It’s Channel 4’s fault!
During the broadcast of channel 4’s “Obsessive Compulsive Cleaners”, I became very concerned about the stigmatising effect this programme was having and the very negative impact on people with OCD of this being broadcast. I contacted several groups. As I had expected, OCDUK were of a similar mind to me, and Ashley Fulwood and I discussed the issues and what to do on an almost daily basis as the series unfolded. In particular we tried to influence Channel 4, who simply stonewalled us. Ashley agreed, at my request, to place a statement from me about our interchanges.

Note that, although I was not speaking for OCDUK, I had been speaking with them and we shared many of the concerns and we were and are supporting each other in our concerns about the likely stigmatising effect of the Channel 4 Programme. Ashley agreed to put my statement on the OCDUK website as a way of reaching people with personal experience of OCD; we felt it important to try to balance out the negative impact which was so clearly manifest in terms of the contacts made by people suffering from OCD, both on the internet and directly.

I had a meeting with OCDAction, who seemed to me to be ambivalent; I shared my concerns with them. In my view, their statement

falls far short of a reflection of the nature of this programme and its impact on people affected by OCD. I also note that Channel 4 interpreted part of it as supportive, specifically the section with says “Although OCD Action was not involved with this programme we do think that anyone with OCD who is willing to share their experience with the media and show the reality of OCD is incredibly brave.”

Why all the fuss?

It is worth pointing out that stigma in the mass media can be tough to define, but in this case it was not any kind of problem. A recent research article available on open access and closely linked to “Time to change” can be found here

Stigmatising themes were taken from the overriding message in terms of “danger to others, problem for others, hopeless victim, strange behaviour, personal responsibility causes, sceptical of seriousness, or pejorative or inappropriate language.”

By any reasonable standard, OCCleaners meets around four of these operationally defined criteria, which is pretty clear even without the harder to define overall impression it left. So….there is little doubt that this programme was stigmatizing.

Nationally, Time to Change (TtC) has identified itself as a leading or even the leading organisation in tackling stigma. They have recruited celebrities to support them, set up newsworthy projects and launched a pledging system so that organisations and individuals could proclaim that they were actively working against stigma. So here’s the thing; OCCleaners was a stigmatising programme coming from a company which had pledged to TtC to seek to eliminate stigma. TtC had lent its support to the signing of the pledge, and this was used by Channel 4 to publicise its programmes. Given my perception of the mission of Time to Change (TtC), I thought is entirely appropriate that I bring this stigmatising programme to their attention precisely because they had strongly and positively associated themselves with Channel 4 around the “4 goes mad” stream. I had previously admired the stance of TtC and hoped that they would be prepared to engage with the issue, which seemed to me to be urgent as the series was just getting under way and there was scope for them (a) to put pressure on recalcitrant channel 4 and (b) to support people suffering from OCD who were struggling with the impact of OCCleaners. It is all very well getting endorsements from celebrities, but that always runs the risk of being empty, more about the celebrities than the cause. So I took the view that here was a chance for TtC to do something helpful for people with personal experience of mental health problems (in this case OCD) in a direct way.

What happened next is that I tried to engage with TtC in order at the very least to get some kind of clear statement from them about their position, and to suggest that they might want to consider some more direct action.

I thought they might want to work with Ashley and I towards limiting the damage which this awful programme had wrought at very least. As things turned out, I seem to have been wrong.I contacted them because it seemed sensible to approach them with a view to working with them; I thought that they might appreciate some input from Ashley and I who have some expertise in OCD, its impact on those who are affected by it, its understanding and treatment. What I found shocking and what has moved me to post this story is the fact that, if anything, one might form the impression that they were looking for ways to distance themselves from me rather than from Channel 4, as you will see below.

You will see my emails but not those from Time to Change and Mind. Although there were no confidentiality clauses in their emails to me, when I specifically asked about this they refused permission to reproduce their emails (an interesting contrast with Channel 4, who had freely given such permission). So I have decided to redact the content of their emails below. I am not sure what such concealment gains from their point of view, so will leave it up to the reader to decide. OK, so on with the story…..

