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There’s still a long way to go.
A NEW FEELING

World Mental Health Day launched in 1992. Here’s what’s changed since then

By Natasha Frost

In the 26 years since the first World Mental Health Day, how we talk about and treat mental illness has changed considerably. Much of our language is different—terms like “crazy” or “lunatic,” once commonly used in media, are now seen as discriminatory and stigmatizing. Terms such as “mindfulness,” “self-care” and “mental health day” are part of the day-to-day conversation.

There’s still a long way to go. Stigma about all kinds of mental illness continues throughout the world—in France, for example, some depression- and anxiety-related conditions are thought of “neuroses,” making their treatment ineligible for public funding. In Italy, only 50% of people who suffer from depression seek treatment. Many countries still have no legislation to protect those with mental illnesses or to support their care. And inhumane treatments persist: In Indonesia, tens of thousands of patients are illegally chained up in mental health “shelters,” while in New Zealand, hundreds of patients have been forced to undergo non-consensual electroconvulsive therapy.

Here’s a look at some key moments of legal and cultural change since World Federation for Mental Health launched the international day of awareness, and how we’ve come to better understand and treat mental illnesses.

1994 Cognitive scientist Jon Kabat-Zinn publishes Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life, launching mindfulness-based stress reduction into the mainstream. In time, it’s used in schools, workplaces and prisons, before becoming an established commercial phenomenon in the mid-2000s.

1996 The US Mental Health Parity Act is passed. When it comes into effect in 1998, it will force health insurers to match annual or lifetime payment limits on mental health benefits to other kinds of medical and surgical carer. Before that, insurers had no obligation to cover mental health care.

1997 The British Labour party, led by Tony Blair, makes mental health a priority for the National Health Service. Labour had a specific target of reducing suicides—while the party was in power, the rate fell by 13.4% between 1997 and 2008.

2001 In Pakistan, the Mental Health Ordinance gives patients admitted against their will a right to appeal and reduces “detention” time to 72 hours from 10 days. Individual provinces have since introduced other measures to give patients more support.

2002 The Mental Health Act is passed in South Africa, reclassifying “patients” as “users” of care and prioritizing their dignity, comfort and convenience in treatment.

2005 Brooke Shields publishes an op-ed in the New York Times about her treatment for postpartum depression after Tom Cruise publicly accuses her of not being able to “understand the history of psychiatry.” Her memoir, Down Came the Rain: My Journey Through Postpartum Depression, sells millions.

2006 Stephen Fry, the British actor, author and presenter, speaks publicly about his experience with bipolar disorder in the television documentary The Secret Life of the Manic Depressive, which is aimed at reducing stigma around the condition. A follow-up documentary airs 10 years later.

2007 The “Time to Change” campaign, focused on tackling the stigma around mental illness, launches in the UK. The campaign now works with hundreds of employers to change attitudes in the workplace and uses support from the government and charity Comic Relief.

2011 Brené Brown’s TED talk “The Power of Vulnerability” about her struggles with mental health goes viral and becomes one of the most viewed TED talks of all time. In the same year, the first International Self-Care Day is observed, as more and more people embrace the benefits of self-care to promote good mental health.

2012 China passes its first-ever mental health law, focusing on preventing people from being involuntarily held and treated in psychiatric facilities. The law standardized services across the country, required hospitals to set up and provide outpatient clinics or counseling, and called for more doctors to be trained in treating mental illness.

2013 The Associated Press stylebook adds its first entry on mental illness, codifying how journalists should address it respectfully and accurately. The World Health Organization introduces a comprehensive action plan to be implemented around the world by 2020—its primary focus is changing “the attitudes that perpetuate stigma and discrimination that have isolated people since ancient times.”

2016 Barack Obama signs the 21st Century Cures Act, with multiple provisions to improve access to US psychiatric care, including reauthorizing the National Suicide Prevention Lifeline Program, targeting support for opioid users, and authorizing grants for community treatment programs for adults with serious mental illness. In Syria, the civil war sparks a mental-health crisis with global repercussions, as millions are displaced and suffer from the effects of trauma. A 2015 study by the German Federal Chamber of Psychotherapists estimated that half the Syrian refugees in Germany had mental health issues, with 50% having been victims of violence.

2017 India overhauls its mental-health legislation, giving every person a right to access government-funded care and treatment. It bans electroconvulsive therapy for children and forbids hospitals from separating mothers who use mental- health services from their children under the age of three.

2018 High-profile American performers and athletes such as Dwayne “The Rock” Johnson, Ryan Reynolds, Michael Phelps, and Kevin Love open up about their experiences with mental illness. Meanwhile, Donald Trump slashes mental health budgets by hundreds of millions. In the UK, prime minister Theresa May creates the position of minister for suicide prevention, though critics point to her previous £4.5m cuts to mental-health services.