side of the brain. Language tends to be on the left, attention more on the right. But people don’t tend to have a stronger left- or right-sided brain network. It seems to be determined more connection by connection, ” said Jeff Anderson, M.D., Ph.D., lead author of the study, which is formally titled “An Evaluation of the Left-Brain vs. Right-Brain Hypothesis with Resting State Functional Connectivity Magnetic Resonance Imaging.” It is published in the journal PLOS ONE this month.

Researchers obtained brain scans for the population they studied from a database called INDI, the International Neuroimaging Data-Sharing Initiative. The participants’ scans were taken during a functional connectivity MRI analysis, meaning a participant laid in a scanner for 5 to 10 minutes while their resting brain activity was analyzed.

By viewing brain activity, scientists can correlate brain activity in one region of the brain compared to another. In the study, researchers broke up the brain into 7,000 regions and examined which regions of the brain were more lateralized. They looked for connections — or all of the possible combinations of brain regions — and added up the number of connections for each brain region that was left- lateralized or right-lateralized. They discovered patterns in brain imaging for why a brain connection might be strongly left- or right-lateralized, said Jared Nielsen, a graduate student in neuroscience who carried out the study as part of his coursework.

“If you have a connection that is strongly left- lateralized, it relates to other strongly lateralized connection only if both sets of connections have a brain region in common,” said Nielsen.

Results of the study are groundbreaking, as they may change the way people think about the old right-brain versus left-brain theory, he said.

““Everyone should understand the personality types associated with the terminology ‘left-brained’ and ‘right-brained’ and how they relate to him or her personally; however, we just don’t see patterns where the whole left-brain network is more connected or the whole right-brain network is more connected in some people. It may be that personality types have nothing to do with one hemisphere being more active, stronger, or more connected,” said Nielsen.

Notes about this neuroimaging and neuropsychology research

Contact: Melinda Rogers – University of Utah Health System
Source: University of Utah Health System press release
Image Source: The image is credited to Jared A. Nielsen, Brandon A. Zielinski, Michael A. Ferguson, Janet E. Lainhart, and Jeffrey S. Anderson; and is adapted from the PLOS ONE open access research paper (doi:10.1371/journal.pone.0071275.g003).
Original Research: Full open access research for “An Evaluation of the Left-Brain vs. Right-Brain Hypothesis with Resting State Functional Connectivity Magnetic Resonance Imaging” by Jared A. Nielsen, Brandon A. Zielinski, Michael A. Ferguson, Janet E. Lainhart, and Jeffrey S. Anderson in PLOS ONE. Published online August 14 2013 doi:10.1371/journal.pone.0071275

A survey on clinical applications of Neuropsychoanalysis

 Dear Friends and Colleagues!

As we were preparing to the International Conference in Cape town:”Clinical applications of Neuropsychoanalysis”, we were reflecting on our practice.

This reflection ended by constructing a questionnaire that we now attach for you to enjoy. This survey is going all over the material worked through the last 14 years of discussions,

Research, and conferences trying to find out what was the benefit of all that endeavor to your practical clinical practice.

We made an online form and will be grateful if you will be able to take some moments from your time and add your words and choices.

You have to click on the link  and reply as you pass over the material. There is some space there to have your input to what we missed.

As this online questionnaire will be answered, we hope to present the statistics on our panel, led by Maggie Zellner, on Sunday morning.

Kind Regards,
 
Irith, Iftah and The Israeli Forum of Neuropsychoanalysis

https://docs.google.com/forms/d/1DmirPISn6llyAejZM-nnDs1qIBlyK0ogCGEYB2sfvzE/viewform

A New Job Board for Applicants with disabilities

 Today I wish to briefly introduce a new Job board for applicants with disabilities. This unique job board was established by the Israel Ministry of Industry, Trade and Labor and is aimed to further enhance work inclusion of people with disabilities in Israel.  For more details (in Hebrew) see: http://www.mtlm.org.il/jobs/ or join the facebook page: https://www.facebook.com/MTLM.JOBS

As part of this project, I had the privilege to write a guide for Job seekers with disabilities. In this guide, I sought to present relevant information about the job search process and to provide practical tools that will assist  job seekers in this complex journey. Furthermore, I discuss the disability disclosure issue, that is, whether, and when the person should disclose her/his disability (to read more on this issue see http://www.uwrf.edu/CareerServices/upload/HandoutDisabilityDisclosure.pdf). I will share this guide with you in the next few days. I will also share a review that I wrote about job boards to people with disabilities, worldwide.

