People with mental illness are subject to prejudice in our society. Although attitudes to people with anxiety and depression have improved, attitudes towards people with serious mental illnesses such as schizophrenia have worsened.

The NHS has a long way to go to achieve the laudable aims set out in High Quality Care for All. In some NHS settings, compassionate healthcare for all will not be achieved without combating prejudice and discrimination.

Prejudice is fuelled by irresponsible media coverage of mental illness, and particularly by a distorted association with homicidal violence. It is perpetuated by a lack of understanding of the importance of mental health to personal and social well-being, and for physical health. As recognised by health minister Lord Darzi and health secretary Alan Johnson, there can be no health without mental health.

Discrimination operates in housing and employment. Research confirms that employment assists recovery from mental illness, so it is vital that social inclusion is promoted for the benefit of the individual and society.

Institutionalised

Regrettably, discrimination against people with learning disabilities and mental ill-health also exists in the NHS. Some patients presenting to accident and emergency departments after deliberate self-harm, for example, are verbally abused and even treated sadistically.

Some NHS staff behave as if their hostility is sanctioned, suggesting that discrimination in the NHS is institutionalised. This is unacceptable and must be challenged by the NHS as an institution, just as racism and sexism have been.

Prejudice in the NHS hinders recognition of mental illness, ready access to services, and effective treatment. Hostility and discrimination deter people from seeking help.

Discrimination is also evident at times in NHS commissioning. Too often, we hear that commissioning for mental health or learning disabilities is "different" or "too difficult". Mental health and learning disability services have not received equitable funding, have been disadvantaged by the lack of a tariff and payment by results, and have suffered repeatedly from the drain of resources to the acute sector. Mental health and learning disability commissioning should be "mainstreamed" conceptually and practically.

Looking ahead

So what can be done? Action is needed to address public prejudice through the education system and public mental health programmes. Mandatory training about learning disabilities (as recommended by the Michael report on healthcare for people with learning disabilities) and mental ill-health should be provided to all NHS and social care staff.

To this list we should add the media, for responsible reporting can reduce the ignorance on which prejudice and discrimination thrives. Public campaigns to challenge prejudice, such as Shift and Do the Write Thing, have a significant role.

As clinical leaders, we have a responsibility to show the way by example, and by explicit expectations of our staff. We should ensure that our organisations employ people with learning disabilities and mental health problems without discrimination. We must define standards of care to ensure that our staff are well informed and respond professionally and compassionately to patients with mental illness or learning disability. Above all, we must confront prejudice and discrimination wherever, whenever and however it is evident.

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