Transcript Slide 1

Challenging Public Stigma: What we
have learned, promising approaches
Amy C Watson, PhD
[email protected]
Jane Addams College of Social Work
UIC
Overview
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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
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Approaches to Challenging Public
Stigma
• Protest
• Education
• Contact
• Social Marketing
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Protest
Confront negative attitudes &
representations
Protest Specific Instances
– Letters to editor
– Letter writing campaigns
– Demonstrations
– Boycotts
EXAMPLE: NAMI Stigmabusters
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(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!
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Burger King “Crazy King”
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A Local, Successful Protest Effort
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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
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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
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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
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Contact: Making it Personal
• Allport’s (1954) Conditions of optimal
contact
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Equal status between groups
Common goals
No Competition
Authority Sanction for the contact
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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
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Contact Strategies in Practice: IOOV
NAMI’s In Our Own Voice: Living with Mental
Illness
– Structured program delivered by persons living with
mental illness.
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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
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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
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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
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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
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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)
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The Audience Matters: Targeting Antistigma efforts
• Target key groups that influence opportunities for
persons with mental illnesses
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Employers
Landlords
Teachers
Mental health and general health care providers
Criminal Justice Personnel
Community leaders
Media outlets
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Employment, Housing, & Healthcare
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Employment-(see Stuart, 2006)
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Housing
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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).
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
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People with mental illnesses appear to get less adequate health care than people without
perhaps due to stigma. (Druss et al 2000)
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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)
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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).
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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
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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
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A Targeted Model of Stigma Change
Corrigan, 2004: Watson & Corrigan, 2005
TARGETS
DISCRIMINATORY CORRESPONDING
BEHAVIOR
ATTITUDES
LANDLORDS
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EMPLOYERS
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HEALTH CARE
PROVIDERS
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CRIMINAL
JUSTICE
PROFESSIONALS
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POLICY
MAKERS
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THE MEDIA
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Fail to lease
No reasonable
accommodation
Fail to hire
No reasonable
accommodation
Withhold some
services
Unnecessarily
coercive treatment
Unnecessarily
coercive
Fail to use mental
health services
Insufficient
resource allocation
Unfriendly
interpretation of
regulations
Perpetuation and
dissemination of
stigmatizing
images
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Dangerousness
Incompetence
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SOCIAL
CONTEXT
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Economy
Hiring
pool
CHANGE
STRATEGIES
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ADA
Erasing
the Stigma
UIC
Challenging Stigma with a Social
Marketing Model (Kirkwood & Hudnall Stamm, 2007)
1. Establish Audience & Message
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Target audience & how they stigmatize
What message might counteract the stigma
What behavior & or attitude change is desired
2. Developing and Launching a Campaign
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Communication tool for reaching target audience
Complete media strategy
Market test Campaign with target audience (s) (focus groups)
Implement the strategy
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Note: Kirkwood’s model involves a participatory process
Jane Addams College of Social Work
UIC
Challenging Stigma with a Social
Marketing Model (Kirkwood & Hudnall Stamm, 2007)
3.Evaluate Campaign
a) Was the process empowering
b) Did campaign materials attract the target audience
(penetration)
c) Did campaign achieve desired attitude or behavior
change? (impact)
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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.
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Jane Addams College of Social Work
UIC
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
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Corrigan’s TLC3 Model of Strategic
Stigma Change
(Corrigan, in press)
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Targeted
Local
Credible
Continous
Contact
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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
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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.”*
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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.
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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.
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UIC
Implications:
How can we erase public stigma?
CONTACT!!!!!!
• Multiple, varied messages, strategically
deployed over sustained period of time
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References
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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.
Jane Addams College of Social Work
UIC
References
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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 & Hudnall Stamm, 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.
Jane Addams College of Social Work
UIC
References
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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), 342346. 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
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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.
Jane
Addams College of Social Work
UIC