The World Future Council is looking for a Policy Officer – Persons with Disabilities

This time I wish to publish a  job offer by the World Future Council (WFC). The WFC is a global forum of 50 respected personalities who give voice to the shared ethical values of citizens worldwide. The Council works closely with policy-makers, civil society and business to identify and implement best policies to protect the rights of future generations (http://www.worldfuturecouncil.org). Good luck!

 

WORLD FUTURE COUNCIL – VACANCY

DEADLINE FOR APPLICATIONS: 14 June 2013

 

The World Future Council is looking for a

Policy Officer – Persons with Disabilities

 

Starting date: 1^st September 2013

Period: 12 months, with possible prolongation

Location: Geneva, Switzerland

Responsibilities:

• Liaise with the Zero Project overall coordinator, the Essl Foundation, as well as project partners: the European Foundation Centre
• Research innovative policies advancing the implementation of the UN Convention on the Rights of Persons with Disabilities
• Co-author the annual Zero Project Report
• Co-organize the annual Zero Project Conferences in Vienna
• Present the Zero Project in briefings, side events and conferences  to stakeholders (especially in Geneva, New York, Vienna)
• Develop the Zero Project network, especially with parliamentarians with disabilities
• Contribute to the Zero Project’s website: www.zeroproject.org and social media presence:www.facebook.com/zeroproject.org
• Develop and maintain the WFC’s Zero Project online presence: www.worldfuturecouncil.org/enable.html as well aswww.futurepolicy.org,
• Support media, fundraising activities and research for cooperation
• ·         Monitor and assess project progress
  • Report to the Supervisor

 

Profile:

•   Academic background, preferably in human rights/disability law and policy, international relations or political sciences
• Working experience in a Disabled Peoples Organisation, direct experience of disability or with persons with disabilities is an asset
• Outgoing and reliable personality with a ‘can-do’ attitude
• Excellent written and oral communication skills
• Very good knowledge of research, editorial work as well as event management
• Excellent knowledge of German, English and of a further UN language, preferably French
• Very good IT literacy. Knowledge of CMS (especially WordPress and Typo3) is an asset
• Committed to the WFC’s vision and mission of long-term sustainability and equity
• Ability to work both independently and as part of an international team
• A Swiss/EU work permit is required

Please address your application to the WFC Coordinator of the Geneva Office: Ms Ingrid Heindorf. Please send a cover letter, CV and published writing sample, as well as your salary expectations, to Ingrid.heindorf@worldfuturecouncil.org. Subject heading: Policy Officer and your name. Deadline: 14 June 2013. Only candidates invited for interview will be contacted. Interviews will be held on 25^th June 2013.

 

A New State of Mind: Ending the Stigma of Mental Illness by Glenn Close

Award-winning actress and mental health advocate Glenn Close will narrate “A New State of Mind: Ending the Stigma of Mental Illness” an inspiring documentary that tells the stories of everyday people to shatter myths about mental illness, highlighting the struggles faced by those with mental health challenges, and their hope, resilience and recovery.

Ms. Close is a dedicated mental health advocate, having founded a national anti-stigma campaign, Bring Change 2 Mind in partnership with The Balanced Mind Foundation, Fountain House, and Garen & Shari Staglin of the International Mental Health Research Organization (IMHRO). The idea for Bring Change 2 Mind was born when Ms. Close volunteered at Fountain House in order to learn more about mental illness, which both her sister, Jessie Close, and nephew, Calen Pick, live with.

“The toxic stigma around mental illness can be as painful as the illness itself,” said Ms. Close. “It’s crucial that these diverse and powerful stories are told and shared so that everyone realizes that mental illness touches us all. No one need struggle in isolation, silence and shame. Listening and having the courage to join the conversation will save lives.”

“A New State of Mind: Ending the Stigma of Mental Illness” is produced by KVIE, Sacramento’s PBS station, as part of a comprehensive statewide effort to increase the number of people who seek early help for mental challenges by reducing stigma and discrimination around mental illness. It is a Prevention and Early Intervention program of California Mental Health Services Authority (CalMHSA), an organization of county governments working together to improve mental health outcomes for individuals, families, and communities, and funded by the voter-approved CaliforniaMental Health Services Act (Prop. 63).

