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Challenging Public Stigma: What we have learned, promising approaches

Challenging Public Stigma: What we have learned, promising approaches. Amy C Watson, PhD acwatson@gmail.com. Overview. Approaches to challenging public stigma The message matters Stigma and key groups A targeted model of stigma change Corrigan’s TLC3 Model of Strategic Stigma Change

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Challenging Public Stigma: What we have learned, promising approaches

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  1. Challenging Public Stigma: What we have learned, promising approaches Amy C Watson, PhD acwatson@gmail.com

  2. Overview • Approaches to challenging public stigma • The message matters • Stigma and key groups • A targeted model of stigma change • Corrigan’s TLC3 Model of Strategic Stigma Change • Implications

  3. Approaches to Challenging Public Stigma • Protest • Education • Contact • Social Marketing

  4. Protest Confront negative attitudes & representations Protest Specific Instances • Letters to editor • Letter writing campaigns • Demonstrations • Boycotts EXAMPLE: NAMI Stigmabusters

  5. (From Vermont Teddy Bear) Caption: Dressed in a white straitjacket embroidered with a red heart, this Bear is a great gift for someone you’re crazy about. He even comes with a “Commitment Report” stating “Can’t Eat, Can’t Sleep, My Heart’s Racing. Diagnosis – Crazy for You!” Trust us. She’ll go nuts over this Bear!

  6. Burger King “Crazy King”

  7. A Local, Successful Protest Effort

  8. Protest • May produce Attitude rebound • Does not decrease stigmatizing views • May increase them (reactance) • Decrease behavior • Punitive response may reduce undesired behavior • Does not increase desired behavior Corrigan et al 2001

  9. Education • Education strategies challenge stigma by providing factual information about mental illnesses or contrasting myths & facts • Classroom lecture, Public service announcements, fact sheets, books, videos, movies, websites, etc.. • Mental Health Literacy Programs

  10. Education(Corrigan et al., 2001; Corrigan et al., 2002) • Evidence that people with a better understanding of mental illnesses are less likely to endorse stigma • Research on educational approaches suggests • Some mild short term improvement in stigmatizing attitudes • not stick over time • Not clear it spreads to behaviors • Research on Mental Health Literacy Campaigns suggests (Jorm & Kelly, 2007) • Increase recognition of specific disorders • More positive beliefs about treatment and treatment seeking • FAIRLY EXPORTABLE

  11. Contact: Making it Personal • Allport’s (1954) Conditions of optimal contact • Equal status between groups • Common goals • No Competition • Authority Sanction for the contact

  12. Involving people in recovery in the Police training process: Collaboration with the Thresholds Theatre Arts Program • Videotaped role-play training with Thresholds actors. • Officers and actors view videotapes and debrief

  13. Contact Strategies in Practice: IOOV NAMI’s In Our Own Voice: Living with Mental Illness • Structured program delivered by persons living with mental illness. • Dark Days • Acceptance • Treatment • Coping Strategies • Success, Hopes & Dreams • The two studies of IOOV published to date suggest that it is effective for reducing stigma and improving knowledge about mental illness in the short term(Wood & Wahl, 2006; Rusch, Kanter, Angelone, & Ridley, 2008). www.nami.org

  14. Research on Contact & Mental Illness Stigma • Improves attitudes (from pre to post as well as compared to protest and education, Corrigan et al 2001) • Improvements seem to stick over time (Corrigan et al 2002) • Effects behavior (Corrigan et al 2002) • Improvements most pronounced when contact moderately disconfirms stereotypes (Reinke et al2004) • In vivo (vs video-though video can have some impact) • Contact effective approach with school children (Pinfold, et al, 2003) • Limitation: Contact less exportable, personal risk of disclosure

  15. Biological v Psychosocial Explanations: The message matters “A ‘mental illness’ is not caused by bad parenting and is not a character weakness or flaw. These illnesses are due to biochemical disturbances in the brain -- they are neurological disorders ... The shame and fear once associated with cancer has largely been dispelled by accurate information and understanding. The same will happen for brain diseases -- mental illnesses -- once the facts are known and shared.” -- Oregon AMI

