Denmark's ONE OF US programme: eradicating mental health stigma and rebuilding people's trust in health systems

Original source (on modern site) | Article images: [1]

In Denmark, the ONE OF US national anti-stigma programme has emerged as a beacon of hope in the fight against mental health stigma. Far beyond a conventional initiative, it involves a profound paradigm shift, rooted in people's lived experiences and courageous narratives.

At its core, ONE OF US embodies a simple yet powerful philosophy: employing trained volunteers, often termed "ambassadors", who intimately understand the complex dynamics of mental health conditions and the pressures of social stigma. The ambassadors bravely share their personal stories with those yet unacquainted with such experiences.

By creating a system for sharing stories across different levels of society, ONE OF US is transforming health care, making it easier for people with mental health conditions to trust their providers. 

In the wake of a pandemic that has eroded people's confidence in institutions, including health systems, the upcoming Tallinn Health Systems Conference will spotlight the critical issues of trust and transformation, and examine the effect this has on health care. 

The conference will focus on the growing sentiment that health services will not deliver for people when they are needed, as well as on health and care workers feeling increasingly undervalued by the system. This is echoed in Rune's testimony below - an instance where a lack of trust hampered a person's access to appropriate care.

Rune's story 

Rune Jørgensen, 49, has lived with a mental health condition for over 2 decades. For the past 5 years, he's been an ambassador for ONE OF US, recommended by a health-care professional who recognized his perception of stigma as a social problem. 

"She knew me, she knew that I viewed stigma as a social issue - so I thought, 'okay, let's give it a try'," he recalls. "By that time, I had learned a lot about myself and how to communicate my thoughts and feelings."

Rune vividly remembers moments when his inability to express his struggles prevented him from receiving the care he desperately needed. But upon joining the programme, he was trained to articulate his story and experiences - what he felt and what it was like to receive mental health care in Denmark. 

As the Tallinn Conference emphasizes the essential link between trust and transformation, ONE OF US stands as a testament to this connection. Trust - the glue binding patients, health workers, and policy-makers - emerges as the cornerstone of impactful change within health-care systems.

For ONE OF US, trust isn't merely an element; it's the linchpin that fosters collaborations within a health system. 

Understanding the harmful effects of stigma 

A 2015 survey conducted by ONE OF US shows the far-reaching effects of stigma. Approximately 9 in 10 people with mental health conditions reported experiencing discrimination, with a troubling subgroup of 1 in 3 people experiencing it in health-care settings.

Anja Kare Vedelsby, the programme manager for ONE OF US in the Danish Health Authority, shares some of the most concerning findings. 

"Some people visiting the emergency room after self-harming reported not receiving adequate anaesthesia for stitches," she said, highlighting a chilling reality within health-care services.

Such discrimination isn't just limited to people's reluctance to seek services. It deeply affects health-care providers as well, making them less confident in their ability to properly deliver care. 

"One common misconception is that people self-harm to get attention, so health-care professionals should not engage with them because it will result in more self-harm to get more attention," Anja notes, warning that this can lead to more self-harm, perpetuating a damaging cycle.

Social contact as the foundation of anti-stigma 

ONE OF US promotes social contact to dispel these and other myths. 

"Social contact is when people who have experienced a mental health condition share their experiences in such a way that the audience's prejudices are not confirmed," says Anja. "These prejudices are thus broken down, paving the way for behaviour change."

"Mental health conditions do not define us," says Rune. "They are just a part of us."

Social contact can come in many forms: trainings, awareness-raising activities or stories shared by ambassadors such as Rune with different groups, including health-care workers. 

Fully integrated in the government, ONE OF US works across Denmark's 5 administrative regions.

In addition to providing an opportunity for social contact and changing stigmatizing attitudes and behaviour, ONE OF US enables ambassadors to share practical information on what can be done to support people with mental health conditions. This is crucial in health-care settings. 

"It helps to dispel the fear of connection," shared one nurse who has worked with ambassadors for years. "For me it's also a relief to see patients who are now doing well." 

In essence, the ONE OF US movement in Denmark isn't merely an initiative; it's a transformational force sculpting societal perceptions and nurturing a landscape where mental health is a conversation, not a stigma - ultimately reinstating trust as the cornerstone of an impactful and credible health-care system.