1/31/2014

1

Opening Minds“Changing How We See Mental Illness”

A presentation to:

Global Alliance Against Stigma

London, UK September 2013

/ 2

Opening Mind Projects

Healthcare Providers

• 109 partners

• 49 active projects

• 29 completed projects

(Some are national in scope)

1/31/2014

2

/ 3

We are evaluating programs, with the goal of replicating

effective ones across Canada

9 evaluation reports complete

12 evaluation reports near completion

Several longer term research projects underway

• Programs are in universities training doctors, psychiatric

nurses, occupational therapists and pharmacists

• Anti-stigma programs in hospitals and healthcare settings, for

healthcare workers – focus on contact-based education

• Skills training for doctors and other healthcare workers, with

shorter contact-based sections

• Online program for family doctors

Healthcare Program Update

/ 4

Program Impact & Knowledge Transfer:

Successful Healthcare Program

Central

LHIN

Central

East LHINIWK

BC

Interior

Health

New

DVD

Vancouver

Island

Health

Authority

Alberta

Health

Seminar

Yellowknife School Pilot

Project

Central

LHIN

Phase II

BC

AB

NS PEI

CPA

CMA

Penticton

Cranbrook

Castlegar

Salmon Arm

Kelowna

Kamloops

Williams Lake

1/31/2014

3

/ 5

What made a difference?

/ 6

Surveys were conducted before and after the program.

AFTER THE PROGRAM

• 34% increase in participants who believed their workplace

was not free of stigma

• 20% increase in participants who agreed healthcare providers

should be advocates for people with mental illness

• 35% increase in participants who agreed it is the healthcare

providers’ responsibility to encourage recovery in people with a

mental illness

Evaluation Results from first

successful program

1/31/2014

4

/ 7

Don’t know why…

/ 8

• Great starting place for organizations to reduce stigmaOne of our principles is not to “recreate the wheel”

• A few positive changes were not maintained at three

months follow-up

• Need for further training programs such as booster sessions

or organizational changes to reduce stigma

• Phase II evaluation nearing completion – preliminary

positive results

Conclusions from program evaluation: “Mental Illness

and Addictions: Understanding the Impact of Stigma”

1/31/2014

5

/ 9

BC Interior: Proportion of correct

(non-stigmatizing responses)

/ 10

Comparing Healthcare Programs

• Opening Minds now has enough data collected from over 17

programs to draw comparisons

• Created chart called a “Forest Plot” to compare programs

• 15 programs show statistically significant improvements

Only 2 programs did not show positive results

• Individual programs achieve different levels of success in

reducing stigma

• Programs with best results aren’t necessarily similar in

length, content and delivery

1/31/2014

6

/ 11

Next Step: Logic Model of Key Ingredients

• Researchers added qualitative component to examine healthcare

programs in greater depth to develop logic model for effective programs

• Programs differ in terms of: program goals; length; intensity / type of

social contact provided; program components; target audience; mode of

delivery; and other factors

• Some programs show more positive evaluations and some show more

sustained changes over time

• Hints on potential key ingredients

/ 12

1. When individuals with lived experience provide contact-

based education by telling their story, they must demonstrate

both recovery and competence

Quote:

“It’s important for healthcare providers to see that recovery is really possible. I think it works even better when they can see recovery in action. Getting up there and telling your story in a positive way evokes admiration and shows competence. It allows the [healthcare provider] audience to see that recovery is real. This changes [healthcare providers’] perceptions of people with mental illness because the stereotype is that people with mental illness aren’t supposed to be competent or capable or funny or likeable.”

[person with lived experience / program presenter]

Potential Key Ingredient #1

1/31/2014

7

/ 13

2. Teach healthcare providers skills so they know ‘what to do’

• Practice Support Program (PSP) on Mental Health – created in British

Columbia through BCMA

This program will be delivered in Nova Scotia to doctors as part of a randomized

control trial, so we establish how it reduces stigma

• Online Family Doctors CME accredited program

Now housed on Memorial U website, allowing evaluation

Now accessible by all Canadian doctors and other healthcare providers

• Cognitive Behavioural Interpersonal Skills training (CBIS)

Interim evaluation results of program delivered by VIHA (Vancouver Island Health

Authority) show it reduces stigma, and greater positive change occurs over time

Potential Key Ingredient #2

/ 14

Quote:

“Many of the questions that come up in discussion period are about ‘what can I do?’ ‘how can I help?’ Healthcare staff are looking for answers to these questions … the message I like to communicate about what they can do is twofold: ‘watch how you speak’ -- just because someone is in distress doesn’t mean they can’t hear what is being said about them. Also, ‘small things make a big difference’: listening, talking, small gestures of kindness, and talking with respect are all very positive. These things stay with people for a long time. It gives them hope and it gives them validation.”

[person with lived experience (program presenter) interview]

Potential Key Ingredient #2

1/31/2014

8

/ 15

3. ‘One-off’ programs rarely deliver sustained positive change

• Many interventions show partial regression back towards being more

stigmatizing at follow-up (one to three months later) – and that is

stopped when boosters are delivered

• Regression also doesn’t occur when more intensive programs are

delivered, usually over longer timeframe

Quote:

“People need boosters, reminders. This is the feedback we’ve

gotten from healthcare providers as well. One great workshop

might make us all warm and fuzzy but it might not last. Getting

periodic reminders is likely to work much better. We all need to

be reminded.”

[program lead interview]

Potential Key Ingredient #3

/ 16

Importance of institutional support:

Quote:

“Make it easy for people to come. This is where getting institutional buy-in is so

important. There is a constant struggle for priority so if you don’t have

leadership on board getting behind what you are trying to do, you won’t get the

funds you need. And you won’t get the participation. The two sessions that were

our most successful were ones where we had the executive director on board.

They sent out the message to the entire staff and set aside the time and

resources for people to come. That’s when we got people. These were very good

sessions with good uptake.”

[program lead interview]

Potential Key Ingredient #4

1/31/2014

9

/ 17

Healthcare programs – looking ahead

• Skills programs for family doctors:

Delivery and analysis in randomized control trial

• Online tool for family doctors:

• Now available to all doctors across Canada

• Evaluation to occur this year

• Online tool for nurses in negotiation

• Looking for ways to replicate four effective university programs

• Pharmacy School, Medical School, Occupational Therapy, Psychiatric Nursing

• Key Ingredients model and toolkits for effective programs

/ 18

• New knowledgeLearn the scope of stigma experienced by people with lived experience

Ingredients for success

• Tools that can be broadly disseminatedEffective programs and toolkits

Measurement instruments

• Outreach across Canada to promote effective programsExpand effective leadership and practice networks

• Foster renewed optimism that stigma can be beaten and

recognition that we all have a role to play

The Opening Minds Legacy

1/31/2014

10

/ 19

Thank you

Contact us: info@mentalhealthcommission.ca

Visit: www.mentalhealthcommission.ca

Follow us:

The views represented herein solely represent the views of the Mental Health Commission of Canada.

Production of this document is made possible through a financial contribution from Health Canada.

Les opinions exprimées aux présentes sont celles de la Commission de la santé mentale du Canada.

La production de ce document a été rendue possible grâce à la contribution financière de Santé Canada.