Can you end mental health stigma with ambassadors and a recovery college? Denmark is trying

The Danish Ministry of Health is putting all hands-on-deck. Will it succeed?

Giuseppe Parlatore was diagnosed with paranoid schizophrenia when he was 25 years old, and that label shaped every aspect of his life. At class reunions, teachers would take a step back, calling him dangerous. When he went to the hospital with a urinary tract infection, the doctor dismissed his symptoms, saying that the problem was just in his mind.

And then, on his anti-psychotic medications, he would sleep 16 hours a day, barely cognizant the waking hours thereafter. “From 2009 until 2016, I was more or less just a vegetable,” Giuseppe says. And sometime during this haze, his son was born. “What haunts me most today is that I wasn’t able to play with him when he was little.”

Today, however, Giuseppe serves on Denmark’s National Council, monitoring the 10-year mental health action plan, working with directors, general secretaries, and the country’s most powerful health officials to guide their work. “I’m a recovering former patient with schizophrenia; I see, hear, experience things that other people don’t.” But here, he was treated as an equal.

Giuseppe Parlatore at the Together Against Stigma Conference in Reykjavík, Iceland

For the past 10-15 years, Denmark has engaged in one of the boldest, most intriguing mental health campaigns in the world. It’s hard to capture all that the Ministry of Health is pursuing, but two programs bear emphasis: ONE OF US and the Recovery College. The former has a network of Ambassadors — or people with lived experience of mental illness — who give talks to students, police officers, nurses, and more, as well as advise the government — as Giuseppe does. The idea is to reduce stigma with social contact, between people with mental illness and the rest of the public.

With the Recovery College, psychiatric patients, their relatives, and healthcare workers take classes about mental health, learning from the teachers — many of whom have lived experience — and each other. “In our classroom, we set aside the roles that these people are usually in,” says Birgitte Kofod, one of the teachers at the Recovery College. “Sometimes, you don’t know who’s staff or patient,” adds Anders Bechgaard, another teacher — who also has ADHD and OCD. The goal is to promote understanding, socialization, and recovery, which naturally helps to reduce stigma.

Denmark is trying to get its countrymen to rethink mental health, but will some Ambassadors and a so-called college really change how people think?

Can social contact reverse stigma?

Across 216 systematic reviews of anti-stigma interventions, the data is clear: social contact is the most effective method to reduce stigmatization, explained Sir Graham Thornicroft, professor of community psychiatry at King’s College London. I met Sir Thornicroft at the Together Against Stigma conference in early June, where he explained that stigma boils down to knowledge, attitudes, and behavior — think misinformation, prejudice, and discrimination. Social contact, in turn, is where there is a positive interaction between a person with mental illness and a particular target group, which can range from an anti-stigma magic show in Andhra Pradesh, India, to a social marketing campaign that reached 2.7 million people in Accra, Ghana.

Can you teach a better mental health paradigm?

The Recovery College promotes this kind of social contact by bringing together patients, family, and medical staff under one roof. There’s something for everybody, with classes ranging from 2.5 hours to 6 weeks, on topics from “living with voices” to “navigating the system.” While Birgitte and Anders will have lesson plans and curricula, the real emphasis is on what they call co-learning, or the development of new knowledge and empathy — from one another.

Birgitte gives the story of two municipal workers who help patients with mental health conditions get jobs. “They had to try to do the assignments we give on, ‘Think back in the past, what were some of your first dreams and goals, and how does it look today?’” she says. “At the end of class, these two staff members were almost tearing up and talking about, ‘Now I know how this can be vulnerable, sensitive.’” Every day, these municipal workers would ask people, hurriedly, about their dreams and goals and how will they move on. But the Recovery College showed them what it was like to actually have to answer those questions — and potentially confront how one’s life didn’t turn out the way they thought it would.

Birgitte Kofod (left) and Anders Bechgaard (right) outside the Recovery College in Ballerup, Denmark — just outside Copenhagen

At some level, the Recovery College can function like a support group, given that patients make up about half of the students — and as much as 70% in some classes. Beyond the benefits of being able to open up and build a community, seeing people at different phase of the recovery process — some in the wards, others coming from home as an outpatient — can also create hope that things will get better.

That diversity, however, can also present a problem. “Some are heavily medicated and fall asleep during class, and others are ready to jump out into the world and get a job,” says Anders. “Sometimes divergence also creates problems in terms of teaching, because people are in such different places.”

