MH-11
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mh-11_mental_health_stigma_2015.docLesson 11: Mental Health Stigma
Readings: Please note that the Corrigan article in the syllabus has been replaced with the Collins and Corrigan articles below:
Required
Collins, R. L., Wong, E. C., Cerully, J. L., Schultz, D., & Eberhart, N. K. (2012). Interventions to reduce mental health stigma and discrimination. http://calmhsa.org/wp-content/uploads/2011/12/Literature-Review_SDR_Final01-02-13.pdf
Corrigan, P., Morris, S., Michaels, P.J., Rafacz, J.D. & Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services 63(10). doi: 10.1176/appi.ps.201100529. http://ps.psychiatryonline.org/article.aspx?articleid=1372999&RelatedWidgetArticles=true
Link, B., Phelan, J. Bresnahan, A.S. & Persosolido, B., (1999). Public conceptions of mental illness: Labels, causes, dangerousness and social distance. American Journal of Public Health (89), 1328-1333.
http://ajph.aphapublications.org/cgi/reprint/89/9/1328.pdf
Swanson, J.W., Holzer, C.E., Ganju, V. K., Jono, R.T. (1990). Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area surveys. Hospital & Community Psychiatry, 41(7), 761-770.
https://www.youtube.com/watch?v=Zn6yw2KUIwc&feature=youtu.be
Optional
Pettigrew, L. R. & Tropp, T.F. (2005). Relationships between intergroup contact and prejudice among minority and majority status groups. Psychological Science (16)12, 951-957.
Summary
Introduction
As many of you have noted in your discussion posts, mental health stigma is a pervasive problem that profoundly affects the lives of those suffering from mental illness. Aided by newspapers, books, movies and television, persons with mental illness have been portrayed and perceived as persons with bad character, demonically possessed, weak, unpredictable, and violent. As a result, many people have separated themselves from those with mental illness out of “distrust, stereotyping, fear, embarrassment, anger and/or avoidance.” (Surgeon General’s Report, 1999).
While some progress has been made in the past 50 years, stigma (often referred to as discrimination) continues to be a significant barrier to persons with mental illness. As we have seen in our readings, several recent documents have given prominence to the issue of stigma. In SAMSHA’s 2011 strategic plan “Leading Change: A Plan for SAMHSA’s Roles and Actions, 2011-2014”, Goal 4.3.2 is to “create a behavioral health awareness campaign focused on decreasing discrimination and improving employment outcomes for persons with mental and substance use disorders.” (p. 59). SAMHSA’s most recent strategic plan: Leading the Change 2.0: Advancing the Behavioral Health of the Nation 2015-2018, Objective 4.4.3 is to “Decrease negative attitudes and discrimination toward people with mental illness and/or substance use disorders and their family members” (p. 26). The World Health Organization recently published “A Mental Health Action Plan: 2013-2020”. One of the action steps includes the implementation of mental health promotion and prevention strategies that “redress the stigmatization and human rights violations all too commonly associated with mental disorders” (WHO, 2013). Furthermore, according to the National Alliance on Mental Illness’s Policy Platform, “NAMI condemns all acts of stigma and discrimination directed against persons with mental illnesses, whether by intent, ignorance, or insensitivity. Epithets, nicknames, jokes, advertisements, and slurs that refer to persons with serious mental illnesses in a stigmatizing way are cruel” (NAMI Policy Plan, nod)
Stigma in Missouri
In Missouri, the issue of discrimination against those with mental illness is still a significant issue. In both 2006 and 2013, the Missouri Institute of Mental Health conducted a random sample survey of adult Missourians on mental health stigma. People were asked how willing they would be to have someone with a mental illness work closely with them, have them as a friend, socialize with and marry into their family. While the large majority would be “very” or “somewhat” willing to socialize and befriend someone with a mental illness, only a little more than half (53%) would be willing to work closely with him/her, fewer than half (45%) would be willing to have them marry into their family and only 16% would be willing to have that person as a boss. Stigma was highest toward people with schizophrenia followed by bipolar disorder.