SOURCE California Mental Health Services Authority (CalMHSA)

Caregivers crisis

A caregiver is someone whose life is in some way restricted by the need to be responsible for the care of someone who is mentally ill, mentally handicapped, physically disabled or whose health is impaired by sickness or old age.  The UK government defines caregivers or carers as:

• People who – unpaid – look after and support family members, friends or neighbours in need of help because of long-term physical or mental illness or disability or problems related to old age.

• People who provide a substantial amount of care on a regular basis for a disabled person  living at home.

The importance of this issue is highlighted by TEDMED as one of the main global challenges. The reason for this move is driven by the fact that unpaid caregivers (65 million in the US alone) struggle with significant  psychological and health issues and economical  burden.

The issue of caregivers is broad and complex. In order to better understand its scope and main objectives, I strongly recommend to read this comprehensive report by National Alliance for Caregiving in collaboration with the American Association of Retired Persons (AARP). For those of us who don’t have the time/energy to read the full report here is its summary and conclusions.

Caregivers are a diverse group. Their caregiving experiences range from those that are relatively easy to manage, to those that are burdensome. We know that most caregivers today are able to fulfill this role without experiencing overwhelmingly negative physical, emotional, or financial consequences. On the other hand, caregivers with the heaviest responsibilities are vulnerable to risks such as a decline in health, emotional stress, and economic hardship. As the baby boom generation ages over the next 25 years, the numbers of people needing care will swell. The numbers of younger people available to provide care are likely to dwindle. This suggests that in the future, caregivers will be older, on average, than today’s caregivers and may have greater infirmity of their own. In addition, the younger people who step into a caregiving role in the future may perceive they have less choice about becoming a caregiver. A greater share of caregivers may provide care to two or more care recipients. The future may bring some positive changes as well. In particular, we are likely to see an expansion of the use of technologies that are already available to caregivers and recipients, as well as the development of new technologies. It is important to recognize that the nearly 66 million caregivers are a critical extension of our formal health care system. Without their efforts, there would be a shift of recipients into public programs such as Medicaid, and the quality of life and the health status of many who need care would decline. It is important to do all we can to support caregivers so they can continue in their roles. Specifically, it is important to:

1) Identify and help caregivers who are most at risk for deteriorating health, financial security, and quality of life so that they can continue to provide care while maintaining their own well-being
2) Identify and advocate for programs that make a real difference in caregivers’ well being and in their ability to continue providing care
3) Identify and promote the use of technologies that can facilitate caregiving
4) Extend the reach of caregiver programs to all caregivers regardless of the age of  their care recipient
5) Encourage families to plan proactively for aging and potential health/disability issue

 

By all means it is time to promote this burning issue!

 

News about the Convention on the Rights of Persons with Disabilities

The United Nations Enable Newsletter is prepared by the Secretariat for the Convention on the Rights of Persons with Disabilities (DSPD/DESA) with input from UN offices, agencies, funds and programmes, as well as from civil society organizations, including organizations of persons with disabilities. I hope that you will find it interesting and helpful.

High-level Meeting on disability and development (23 September 2013)
The High-level meeting of the General Assembly on disability and development (HLMDD:http://www.un.org/hlmdd2013) is expected to take place at the level of the Heads of States on 23 September, this year. Prior to the meeting, a draft text of the outcome document will be produced by the President of the General Assembly in consultation with Member States, along with input from organizations of persons with disabilities and other relevant stakeholders, through online discussions and informal consultations. Toward this end, DESA, in partnership with UNICEF will conduct online consultations under the existing platform of the World We Want 2015 from 8-28 March. (http://www.worldwewant2015.org)

Commission for Social Development concludes its session
The 51st session of the Commission for Social Development (CSOCD) met in New York from 6 to 15 February under the theme: “Promoting empowerment of people in achieving poverty eradication, social integration and full employment and decent work for all”. Two reports were presented to the Commission at this sessions: “Report of the Secretary General on Mainstreaming Disability in the Development Agenda” (E/CN.5/2013/9) and “Report of the Special Rapporteur to the 51st Session of the Commission for Social Development: Monitoring of the implementation of the Standard Rules on the Equalization of Opportunities for Persons with Disabilities” (E/CN.5/2013/10). The Special Rapporteur on Disability, Shuaib Chalklen, also presented his statement to the Commission. (http://www.un.org/disabilities/default.asp?navid=48&pid=38)