  16. Biological v Psychosocial Explanations: The Message Matters “viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species” -- Mehta and Farina, 1997

  17. The Message Matters: Bio/genetic explanations v psychosocial explanations • Biological explanations decrease blame… • May increase “benevolence stigma” (Fisher & Farina, 1979) • May increase some negative attitudes & evoke harsher behavior (Mehta & Farina, 1997) • May lead to more negative views of prognosis (Phelan, 2002) • May increase perceptions of dangerousness and desired social distance (Read & Law, 1999) • Psychosocial Explanations (Read & Law, 1999) • May increase positive perceptions of persons with mental illnesses • May reduce fear • Messages about Dangerousness • May increase blame (Corrigan et al 2002) • May decrease fear and desire for social distance (Penn et al 1999)

  18. The Audience Matters: Targeting Anti-stigma efforts • Target key groups that influence opportunities for persons with mental illnesses • Employers • Landlords • Teachers • Mental health and general health care providers • Criminal Justice Personnel • Community leaders • Media outlets

  19. Employment, Housing, & Healthcare • Employment-(see Stuart, 2006) • most people with serious mental illnesses are willing and able to work, yet unemployment rates are extremely high (20-90% depending on disorder) • Research suggests that many employers hold stigmatizing views of mental illness and are reluctant to hire persons with mental illnesses • People with mental illnesses report employment related discrimination as one of their most frequent stigma experiences ( Wahl, 1999). • Housing • landlords are hesitant to rent to persons with mental illnesses (Forchuk, Nelson& Hall, 2006;) • Communities resist groups homes and other types of housing for persons with mental illnesses (Zippay, 2007). • Healthcare providers • People with mental illnesses appear to get less adequate health care than people without perhaps due to stigma. (Druss et al 2000)

  20. Mental Health Service Providers Mental Health service providers • In a recent study of practicing social workers, nearly 70% of social workers indicated that they did not prefer to work with individuals with severe mental illnesses(Newhill & Korr, 2004). • A study of mental health case managers found that social workers and other intensive case managers were as likely to hold stigmatizing and restrictive attitudes as community members toward individuals with mental illnesses (Murray and Steffan, 1999) • Magliano and colleagues (2004) found that over 50% of psychiatric nurses surveyed in Europe thought that individuals with schizophrenia should not get married, and 30% thought that such individuals should be sent to the asylum to live. • Persons with mental illnesses identify providers as a significant source of stigma and discrimination (Corrigan, Thompson, Lambert et al 2003)

  21. Criminal Justice Personnel • Police officers view persons with mental illnesses as more dangerous , less credible than others (Ruiz, 1993, Watson, Corrigan, Ottati et al, 2004) • Parolees with serious mental illnesses are more likely to have parole revoked for technical violations (Messina, Burdon, Hagopian, & Prendergast, 2004).

  22. Media Representations • 73% of characters with mental illnesses in U.S. TV dramas were portrayed as violent (e.g. “mentally ill killer”) (Sayce, 2000) • Dangerousness the most common theme in news papers (may be decreasing as stories about treatment and policy increase) • Negative portrayals of mental illnesses common in children’s television and movies • Distorted images of mental health professionals common See Stout, Villegas & Jennings, 2004

  23. Targeting your approach • Depends on: • Target Group • Target Attitude • Target Behavior • Social Context • Caution-remember, some strategies exacerbate some domains of stigma, while improving others

  24. A Targeted Model of Stigma ChangeCorrigan, 2004: Watson & Corrigan, 2005

  25. Challenging Stigma with a Social Marketing Model (Kirkwood & HudnallStamm, 2007) • Establish Audience & Message • Target audience & how they stigmatize • What message might counteract the stigma • What behavior & or attitude change is desired • Developing and Launching a Campaign • Communication tool for reaching target audience • Complete media strategy • Market test Campaign with target audience (s) (focus groups) • Implement the strategy • Note: Kirkwood’s model involves a participatory process