Time to Change and the story so far

I had copied Time to Change, the CEO of Mind and Rethink into my correspondence with Channel 4 and their stonewalling responses. On the 21st February, I wrote directly to Sue Baker at TtC who had commented extensively on C4’s pledge signing. Here is what I said:

Dear Sue
I know that Ashley has been in touch separately.
Channel 4 made a great show of endorsing time to change and were appropriately endorsed by you at the time they ran “four goes mad”.
Given their official responses to concerns raised both by experts, advocates and sufferers, (which, as you will see from the enclosed, characterised by a “nothing wrong with this” type of response in what appears to be a reflexive and non-reflective ay, I am hoping that Time to change will give due consideration to it. It is of course up to the organisation, but I very much hope that if you choose not to offer a critical response to this ongoing series, that some public acknowledgement of the universal distress experienced by sufferers and clear reasons for your response will be forthcoming.
I look forward to hearing from you in due course
With best wishes
Paul Salkovskis

On the same day, I was pleased when Paul Farmer from Mind responded on 21st February, a positive response indicating that Sue Baker would be in touch shortly

Sadly, they were not in touch. Nothing happened, until OCDUK posted my statement about contact with C4, which mentions involvement (rather, apparent non-involvement) of these three groups including Mind and TtC. Oddly the response was not directed to me. As I say in an email to Sue Baker of TtC on the 14th March:
Dear Sue
I was encouraged when Paul Farmer indicated that you would be looking into the concerns raised by various people about channel 4, who appear to me to have broken their pledge regarding stigma
I note that Mind, within minutes of OCDUK publishing a statement from me about this issue which mentioned TfC, Mind and Rethink. It is therefore with some disappointment that I note apparent inactivity from these organisations in the face of some very concerned reactions particularly from those suffering from OCD.
Can you possibly let me know what TfC and Mind’s position is on this matter please?
With best wishes
On the same day I reminded Sue Baker of the earlier email, saying
Dear Sue
To remind you, here is my previous email.
With best wishes
With, of course, a copy of the text to help her find it.
Four days later, 18th March, in comes a new character, Jenni Regan, who has a TtC email address but signs herself as from MIND, saying that they were taking action by meeting channel 4 and inviting me to attend that meeting if I wished. The rest you may be able to work out from my response which follows.
Dear Paul and Ashley,
‘ ”””””””’ ”” ”””””””” ””” ””” ””””” ”” ”””””””””””’ ””’ ”””’ ””’ ”””’ ”””””””” ””” ””””” ””’ ””””’ ””””” ””””””” ”” ”” ”””’ ”” ”””” ””””””””” ”””” ”””””””’ ”” ”””””””” ”””” ””” ”””’ ””””” ”” ””” ”’ ”””” ”” ””” ””””” ””’ ””’ ”””’ ””””’ ”””” ”””””” ””””””’ ”” ”””””””’ ”””’ ””””””””’ ”””’ ”””’ ””””””””””””’ ”””” ”””””””’ ”””” ”””””””””’ ””””””’ ””””’ ””””””’ ”””” ”””’ ”””””” ”””” ”” ””””’ ”” ””””’ ””””’ ”””” ”””””” ”””””””” ””’ ””” ”””””””’ ”” ”””””””””” ” ””””’ ””””’ ””””’ ””” ”””” ”””” ””’ ”””””””’ ”””””’ ”””””””””’ ””’ ””””””’ ”””’ ””””” ””’ ”” ””””””” ”’ ””””””” ”””” ”””””””’ ””””’ ”” ”””””
”” ”””’ ”””””” ””””” ””” ”””” ””””” ””””””””””’ ””””””” ””””” ””” ”””””’ ”””””” ””””’ ”””” ”””’ ””””’ ””””’ ””” ””””””” ””””””’ ”””” ”””””””’ ””””””””””” ”” ”””””””’ ” ”” ””” ”””””””” ‘ ”””’ ””””” ”” ””””” ””””” ””””””””’ ””””’ ”””’ ”’ ””””””’ ””””’ ”””” ”” ””””””’ ”” ””””’ ””’ ””””””
” ””””’ ””””””” ”” ”””””’ ”””””’ ”””’ ””””””” ””””””” ””” ””’ ”””””””””””””’ ”””’ ”””””” ”’ ”””’ ”’ ”””””””” ””’ ”””””” ”””””””””” ””” ””’ ””””””””””” ”””””””””’ ””’ ”””””””””””” ”””” ””” ””””””””””””’ ”” ””””””’ ”” ””’ ””””” ””’ ””””” ””””””” ”””” ”””””””””””””” ””” ”””””’ ”” ””””’ ””””’ ”” ”””””””””””” ”” ”””’ ”””””” ”””””’ ”” ”””””””””” ””’ ”””’ ””””””””’ ”””’ ”” ”””’ ”””” ”””””””’ ”’ ”””’ ”””’ ””””””” ”””’ ””””” ”””””’ ””””” ”’ ””” ””””” ””’ ””””””””””””’
”””””’ ””””””’
The same day, I responded, saying
Dear Jenni
That is an interesting position (as set out in your email below). I had very much hoped for a position to be expressed on the programmes rather than on a meeting.
I have seen the social media reactions you have solicited. It is I think a pity that the panorama and OC Cleaners were combined, but nevertheless the responses are I think clear.
I understand your point about the pledge; I’m not sure if you understand mine, and would be reassured by an appropriate response. It is worth bearing in mind the definition of a pledge, which is supposed to be “A solemn promise or undertaking” or “A binding promise”. The key point for me is that when channel 4 “pledged” itself, Time for Change then applauded this and in doing so implicitly supported the channel and its output (and why not? They had made a binding promise). It may be that T4C and its supporting organisations believe that what has happened recently does not represent C4 reneging on this pledge, but the reactions of people suffering from OCD presumably allow at least some room for doubt?
In any case complete silence in the face of calls for Mind, Rethink and T4C to respond to some very articulately outraged service users is giving an implicit message; see for example:

