Founded in 1992 by James Partridge, Changing faces is the UK's charity providing emotional and practical support to people with disfigurements. It was established after James suffered severe burns in a car accident, aged just eighteen. As he told JuniorDr's Michelle Connolly it was a life-changing event that forced him to rethink everyday life and drastically reconsider things he had previously taken for granted.

Everyday since his accident people have stared at him and appeared uncomfortable and embarrassed when in his company. Ridicule on the street was common and he has even been turned away from restaurants. But James gradually discovered ways of managing other peoples' unkind reactions. Since then he has brought help to other people affected by disfigurement through Changing Faces.

How did you personally deal with your disfigurement?

I didn't adjust to the positive until I could deal with the disfigurement. I coped with the nervousness and avoided all social interaction. It was like going back to school having to learn how to react all over again. Then I became proactive and learnt how to reach out to others if they are not going to reach out to me.

Of which achievement are you most proud?

It would be the disfigurement support unit at Frenchay hospital in Bristol - Outlook. It's the only one of its kind that acts as a central referral unit, whether from cancer treatment or Bell's palsy, offering patients access to psychologists.

Regarding peoples' attitudes it was a massive boost to have the Disability Discrimination Act (DDA) amended to include disfigurement. This makes it unlawful for companies to discriminate against people with disfigurement, however greater clarity is required as ridicule is not recognised in the Act.

Unfortunately despite the act, discrimination persists. People may be overlooked for promotion and I know of one exceptionally well-qualified teacher who was turned down for the job solely on his looks - however it is difficult to prove that it was because of disfigurement that he didn't get the job.

Harassment from other colleagues also occurs in the workplace. People phone us in tears saying they've been called ‘scarface' and other hurtful names. Employers need to implement anti-bullying policies but we know that bullying is unfortunately a fact of life.

Why did you establish Outlook?

In the mid 90s there was a package of psycho-social interventions called the Changing Faces approach which was centered around the development and maintenance of self esteem. Amongst the NHS community at that time there was interest from plastic surgeons and dermatologists. In several journals we argued that such care should be part and parcel of routine care provided to patients within the NHS.

Psychosocial help is a highly cost-effective intervention that complements the surgery. People doubted that this type of therapy would be of benefit so it's fantastic seeing that it does. Some interventions that were developed at the Outlook centre are now being used in Soweto, South Africa to help similar people out there.

Tell us more about your programme for people with disfigurement

We use an acronym, SCARED, to represent other people's attitudes towards people with disfigurement. S is for staring, which happens daily to someone with a disfigurement. C is for curiosity. People ask, "What happened to you?" A is for anguish. It's not the scars that hurt, it's the reactions that do. R is for recoil. People sometimes leave the room as they do not want to be in the presence of someone who looks different. E is for embarrassment. People don't know how to ‘deal' with a disfigured person - they feel awkward. D is for dread. In people who have been diagnosed with cancer others don't know what to say.

Is it a key goal of yours to have a psychologist on every surgical team?

The teams of doctors looking after patients with cleft palate have a psychologist as a core member. Such patients are routinely assessed for psychosocial issues. At St Thomas' in London, the dermatology department is close to having a psychologist on the team. There are some thirty burns units around the country but psychological care is very patchy. At present the National Burns Care Group is working to provide routine clinical assessment but in other injuries resulting in disfigurement, the care is less sophisticated.

Do you support people who have become disfigured after botched plastic surgery?

Yes. We provide a factsheet detailing legal advice and compensation. The pressures on people to look good have become so great that it's no wonder they have surgery. We do not blame them and completely understand. They needed a better assessment and information - then they would not have made the decision to have surgery.

How does Britain's care for people with disfigurement compare with other countries?

Britain is at the forefront of healthcare for people with disfigurement. Sporadic health insurance cover in the United States, especially amongst poorer people, means it's difficult for those with disfigurement to get the holistic help, which we've shown to be so useful.

Do you support face transplantation?

In principle we are in favour of all advancements in facial healthcare, we are also pro-stem cell research, however the patient must be extremely well informed of all the psychological issues of receiving someone else's face. In spring 2003 we reviewed the evidence for face transplantation and felt at that time it wasn't viable. Even now we continue to have doubts over the benefits and risks and have stipulated 15 conditions that we feel must be met.

Do you think people with disfigurements are represented fairly in the media?

The image of people with disfigurement needs to be normalised - at present we're portrayed as victims. Documentaries about disfigurement rely too much on voyeurism. If there was a newsreader with a disfigurement this would go a long way towards normalising the condition. People never thought you'd see a black newsreader and now our most famous newsreader is black! So progress can be made.

For more information on helping patients with facial disfigurement you can visit the Changing Faces website at www.changingfaces.org.uk

About Changing Faces

Changing Faces' vision is to create a better and fairer future for people who have disfigurements to the face, hands or body - whatever the cause. The ultimate goal is to enable everyone to face disfigurement with confidence. Changing Faces employs a team of specialists who offer counselling and a range of practical strategies to children, young people, their families and adults with  disfigurements, to enable them to manage public reactions and succeed in every part of their life. It also offers a consultancy and training service to health professionals.

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