  26. Challenging Stigma with a Social Marketing Model (Kirkwood & HudnallStamm, 2007) 3.Evaluate Campaign • Was the process empowering • Did campaign materials attract the target audience (penetration) • Did campaign achieve desired attitude or behavior change? (impact)

  27. SAMHSA/Ad Council Campaign: What a difference a friend makes • Designed to encourage young adults to step up and support their friends who are living with mental health problems • Developed via participatory approach • PSAs launched nationally in December 2006 and included television, radio, outdoor, print and web elements, as well as a printed brochure and new website • Distributed to over 28,000 media outlets • www.whatadifference.samhsa.gov.

  28. What a difference a friend makes campaign • March 2008 online tracking survey found that 31% of 18-25 year olds recognized at least one PSA from the campaign • 2006-2008 median monthly website visits=64,098 • Average time spent per website visit =8 minutes • Online survey found that PSA aware respondents were 1.99 times more likely to report they would support a friend with mental illness • PSA aware respondents were 2.3 times more likely to report visiting a website to get mental health information in previous 6 months

  29. Corrigan’s TLC3 Model of Strategic Stigma Change(Corrigan, in press) • Targeted • Local • Credible • Continous • Contact

  30. Contact • Contact with persons with mental illnesses is fundamental to stigma change • Face to Face seem most effective • Contact alone or contact combined with education has stronger and lasting effects compared to education alone

  31. Targeted • Who: Rather than population as whole, contact is more effective when targeting key groups (typically people with power) • What: what behaviors need changing. What do you want people to do (not just what you want them to stop)? • Consider venue & timing • Who and what inform the message. • Stories> “way down” to “way up” • Punchline:”despite significant recovery, many goals still impeded by ongoing stigma.”*

  32. Local, Credible & Continuous • Local has several meanings • Geographic, urban rural, ses, diversity factors • Credible • Mirror local concerns • Contact person should be similar to target* • Contact person in process of recovery • Continuous • Multiple and varied contacts over time.

  33. TLC3 benefits (v. broad population-focused public marketing campaigns) • Less penetration than large campaigns but- • More personalized messages • More flexible for identify emerging stigma issues and responding • Thus more interactive • Less redundant messaging • Call for redirecting funds from large public marketing campaigns to local TLC3 approaches.

  34. Implications: How can we erase public stigma? CONTACT!!!!!! • Multiple, varied messages, strategically deployed over sustained period of time

  35. References • Ad Council. (n.d.). Retrieved August 18, 2010, from http://www.adcouncil.org/ • Allport, G. (1954). The nature of prejudice. Cambridge, MA: Addison Wesley Publishing. • Corrigan, PW; Watson, AC; Gracia, G; Slopen, N; Rasinski, K; Hall, L L. Newspaper Stories as Measures of Structural Stigma. (2005) Psychiatric Services. 56(5), 551-556. • Corrigan, P.W. (in press) Strategic Stigma Change (SSC): Five Principles for Social Marketing Campaigns Meant to Erase the Prejudice and Discrimination of Mental Illness. Psychiatric Services. • Corrigan P. Target-specific stigma change: A strategy for impacting mental illness stigma. Psychiatric Rehabilitation Journal, 2004;28:113-121 • Corrigan, P., River, L., Lundin, R., Penn, D., Uphoff-Wasowski, K., Campion, J., ... Kubiak, M.A. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2), 187-195. • Corrigan, P., Rowan, D., Green, A., Lundin, R., River, P., Uphoff-Wasowski, K., ... Kubiak, M.A. (2002). Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28(2), 293-309. • Corrigan, P., Thompson, V., Lambert, D., Sangster, Y., Noel, J., & Campbell, J. (2003). Perceptions of Discrimination Among Persons With Serious Mental Illness. Psychiatric Services, 54(8), 1105-1110. doi:10.1176/appi.ps.54.8.1105.

