Anti-stigma Campaign Research Articles

Stigma of Mental Illness among Patients with Schizophrenia

Objectives: The study aims to explore the stigma of mental illness among schizophrenic patients in governmental psychiatric outpatient in Baghdad and to identify the association between the stigma and some of patients' socio-demographic characteristics. Methodology: A descriptive analytic design was used on purposive (non probability) sample of 100 schizophrenic outpatients throughout the period between March / November, 2013. The schizophrenic patients were enrolled in this study of out patient psychiatric clinic at Ibn-Rushd Psychiatric Teaching Hospital, Al-Rashad Psychiatric Teaching Hospital and Baghdad Teaching Hospital. Self administrative questionnaire was used by the investigators for the present study. The validity and reliability of the instrument was determined by using through the panel of experts, and internal consistency through the computation of Alpha Correlation Coefficient. The data have been collected through the utilization of the self administrated questionnaire as a mean of data collection except the respondents who are unable to read and write via structured interviewing. Data analysis was employed by applying the Statistical Package for Social Science version 17.0 (SPSS). Results: The finding of the study showed that the majority of the sample was unemployed, single males, aged between 33-40 years old and graduated of institute or college. They have more than 11 years duration of illnessand admitted 1-3 time in psychiatric hospitals. The schizophrenic patients experience a moderate level of mentalillness stigma. The correlation analysis indicated that there is significant association between stigma with maritalstatus and with their duration of illness but there is no association with remaining variables. Conclusion: The study concluded that schizophrenic patients have moderate level of mental illness stigma. Mental illness stigma associated significantly with marital status and the duration of illness for schizophrenic patients. Recommendations: The study recommended to increase public awareness about mental illness through the anti-stigma campaign and replication of the study on a large sample with more different variables its important.

Effect of the Time to Change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003–13: an analysis of survey data

Understanding trends and effective mechanisms that are likely to reduce public stigma and discrimination towards people with mental illness is important. We aimed to assess changes in public stigma in England after the introduction of the Time to Change anti-stigma campaign. We used data from the 2003 and 2007-13 national Attitudes to Mental Illness surveys to investigate 10-year trends in public attitudes across England before and during the Time to Change anti-stigma campaign. We present annual mean scores for attitude items related to prejudice and exclusion, and tolerance and support for community care. We also present an extrapolated linear trend line for the years 2009-13 and estimate population attitude scores without the campaign. We present unadjusted and adjusted linear regression models. In addition, we used multivariable linear regression models fitted to data aggregated by region to investigate whether a dose-effect response exists between campaign awareness and regional outcomes related to knowledge, attitudes, and intended behaviour. About 1700 respondents were surveyed each year. Significant increases in positive attitudes related to prejudice and exclusion occurred after the Time to Change campaign. In the multivariable analysis, we noted a significant increase in positive attitudes in relation to prejudice and exclusion after the launch of Time to Change (reverse-coded Z score 0·02, 95% CI 0·01 to 0·05; p=0·01), but not for tolerance and support for community care (Z score 0·01, -0·01 to 0·03; p=0·27). We also found evidence for a dose-effect relation between campaign awareness and regional improvement in knowledge (p=0·004) and attitudes (tolerance and support p<0·0001; prejudice and exclusion p=0·001), but not intended behaviour (p=0·20). The positive effects of Time to Change seem to be significant and moderate. Although attitudes are probably more at risk of deterioration during times of economic hardship, anti-stigma programmes might still play an active part in long-term reduction of stigma and discrimination, especially in relation to prejudice and exclusion of people with mental health problems. UK Department of Health, Comic Relief, Big Lottery.

