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Some slides from Patrick Corrigan PhD, IL Institute of Technology
WISE BasicsIncreasing Inclusion, Hope and Support
Beating the Stigma of Mental Illness
Statewide collaboration oforganizations and individuals. Promote evidence based practices, current research and outcomes evaluation. Majority speak from experience of stigma and recovery.
Offer insights, resources, and support for stigma reduction
WISE Active Partners:
Care Connections (Waukesha County NAMI Support Group)Center for Suicide AwarenessCOPE ServicesDry HootchGrassroots Empowerment ProjectIllinois Institute of Technology LaCrosse Mental Health CoalitionLatino Health Coalition – Mental Health Action TeamMHA SheboyganMHA WisconsinMarian UniversityNAMI WI, Fox Valley, Greater Milwaukee, RacinePrevent Suicide WI and local coalitionsRogers InHealthUniversity of WI Eau Claire, Milwaukee, MadisonWI Department of Health Services WI Family TiesWI United for Mental Health
ETC.
Explore stigma ◦Public stigma
◦Internalized shame Frame stigma change Connect to your work and that of WISE
GOALS
4
IIT – Patrick Corrigan PhD Yale U Penn Rutgers Temple
www.ncse1.org
National Consortium on Stigma and Empowerment
schizophrenia
depressiontrauma
anxiety
eating disordersDrug and alcohol abuse
They are us!
1 in 4
47% in our lifetime
What is stigma?
Where does it come from?
8
Stigma Definition and Types
StigmaDefinition:
Stereotype (ideas) > Prejudice (beliefs) >
Discrimination (actions)
In a relationship of power - Oppression
Types:
Internalized Shame
Public
StructuralLanguage barriers
Examples of Stereotypes- Ideas
People with mental health challenges are incapable, fragile, dangerous, cannot recover
Mark
Mike
Linda and Nneka
Val
Dori
Examples of Prejudice- Beliefs
They are scary, shameful, less than.
Charles
Simone
Sumi
11
Social◦ I don’t want them to live next door, be a co-worker,
marry into my family
Structural◦ Employers do not hire/support recovery◦ Health insurance does not provide equal coverage -
parity is not enforced◦ Education lacks effective supports for success
Examples of Discrimination- Actions
Paul
Pastor TimDenise
Avoidance and apathy
self esteem
So, why try?
I am not good
Internalized Shame/Self StigmaPublic Stigma
sense of efficacy
I am not able
Characteristics of People Facing Mental Health and Addiction Challenges
Stubborn
Strength
Resilient
Flexibility
Compas
sion
Organization
Intelligent
Empathic
Creative
Funny
Short
Tall
Old
Young
Agnostic
Religious
14
Racial Oppression
15
Religious Oppression
Gender Oppression
Co-Occurring Stigma (public and internalized) Heterosexism Racism Sexism Ableism Etc.
2011 YRBS data showed LGBT youth in WI had:
- 5X the rate of suicide attempts - 3X more likely to skip school due to feeling
unsafe- 50% felt like they did not belong at school
18
Movies
Drivers of Public Stigma
Newspapers
AdvertisingUnethical Research, Drug Side Effects &Poor Quality Care
19
Benevolent Stigma
People with mental illness are “lovable and incapable”
Stigma’s Impact on SOCIAL INCLUSION
Lost employment
Subpar housing
Worse health care
Diminished education opportunities
Alienated from faith community
21
OK, but isn’t it better lately?
Trenton State
Hospital has fire.
July 10th, 2002
Despite what you might think, the percentage of Americans who viewed people with mental illness as dangerous doubled from 1956 to 1996.
Source: BG Link, JC Phelan, M Bresnahan, A Stueve, BA PescosolidoAmerican Journal of Public Health 89 (9), 1328-1333
1956 19960%
20%
40%
60%
80%
100%
20%
40%
% who viewed those with mental illness as danger...
1956 1996 20060%
20%
40%
60%
80%
100%
20%
40% 40%
% who viewed those with mental illness as danger...
…That figure held steady from 1996 to 2006.
Source: BG Link, JC Phelan - The Lancet, 2006
In any given situation we can be:
Stigmatizers
Stigmatized
De-stigmatizers
(Healthcare Workers and Stigma, Ross C. A. & Goldner E. M.
2009)
Protest
Education
Contact
27
Stigma Change Processes
28
Protesto Review stigmatizing images
o “Shame on you for thinking that way”
o Be aware of unintended consequences of well intended actions
o The rebound effect
29
Education
Counters myths with facts
Myth: People with serious mental illness can not care for themselves; need to be institutionalized.
Fact: Long term follow-up research suggests 2/3rds of people with schizophrenia learn to live with their disabilities.
RECOVERY is the rule
Myth: People with serious mental illness are dangerous.
