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Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.

This article begins by locating Patient and Public involvement ((PPI) historically and argues that ‘mental health’ was a special case. This movement held promise for service users in repositioning them as researchers as opposed to ‘subjects’. We argue, however, that ultimately it failed and was reduced to involved publics ‘tinkering at the edges’. In respect to this we reference institutions, hierarchies, organisations and the overall political climate. Ultimately, however, it failed at the level of knowledge itself in that t he underlying assumptions of conventional researchers, their aims and goals, clashed with those of the assumptions and aims of survivors. However, we argue that all is not lost, the mainstream itself is imploding and beneath the surface forms of distinctly survivor-led knowledge are emerging.

In recent years, there has been a growing and high-profile movement for ‘global mental health’. This has been framed in ‘psych system’ terms and had a particular focus on what has come to be called the ‘Global South’ or ‘low and middle-income countries’. However, an emerging ‘Mad Studies’ new social movement has also developed as a key challenge to such globalising pressures. This development, however, has itself both being impeded by some of the disempowering foundations of a global mental health approach, as well as coming in for criticism for itself perpetuating some of the same problems as the latter. At the same time, we are also beginning to see it and related concepts like the UNCRPD being given new life and meaning by Global South activists as well as Global North activists. Given such contradictions and complexities, the aim of this paper is to offer an analysis and explore ways forward consistent with decolonizing global mental health and addressing madness and distress more helpfully globally, through a Mad Studies lens.

Purpose Service user involvement in instrument development is increasingly recognised as important, but is often not done and seldom reported. This has adverse implications for the content validity of a measure. The aim of this paper is to identify the types of items that service users felt were important to be included or excluded from a new Recovering Quality of Life measure for people with mental health difficulties. Methods Potential items were presented to service users in face-to-face structured individual interviews and focus groups. The items were primarily taken or adapted from current measures and covered themes identified from earlier qualitative work as being important to quality of life. Content and thematic analysis was undertaken to identify the types of items which were either important or unacceptable to service users. Results We identified five key themes of the types of items that service users found acceptable or unacceptable; the items should be relevant and meaningful, unambiguous, easy to answer particularly when distressed, do not cause further upset, and be non-judgemental. Importantly, this was from the perspective of the service user. Conclusions This research has underlined the importance of service users' views on the acceptability and validity of items for use in developing a new measure. Whether or not service users favoured an item was associated with their ability or intention to respond accurately and honestly to the item which will impact on the validity and sensitivity of the measure.

This article is a response to Oliver et al.’s Commentary ‘The dark side of coproduction: do the costs outweigh the benefits for health research?’ recently published in Health Research Policy and Systems (2019, 17:33). The original commentary raises some important questions about how and when to co-produce health research, including highlighting various professional costs to those involved. However, we identify four related limitations in their inquiry, as follows: (1) the adoption of a problematically expansive definition of co-production that fails to acknowledge key features that distinguish co-production from broader collaboration; (2) a strong focus on technocratic rationales for co-producing research and a relative neglect of democratic rationales; (3) the transposition of legitimate concerns relating to collaboration between researchers and practitioners onto work with patients, service users and marginalised citizens; and (4) the presentation of bad practice as an inherent flaw, or indeed ‘dark side’, of co-production without attending to the corrupting influence of contextual factors within academic research that facilitate and even promote such malpractice. The Commentary’s limitations can be seen to reflect the contemporary use of the term ‘co-production’ more broadly. We describe this phenomenon as ‘cobiquity’ – an apparent appetite for participatory research practice and increased emphasis on partnership working, in combination with the related emergence of a plethora of ‘co’ words, promoting a conflation of meanings and practices from different collaborative traditions. This phenomenon commonly leads to a misappropriation of the term ‘co-production’. Our main motivation is to address this imprecision and the detrimental impact it has on efforts to enable co-production with marginalised and disadvantaged groups. We conclude that Oliver et al. stray too close to ‘the problem’ of ‘co-production’ seeing only the dark side rather than what is casting the shadows. We warn against such a restricted view and argue for greater scrutiny of the structural factors that largely explain academia’s failure to accommodate and promote the egalitarian and utilitarian potential of co-produced research.