Impact of the “Like Minds, Like Mine” anti-stigma and discrimination campaign in New Zealand on anticipated and experienced discrimination

The "Like Minds, Like Mine" anti-stigma and discrimination programme has been running in New Zealand since 1997. We aimed to investigate the nature and degree of anticipated and experienced discrimination reported by people with mental illness, and their views on whether the campaign was contributing to reductions in stigma and discrimination. Questionnaires were sent to randomly selected people who were representative of those who had recently used mental health services in New Zealand. The measure used was the modified Discrimination and Stigma Scale (DISC-12), adding questions on the effect of "Like Minds, Like Mine", and also assessing overall changes in discrimination in the previous 5 years. A total of 1135 participants completed the questionnaire. This included 225 Ma-ori, 196 Pacific, and 152 Asian persons. Over half of all participants reported improvement in discrimination over the previous 5 years, and 48% thought that the "Like Minds Like Mine" programme had assisted in reducing discrimination "moderately" or "a lot". Nevertheless, a clear majority (89%) reported experiencing at least "a little" unfair treatment in the previous 12 months due to their mental health problems. The primary source of both positive and negative discrimination was the family. Many (57%) participants had concealed or hidden their mental health problems from others, and 33% had stopped themselves from applying for work because they anticipated discrimination. Family, friendship, and social life were the most common areas of discrimination reported by the participants; however, many believed the overall level of discrimination had reduced over the previous 5 years. Overall, these results characterize the nature of stigma and discrimination anticipated and experienced by people with mental health problems and indicate modest but clear and positive recent progress in their reduction.

Impact significatif auprès des conseillers à l’emploi d’une action de sensibilisation à la santé mentale et de déstigmatisation incluant des usagers-formateurs

Developing programs and actions to fight stigma and discrimination against people living with mental disorders is a priority both internationally and in France. Involving mental health service users in these anti-stigma programs has proved to be a key element for effective programs. The present study evaluates the impact of user-trainers in an anti-stigma campaign with job counselors on their knowledge, beliefs, and desire for social distance with regard to mental illness and the mentally ill. Eighty-nine professionals participated in eight mental health awareness days from December 2008 to June 2009. Each training day was built around two pedagogical units: firstly, a psychiatrist providing a theoretical overview of mental illness and care and secondly, user-trainers describing their point of view on mental illness and exchanging with participants. A questionnaire administered at the beginning and at the end of the mental health awareness day assessed the impact of the day on participants' knowledge, beliefs, and desire for social distance. Answers to open questions were evaluated using thematic qualitative analysis. The intervention had statistically significant positive effects on all three training objectives: knowledge, beliefs and desire for social distance. Analysis of qualitative data confirmed participants' need for information and training with regard to providing support to clients with mental health problems; participants frequently attributed their improved self-confidence at the end of the day with regard to providing job coaching for this population group to the presence of user-trainers. A mental health awareness day using mental health service users and psychiatrists as trainers had significant positive effects in terms of reducing stigma with regard to people with mental illness. Further research is needed to understand whether the impact of such awareness approaches can be maintained in everyday professional practice over time.

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AbstractMagellan Contract Will Offer Specialty Integrated Care for Florida ConsumersMaine Psychiatrists Step up to Plate for Strategy to Address ShortageShutdown Raises Concerns about MH Funding, ServicesFDA Approves New Drug to Treat Major Depressive DisorderCommunity, Entertainment Leaders Honored at SAMHSA Voice AwardsNAMI‐NYC Anti‐Stigma Campaign Encourages Social Media UseBriefly NotedState NewsResourcesComing up

Economic evaluation of the anti-stigma social marketing campaign in England 2009-2011

Evidence on the economic impact of social marketing anti-stigma campaigns in relation to people with mental illness is limited. To describe the economic impact of the Time to Change (TTC) anti-stigma social marketing campaign, including the potential effects on the wider economy. Data collected for the evaluation of TTC were combined with the social marketing campaign expenditure data to investigate differences in knowledge, attitudes and behaviour in relation to campaign awareness. To evaluate the return on investment, we applied a decision model that estimated the impact on employment for people with depression. Based on average national social marketing campaign costs, the economic benefits outweighed costs even if the campaign resulted in only 1% more people with depression accessing services and gaining employment if they experienced a health improvement. The cost per person with improved intended behaviour was at most £ 4 if we assume the campaign was responsible for 50% of the change. Costs associated with improved knowledge and attitudes, however, were more variable. The findings suggest that the TTC anti-stigma social marketing campaign is a potentially cost-effective and low-cost intervention for reducing the impact of stigma on people with mental health problems.