The two surveys were compared to explore whether there had been reduction in stigma since 2006 when the Missouri Department of Mental Health first explored stigma among adults in Missouri. The study showed that while there was a decrease in stigma toward people with depression, there was an increase in stigma towards those with schizophrenia and bipolar disorder. (Missouri Institute of Mental Health, 2013).
The most recent Missouri statewide mental health needs assessment identified stigma as one of the major concerns of mental health policy makers, providers, consumers and the general public (Missouri Institute of Mental Health, 2008). In that report, a Missouri Area Agency on Aging director stated that, “the current generation of older persons still views mental illness as a “personal flaw,” not an illness that can be successfully treated” (p. 88). An adult focus group member living in rural Missouri stated that in her town “they got rid of a pastor who admitted to being depressed” (p. 95). According to one African-American male study participant, “I’ve had people try to run me down and beat me up…the basic person is going to say he’s got mental problems; he is crazy” (p. 98).
Effects of Stigma
How does stigma affect those with mental illness? The negative effects of mental illness stigma include fewer employment and housing opportunities, greater family stress, and exclusion from friendships (Link et al., 2001). In addition, those with severe mental illness may internalize stigma reactions resulting in depression, increased anxiety, poor social performance, lower self-esteem, and the adoption of secrecy and withdrawal as coping strategies (Penn & Martin, 1998). Poor self-esteem caused by stigma may result in a fear to pursue goals and form new relationships. Finally, stigma can also impact treatment participation and effectiveness. When persons with a mental illness become aware of the stigma associated with mental illness, they may not access mental health treatments in an attempt to avoid being labeled incompetent, weak, or dangerous (Clement et al., 2015; Corrigan, 2004).
Combatting Stigma
Some suggested strategies for reducing public stigma include protest, education, and contact (Corrigan & Penn, 1999). Protest approaches highlight the injustice of specific stigmas and lead to a moral appeal for people to stop holding stigma. Education approaches replace the myths of mental illness with facts that counter the myths. Approaches that utilize contact involve meeting or otherwise interacting with people with mental illness. Out of the three approaches, contact has been shown to have greatest impact on changing stigma (Tropp & Pettigrew, 2005), with in-person contact being more effective than video contact (Corrigan et al, 2012).
One major deterrent to contact is the myth of perceived dangerousness. The risk of violent behavior among persons with serious mental illness is modest relative to the risk associated with age, gender, violence history, socioeconomic status, and educational level (Penn & Martin, 1998). Yet a high percentage of Americans believe that most violent acts are perpetrated by people with mental illness. However, in a study by Meloy et al., (2001), only 23% of adolescents who had murdered three or more people in one event had a diagnosable mental illness. A very recent poll of Americans found that 63% blamed mental illness for mass gun violence (Washington Post/ABC News Poll, October 2015) and according to a 2013 Gallup poll, almost half (48%) of Americans blamed the mental health system "a great deal" for U.S. mass shootings. The media has played a role in perpetuating this belief and helped fuel the fear that many people have toward mental illness as we have seen in the shootings in Oregon, Texas, South Carolina, Colorado, and Connecticut in the past few years (McGinty, Webster & Barry, 2011).
Nonetheless, persistent myths about the dangerousness of people with mental illness result in a greater desire for social distance, thus creating a cycle in which fear of social contact with people with mental illness results in avoidance. The desire for social distance discourages social contact, which contributes to the dangerousness myth by deterring information that might otherwise counter the myth. This principle was illustrated a study by Alexander & Link (2003), who found that social contact with mentally ill persons was strongly related to the perceived dangerousness of that person. As total contact increased, the perceived dangerousness and desired social distance from the person with mental illness decreased. Other studies have also demonstrated that stronger beliefs in the dangerousness of persons with mental illness result in a greater desire for social distance (Angermeyer & Matschinger, 2005).
