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4 Approaches to Reducing Stigma
Pages 69-92

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From page 69...
... When relevant information is available, the descriptions of the interventions also include a discussion of both their intended outcomes and unintended consequences. As noted above, the dearth of data on what works to reduce stigma is particularly acute as it relates to substance use disorders, and it is not always clear that findings related to mental illness can be generalized to substance use disorders, or even applied across all mental disorders.
From page 70...
... In contrast, a brief social media intervention in Canada called In One Voice1 resulted in improved attitudes toward mental health issues and less social distance at the 1-year follow-up. However, the participants reported that they did not gain knowledge or confidence about how to help someone experiencing a mental health problem, nor did the intervention motivate young people to engage in more helpful or supportive behaviors toward those with mental health needs.
From page 71...
... For example, one meta-analysis found that, when educational materials highlighted biogenetic causes of mental illness, participants were less likely to blame people with mental illness; however, they were more likely to believe that people with mental illness had low chances of recovery and more likely to say that they did not want to interact with them (Kvaale et al., 2013a)
From page 72...
... There is also some evidence that basic health education to improve mental health literacy may be effective in reducing stigma for school-age children; however, to improve public attitudes without negatively impacting self-stigma, the curricula need to be recovery focused and developmentally and cognitively tailored to different age groups (Wei et al., 2013)
From page 73...
... and promote parental help-seeking behaviors for children's mental health problems. Efforts to close the treatment gap in access to mental health care between whites and ethnic minorities might include campaigns that target ethnic minority parents, as well as trusted community figures with messages about the biological underpinnings of mental illnesses.
From page 74...
... Results of a meta-analysis of 79 studies found that effect sizes for contact on attitude change and intended behaviors were twice those of education alone (Corrigan et al., 2012)
From page 75...
... . An example is found in Active Minds, a grassroots college student mental health advocacy group that reaches out to young people on college campuses across the United States with several programs including a speakers bureau.3 Peer support also acts as a counterbalance to the discrimination, rejection, and isolation people may encounter when trying to seek mental or substance use treatment and services.
From page 76...
... . Among the behavioral health stigma change strategies discussed
From page 77...
... The internet serves as a potential platform for advocacy and for monitoring changes in social norms. Psychiatrists and psychologists in particular have been identified as potentially valuable voices against stigma online, and there are calls for health professionals to take up advocacy blogging to further educate the public about mental health conditions and counter stigmatizing stereotypes (Peek et al., 2015)
From page 78...
... Policies that disqualify people with mental illness from receiving health insurance coverage are an example of overt structural stigma; in contract, failure of police officials to distinguish between mental health apprehensions and suicide attempts on criminal record checks is an example of covert structural stigma or of stigma at the structural level (Mental Health Commission of Canada, 2013)
From page 79...
... . The VA's Make the Connection website hosts a wealth of behavioral health resources for veterans, and serves as a venue by which veterans can share their lived experiences.
From page 80...
... The information presented in these summaries was drawn from the researchers' presentations, published reports of campaign outcomes, and the peer-reviewed literature. Table 4-1 and the discussion that follows summarize the lessons learned from successful well-evaluated national-scale campaigns about how to inform a national dialogue and improve public attitudes and behaviors concerning people with mental and substance use disorders at the population level using multifaceted, long-term strategies that engage state, local, and grassroots community groups; permit the scaling up of successful smaller scale interventions; and facilitate research on what works to reduce stigma in population subgroups, such as racial and ethnic minorities and relevant target groups, such as educators, employers, and health care providers.
From page 81...
... § Community education (ongoing) 2000-2005; $80 programs million from § Training of prominent 2005-2010 people as champions § Digital and print materials § Mental health literacy § Community discussion forums § Mindframe, a national media initiative about responsible reporting of suicide § Research and evaluation
From page 82...
... to design and deliver a multiphase, multifaceted campaign that included • social marketing and mass media activity at the national level to raise awareness of mental health issues; • local community events to bring people with and without mental health problems together; • a grant program to fund grassroots projects led by people with mental health problems; • a program to empower a network of people with experience of mental health problems to challenge discrimination; and • targeted work with stakeholders, for example, medical students, teachers in training, employers, and young people. Funding also allowed the campaign to do formative research during the first year involving more than 4,000 people with direct experience of mental health problems to provide input on stigma and discrimination and specific targets for change, which then guided the campaign.
From page 83...
... At the community and grassroots levels, the project included varied activities based on the theme "start a conversation." Community-level social contact included "Living Libraries" where, instead of borrowing only books, library visitors could borrow a person and hear about firsthand experiences of stigma discrimination from those with lived experience of mental illness. Data were collected at the community level during these social contact events in different cities across England to assess the relationship between the quality of the social contact and intended stigmatizing behavior and campaign engagement.
From page 84...
... The national scale social marketing campaign included mass media components and assessment of knowledge, attitudes, and behavior across the country. The social marketing mass media component of the campaign was most effective at influencing intended behavior toward people with mental illness.
From page 85...
... said they had met someone without a mental health problem during the event. These outcomes are salient because selective disclosure can facilitate positive social contact, and intergroup interactions between people with and without mental illness helps reduce stigmatizing "us versus them" thinking.
From page 86...
... The initiative grew out of efforts beginning in the 1990s to improve the knowledge and skills of primary care practitioners to address mental health problems. The goal of the mental health literacy campaign was to raise awareness of the importance of the public's knowledge, beliefs, and skills related to mental disorders, including prevention and treatment.
From page 87...
... What Did They Find? Periodic surveys of national mental health literacy were conducted in Australia from the mid-1990s allowing researchers to monitor trends in public attitudes before and during the implementation of beyondblue.
From page 88...
... Opening Minds The Mental Health Commission of Canada was launched in 2007 with federal funding. Opening Minds is the ongoing anti-stigma initiative of the commission and was launched in 2009 with a 10-year mandate and an annual budget of $2 million.11 Its goal is to change the attitudes and behaviors of Canadians toward people with a mental illness and to encourage individuals, groups, and organizations to eliminate discrimination.
From page 89...
... Workshops were originally developed for use by emergency room staff, but they were later adapted for other groups. The program objectives are to raise awareness among health professionals of their own attitudes; to provide them with an opportunity to hear personal stories of mental illness, hope, and recovery from people with mental illness; and to demonstrate that health care providers can make a positive difference.
From page 90...
... Researchers evaluated the Opening Minds programs using mixed methods, including qualitative methods such as focus groups and standardized instruments to measure stigma and social distance pre- and postprogram implementation. The researchers developed fidelity scales for contact-based education programs.
From page 91...
... In the future, the Opening Mind's team will focus on identifying the components of successful programs, how success in reducing stigma varies by health care professional target audience, and what processes actually bring about positive changes in attitudes and intended behavior toward people with mental illness. In an analysis of more than 20,000 print articles from 2005 to the present in Canadian newspapers along with 1,300 television reports, the campaign found that 40 percent of newspaper articles focused on crime and violence and only 20 percent focused on recovery, shortage of resources, and issues related to treatment.
From page 92...
... A meta-review of media campaigns in particular found that evaluations often fail to include data on financial costs, adverse effects, and unintended consequences (Clement et al., 2013)


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