If there was simply inattention on the part of these organisations, then it might be understandable, but the fact that Mind responded immediately to my statement on the OCDUK website via Ashley by demanding a correction (without any communication to me at all) seemed to indicate an acute awareness and strongly implies deliberate inaction.
The cleaned up version is here, in case you haven’t seen it.
As the series comes to a close you have requested social media based response which is useful, but you have not actually responded yourselves other than requesting a meeting, which in my view is too little too late. As you say, you can get the same info from OCDUK bulletin boards and indeed Twitter more generally.
You go on to say
“”””’ ””””’ ”” ””””” ””””’ ””’ ””””””””””””””’ ””’ ”””’ ”””””” ”””””’ ”” ””””””””” ””’ ””” ””””””””” ”””” ”” ”””’ ”””” ”””””””’ ”’ ””” ””””’ ””””””’ ””””’ ””””” ””””””’ ”””””’ ”’ ””’ ”””””’ ””’ ””””””””””””’.”

I really hope the first part of this is not true. There are organisations out there which advocate eugenics for people with mental health problems….and worse.
As for the second part, as I understand it the idea is that you seek to convert. Once a conversion has been advertised (which is what happened, after all, with 4 goes mad…you helped them gain more viewers for those programmes) there is a clear case for a symmetrical response. I documented in my statement the fact that Ashley and I were stonewalled. It simply didn’t suit C4 to “take on board” the criticisms in any way at all. This indicates to any reasonable observer that they were not converted, they gave the appearance of being converted for reasons very far removed from a desire to reduce stigma.
I’m sorry to be so direct, but I and I think many others are very disappointed in the way Time for Change, Mind and Rethink have failed to deal with this matter. I hope that I am not coming over as hostile, but rather as feeling let down and concerned that principles may have been compromised.
It has been speculated by some (and I understand why) that what we are seeing may represent some kind of implicit hierarchy of mental health problems. If the subject of the programme had been people suffering from bipolar problems being sent along to cheer up people who are suicidal, or if people with schizophrenia had been sent to amuse people with learning disability, would this have elicited no response? These programmes have been six weeks of extremely cleanliness concerned people (styled Obsessive Compulsive, which some seem to be and others not) being pitted against very dirty and disorganised people, with the entertainment value emerging from that contrast and the interactions between them.
OCD is a very very unfunny problem. Bottom line: I would like to be reassured that your organisations, through your reactions to C4, are not seeing it as somehow less worthy or your efforts.
Yes, I would be happy to attend a meeting with your organisations and C4.
I would also dearly like to understand the position of the organisations ahead of that meeting, which runs the risk of being tokenistic I fear. The programmes are out there, and can be judged for themselves and in the light of the reactions of professionals such as myself and most importantly people struggling on a daily basis to cope with the torment that is OCD, whether it involves cleaning or no. You don’t need a meeting for that. There may be another agenda for the meeting but can we be clear about what it is?