Panel discussion on a post-2015 development framework
A panel discussion was organized by DESA in collaboration with the UN Regional Commissions on 12 February, as a side-event to the above session of the Commission. The event entitled: “Toward a disability-inclusive post-2015 development framework: Regional perspectives” was organized with a view to generate input to the outcome document for the High-level Meeting of the General Assembly on disability and development to be held on 23 September, this year. Focusing on the role of UN Regional Commissions, the discussion highlighted current efforts to integrate existing international instruments on disability in regional and national policies and frameworks on development. (http://www.un.org/disabilities/default.asp?navid=48&pid=38)

New Enable webpage on Indigenous persons with disabilities
DESA has prepared a new web page to draw attention to issues related to indigenous persons with disabilities. While no global data exists regarding indigenous persons with disabilities, available statistics show that indigenous peoples are disproportionately likely to experience disability in comparison to the general population. Indigenous persons with disabilities often experience multiple discrimination and face barriers based on their indigenous status, as well as their disability. The international community has also recognized that special measures are required to protect the rights of the world’s indigenous peoples. This web page will continue to develop as a hub of news, resources and links related to indigenous persons with disabilities. (http://www.un.org/disabilities/default.asp?id=1605)

My World: The United Nations global survey
Make the voices of persons with disabilities heard… LOUD!
Vote for the changes that would make the most difference to your world! MY World is a United Nations global survey asking you to choose your priorities for a better world. There are 16 priority areas in the survey, plus one more for you to decide, which can be made disability-specific. For example: Freedom to make my own decisions; Being included in the community by removing architectural and attitudinal barriers; Including persons with disabilities in all development plans, programs and activities. You decide! Forward, translate and send this around the world!Results will be shared with world leaders in setting the next global development agenda. Tell them about the world you want, because your voice matters!
Vote at: http://enable.myworld2015.org

HRC – Work and employment of persons with disabilities
The fifth interactive debate of the Human Rights Council (HRC) on the rights of persons with disabilities will take place on Wednesday, 6 March 2013 in Geneva, focusing on the issue of work and employment of persons with disabilities. The debate will bring together experts in the field of promoting employment opportunities for persons with disabilities, including: representatives of a organization of persons with disabilities (DPO), the International Labour Organization (ILO), the private sector, the Committee on the Rights of Persons with Disabilities and a social entrepreneur. Presentations by panelists will be followed by an interactive discussion among Human Rights Council Member States and observers. The debate will seek to identify good practices in promoting employment opportunities for persons with disabilities in both public- and private-sector workplaces. It will also contribute to raising awareness of the challenges that persons with disabilities continue to face in employment, and to highlight the measures that States and employers can take with a view to ensuring that persons with disabilities enjoy access to, retention of and advancement in employment on an equal basis with others. The panel and its web cast will be made accessible to persons with disabilities through real time captioning and sign language interpretation. (http://www.ohchr.org/EN/Issues/Disability/Pages/Workandemploymentofpersonswithdisabilities.aspx). As requested by the HRC, OHCHR has also prepared a thematic study on the work and employment of persons with disabilities (A/HRC/22/25). (http://www.ohchr.org/EN/Issues/Disability/Pages/ThematicStudies.aspx)

HRC – Side-event on Inclusive Education
As a side-event to the 22nd session of the HRC, UNICEF and the Permanent Missions of Finland and Spain will co-organize a side-event titled: Inclusive Education for Children with Disabilities: Examples from Central and Eastern Europe and the CIS region, on 1 March, in Geneva, Switzerland. Speakers include: H. E. Mr. Zarko Obradovic, Minister of Education, Science and Technological Development of Serbia; H. E. Mr. Pance Kralev, Minister of Education and Science of the former Yugoslav Republic of Macedonia; H. E. Ms. Vesna Vucurovic, Deputy Minister of Education and Sports of Montenegro; Ms. Yoka Brandt, UNICEF Deputy Executive Director; and Mr. J Patrick Clarke, Chief Executive Officer of Down Syndrome Ireland, representing the International Disability Alliance.

