National Anti-Stigma Campaign Research Findings and Strategy

1. National Anti-Stigma Campaign Research Findings and Strategy Deborah Leiter, VP Campaign Director The Advertising Council June 20, 2005

2. Agenda

3. Agenda • Research Objectives and Goals • Research Findings • Campaign Strategy • Questions and Answers

4. Exploratory Research Objectives and Methodology

5. Objectives • Explore the public’s perceptions of people with mental illness and what can be done to effectively change these perceptions • How are people with mental illnesses perceived • What information is most effective in helping to overcome negative perception of people with mental illness • How does the public define “recovery” • Add texture and richness to the vast amount of existing research on this topic • Should be additive to the research conducted for EBI

6. Methodology • 20 individual, one hour, in depth interviews among adults ages 25-75 • 2 markets: St. Louis and Atlanta • Mix of men and women and racially diverse • All respondents screened to exclude those who had personally experienced a mental illness or who had close friends or family members with any mental illness.

7. Methodology • Interviews consisted of: • Discussion of experience with and knowledge of mental illnesses • Homework assignment – asked to bring 4 pictures that show how they feel about mental illnesses • Responses to false statements to assess some of the roots of stigma • Responses to statements that could be springboards for advertising messages

8. Research Findings

9. Knowledge of and Experiences with Mental Illnesses • Little direct experience with mental illnesses - hadn’t had to deal with a family member with mental illness or close friend • They get most of the information that shapes their perceptions from the media • News (Florida drownings, Terry Schiavo, school shootings, Michael Jackson) • Oprah (positive stories on recovery) • Movies (One Flew Over the Cuckoo’s Nest, Sybil, Lifetime movies, The Aviator, A Beautiful Mind) • However, personal experiences, positive or negative, are far more influential

10. Perceptions of Mental Illnesses • Believe that people with mental illnesses are stigmatized and discriminated against, especially in the workplace • However, a mental illness can be “hidden” unlike race, age, gender or physical disabilities • Difference in treatment between mental illnesses versus physical illnesses • I can see a broken leg. I know what cancer is. I can imagine having both of these problems. But mental illness, it’s harder for me to relate. I feel sorry for them, but I can’t relate to them.”

11. Perceptions of Mental Illnesses • Huge disparity in knowledge and levels of fear/discomfort depending on the specific type of mental illness • Depression • Anxiety Disorder • Bi-Polar Disorder • Schizophrenia

12. Older Adults (ages 55-75) • For the most part, consistent with those 25-54 • Some variances in degree were seen among those 70 and older • Less knowledgeable and less willing to discuss what they didn’t know • More private in their own daily lives • Less accepting, even of depression “I wouldn't want to go to my friends and tell them if I was depressed. Why? Pride. I wouldn't tell them that, you want a little pride in yourself if you have any left."

13. Feelings about Mental Illnesses

14. Compassion “I want to reach out and comfort them but I don’t know how”

15. Curiosity and an openness to learn more “It’s still a mystery. It’s very interesting…the mind is so difficult to fathom.”

16. Curiosity and an openness to learn more “I feel curious. I want to know what happened to them…but I don’t want to be nosy.”

17. Negative Feelings • However, the pictures also provided insight into the respondents own stigma towards those with mental illnesses

18. Protection of self and family Mental illness seen as a potential threat to their well being “I feel most of all, the need to protect myself. It’s instinctive.”

19. Fear of triggering an episode • One of the worst things about major mental illnesses, according to the respondents, is the unpredictability of the situation • “He might go ‘postal’ at any moment” • It’s like a ticking time bomb” • “I could make the situation much worse without even knowing it”

20. Fear of triggering an episode “I’d always be wondering ‘what are they going to do? Are they going to go postal”

21. Shame at not knowing how to act • “It’s like when there’s a death in your neighbor’s family. I never know what the right thing is to say. So I don’t say anything at all. I know that’s wrong, because it makes them feel more isolated, but I just don’t know what to do.”

22. Shame at not knowing how to act “Sometimes I find myself turning away from or just ignoring someone with a mental illness, avoiding eye contact. I know it is not their fault but sometimes I don’t know how to communicate with them.”