Fact: People with untreated mental illness are slightly more dangerous especially when using drugs or alcoholBUT…
◦They are more likely to be victims of violence
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
DOES STIGMA DECREASEAS KNOWLEDGE INCREASES?Results from a meta-analysis study:
Knowledge: Causes of Mental Illness Stigma: Acceptance
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Brain Disease
META-ANALYSIS FINDINGS: CAUSE
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Neighbor
META-ANALYSIS FINDINGS: ACCEPTANCE
Impact?
◦Blame went down
◦Belief in recovery also went down
1990-2000 Decade of the Brain
36
Contact“I’d like you to meet
Simone, Mike, Linda, Nneka, Paul, Charles, Val, Sumi, Denise, Tim, Mark and Dori”
37
Their Recovery Story (part1)
My name is ______ and I have faced mental health and/or addiction challenges…
My childhood was…
My mental health challenges were difficult for me and others. They did not go away quickly…
Their Recovery Story (part2)
Combining my internal resources with external resources, I found my unique path to recovery…
I have achieved a satisfying life with several accomplishments.
Many education efforts have helped us to understand the pain of mental health crises.
Yet, there exists a curtain of
ignorance about resilience and
recovery.
Resilience and RecoveryResilience- the capacity of children and adults to succeed and thrive, despite experiencing trauma, mental illness and/or addiction. Resilient people have internal and external "protective factors.”
Recovery- A process of change through which people work to improve their health and wellbeing, live a self-directed life, and strive to achieve their full potential.
Four dimensions of recovery: My Health A safe and supportive Home A sense of Purpose in my life Belonging to Community
(from SAMHSA)
controlgroup
education:danger-ousness
education:responsibility
contact:danger-ousness
contact:responsibility
5.8
6.8
7.8
8.8
9.8
10.8
11.8pre post
Contact with someone with lived experience was more effective than education in reducing the perception of people with mental illness as dangerous.
A randomized control trial: Corrigan, P.W., et al. (2002). Challenging two mental illness stigmas: Personal responsibility and dangerousness.
Schizophrenia Bulletin, 28, 293-310
The effects of contact versus education were also greater when measuring attitudes of avoidance.
controlgroup
education:danger-ousness
education:responsibility
contact:danger-ousness
contact:responsibility
-4
-3
-2
-1
0
1
2
3pre post
controlgroup
education:danger-ousness
education:responsibility
contact:danger-ousness
contact:responsibility
-4
-3
-2
-1
0
1
2
3 pre follow-up
The effects of contact on attitudes of avoidance were sustained at the one month follow-up.
45
Framing Stigma Change
Protest Education Contact
Media-based
X XX XXXX
Live X XX XXXXXX
vehicle
-------processes--------
What a DIFFERENCE a friend makes!
47
frequency
27%27%
28%28%
29%29%30%
30%31%
31%32%
(March 2008) (May 09
frequency
Video Games
48
Website visits
49
Effect Size100 MILLION
thousands
50
Effect Size100 MILLION
thousands
Just going to the site is not enough
88% left after one minute!
Targeted Local Credible Continuous Change-focused Contact
TLC4
51
Who Should the TARGETS Be?
Health care professionalsEmployersLandlordsTeachersLegislatorsFaith communities
x
MILWAUKEE
Does it play in
Wausau?
What is LOCAL Contact?
Contact with peer
Example- • Nurse to nurse• Pastor to pastor• Football player to football player
What is CREDIBLE Contact?
54
Once is not enough
And variety is needed
CONTINUOUS Contact
55
What do you want the target group to do differently as a result of the contact?
CHANGE-FOCUSED Contact
Targeted Local Credible Continuous Change-focused Contact
TLC4
57
the Grand Plan
Speak up everyoneSpeak up everywhere
Carefully
Honest, Open & Proud
“strategic disclosure”
Levels of Disclosure
Social Avoidance – avoid situations
Secrecy – work to keep it a secret
Selective Disclosure – share it with select
people
Open Disclosure – no longer hide it
Broadcast Your Experience – actively share it
6060
Your Recovery Story
Motivated engagement
self esteem
I care for myself & others
I am good
Reversing Self and Public Stigma
Public Stigma
sense of efficacyI am able
Inclusion and Self-Directed Support
Engage Organizations Seeking to Reduce Stigma
Train/Support Storytellers
General Public Programs/Contact
Components:
1. WISE Basics Discussion
2. Support for Strategic Disclosure HOP
3. Consultation with organizations as they
Design, Implement and Evaluate TLC4
4. Share learnings statewide
What YOU Can Do Today 1. Seek out people with lived experience - listen to
their story.
2. Reinforce & support their resilience & recovery.
3. Wear lime green to create curiosity - be prepared to speak up.
4. Consider the story you can tell about recovery
5. Share other’s stories – one resource for short video stories is Rogersinhealth.org
6. Bring the conversation to your community – work, civic, faith, schools
Discussion
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