Anti-stigma campaigns: Time to change

This evaluation of the Time to Change anti-stigma campaign in England represents a milestone in international stigma research. While showing some positive outcomes, the overall picture is mixed and falls short of the wholesale shift in attitudes that is needed. A new approach is proposed for the coming decades.

Sociodemographic determinants of attitudinal barriers in the use of mental health services in Japan: Findings from the World Mental Health Japan Survey 2002–2006

Sociodemographic correlates of Japanese attitudinal barriers to mental health services might be different from previous studies in Western countries, reflecting a different culture. We investigated sociodemographic correlates of attitudinal barriers to mental health services in a community population in Japan, based on data collected in the World Mental Health Survey Japan surveys. An interview survey was conducted of a random sample of residents living in 11 communities across Japan during 2002-2006. A total of 1359 participants were analyzed. The variables on attitudinal barriers to mental health services were measured by using the World Health Organization Composite International Diagnostic Interview 3.0. The association between these variables and sociodemographic variables were analyzed by using multiple logistic regressions. Being male was significantly associated with willingness to go for professional help and feeling comfortable to talk with a professional. Compared to the youngest group (20-34 years old), those aged from 35 to 49 years had a significantly lower prevalence of feeling embarrassed about friends knowing about their getting professional help, while the oldest group (aged over 65 years) had a significantly higher prevalence of being embarrassed. Being currently married was significantly associated with higher expectations about mental health services, but it was significantly and negatively associated with willingness to go for professional help. These results suggest that demographic patterns of attitudinal barriers to mental health services in Japan are unique, compared with previous studies in Western countries. An anti-stigma campaign may need to consider such country-specific patterns in a particular country.

3016 – How can we use social contact interventions to reduce stigma and discrimination against people with mental health problems?

Introduction Social contact is one of the most effective strategies for improving inter-group relations and is supported by decades of positive evidence. Several studies specifically support social contact interventions as a way of reducing stigma against people with mental health problems. Despite the effectiveness of this approach, some social groups have few opportunities for social contact in the real world. Objectives Using the England Time to Change anti-stigma campaign as an example, we investigate the feasibility and effectiveness of delivering social contact interventions at the mass population level to reduce stigma and discrimination against people with mental health problems. Aims To investigate: (i) the feasibility of scaling up social contact interventions to reduce stigma and discrimination against people with mental health problems and (ii) the effectiveness of mass population social contact interventions to: improve intended stigmatising behaviour, increase willingness to disclose mental health problems and to promote engagement in antistigma activities. Methods Two types of mass participation social contact programmes within England's Time to Change campaign were evaluated via self-report questionnaire. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health, and intended behaviour towards people with mental health problems. Results Findings on feasibility and effectiveness of social contact programmes will be presented. Conclusion This study suggests that social contact interventions can be used by anti-stigma campaigns to reduce stigma and discrimination against people with mental health problems. Further investigation is needed regarding the maintenance of these changes

Penetration of Time to Change leaflets on stigmatised attitudes to people with mental illness

Aims and methodTo determine whether members of the general public read a leaflet from the Time to Change anti-stigma campaign. The leaflets were sent to 1000 members of the public at random. Those who read the leaflet were asked, in a statement concealed within the text, to return it. A second study involved modified leaflets being posted to 400 members of a representative panel of the UK general public.ResultsOnly 20 of the 1000 (2%) people who received the unsolicited leaflet returned them, which suggests that the vast majority were unread. However, the leaflet achieved a good response in the sample from the research panel with at least 29% of participants (115 of 400) reading the leaflet.Clinical implicationsA very small proportion of people acknowledge unsolicited leaflets. However, the leaflet was read by almost a third of a research panel. Hence, few people are likely to read unsolicited leaflets, including those containing a public health message.