More broadly, there’s a real question of how much difference the Recovery College can make on its own, especially because patients can only come if they are actively receiving treatment — at which point, they might not actually be ready to come in. And sure, you can help the college student with bipolar disorder in your class, but who’s teaching the other students who kicked her out of the study group after she had a manic episode? The Recovery College can help address stigma among patients, relatives, and healthcare personnel, but how about the rest of society?

Nyhavn District in Copenhagen, Denmark

How can Ambassadors change things?

That’s where ONE OF US might be able to fit in, since the Ambassadors speak to a much broader swath of Danish society, sharing their experiences and promoting social contact. The organization started back in 2011 as an independent organization headquartered in the Danish Committee for Health Education with the notion that “it should be easier to live with a mental illness, that there should be less stigma and discrimination and more opportunities,” says Anja Vedelsby, project manager of ONE OF US. Remarkably, a decade later, the program was integrated into the Ministry of Health (specifically the Danish Health Authority) and given a pulpit to address stigma at a much broader scale.

The story of how ONE OF US “made it” is one for another time, but it’s Ambassador-focused programming is remarkable because it promotes change in two ways. First, people get the chance to learn about topics that are rarely discussed openly and ask questions, improving their understanding of mental health, empathy, and ability to support others. This is especially relevant for healthcare personnel and police, who “don’t meet the persons when they have recovered; they only meet them when they are most sick,” says Ulla Lindgren, the coordinator of ONE OF US in the Southern Denmark region.

The second benefit is that the Ambassadors themselves feel empowered being able to tell their story — and that’s a form of recovery for them as well. For example, Pernille Petersen has been committed to mental health wards about a hundred times in her life and, for ten years, lived in a long-term facility, where the staff told her she had to accept she wasn’t going to get better. When ONE OF US was founded, it felt like a lifeline: “I thought I could do something positive with my negative experience,” says Pernille. She’s been an Ambassador for nine years now and describes how it’s helped her “become more than my diagnosis,” since she feels like she is making a real difference.

Pernille Petersen at the Together Against Stigma Conference in Reykjavík, Iceland

There will be other events, such as a big film festival “Don’t Fear the Weird,” a three-day event of movies, music, and arts — designed to promote openness and break down taboos around mental illness. The bread and butter of ONE OF US are the Ambassadors regularly sharing their stories and helping break down people’s prejudice one person at a time. For example, when I was in Copenhagen last month, I sat in on a session on self-harm, which covered everything from digital forms of self-harm like self-baiting (#RoastMe) to how patients can be better supported, and there were nurses, parents, and everyday people all sitting in rapt attention.

The final reason Ambassadors can change things is because, with the recent integration of ONE OF US into the Ministry of Health, now the organization has the weight of the crown behind it — Denmark is a constitutional monarchy, after all. So, Ambassadors will serve on the National Council like Giuseppe, and the Ministry will consult ONE OF US on broader stigma reduction efforts (like for obesity).

Perhaps most impressively, stigma reduction was highlighted as one of the five key priority areas in Denmark’s ten-year-plan for mental health, in no small part because of ONE OF US pushing for that centrality. Sure, there might be limits to what Anja or other ONE OF US leaders can say now that they’re within the government system, but they emphasize how the national pulpit and all other associated benefits clearly outweigh the harms.

Copenhagen, Denmark from the top of Christiansborg Palace

Ultimately, ONE OF US and the Recovery College are only two programs and won’t be enough to solve mental health stigma on their own. But they reflect a unique level of commitment on behalf of the Danish government, as well as a remarkable prescience about how stigma is a fundamental cause of population health inequities.

I asked Niels Sandø, Director of Prevention and Inequity in Health, Danish Health Authority, about why the government would invest so much into destigmatization. He told me simply that stigma “has such an effect that people do not seek psychiatric services,” so “if I want to do something about strengthening the treatment program, we have to do something about the stigmatization.”

In turn, what’s the end game of these programs? To get rid of them, says Charan Nelander, who is the director of the Danish Committee for Health Education. “I hope that one day, we can close it down because it’s natural. It is as natural to talk about depression or schizophrenia, as it is to talk about a broken leg,” he says.

“Whether we reach that stage, I don’t know…”