  36. References • Druss, B. G., Bradford, D. W., Rosenheck, R. A., Radford, M. J., & Krumholz, H. M. (2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. Jama: Journal of the American Medical Association, 283, 506-511. • Fisher, J. D., & Farina, A. (1979). Consequences of beliefs about the nature of mental disorders. Journal of Abnormal Psychology, 88(3), 320-327. • Jorm, AF & Kelly, CM (2007). Improving the public’s understanding and response to mental disorders. Australian Psychologist, 42 (2): 81-89. • Kirkwood, AD & HudnallStamm, B (2007). A Social marketing approach to challenging stigma.Professional Psychology: Research & Practice, 37 (5) 472-476. • Magliano, L., De Rosa, C., Fiorillo, A., Malangone, C., Guarneri, M., Marasco, C., et al. (2004). Beliefs of psychiatric nurses about schizophrenia: A comparison with patients' relatives and psychiatrists. International Journal of Social Psychiatry, 50(4), 319-330. • Mehta, S., & Farina, A. (1997). Is being "sick" really better? Effect of the disease view of mental disorder on stigma. Journal of Social & Clinical Psychology, 16, 405-419.

  37. References • Messina, N., Burdon, W., Hagopian, G., & Prendergast, M. (2004). One year return to custody rates among codisordered offenders. Behavioral Sciences and the Law, 22, 503-518. • Murray, M. G., & Steffen, J. J. (1999). Attitudes of case managers toward people with serious mental illness. Community mental health journal, 35(6), 505-514. • Newhill, C. E., & Korr, W. S. (2004). Practice with people with severe mental illness: Rewards, challenges, burdens. Health & Social Work, 29(4), 297-305. • Phelen, J. (2002). Genetic bases of mental illness - a cure for stigma? Trends in Neurosciences, 25(8), 430-431. • Penn, D. L., Kommana, S., Mansfield, M., & Link, B. G. (1999). Dispelling the stigma of schizophrenia: II. The impact of information on dangerousness. Schizophrenia Bulletin, 25, 437-446. • Pinfold, V., Toulmin, H., Thornicroft, G., Huxley, P., Farmer, P., & Graham, T. (2003). Reducing psychiatric stigma and discrimination: Evaluation of educational interventions in UK secondary schools. British Journal of Psychiatry, 182(4), 342-346. doi:10.1192/bjp.182.4.342. • Read, J., & Law, A. (1999). The Relationship of causal beliefs and contact with users of mental health services to attitudes to the 'Mentally Ill'. International Journal of Social Psychiatry, 45, 216-229

  38. References Reinke R, Corrigan P, Leonhard C, Lundin R, Kubiak M. Examining two aspects of contact on the stigma of mental illness. Journal of Social and Clinical Psychology, 2004; 23:377-389 Ruiz, J. (1993). An interactive analysis between uniformed law enforcement officers and the mentally ill. . American Journal of Police, 12(4), 149-177. Rusch, L. C., Kanter, J. W., Angelone, A. F., & Ridley, R. C.  (2008). The impact of In Our Own Voice on stigma. American Journal of Psychiatric Rehabilitation, 11(4), 373-389. Sayce, L. (2000) From psychiatric patient to citizen: Overcoming discrimination and social exclusion. New York, NY: St. Martin’s Press Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry, 19(5), 522-526. Stout, PA, Villegas, J & Jennings,NA (2004). Images of mental illness in the media: Identifying gaps in the research. Schizophrenia Research, 30 (3) 543-561. Wahl, O.F. (1999). Telling Is Risky Business: The Experience of Mental Illness Stigma. New Brunswick, NJ: Rutgers University Press. Watson, A.C. & Corrigan, P.W. (2005). Changing public stigma: A targeted approach. In P.W. Corrigan (Ed) A Comprehensive Review of the Stigma of Mental Illness: Implications for Research and Social Change. Washington D.C.: American Psychological Association pp 281-295. Watson, A.C.; Corrigan, P.W., Ottati, V. (2004) Police responses to persons with mental illness: Does the label matter?  Journal of the American Academy of Psychiatry and the Law, 32, 378-385.

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