OHCHR – General Discussion on women and girls with disabilities
The Committee on the Rights of Persons with Disabilities will hold a half Day of General Discussion on Women and Girls with Disabilities on Wednesday, 17 April 2013. Women and girls with disabilities experience multiple forms of discrimination, which hinder their meaningful participation on an equal basis with others in all spheres of life. The Committee has invited persons with disabilities and their representative organizations to submit their inputs to the Committee. (http://www.ohchr.org/EN/HRBodies/CRPD/Pages/CRPDIndex.aspx)

WHO – JPMH Mental health and human rights: Call for papers
The Journal of Public Mental Health (JPMH) announces a call for papers for a special issue on mental health and human rights, to be published in 2013. Accepted contributions include original research papers, systematic reviews, policy analyses and case studies. In 2012, the World Health Organization (WHO) Department of Mental Health and Substance Abuse launched the QualityRights (QR) Project, which aims to improve the quality and human rights conditions in mental health and social care facilities and empower civil society organizations to advocate for the rights of people with mental and psychosocial disabilities. This call for papers aims to inform the core objectives of QualityRights. JPMH hopes to attract papers from academics, practitioners and activists in resource-scarce countries. Papers submitted for this special edition should be marked with “QualityRights” in the title. The manuscript selection process will follow the Journal’s peer-review procedures. Submit articles to http://emeraldinsight.com/products/journals/journals.htm?id=jpmh before 1 June 2013.  Informal enquiries to: Leeknifton@gmail.com. Information on WHO’s QualityRights Toolkit is available at: http://www.who.int/mental_health/publications/QualityRights_toolkit/en/index.html.

World Bank – Disability & Development training course
The World Bank’s core course on Disability & Development aims to provide participants with an in-depth understanding of the conceptual and practical issues involved in the development and implementation of inclusive economic and social policies that are relevant for persons with disabilities. The course aims to help increase knowledge on disability, its social and economic relevance and development policies and programs responsive to the needs of persons with disabilities; increase understanding of the main issues involved in the process of including disability into development to ensure that persons with disabilities have equal access to all mainstream policies and services and to eliminate “disability disadvantage”. Deadline for registration: Friday, 1 March 2013. (https://www.surveymonkey.com/s/disability2013; http://www.worldbank.org/disability/corecourse)

UPCOMING EVENTS
(Send us information on major international disability events for possible inclusion in the list below)

27 February to 1 March: Seminar on Indigenous peoples
The “International Expert Seminar on Access to Justice for Indigenous Peoples including Truth and Reconciliation processes” held at the Institute for the Study of Human Rights at Columbia University, New York, will contribute to the work of the United Nations Expert Mechanism on the Rights of Indigenous Peoples. Agenda Item 12 of the seminar covers: “Indigenous Women, Youth and Persons with Disabilities and Access to Justice”. (http://hrcolumbia.org/indigenous/seminar)

11 March: ReelAbilities: NY Disabilities Film Festival at UN HQ
The Permanent Mission of Sweden will sponsor the screening of the film: “The Importance of Tying Your Own Shoes” at UN Headquarters in New York. Film synopsis: When Alex gets a job as the leader of a local theater group for persons with disabilities, his outlook on life begins to change. Through the theater group’s work, Alex comes to appreciate that every person has his or own talents, which can grow if given the opportunity and support. (Lena Koppel / 100 min.) The event is being organized by ReelAbilities: NY Disabilities Film Festival, the UN Department of Public Information (UNDPI) and DESA.  (http://www.un.org/disabilities/documents/idpd/reelabilities_11march2013_un.doc)

4 to 15 March: Commission on the Status of Women, 55th session
The fifty-seventh session of the Commission on the Status of Women will take place at UN Headquarters under the priority theme: “Elimination and prevention of all forms of violence against women and girls.” The review theme chosen is “the equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS (agreed conclusions from the fifty-third session). (http://www.un.org/womenwatch/daw/csw/57sess.htm)

21 March: World Down Syndrome Day
In 2011, the General Assembly declared 21 March as World Down Syndrome Day (A/RES/66/149). This year at the United Nations the World Down Syndrome Conference 2013 will be organized at UN Headquarters in New York on 21 March, under the theme “The Right to Work”. This year’s Conference will focus on the rights of persons with Down syndrome to work in open, inclusive and accessible environments. It will help raise awareness on the importance of promoting early development and education, proper medical care, and providing for independent living in communities. The multi-stakeholder event will be organized in collaboration with Down Syndrome International, the Missions of Australia, Brazil, Poland, India, DESA and other partners. (http://www.un.org/en/events/downsyndromeday;  http://www.worlddownsyndromeday.org)

2 April: World Autism Awareness Day
The United Nations General Assembly unanimously declared 2 April as World Autism Awareness Day (A/RES/62/139) to highlight the need to help improve the lives of children and adults who suffer from the disorder so they can lead full and meaningful lives. (http://www.un.org/en/events/autismday/)