I look forward to hearing from you.
With best wishes
Paul Salkovskis
23rd March Jenni Regan gets back to both OCDUK and myself. Unlike before, she is now copying her email to several others in Mind (Paul Farmer), Sue Baker and two others who I don’t know. One turns out to be head of media at mind, Maria Lam; more of her later.
Dear Paul and Ashley,
””””””’ ””””’ ”””””””””’ ””’ ”””””” ”” ”””””””’ ””””’ ””’ ”””” ” ”””’ ””””” ”””” ””””’ ”””” ”””” ””” ”” ””” ”””””’ ””” ””””’ ”” ”””’ ””””” ”””””’ ””””””’ ””””” ”’ ””””” ”’ ””” ”””’ ”” ”””””””””””””””””
‘ ”””””””’ ”” ”””””””” ”””’ ”””’ ”””’ ””””’ ”””” ”””’ ””””””””’ ”””” ””’ ””” ”””’ ”’ ”” ”””’ ””””””’ ”” ””” ”””””””””’ ”” ”””” ”””’ ””””””””””” ””’ ””””’ ””””””” ”””””” ”””””””””” ””””””””’ ””””””””’ ””” ””””’ ”””” ””””’ ””””” ”””””’ ”””””””””’ ””’ ”””””” ” ”””””””””” ””””””” ”””’ ”””” ”” ””””” ””””””’ ”””’ ”””””” ”” ””””””” ”” ”””’ ”””””””” ””””””’ ”” ””” ”””””””’ ””””””” ””””””””” ””””””””””” ”” ””’ ”” ”””””””’ ””” ”””””””””’ ””’ ”””””” ”””” ””””””’ ”””””” ”””””””” ”””” ”””’ ”’ ””” ””””””””’ ”” ”””’ ”””””””” ”””””
”””’ ”””’ ””””””’ ”” ””””’ ”””””””” ”’ ””’ ””’ ””””” ””””””’ ”””””””” ”””””””” ””””””” ””” ””’ ””””” ”””””””’ ””” ”””” ””””’ ””””””””’ ”” ”””’ ” ”””” ”” ””” ””””” ””””’ ”””’ ””””” ”””” ””” ”””” ”” ””””””’ ”””’ ”””””””” ”””’ ”””””””” ”” ””” ”””””””””” ”””’ ”””’ ””’ ””””””” ””””” ”””” ”” ”””””””’ ”” ””” ””” ”””’ ”””””’ ”” ”””” ”””””” ””””’ ”””””””’ ”””’ ”””””””” ”” ”””’ ”””””””’ ”’ ””””””””””””’
””” ””””””” ”””””’ ”””””””” ”’ ”””” ”” ”””’ ”””””””” ””’ ”””” ”””’ ”””” ””””””’ ”””””” ”””””””” ”””” ””” ”””’ ””’ ”””””””””’ ”””’ ”” ””” ”””””””” ”””’ ”””” ”””””” ”””’ ””” ”””’ ””””’ ”””””””’ ”’ ””””’ ”””””” ”””’ ””””””’ ”””””” ””’ ”””””’ ”””””””’ ”” ”””””” ”” ””””””””””” ””””””””’
”” ”””’ ””””’ ”” ””” ””””” ”””” ”””’ ””””’ ”””’ ””””” ””””””””””””””””’ ””” ”””’ ”””” ””’ ””””””’ ””’ ”””””” ””””””’ ””””’ ”””’ ””””””””” ”””””””” ”””” ”’ ””””””””’ ”””’ ””””’ ”” ”””’ ”’ ””” ”””’ ”””””””””” ””””” ”” ””””” ”””””””””””””’ ”” ””” ””””’ ””””’ ””””””””” ”””’ ””””’ ””””””
””” ””””” ”’ ”””’ ””””’ ”””’ ”””’ ”””””’ ”” ”””’ ””””’ ””” ”””” ”””””””” ”’ ”’ ””” ”””””””’ ”” ””””’ ”””” ”””’ ”””””” ”” ”””””””””’ ”””””” ”””””””” ””””””’ ””””’ ”””””””’ ””””””” ””””””””””””” ”””’ ””” ””””” ”””””’ ”””’ ”” ””’ ”’ ”””””’ ””””””””” ”””” ”” ””””””””””’ ”” ”””’ ”””””
”””” ”””’ ”””’ ”””” ”””” ””””’ ”””” ”””’ ””””””’ ””’ ””””” ”””” ”””’ ”” ””””””” ”””’ ””””””” ” ”””’ ”” ””””””””””’ ”””” ””””” ””” ”” ”””’ ”””’
”””””’ ””””””
Jenni Regan
Senior Media Advisor, Mind
There was a suggestion that I should be reassured by them; in fact, I was not even slightly reassured by what was said. Also I couldn’t help but notice that the invitation to join in the meeting with Channel 4 has gone; it had been arranged, and there was no attempt to check my availability. Not possible for me to be sure what this means, but I had a few Ideas. In my most recent contact on the phone with Maria Lam from Mind she confirmed verbally that this was connected to worries that I might be overly assertive.

