The focus of this year's World Mental Health Day, on 10 October, is schizophrenia, one of the most stigmatised and misunderstood of all mental illnesses. It's common to hear the condition used as a catch-all term for individuals who are violent, dangerous and mentally ill, and popular culture is full of misconceptions about people experiencing schizophrenia as volatile, 'Jekyll and Hyde' figures.
In fact, a study by Australian academics last year found that 13% of news stories mentioning schizophrenia misused the term as a metaphor for split personality, and almost half (47%) linked the condition to some form of violence. But, for most people with schizophrenia, the reality is very different, and the stigma itself can be a real barrier to effective treatment.
Stigma around schizophrenia manifests itself in a number of different ways, from name-calling to physical bullying and exclusion from homes, social situations and places of work. Terms like "crazy", "schizo" and "psycho" are common, especially when those affected are discussing symptoms such as hearing voices, says Chartered Psychologist Julie Scheiner.
Though such judgments often remain unsaid, people affected by schizophrenia may be aware of the fear and disdain held by those around them, which can distort their own perception of themselves and their condition.
Inevitably, the negative impact of this stigma makes schizophrenia harder to diagnose, treat and live with.
Chartered Psychologist Graham Price says: "Anyone who acts abnormally is going to feel that they get noticed. This stigma can lower their self-esteem, which actually makes it harder to deal with the problem they have."
Name-calling may make people reluctant to speak out about the problem in case its symptoms spark ridicule, fear or rejection from those around them. Those who do speak out and seek treatment for the condition may find themselves socially excluded, which can understandably be an upsetting experience.
"Everyone experiences stigma and trauma in different ways, but certainly experiencing stigma can well be similar to experiencing trauma," Julie says. "People may avoid [them] and become frightened about being around them, so they may become paranoid, which can further exacerbate symptoms."
Moreover, Chartered Psychologist Grazia Zovanni believes that many people, from healthcare professionals to friends and family, tend to assume that people living with schizophrenia can only expect to lead a deprived and unfulfilled life, instead of viewing the potential in people with the condition.
"That hugely reduces the prospects of understanding and treating schizophrenia as a condition that allows [clients] a more extended range of possibilities [from their lives]," she says.
Graham puts this stigma down to a lack of understanding and empathy, saying "there's very little understanding of anything people don't have personal experience of, or people who are different in any way – in the same way that people who are thin might not understand obesity."
For Julie too, the biggest factors behind stigma are misunderstanding and fear. "It's important to note that those who suffer with obvious symptoms, like voices talking to them, can experience members of the public being frightened of them. This is made all the more difficult when newspapers sensationalise and focus on cases of people being murdered by those experiencing mental health problems such as schizophrenia."
As the Australian study found, the term 'schizophrenia' is often associated in the media with reports of violent crime. This is despite the fact that, according to Rethink Mental Illness: "research shows that the risk of someone with schizophrenia committing murder each year is 1 in 10,000."
Writing in The Independent last year, Rethink Mental Illness press officer Brian Semple said: "Ninety-five per cent of all violent crime is carried out by people who don't have a mental illness. In fact, people with conditions like schizophrenia are far more likely to be the victims of violent crime than the perpetrator."
Julie believes it's hardly surprising that stigma continues, thanks to this disproportionately violent representation of the condition: "With the lack of [public] understanding, and the 'moral panics' [around schizophrenia], those suffering with mental health problems will be stigmatised."
All three therapists agree that the only way to challenge the stigma around schizophrenia is through improving education and awareness, both in schools and the media. "Education around mental health should ideally start at a younger age, in school," Julie says.
"Mental health [problems], including schizophrenia, can be seen starting at a young age, especially in males. With a lack of service provision, coupled with a lack of education, it's not surprising that the general public is frightened," she continues.
"With education starting from a young age, and appropriate service provision, children and adults would have a better understanding of the symptoms of schizophrenia and how it affects people. People experiencing mental health problems are not to be avoided as we can all learn from each other, and you never know when you may need someone's help."
In terms of treatment, Grazia says: "Let's start to look at schizophrenia from a new perspective, which will enable people to recognise their own strengths and resources, rather than using a limited and judgmental view that focuses only on their weaknesses and what they lack."
She adds: "People can function well if they are supported efficiently by an adaptive and understanding network. Treating schizophrenia with compassion, and looking at it in a new and more positive way, can challenge the stigma around it. Schizophrenia is not a mental health issue that prevents people from living their life in its entirety; it contains a widespread potential, which needs the proper support to express itself."