So, how can national, state and local efforts to reduce stigma promote greater contact and acceptance of mental illness? Many mental health advocates in recent years have believed that providing more information about the genetic causes of mental illness would result in greater empathy and acceptance toward persons with mental illness because the disorder would be seen as outside the personal control of the sufferer (Hinshaw & Steir, 2008). However, some studies have shown that genetic explanations for mental illness have increased negative attitudes, perceptions of dangerousness and fear (see Read et al. 2006, and Read, 2007 for reviews). However, Martin, Pescosolido, & Tuch (2000), using data from 1,444 respondents who completed the General Social Survey (GSS) in 1996, reported that those who felt that “genetic transmission” was a cause of mental illness were more willing to associate with someone with a mental illness. The perception of a chemical imbalance as a cause, another biogenic explanation, did not alter perceptions of social distance. Phelen et al. (2000), using the same dataset, found that genetic explanations and negative attitudes regarding mental disorders both increased between 1950 and 1996.
Anti-Stigma Efforts
This discussion of stigma highlights the complexity of combatting the stigma surrounding mental illness. Suggested approaches include speaker’s bureaus and other programs that link persons with mental illness to the community, ad campaigns, radio and television spots, media education, advocacy efforts to change discriminatory laws and awards ceremonies that publicly acknowledge mental health champions. Nationally, the National Mental Health Anti-Stigma Campaign launched in 2006 focuses on the importance of reaching out to persons who might be in need of some mental health care. Other countries also have invested significant resources into anti-stigma campaigns as well (see BeyondBlue.org.au; Seemescotland.org.uk). In Missouri, the National Alliance for the Mentally Ill offers “In Our Own Voice” to organizations throughout the state where persons with mental illness tell their story to break down myths related to mental illness. The Missouri Department of Mental Health (DMH) launched two programs to combat stigma and increase understanding of the issues facing those with mental illness. RESPECT is a statewide program that trains persons with mental illness to “tell their story” to the general public, thus increasing their connection to their communities while educating the public on the experience of mental illness. Mental Health First Aid is a 12-hour training aimed to inform individuals about different mental illnesses and assist those in need seek help (see http://mentalhealthfirstaidmissouri.com). The state also has an annual Mental Health Champions Dinner honoring people with mental illness who have championed mental health initiatives in Missouri. It is also hoped that the new Health Care Home initiative, by linking behavioral and physical health care, will also result in a reduction in stigma.
Assignment and Group Discussion
Your response to the assignment below and your participation in the group discussion will be worth points
There are anti-stigma efforts taking place across many states in the U.S. and several countries. Identify a state or country with an active campaign that has been researched for its effectiveness. Outline the initiatives that are part of that campaign with specifics about its approaches to combatting stigma. Discuss the possible effectiveness and possible unintended negative consequences of the campaign and/or its components in reducing stigma. Include the website(s) for the campaigns.
Again, please try to have your initial answers to the question on the Discussion Board by Friday so that you can respond to others in the class by Sunday night.
References
Alexander, L. A. & Link, B. G. (2003). The impact of contact on stigmatizing attitudes towards people with mental illness. Journal of Mental Health, 12, 271-289.
Angermeyer, M.C., Matschinger, H. & Corrigan, P.W. (2004). Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophrenia Research 69. 175-192.
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625.
Corrigan, P. (2012). Research and the elimination of the stigma of mental illness. British Journal of Psychiatry, 201: 7-8. http://bjp.rcpsych.org/content/201/1/7.full.pdf+html.
Corrigan, P. & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765-776.
Corrigan, P., Morris, S., Michaels, P.J., Rafacz, J.D. & Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services 63(10). doi: 10.1176/appi.ps.201100529. http://ps.psychiatryonline.org/article.aspx?articleid=1372999&RelatedWidgetArticles=true
Dietrich, S., Matschinger, H., & Angermeyer, M.C. (2006). The relationship between biogenetic causal explanations and social distance toward people with mental disorders: results from a population survey in Germany. International Journal of Social Psychiatry 52(2),166-74.