This essay argues that Leslie Marmon Silko's 1999 historical-fiction novel Gardens in the Dunes enables Indigenous-centered interventions into Victorian studies, ecocriticism, and their intersection. Dramatizing an animistic Native American view of nature as agentic and enspirited, Silko's novel critiques Victorian plant hunting as rooted in settler-colonial logic that treats nature as inert. In turn, through representations of late Victorian gardeners, Silko suggests that British horticulture was also informed by colonial and capitalist ways of thinking about plants. At the same time, however, the novel locates an animistic strain running through Victorian gardening discourses, which I demonstrate through readings of Victorian garden books depicting plants as agentic and enspirited. Silko, I argue, invites us to revisit the late nineteenth century as characterized by a cultural revival of animistic thought, even as this period also saw the racist stigmatization of animism in the field of Victorian anthropology. I connect this fraught discursive moment in British history to an inherited hesitation toward animism in contemporary Victorian studies and ecocriticism, a hesitation that has contributed to uneven engagement with Indigenous thought in both fields. In response, this essay explicates and emulates Silko's critical methodology for an undisciplining engagement with animism in white-authored, ecocritical Victorian studies.

Microbial eukaryotes are vital to global microbial diversity, but there is limited information about their composition and sources in contaminated surface waters. This study examined the pathogens and potential sources of microbial eukaryotic communities in polluted sink environments using the 18S rDNA amplicon sequencing combined with the fast expectation–maximization for microbial source tracking (FEAST) program. Six sampling sites were selected along the Pasig–Marikina–San Juan (PAMARISAN) River System, representing different locations within the waterway and classified as sinks ( n  = 12), whereas animal fecal samples collected from various farms were classified as sources ( n  = 29). Taxonomic composition revealed Stramenopila, Alveolata, Rhizaria (SAR), Archaeplastida, and Excavata in the rivers, accounting for 85.1%, 13.2%, and 0.36% mean abundance of microbial sink communities, respectively. Clinically relevant human pathogens were also observed in sink environments. The correlation test demonstrated that dissolved oxygen, total suspended solids, pH, temperature, fecal coliform count, and phosphates were important environmental factors driving community variations. Moreover, FEAST results indicated that sewage (19.6%) was the primary source of microbial eukaryotes, followed by duck (0.644%) and cow (0.566%) feces. Spatio-seasonal variations showed higher contributions at downstream stations and during the wet season, highlighting the role of rainfall in enhancing microbial dispersal. Results from community-based microbial source tracking can be used to explore factors shaping microbial eukaryotes in freshwater environments, assess potential pathogen-related hazards, and inform river conservation and management strategies. Furthermore, this also serves as preliminary data for microbial eukaryotic source tracking in the Philippines, laying groundwork for future research.

Plague is a central, albeit strangely indeterminate feature of Mary Shelley’s The Last Man. I argue that this indeterminacy is a crucial insight into the etiological and ethical questions at the novel’s core. Drawing from debates in early nineteenth-century medicine, Shelley’s representation of pandemic indexes the living body’s contingency—its indefinite yet continuous exposure to other potentially infectious bodies and environments. Shelley’s approach to contingent embodiment intervenes in the Romantic-era reception of vitalism, particularly Baruch Spinoza’s vitalist ontology of interconnection. Pandemic in The Last Man troubles the Romantic ethical idealization of interconnection, illustrating the potential for life’s contingencies to hurt connected bodies, and especially bodies of color, which are unrecognized by that ethical ideal and disproportionately exposed to sickness and pain.

Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness. South London and Maudsley NHS Foundation Trustees, UK Department of Health SHiFT programme, German Ministry of Education and Research.

The term stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). Most research in this area has been based on attitude surveys, media representations of mental illness and violence, has only focused upon schizophrenia, has excluded direct participation by service users, and has included few intervention studies. However, there is evidence that interventions to improve public knowledge about mental illness can be effective. The main challenge in future is to identify which interventions will produce behaviour change to reduce discrimination against people with mental illness.