17 April: General Discussion on women and girls with disabilities
The Committee on the Rights of Persons with Disabilities will hold a half Day of General Discussion on Women and Girls with Disabilities. (see OHCHR above)

29 to 30 April: 29th Pacific Rim International Conference on Disability and Diversity
The theme for the 29th Pacific Rim International Conference on Disability and Diversity: “Being in Community”, embraces the ideals of all people living together harmoniously and happily in a barrier-free world without fear of exclusion from social, economic or political life. (http://www.pacrim.hawaii.edu)

20 to 31 May: 12th session, Permanent Forum on Indigenous Issues
The session will be held at UN Headquarters, New York and include a review year of the Forum. (http://social.un.org/index/IndigenousPeoples/UNPFIISessions/Twelfth.aspx)

6 to 7 June: M-Enabling Summit 2013
The second M-Enabling Summit 2013: Global Summit on Accessible Mobile Technology for Senior Citizens and Users of All Abilities is organized by the Global Initiative for Inclusive ICTs (G3ict) and E.J. Krause and Associates (EJK) in cooperation with the International Telecommunication Union (ITU) and the Federal Communications Commission (FCC), ensuring substantial participation for leading international mobile service providers, policy makers, apps developers and manufacturers. (http://www.m-enabling.com)

27 to 28 June: Symposium on Disability, Technology and Rehabilitation in Low and Middle Income Countries
The Symposium to be held at the University of Washington, Seattle, Washington, will focus on improving and increasing access to technology and rehabilitation products and services with the goal of ensuring full inclusion and participation for persons with disabilities in low-resourced communities in low and middle income countries.  The keynote speaker will be Chapal Khasnabis, Disability and Rehabilitation Team, World Health Organization. (http://idtr.uwctds.washington.edu/workshops/2013)

2 to 3 July: Include 2013: Global Challenges and Local Solutions in Inclusive Design
The event will be organised by the Helen Hamlyn Centre for Design, Hong Kong Design Centre and the School of Design at the Hong Kong Polytechnic University. (www.hhc.rca.ac.uk/4989/all/1/include-2013.aspx)

2 to 13 September: 10th session of the Committee on the Rights of Persons with Disabilities
(Details forthcoming)

9 to 11 September: 6th International Urban Design Conference
The Conference will be held at the Novotel Sydney Olympic Park.  The conference “UrbanAgiNation” urbanisation | agitation | imagination will examine the future Density and Infrastructure requirements in cities. The call for abstracts is now open. (http://urbandesignaustralia.com.au)

23 September: High-level meeting on disability and development
(See item above).

16 to 18 October: 2nd International Conference of the WFD
The 2nd Conference of the World Federation of the Deaf (WFD) will be held in Sydney, Australia under the theme: “Equality for Deaf People”. (www.wfdsydney2013.com)

3 December: International Day of Persons with Disabilities
The details and theme for 2013 are forthcoming.
(http://www.un.org/disabilities/default.asp?id=111)

OTHER NEWS
(DISCLAIMER: The information below is provided by civil society organizations and others for informational purposes only. This does not constitute endorsement of, or an approval by, the United Nations of any of the products, services, or opinions of the organization or individual. The United Nations bears no responsibility for the accuracy, legality or content of their statements and opinions.)

New “COMPASS” on Human Rights Education
The Council of Europe’s Human Rights Education Manual “COMPASS”, a new, revised version now includes “Disability and Disablism” as a theme, as well as a 10-page background text on the topic produced through a multi-stakeholder partnership of the CoE, UN, European Disability Forum, IFHOHYP and other DPOs. COMPASS also includes training activities on disability and disability rights. (http://eycb.coe.int/compass/download_en.html)

Ibero-American Year for Workplace Inclusion of Persons with Disability
The XXII Ibero-American Summit of Heads of State and Governments held in Cadiz in November 2013 agreed to declare the year 2013 as the “Ibero-American Year for Workplace Inclusion of Persons with Disability”. This idea first came from an agreement initially signed by the Vice-presidency of Ecuador, the Employment Ministers Iberoamerica, the Ibero-American Secretariat (SEGIB) and the Ibero-American Social Security Organization (OISS). To support their proposal to the Ibero-American Summit, SEGIB and OISS presented the results of a study, which described the situation of persons with disability in Iberoamerica and the barriers they face to access the labour market (http://segib.org/es/node/4788; http://segib.org/cumbres/files/2012/03/11-COMESP-INCLUSION-DISCAPACIDAD-ESP.pdf)

