CALIFORNIA CENTER FOR DIGNITY , SOCIAL INCLUSION & STIGMA ELIMINATION

1. Eduardo Vega, MPH Executive Director Mental Health Association of San Francisco Co-Principal Investigator Center for Dignity, Social Inclusion and Stigma Elimination CALIFORNIA CENTER FOR DIGNITY, SOCIAL INCLUSION & STIGMA ELIMINATION Glen McClintock, MSW Project Manager Center for Dignity, Social Inclusion and Stigma Elimination Exploring Efficacy and Innovation in Stigma Reduction CASRA Spring Conference “The Power of Connection in a Time of Change” April 12, 2012 Richard Krzyżanowski Resource Development Program Manager Center for Dignity, Social Inclusion and Stigma Elimination

2. To advance human dignity and wellbeing on a sustained basis by changing behavior and bias associated with mental health and mental illness in California through integrated evaluation, refinement and dissemination of best practices in stigma reduction that are effective in the state’s many communities; and to advance the field of stigma and discrimination practice and research globally. CALIFORNIA CENTER FOR DIGNITY, SOCIAL INCLUSION & STIGMA ELIMINATIONMission:

3. Center Objectives and Core Values

4. Lived Expertise in the effects of mental illness and stigma • Interdisciplinary Approaches • Recovery, Compassion, Dignity, Hope & Self-determination • Efficacious use of Community Resources • Consumer and Family Empowerment Center Core Values

5. Cultural Competence, Linguistic Diversity and Cultural Effectiveness • Community Expertise • Community Empowerment • Life at all ages • Youth Empowerment. Center Core Values

6. Center Objectives

7. Drive research on what really works in stigma reduction into practice across California • Actively collaborate with other SDR programs and projects statewide to achieve maximum impact. • Establish strategic areas of SDR practice improvement and innovation • Identify programs that are most effective culturally and cross-culturally; advance the R&D of these in multiple communities and advance the field of SDR knowledge and practice across cultures and linguistic barriers • Advance the field of SDR knowledge and practice internationally through excellence in SDR practice evaluation, development and dissemination Center Objectives

8. Promote empowerment of clients/consumers and youth as change champions informed by research and best practices • Empower California communities and grass-roots organizations with tools, knowledge and training for implementing best practice SDR • Create tools and sustainable frameworks for programs to evaluate themselves and their outcomes for SDR Center Objectives

9. Establish parameters for and engage cross-systems evaluation and evidence-based projects • Assist in development of trainings, manuals, etc. for promulgation of leading and best practices • Develop evidence-based, best and promising practices database or clearinghouse • Establish the Center as a sustainable stigma TARTC and research entity in California and internationally Center Objectives

10. The goal of the TARTC model is to simultaneously evaluate, support and advance leading and promising practices into implementation through tightly integrated research and development and rapid knowledge transfer. Technical Assistance Research and TrainingCenter (TARTC)

11. 3 Core Units • Research/Evaluation • Training/TA • Communications & Dissemination Technical Assistance Research and Training Center Model

12. Current Projects

13. Promoting Efficacy and Innovation Evidence Based Practices Promising Practices Best Practices Outcome Evaluation Emerging Practices

14. Resource Development • Will Identify stigma reduction programs, providing research and evaluation of the most effective strategies for reducing stigma, with the hope of bringing these strategies into practice statewide. This project will partner community leaders in stigma reduction across California with the National Consortium on Stigma and its director, Dr. Patrick Corrigan, a Co-Principal Investigator. CalMHSA Programs

15. Promising Practices • Will engage with California communities to examine cultural strengths and resources; identify culturally specific attitudes towards mental health; and support approaches that reduce stigma within the State’s culturally, ethnically and linguistically diverse communities. This research will be led by Dr. Sergio Aguilar‐Gaxiola, Co-Principal Investigator and director of the UC Davis Center for Reducing Health Disparities. CalMHSA Programs

16. Resource Development Program already primarily identified as SDR Leaders may already be part of existing networks Identification based on assumptions within the culture of mental health/ SDR services Relationship with Promising Practices and Resource Development Promising Practices Programs not previously identified Community stakeholders/leader may be primarily unknown Cultural needs may not be readily acknowledged/understood

17. Promoting Efficacy and Innovation Evidence Based Practices Promising Practices Best Practices Outcome Evaluation Emerging Practices

18. The Challenge: Stigma and Stigma Change

19. Some Definitions of Stigma • A mark of disgrace or infamy; a stain or reproach, as on one's reputation. • An attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, “normal” one.

20. Varieties of Stigma • Public stigma • Self-stigma • Structural stigma • Label avoidance (No treatment =no labels = no shame) 20

21. Self Stigma • The prejudice which people with mental health issues turn against themselves. • Defined as negative attitudes about mental health challenges and its treatment that are held by the individual with the stigmatized condition. • Has been cited as a major public health concern, contributing to decreased treatment seeking, lowered self-esteem, and lowered self-efficacy.

22. Self Stigma Many people with serious mental issues are challenged doubly: On one hand, they may struggle with the symptoms and disabilities that result from the condition. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental health challenges are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people.