Réduire la stigmatisation des personnes souffrant de troubles psychiques par une campagne de communication ? Une synthèse de la littérature

ObjectiveFight against discrimination and stigmatization of people living with mental health disorder has become one of the most important political public health objectives. It has been identified as one of the five priorities of the 2008 European Pact for Mental Health and Well-Being. Stigmatization impacts the quality of life and jeopardizes the social integration. It has been shown that compliance to medical care was also impacted by individuals’ perception of their stigmatization. Numerous international programs targeting general population have been elaborated since the last decades, but those communication strategies haven’t raised the interests of researchers and academics. Hence, very few data are available to set new objectives to lower the social impact of stigmatization in people living with mental health condition. Material and methodsThis paper examines the rational and effectiveness of different anti-stigma campaign targeting mental health. By reviewing the scientific literature and policy documents on different strategies to address and lower stigmatization, we identified a typology of stigma-orientated actions and policies. Communication campaigns are the most common instrument used to address stigmatization. They are sometimes associated with communication programs targeting representations in general population through campaigns as well as representations in subgroups, through local and/or national actions. Specific information and training for journalists have also been experienced. ResultsVery few researches have observed convincing effects of anti-stigma campaigns in general population. Evaluations of the communication campaigns have revealed that they had a limited impact on representations. Attitudes towards people living with a mental disorder were still negative 5 years after the Changing Mind campaign, although there was an impact on the perceived distance by the respondents (how people living with mental health condition feel different from us). Actions targeting media and journalists led to ambivalent results, with a rise of positively connoted journal articles as well as negatively connoted papers. ConclusionsCampaigns targeting general objectives have not been proven to be effective. Some authors state that they should be replaced by local actions and programs, orientated to specific subgroups and should (a) associate the psychiatric services users and their families, (b) empower people living with mental health conditions, (c) be developed upon the experience of people who are been stigmatized. The rational of past communication campaigns as well as global communication programs were impaired by the absence of an operational definition of the problem addressed (discrimination, stigma, and stigmatization). Lack of empirical data on stigmatization jeopardizes the effects of these campaigns and their potential development. Conflict of interests in people managing the campaigns and the absence of systematic evaluation are also pointed as limitation for future developments.

Mass social contact interventions and their effect on mental health related stigma and intended discrimination

BackgroundStigma and discrimination associated with mental health problems is an important public health issue, and interventions aimed at reducing exposure to stigma and discrimination can improve the lives of people with mental health problems. Social contact has long been considered to be one of the most effective strategies for improving inter-group relations. For this study, we assess the impact of a population level social contact intervention among people with and without mental health problems.MethodsThis study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England’s Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4–6 weeks later.ResultsThis study investigated the impact of social contact and whether presence of specific facilitating factors (equal status, common goals, cooperation and friendship potential): (1) improves intended stigmatising behaviour; (2) increases future willingness to disclose a mental health problem; and (3) promotes behaviours associated with anti-stigma campaign engagement. Two mass participation social contact programmes within England’s Time to Change campaign were evaluated via a 2-part questionnaire. 403 participants completed initial questionnaires (70% paper, 30% online) and 83 completed follow-up questionnaires online 4–6 weeks later. Campaign events facilitated meaningful intergroup social contact between individuals with and without mental health problems. Presence of facilitating conditions predicted improved stigma-related behavioural intentions and subsequent campaign engagement 4–6 weeks following social contact. Contact, however, was not predictive of future willingness to disclose mental health problems.ConclusionsFindings emphasise the importance of facilitating conditions to promote positive social contact between individuals and also suggest that social contact interventions can work on a mass level. Future research should investigate this type of large scale intervention among broader and more representative populations.

Two Nations Assess Results of Stigma-Fighting Efforts

A major British anti-stigma campaign achieves modest progress in reducing mental-health-related discrimination, while Australian researchers report gains in public understanding of mental illnesses and their treatment.