Gallup (2013). Americans Fault Mental Health Systems for Gun Violence. Retrieved from http://www.gallup.com/poll/164507/americans-fault-mental-health-system-gun-violence.aspx.
Hinshaw, S.P. & Stier, A. (2008). Stigma as related to mental disorders. Annual Review of Clinical Psychology, 4, 367-393.
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328-1333.
Link, B., Struening, E., Neese-Todd, S., Asmussen, S., & Phelan, J. (2001). The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52(12), 1621–1626. doi: 10.1176/appi.ps.52.12.1621. PMid: 11726753.
Markowitz, F. (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior 42, 64-79.
Martin, J.K., Pescosolido, B.A., & Tuch, S.A. (2000). Of fear and loathing: The role of ‘disturbing behavior’ labels, and causal attributions in shaping public attitudes toward people with mental illness. Journal of Health and Social Behavior, 41, 208-223.
McGinty E. E., Webster D. W., Jarlenski M., Barry C. L. (2014). News media framing of serious mental illness and gun violence in the United States, 1997-2012. American Journal of Public Health, 104, 406-413. 10.2105/AJPH.2013.301557.
Meloy, J.R., Hempel, A.G., Mohandie, K., Shiva, A.A., Gray, B.T. (2001). Offender and offense characteristics of a nonrandom sample of adolescent mass murderers. Journal of American Academy of Child and Adolescent Psychiatry, 40, 719-728.
http://forensis.org/PDF/published/2001_OffenderandOffe.pdf
Missouri Institute of Mental Health (2013). Telephone survey of Missourians regarding attitudes toward people with mental illness, substance use and developmental disabilities. St. Louis, Missouri: Hendricks, M., Miller, C., Kryah, R. & Sale, E.
National Alliance on Mental Illness (2015). National Alliance on Mental Illness Policy Plan (2015). Retrieved from https://www2.nami.org/Template.cfm?Section=NAMI_Policy_Platform&Template=/ContentManagement/ContentDisplay.cfm&ContentID=105496.
New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD.
Penn, D.L., Judge, A., Jamieson, P., Garczynski, J., Hennesy, M., & Romer, D. (2004). Stigma. In M. Seligman (Ed.), The Annenberg adolescent mental health initiative. Oxford, England: Oxford University Press.
Penn, D. L., & Martin, J. (1998). The stigma of severe mental illness: Some potential solutions for a recalcitrant problem. Psychiatric Quarterly, 69, 235–247.
Pescosolido, B. A., Martin, J.K., Link, B.G., Kikuzawa, S., Burgos, G., & Swindle, R. (2000). Americans’ views of mental illness and health at century’s end: Continuity and change. Public report on the MacArthur Mental Health Module, 1996 General Social Survey. Bloomington, Indiana: Indiana Consortium for Mental Health Services Research.
Phelan, J.C. (2002). Genetic bases of mental illness- a cure for stigma? Trends in Neurosciences, 25, 430-431.
Read, J., Haslam, N., Sayce, L., Davies, E. (2006). Prejudice and schizophrenia: a review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatrica Scandinavica, 112, 303-318.
Read, J., & Harre, N. (2001). The role of biological and genetic causal beliefs in the stigmatisation of ‘mental patients.’ Journal of Mental Health,10, 223–235.
Stuart, H., & Arboleda-Florez, J. (2001). Community attitudes toward people with schizophrenia. Canadian Journal of Psychiatry, 46, 245-252.
Substance Abuse and Mental Health Services Administration (2011). Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014. HHS Publication No. (SMA) 11-4629. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Tropp, T.F., & Pettigrew, L. R. (2005). Relationships between intergroup contact and prejudice among minority and majority status groups. Psychological Science (16)12, 951-957.
U.S. Department of Health and Human Services. (1999) Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Washington Post/ABC News (October 15, 18 2015), p. 10. ( http://apps.washingtonpost.com/g/page/politics/washington-post-abc-news-poll-oct-15-18-2015/1852/ .
World Health Organization (2013). A Mental health action plan: 2013-2020. Geneva, Switzerland.
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