Anyway, on the 26th March I have another attempt at getting some direct answers. I am actually getting a bit more direct, but that’s because being nice doesn’t seem to be getting any real answers and I really think that my questions are worth consideration by Time to Change. I’m also now wondering why this is being dealt with by a media officer.
Dear Jenni
Other than defending your organisations against the suggestion that perhaps OCD seems to be taken less seriously (and whilst accepting that perhaps the organisations do take it seriously, the idea that you SEEM to remains), most of my points have gone completely unanswered. Also note that in the end the if there appears to be some discrimination (w.r.t. OCD and your organisations) then that gets pretty close to there BEING discrimination, as I am sure you well know. Please bear in mind that I carry out research on stigma, so I’m not entirely unfamiliar with the issues.
You touch on another issue, but in a very very strange way
You say
“””””””””’ ””””””””” ””” ””””” ”””” ””””’ ””””” ”””””” ””””””””” ””’ ””””””’ ”’ ”””””””””’”
(note from Paul: this quote from the previous email indicated that they don’t like to make public statements)
Can you square that with this:
In that article, it says
Sue Baker, Director of Time to Change, said: “This is the first time we have seen a major broadcaster committing to tackle the stigma that people with mental health problems experience. This is really setting the standard and we hope that others in the media industry will follow their lead.
“In recent weeks we have seen a surge in people disclosing their mental health problems from MPs to Olympians. Now, Channel 4 is an influential addition to our movement for change.”
I don’t really think you can support the position that you don’t deal with these matters publicly.
I also see that the meeting with channel 4 has been scheduled, so the option of my joining that which you offered has gone, which is a pity. Can I ask why?
This is all very disappointing, and more so because of a particular issue which I am not sure if you have spotted.
On this issue, Mind, Rethink and TtC are speaking (or not speaking in a public sense) with one voice. Is this entirely healthy? Have these matters been considered across the organisations and an explicit consensus agreed? Is that the best way to deal with matters of this type?
Right now, only OCDUK has actually brought attention to the unambiguously distressed voices of people who have found the C4 programme upsetting and are concerned about the wider impact on the public perception of OCD. Your support for C4 stands as indicated in that news item.
Finally, I note that there is no confidentiality note on your emails, but for the avoidance of doubt, are you happy for me to reproduce our discussion as I had previously that with channel 4?
I look forward to a proper response to my concerns
With best wishes
Paul Salkovskis
On the 28th of March, this arrives.
That last bit is important; it was only in the recent phone conversation with Maria Lam that this was answered; she was clear that they did not want their emails reproduced.
Dear Paul,
” ”””””””’ ”” ””””””” ””””’ ””” ”””’ ””””””’ ”””””’ ””’ ”””’ ””””””” ””” ””’ ””””” ””””’ ”” ””””’ ”””””””” ”””’ ”””’ ””””’ ””’ ””””””” ””””’ ”’ ”” ”” ””””’ ”””’ ”””””””” ”””” ”””””””””” ”” ” ”””””””’ ””””’ ””” ”””””””’ ”” ” ”””” ”””” ”””’ ””””””” ””””’ ”””’ ”” ””” ”””” ”””” ”” ””””””””””” ”””’ ”””” ”””’ ””””””’ ””””’ ””’ ””””” ””””””””” ”””””””””’ ”’ ””” ””’ ”””’ ”” ””””””’ ””” ””””””””’ ”””” ”””’ ”””” ””””””’ ””” ”””””” ””””’ ””’ ””””’ ””””””’ ””’ ””””””” ””””””
”” ”””””’ ”” ””” ””””””””” ””’ ”””” ””””” ””””””” ””’ ”””’ ”’ ”””” ”” ”””’ ””””’ ””’ ””””’ ”” ””””””””’ ” ”””””””””’ ”””” ”””””’ ”””” ””””””’ ””’ ””””’ ”””” ”””””””””” ””’ ””’ ”””’ ””””” ””””” ”””””” ”” ”””” ””””’ ”””””””” ””””” ”” ”””’ ”””””””’ ”””” ”””
”””” ”” ”””””””” ”’ ”’ ”””””””””” ”””’ ”” ””””’ ”””’ ””””””” ””””””’ ”””””” ”””’ ””” ””” ”” ””””””””””” ””’ ”””’ ””””””””” ””’ ”””’ ”””””
””” ”””’ ””””” ””””’ ””” ””””””’ ””””””””’ ”” ””” ”””” ””””’ ”” ””””””””””””” ”””’ ”””’ ””” ”””’ ”””””” ””” ”””””” ””’ ”””” ”” ”” ””””””””””””’
”””””” ””””””’ ”””’ ””””” ”’ ””””” ””””””
To be honest, what was written looked like a “Dear John” letter to me, so I tried to confirm the impression and get minimal information, sending this back to Jenni on the same day:
Thank you; I’m presuming that you don’t wish to address any of the issues I raised; is that correct? And the reproduction of your responses issue?
With best wishes
Then IT ALL GOES QUIET, Jenni does not answer at al. I’m thinking in part because of the meeting with channel 4, so I wait until the 16th April before sending another email. In the interim, something else has happened reminiscent of what went on when the statement went up:
MIND ring up Ashley at OCDUK and in order to have a conversation about me, my position vis a vis OCDUK and in general. I mention this curious thing in the email to Jenni. I found it odd that they wouldn’t respond to me, but were prepared to take the trouble to “check me out”.
Dear Jenni
I understand that someone from Mind contacted Ashley at OCDUK, presumably on your behalf or prompted by yourself, indicating that I had been bombarding you with emails. I hope that on reflection you will see why I find this odd in various ways (you didn’t respond to my email but instead talked to press office at Mind, that it was Mind not you following it up, that it was to OCDUK that concerns were raised rather than myself and so on).
I don’t really think three emails is a bombardment, particularly in the face of neither the fundamental questions nor the simple ones (as in the very short one below sent a couple of weeks ago) being answered!