England's Time to Change Antistigma Campaign: One-Year Outcomes of Service User-Rated Experiences of Discrimination

This study evaluated the progress at one year of England's Time to Change (TTC) program, launched in 2009, toward meeting its target to reduce mental health-related stigma and discrimination by 5%. TTC comprises three national components: antistigma marketing campaign activities, mass physical exercise events (Time to Get Moving) to facilitate social contact between people with and without mental health problems, and an online resource on mental health and employment (Time to Challenge). Part of the TTC evaluation consists of an annual national phone survey of mental health service users. Participants (537 in 2008 and 1,047 in 2009) were current outpatient service users aged 18-65 registered with National Health Service community mental health teams that are selected annually to represent the range of socioeconomic deprivation. Telephone interviews were conducted with service users with the Discrimination and Stigma Scale (DISC) to document experienced discrimination and anticipated discrimination in the past 12 months. One or more experiences of discrimination were reported by 9-1% of participants in 2008 and 87% of participants in 2009 (p = .03). In 2009 significantly less discrimination was reported from a number of common sources, including family (reported by 53% in 2008 and 46% in 2009), friends (53% and 39%), finding employment (24% and 16%), and keeping employment (from 17% to 13%). Experiences of discrimination from mental health professionals did not change significantly (reported by about one-third of participants in both years). Results suggest positive progress toward meeting the program's targeted 5% reduction in discrimination.

Introduction to the Special Section: Toward Social Inclusion

Introduction to the Special Section: Toward Social Inclusion

Impact of the first national campaign against the stigma of mental illness

Background Egypt experienced its first nationally televised antistigma campaign in 2007. This independent study aims at a scientific evaluation of the potential benefits of this campaign. Methods Two educational clips lasting 1 or 2 min each were aired daily on prime time television between 1 and 31 October 2007. Five messages were relayed as the clip rolled on. A specially designed questionnaire covering six areas was used; these included demographics, identifying those who have seen the clips, memory and opinion about each message, stigma-related attitudes, and behavior toward the mentally ill persons. Twenty mental health workers with experience in field work ranging in training from 1 to 13 years received two training sessions. The questionnaire was piloted on 82 participants and subsequently modified. A total of 3000 participants who consented to being interviewed were selected to participate. The data of 2274 participants from the Greater Cairo region are reported in this study (75.8%). Results The study sample is more representative of the younger, as only 21% of the sample were above 46 years, educated, as only 18% were illiterate, married, as 55% of the sample were married, and employed sections of the population. A total of 55% reported that daily life stressors were the cause of mental illness. Only 17% of the study sample actually acknowledged seeing the antistigma adverts (campaign exposed, CE) and 83% were campaign unexposed. There were no statistically significant demographic differences between both groups. Among those who saw the campaign adverts, a significant proportion reported a number of positive effects on attitude and behavior. However, when CE and campaign unexposed participants were compared, no statistically significant differences emerged. A total of 50% of the participants remembered that mental illness is curable. The question that psychiatric patients are dangerous to self or others showed a statistically significant difference between participants who were CE and those who were not exposed. Conclusion The public were willing to express their opinions as they showed significant cooperativeness and validity of their answers, especially those exposed to the campaign. The television is the medium of choice that the public prefer is the evidence stated in the paper. The antistigma media campaign leads to changes in the attitude of participants who are exposed to mental illness. Positive messages influenced attitude change more.

Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries

Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems is needed. This study links two large, international datasets to explore the association between public stigma in 14 European countries (Eurobarometer survey) and individual reports of self-stigma, perceived discrimination and empowerment among persons with mental illness (n=1835) residing in those countries [the Global Alliance of Mental Illness Advocacy Networks (GAMIAN) study]. Individuals with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment utilization and better perceived access to information had lower rates of self-stigma and perceived discrimination and those living in countries where the public felt more comfortable talking to people with mental illness had less self-stigma and felt more empowered. Targeting the general public through mass anti-stigma interventions may lead to a virtuous cycle by disrupting the negative feedback engendered by public stigma, thereby reducing self-stigma among people with mental health problems. A combined approach involving knowledge, attitudes and behaviour is needed; mass interventions that facilitate disclosure and positive social contact may be the most effective. Improving availability of information about mental health issues and facilitating access to care and help-seeking also show promise with regard to stigma.