23. Responses to Motivational Concepts What can we say to overcome these feelings?

24. Responses to motivational concepts • A number of statements were tested in order to assess which were the best at changing perceptions and attitudes about mental illnesses

25. Prevalence of the condition In 2003, an estimated 28 million adults received treatment for mental health problems. This estimate represents 13.2% of the adult population, or 1 in 7. • Our initial hypothesis was that the prevalence of mental illnesses would help to “normalize” it in people’s minds, however… • Majority unimpressed by 13.2% of the population seeking treatment, nor were they impressed by the actual number of 28 million people and they were even unimpressed with the ratio 1 in 7 people • The respondents who were impressed were the ones who knew the least and would require the greatest amount of work to educate

26. Recovery Mental health organizations have changed their approach to helping people with mental illness. It is no longer about accepting long-term disability and treating symptoms but rather about helping people recover. 74% of people diagnosed with schizophrenia recover with early intervention1 80% of people diagnosed with depression recover2 1NIMH, 2003 2 National Advisory Mental Health Council, 1998

27. Recovery • Impressed that new goal is recovery • Most hopeful of all the messages – hope for better outcomes • Newsworthy information – they reacted with “shock” to recovery statistics.

28. What does ‘recovery’ mean to them? • “Cured” – a return to normal life without the need for medication • Able to function in society • Illness is gone and won’t come back • Many respondents were concerned that the word “recovery” promises more than is possible and were more comfortable with terms like “management” of the illness

29. Summary and Conclusions

30. Summary and Conclusions • Overall consistency in findings among age, gender, race and location • People don’t think about mental illness or how they respond to people with mental illness unless put in a situation in which they are forced to confront their beliefs and behaviors. • When confronted, they are ashamed of the way they behave but see it as necessary and inevitable. • The fact that mental illness is a common occurrence is accepted as true but doesn’t make mental illness any more normal or acceptable

31. Summary and Conclusions • There is a spectrum of severity and threat. • Knowledge and experience with Depression has helped to ‘normalize’ it within people’s minds • Most hesitancy and fear was associated with schizophrenia -- least amount of knowledge and experience • On a rational level, they don’t believe people with mental illnesses are more violent than others, yet they are still hesitant and protective. • Though respondents were admittedly ignorant they were not overtly mean-spirited toward those with mental illness

32. Summary and Conclusions • Compassion is counterbalanced by fear, uncertainty and doubt • Fear of unpredictability • Fear of unknown • Fear of their own lack of knowledge in what to say or do • The ‘recovery’ idea helps to counter much of this fear

33. Creative Strategy

34. Why are we advertising? Campaign Objective: To change negative attitudes associated with mental illnesses in an effort to reduce stigma

35. To whom are we advertising? • General Public, ages 25-65 • Given the prevalence of mental illness they probably know someone who has experienced a mental health problem, though they are not faced with this issue on a daily basis • They feel as though they don’t know much about mental illness, however, when pressed they will talk about negative media portrayals, negative personal experiences, and antiquated stereotypes related to institutionalization and out-of-control behavior • Key element of this target is also those who have an unmet need for mental health care and are inspired to seek help

36. Key Insight • People are unaware how common it is to recover from a mental illness and that individuals with mental illnesses can overcome these problems to lead meaningful and productive lives

37. What should the advertising say? (message/benefit) • Recovery is real, recovery is possible • Get more information; seek help if you need it • Call SAMHSA’s National Mental Health Information Center

38. Why should anyone believe us? (support) • More people are recovering from mental illnesses than ever before • 80% of people diagnosed with and treated for depression recover • 74% of people diagnosed with and treated early for schizophrenia recover • Mental Health professionals are treating mental illness differently, adopting an approach that helps people recover their lives and gain control over their illnesses. • Recovery is a universally relevant and inspiring platform that can change attitudes and encourage those in need to seek help and work on their own recovery.

39. What do we want the target to think/do as a result of seeing the advertising? • We want people to realize that individuals with mental illnesses recover and lead productive lives. • If the viewer/listener is a mental health consumer we want this positive message to inspire them to log onto a website or call a toll free number to seek help.

40. What’s the tone of the advertising? • Honest and straightforward – mental illness is not “pretty” and shouldn’t be oversimplified or misrepresented • Positive and hopeful, but not unrealistic or overly optimistic • Provocative, but not accusatory • Illuminating, but not didactic • Strength-based and respectful images of mental health consumers

41. How will we know when we have succeeded? • Number of people calling the toll free number or logging on to the website to get more information or to request referrals for help. • Changes over time in awareness and attitudes about recovery.

42. What are the executional guidelines, constraints, etc? • Call to action to campaign website and toll free number – get the facts about mental illness and seek help if you need it. • The term “recovery” must be clearly defined – creative should test different definitions and ways to discuss the idea of recovery. • Need to be cautious NOT to reinforce negative stereotypes – a rebound effect could happen if PSA messaging centers around existing negative beliefs and attitudes. • SAMHSA and Ad Council logos • TV, Radio, Print, Internet and Outdoor