Funding opportunities for disability policy scholars  
The Center for Studying Disability Policy (CSDP), through the Disability Research Consortium (DRC) and the Social Security Administration (SSA), is funding disability policy scholars.  Applications are being accepted for three grants that offer funding opportunities for graduate students and new researchers conducting disability policy research, under the Disability Policy Research Summer Scholars Program, the Disability Policy Research Dissertation Scholars Program, and the Disability Policy Research Emerging Investigator Award Program. Deadline: 8 March 2013. (http://www.disabilitypolicyresearch.org/DRC/DRC_grants.asp)

Inclusion International Launches Global Report on Article 19
Inclusion International launched a new global report entitled: “Inclusive Communities = Stronger Communities”. The report confirms that most adults with intellectual disabilities live at home and do not have the support they need to live and be included in their communities. It reveals that families are the major source of support. The report highlights that transforming communities to be inclusive and ensuring that people with disabilities are included in mainstream programmes are essential for securing the rights of people with intellectual disabilities. (http://www.inclusion-international.org)

Strengthening the voices of the users and survivors of psychiatry
WNUSP, an international representative network of the voices of users and survivors of psychiatry, is working to ensure that the views and opinions of all users and survivors of psychiatry around the world are respected and upheld. Find out more about its new project “Strengthen Our Voices!” (http://www.wnusp.net)

LCD New publication on inclusive education
Leonard Cheshire Disability (LCD) has recently published “Inclusive Education – An Introduction”. Every child in the world has a right to education. However, children with disabilities are still disproportionately excluded from school. In an inclusive school, disabled children do not study in separate classes; all children learn together in the same classroom using materials appropriate to their various needs. This publication explores LCD’s approach to inclusive education and highlights their projects in Africa and Asia that support children with disabilities to get the education that they, and all children, deserve. (http://www.lcint.org/?lid=5136)

A Health Handbook for Women with Disabilities
Women with disabilities often discover that the social stigma of disability and inadequate care are greater barriers to health than the disability, itself. This Handbook, developed with the help and experience of women with disabilities in 42 countries, can help women with disabilities overcome barriers, improve their general health, self-esteem and ability to care for themselves, as well as increase their participation in their communities.
(http://en.hesperian.org/hhg/A_Health_Handbook_for_Women_with_Disabilities)

DPI convenes meeting on youth with disabilities in India
Disabled People’s International (DPI), India, organized a 2-day National Convention for Youth with Disabilities on 7 to 8 February in New Delhi. Around 50 young students with disabilities from the top colleges and universities, including engineering, medical, law, media and design institutes, participated in this first-ever initiative. The objective of the event was to reach out to young people with disabilities and inspire the next generation leaders of, not just the Indian disability sector, but also those who would be agents of change in other fields. The Convention was inaugurated by the Government Minister for Social Justice and Empowerment. DPI has also launched its new website. (www.dpi.org)

CONTACT INFORMATION

Secretariat for the Convention on the Rights of Persons with Disabilities
Division for Social Policy and Development (DSPD)
Department of Economic and Social Affairs (DESA)
S-2906, United Nations, New York, NY 10017, USA.
Website: www.un.org/disabilities
Email: enable@un.org
Facebook: www.facebook.com/pages/United-Nations-Enable/196545623691523
Twitter: http://twitter.com/UN_Enable

A New Paper Concerning Depression-related Stigma and Discrimination

The results of the paper below which was written by some of the leading figures in the field, will probably not strike you: stigma and discrimination toward people with major depression still exist, and is still, indeed, one of the main barriers to recovery and social inclusion of people with psychiatric illnesses. While not surprising, the results of this comprehensive research require us to think harder of effective ways to tackle this negative phenomenon. Any ideas?  

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey

Background: Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination.
Methods: In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data.
Findings: 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coeffi cient 0·20 [95% CI 0·09–0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15–0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01–0·19], p=0·032; unpaid employed 0·34 [0·09–0·60], p=0·007; looking for a job 0·26 [0·09–0·43], p=0·002; and unemployed 0·22 [0·03–0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in fi nding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination.
Interpretation: Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving eff ective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the eff ects of stigma when it is already established.

For the full paper click HERE