23. Confounding facts and fallacies A set of social attitudes with institutional implications Not always negatively phrased or ill-intentioned Legacy of Paternalism Some Hallmarks of Stigma

24. STEREOTYPES:People with mental health issues are: fragile, unstable, violent, dangerous OR childlike, lovable bafoons(“benevolence stigma”) PREJUDICE: They are bad because they are: scary, shameful, unpredictable DISCRIMINATION: So, don’t hire, serve, rent to them Social constructs 24

25. Lost employment Subpar housing Worse health care Worse education opportunities Diminished legislative support Alienated from faith communities Coercive treatment The Effects of Public Stigma and it’s impact on Social Inclusion

26. People with mental health conditions are: • Twice as likely to have been denied insurance. • Less likely to leave job in fear of losing insurance. • Twice as likely to delay care seeking. • Twice as likely to obtain needed medical care. Druss and Rosenheck, 1998 Insurance Coverage

27. Stigma Change:What do we know works?

28. Education Review key myths and facts that counter these myths • Protest • Take people to task for stigmatizing images • “Shame on you for thinking that way!” • The rebound effect: ”The White Bear” • Contact Strategies

29. Contact • Contact with people who have mental health issues tends to decrease stigma • Meeting people who have mental health challenges weakens people's tendency to link mental illness and violence Corrigan, P.W. (2005). Onthe stigma of mental illness: Practical strategies for research and social change. Washington, D.C.: APA. • "If you focus on the competence of people with mental illness, that tends to lead to greater tolerance.” Pescosolido, B.A., Jensen, P.S., Martin, J.K., Perry, B.L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study—Children. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 339–349.

30. Education increases knowledge but knowledge does not seem to change attitudes. • A media-based anti-stigma campaign reaches a broader population • Direct contact (“In vivo”) approach has a bigger impact Education vs. Contact

31. 8200 papers, 71 articles, 79 studies, 612 ESs • 38,362 Ss, Med=150.0 (range 19 to 7225) • Outcomes: Attitudes Affect Behavior Knowledge Meta-Analysis of Public Stigma Change:Contact, Education, and Protest Corrigan, Morris, Michaels, Rafacz, & Rusch, in review

32. Mean effect by anti-stigma approach: overall attitudes, affect, and behavioral intention

33. Mean effect sizes by anti-stigma approach – RCTs only: overall, attitudes, and behavioral intention

34. Targeted • Local • Credible • Continuous • Contact TLC3 Best Practices: Strategic Stigma Change (SSC): Five Principles for Social Marketing Campaigns to Reduce Stigma Patrick W. Corrigan, Psy.D.

35. Targets Landlords Health care professionals Teachers Legislators Employers

36. How Can the Center help Eliminate Stigma?

37. 3 Core Units • Research/Evaluation • Training/TA • Communications & Dissemination Technical Assistance Research and Training Center Model

38. Project Management Framework Cost Scope Outcomes Schedule

39. Project Management Framework Cost Quality Scope Outcomes Schedule

40. QUALITY

41. Project Partners An example of the Power of Connection in a time of change

42. Center Project Partners PEERS Envisioning and Engaging in Recovery Services (PEERS)(Oakland) PEERS is a consumer-run organization that promotes wellness for people with mental health difficulties and their families through community outreach, empowerment, education, advocacy for social inclusion, and elimination of stigma and discrimination. Project Return Peer Support Network (Los Angeles) PRPSN offers its ever-widening circles of empowerment and integration through involvement in our self-help groups and Warm Line, membership in our centers, and independence through employment and advocacy.

43. Family Youth Roundtable (FYRT)(San Diego) Family Youth Roundtable is an independent family and youth led organization. The foundation of our work is to build an interconnection between the families and youth receiving services and the public child-family serving agencies that serve our communities. Public agencies such as: Children’s Mental Health, Juvenile Justice, Education and Child Welfare California Youth Empowerment Network (CAYEN)(Sacramento) CAYEN influences policy by engaging our all TAY Steering Committee, adult advisory committee, and other people from across the state that care about mental health for youth and young adults. With input from these important voices we advocate, engage in policy discussions, and participate in state level committees to ensure that the youth voice and youth needs are included in all policy decisions around mental health services for TAY. Center Project Partners

44. The Racial & Ethnic Mental Health Disparities Coalition (REMHDCO) (Sacramento) is a statewide coalition of non-profit state wide and local organizations whose mission is to work to reduce mental health disparities through advocacy for racial and ethnic communities. Center Project Partners

45. What can we do for you?

46. Establish a Database Clearinghouse of information regarding identified SDR programs and SDR Promising Practices across California. Provide technical assistance and training to support the development of quality, (best practice) SDR programs and SDR Promising Practices. Center (TARTC) Goals

47. Age Ethnicity Language Targeted Goals Type of Stigma Geography Targeted Community Clearinghouse Database Index: • Approach • Venue • Medium • Other Diversity • ?

48. Engage in co-learning dialogue with both identified SDR Programs and SDR Promising Practices to identify program strengths and areas of development Utilize Development Tool (SDR Fidelity Measure) to align program with Best Practices Provide feedback and support for future program development Provide ongoing follow-up Quality Technical Assistance available July, 2012

49. Community Development Partners Community Investigators Youth Champions / Young Investigators Final thoughts – Creating Living Laboratories

50. Questions? / Thoughts?