Now that the meeting with Channel 4 has been concluded, I would be very grateful if you might address my concerns and answer at the very least the simple questions.

With best wishes

PS For the avoidance of doubt (given questions raised by Mind to Ashley), I am emailing on my own initiative, not on behalf of OCDUK. I work with OCDUK and we have shared concerns and issues, and are in agreement. We are also in agreement with a raft of other professionals and service users/sufferers/carers, but my opinions are my own. Hopefully they have some merit as such.

And now, coming up to date:

And that was it until a few days ago. I received an email from Maria Lam, who indicated that she is Jenni’s manager, and has instructed her not to reply. She requested a phone conversation. I called her, and we rehearsed the issues. A recurrent phrase, which I had heard before, is that we needed to agree to differ. The other issue raised by her was the impressive viewing figures; I pointed out that this was not in any way a positive thing in this context. It was made clear that they intended to engage with Betty TV (something I was considering) and indicated that they would make a more public statement if series 2 were not better than the first. Fascinating; it would be very hard indeed for it not to be better!
Since writing the above, Betty TV have started seeking people for their series 2; their email says:
“….basically we are looking for people that love to clean to a point where it has become an obsession. At the moment we are especially looking for the complete opposite, people who are in dire need of a spring clean, maybe a hoarder or someone whose organisation and cleaning has gone out the window. Our hope is that we introduce these two very different people and give them a better understanding of why they behave in such an extreme manner, while also helping each other.”

I’m left with an important question in my mind. I thought that because time to change describes itself as “England’s biggest programme to challenge mental health stigma and discrimination”, its mission was to take a stand against stigma in mental health. I can’t find any specific mission statement, but I’m now wondering about the reality of its implicit mission as well as its effectiveness, and I remain extremely surprised by their unwillingness to work with others seeking to challenge stigma.
Paul Salkovskis