What purpose does a website linked to a mental health anti-stigma campaign serve? Evaluation of the Open UP Website using surveys and Google Analytics

Background/Objectives: Open Up is the grass-roots anti-discrimination project run by Mind (mental health charity for England and Wales) and led by people with lived experience of mental health problems. It is one of the major components of the England-wide anti-stigma campaign „Time to Change“ that aims to reduce stigma towards mental health issues. As part of this campaign, Open Up has created the website „open-up.org.uk“ that provides information on mental health issues, Open Up events and it also gives the opportunity to exchange information and views on blogs. As part of the official evaluation, The Institute of Psychiatry at King's College London has set up an online survey that users could fill in, so use of and satisfaction with the site can be investigated in addition to data from Google Analytics. Methods: Data from Google Analytics was compiled to learn about the frequency and pattern of the website usage of all visitors. A supplemental online survey consisted of 7 closed questions inquiring about the effects of website use, satisfaction with the site, how people found out about the site and who they considered to be the closest person known with mental health problems. In addition, an open ended question prompted website users to make further comments which were analysed using thematic analysis. These data were compiled together to offer a framework for discussing the results found in Google Analytics and the survey with regard to reported benefit of one or several website visits. Results: Google Analytics revealed data on over 5,000 unique visitors for the year of 2010. Additionally, 27 visitors filled in the online survey between April and August 2010. Detailed findings will be presented for: (i) website satisfaction, (ii) self-reported motivation for and effects of the website use, (iii) qualitative analysis of comments provided about the website, and (iv) results from Google Analytics on the trends and profile of site usage. Discussion/Conclusions: The results help us to understand the role this website seems to play in the Time to Change anti-stigma campaign in terms of empowerment, providing information or facilitating contacts with other people associated with this campaign. Knowledge of the quality and specific function of such a website should help to improve and tailor its content to the aims defined by its purpose and use. As there were repairs performed on the website over the summer, this may have influenced low response rates. We will also discuss, however, practical issues around the evaluation of websites. The general usefulness of having websites as part of an anti-stigma campaign will also be discussed. Funding: Big Lottery, Comic Relief and Shift. Keywords: Discrimination, stigmatization, mental disorders.

Evaluation of Time to Change, a nationwide anti stigma campaign

The Time to Change anti stigma campaign is the largest campaign of its kind to be attempted in England. Launched in 2009 and running until 2011, the campaign aims to improve public knowledge and attitudes and to decrease discriminatory behaviour towards people with mental illness. The evaluation of the campaign presented here illustrates findings regarding various aspects of the campaign, including a national media campaign, local projects and an online resource.

FC20-04 -’Who is on my side?’ - qualitative analysis of ethnic minorities experiences of mental health related stigma and discrimination

IntroductionThe Time to Change (TTC) anti-stigma campaign, launched in January 2009 in England, intends to make fundamental improvements across England in: public knowledge, attitudes and discriminatory behaviour in relation to people with mental illness. To be effective and valid the campaign must reach a wide range of diverse audiences. This study explores attitudes of people from ethnic minority communities in relation to mental health.ObjectivesThe study investigates:1)General attitudes and perceptions about mental illness in ethnic minority communities2)How we might increase awareness about mental wellbeing and decrease stigma in ethnic minority communities.MethodsTen focus groups with members of ethnic minority groups were conducted. Five groups consisted of service users and five were composed of non-service users. Two groups comprised participants from an Indian origin, two Somali origin, two Afro-Caribbean origin and the other groups were mixed.ResultsWe will present findings regarding the ways in which traditional perceptions of mental health and personal experiences of ethnic minority service users affect their perceptions of sources of support such as family, friends, medical staff and religion and how this feedback could inform ant-stigma interventions.ConclusionThe study suggests that in order to maximise the impact of anti-stigma campaigns, attention should be given to sources of discrimination and traditional perceptions of mental illness which are emphasised by ethnic minority groups. When planning anti-stigma campaigns it is important to incorporate experiences and perceptions from a wide range of audiences.