It has been shown that stigmatization reduces life chances for persons suffering from mental illness. The negative effects include less access to mental health services and to advances in psychiatric treatment [3,4], to psychosocial stress, to low socio-economic status and to delay in appropriate help seeking [5]. Relatives of mentally ill persons identify stigma as a key problem that causes their ill relatives a lowered self-esteem, difficulties in making and keeping friends, and a tendency to deny that they have a mental illness [6]. The relatives also experience burden due to the stigma associated with mental illness. In a study investigating family stigma one group of relatives reported thoughts of life and death in terms of their relatives and themselves.. Eighteen per cent of the relatives had sometimes felt that the patient would have been better off dead. Ten per cent of the family members in the same study reported that they now and then had experienced suicidal thoughts [7].

Persons with a diagnosis of mental disorder also present difficulties in seeking and keeping work. In a study of people suffering from schizophrenia in five European countries the employment rate ranged from 5% (England) to a maximum of 23% (Italy) [8]. One explanation for the low employment rate is that employers discriminate against persons who have a history of psychiatric treatment. In a study of 200 Human Resource Officers in UK companies it was shown that a history of mental illness significantly reduced the chances of employment in comparison with a history of diabetes [9]. Two studies in California found that employers perceived people with mental illness as being as undesirable as ex-convicts and that the only group they were more reluctant to hire were people with active tuberculosis [10].

To suffer from mental health problems also leads in many cases to a process of identity transformation where persons lose their previously held or desired identities and adopt a stigmatised view of themselves. This process is referred to as self-stigma [11], internalised stigma [12] or anticipated stigma [13]. Self-stigma has been associated with reductions in protective psychological variables such as hope [14], self-esteem [15,16], self-efficacy [17], empowerment [17,18] and recovery beliefs [18]. It is also associated with lower quality of life [15,17] and an increase in avoidant coping strategies such as withdrawal and secrecy.

Several programs to fight stigma have been initiated as a consequence of the research findings that have indicated stigmatization as a threat to successful treatment and rehabilitation of individuals with mental illness. Some of these programs have been international, such as the World Psychiatric Association's Global Programme against Stigma and Discrimination because of Schizophrenia [19], others have been national such as the Changing Minds Campaign by the Royal College of Psychiatrists in the United Kingdom [20,21], the PSYKE-Campaign in Sweden [22] and the National Mental Health charity SANE Australia [23]. The overall ambitions have been to increase public knowledge about mental illness and its treatment possibilities, to create more positive attitudes towards people with mental illness and to reduce prejudice and discrimination. To some extent the aims of these campaigns have been achieved [19,24]. However, despite all efforts to reduce stigma through public campaigns the results are not convincing and the field suffers from a lack of evidence about what works [1]. The process appears to be a slow one. In a recent study 73% of a cohort of persons suffering from mental illness believed that most employers would pass over an application from a former psychiatric patient in favour of another applicant and that they are not considered as trustworthy as the average citizen (67%) or as intelligent as other people (56%) [25]. In another recent study a list of 250 derogatory labels used among fourteen year old schoolchildren to stigmatize people with mental illness were described. The authors suggest that this wide-ranging and negative number of terms about mental illness appears to emanate from the media and from family and peers [26]. All these findings indicate a quite persistent negative attitude in the general population.

- to investigate test-retest reliability of the Swedish versions of the self-report inventory: FABI and of the "Changing Minds"- questionnaire

The complete "Changing minds" questionnaire consists of 56 items and 10 of these (17.9%) present poor test-retest reliability, 26 items (46.4%) fair and finally 20 items (35.7%) moderate test-retest reliability.

The weighted kappa values for the self-report inventory of fear and behavioural intentions towards the mentally ill (FABI) also attain at best moderate test-retest reliability. However, none of the items fall below a fair agreement level between the test and retest. The questionnaire shows high internal consistency (table ​(table22).

Comparisons are difficult to make being as no previous psychometric data for the instruments have been published. The internal consistency reliability of scales measuring social distance tends to be good or excellent [27], which is also repeated for the self-report inventory of fear of and behavioural intentions towards the mentally ill (FABI) in the present study. The questions in FABI deal with intentions that to a high degree reflect social distance, so in that respect the results are quite consistent with earlier findings.