Table 4 Health promotion example 2: Tackling stigma through theatre

One contributing factor to disability and poor QoL in people with mental illness is the degree of stigma they experience[26, 43, 44]. It is now well-recognized that the stigmatization of mental illness leads some individuals to avoid or discontinue treatment for their mental health problems[45]. CREST.BD has generated knowledge relating to stigma in BD from several research projects, demonstrating, for example, that ‘moving beyond internalized stigma’ (a progression from a state of self-stigmatization to one where society’s stigma toward people with mental illness is no longer internalized[8] is, an important facet of living well with BD[8, 46].To share knowledge about stigma in BD with both people with BD and their health care providers, one component of the team’s CIHR KTA grant involves team member Victoria Maxwell (an actress and mental health educator who lives with BD) performing a new one-woman theatrical performance entitled ‘That’s Just Crazy Talk’ commissioned as part of the grant. Although drama has been used with success elsewhere to target mental illness stigma awareness[47, 48], this is the first example of such an initiative in the BD field. CREST.BD launched the play in Vancouver and Toronto in July of 2011. Health care providers and people with BD were invited to participate in the research component of the activity, which involved pre- and post-performance questionnaires. The general public was also invited to attend.

The two performances attracted 65 health care providers, 54 people with lived experience, 3 individuals who identified as both, and over 100 additional audience members.In ‘That’s Just Crazy Talk,’ dramatic narrative is used to convey the corollaries of decades of personal and familial mental illness, effectively translating the narrator’s personal experiences of both external and internalized stigma into a vivid, often humorous and sometimes troubled, portrait of life lived with BD. The narrator addresses her family’s profound experiences of mental health stigma and her attempts to come to terms with the implications of her chronic and complex illness. The audience’s intimacy with the narrative is underscored by the community-accessible locations where the play is held, the small audience size (approximately 140 participants per show) and a post-performance question and answer period where Victoria’s ‘character’ is cemented in reality as individuals engage with her present and vibrant self. The lived-experience aspect of the performance is unique in this genre of theatre, and is viewed by the team as a key dimension for using this approach to address stigma. Further performances of ‘That’s Just Crazy Talk’ have been planned in Canada and internationally, and a DVD of the performance has been produced.