Assessment Results
Trends
and Patterns with Supporting Quotations:
1. Stigma comes from a lack of
understanding.
One major trend
that emerged from the two focus groups we conducted is that there is a lack of
understanding regarding mental illness and mental health stigma. Focus group members identified multiple
populations that need further education about stigma and mental illness,
including: peers, teachers, parents, mental health professionals, and the
public. A common report was that these groups’ lack of understanding leads to
mental illness frequently being viewed as something negative, and that
increasing understanding may decrease stigma.
“Therapists
and people in the field are judgmental and this stigma from them is very
damaging, as they
are the ones that are supposed to be helping us.”
“…Staff are like
‘this is what your file says so this is what you are.’”
2. Stigma comes from labels
The second quote
above also represents another trend that emerged; being labeled as a diagnosis
rather than a person. Multiple focus
group members expressed that they have a negative view of being labeled and
have endured negative experiences regarding being lumped into a “depression” or
“anxiety” category, rather than being acknowledged by teachers, parents, mental
health workers, and friends as a human being who experiences symptoms
associated with depression or anxiety. Furthermore,
labeling can become a self-fulfilling prophecy, especially during the time of
adolescence when youth are striving to find their identity. Adolescents may incorporate their diagnosis
into their identity, or their diagnosis may become their identity. “So many kids
become whatever their diagnosis is. They
get so trapped in that that they get really
depressed by thinking ‘I’m no longer the happy person I used to be. I’m just my depression.’ And I
think it affects people immensely.” “When you’re a kid
you’re trying to figure out who you are, trying to find your identity. I think that
sometimes when you’re labeled with things that, like that’s your identity so you have to live
up to it.”
3. Stigma can be reduced by
education
In a variation on
the first theme of stigma arising out of a lack of understanding of mental
illness, focus group members identified that education is a solution to help
reduce mental health stigma. Ideas about
education varied greatly, from incorporating mental health lessons into high
school health curriculum to using personal stories and “strategic sharing” to
political advocacy seeking legislative action. These various efforts of education echo some
of the efforts put forth and later examined by California’s Mental Health
Services Act in 2004 (Clark, Welch, Berry, Collentine, Collins, LeBron, &
Shearer, 2013). These similarities
suggest that the members of our focus groups demonstrated impressive insight
into how to foster change and reduce stigma. Additionally, another article
about stigma identifies potential solutions to reducing mental health stigma as
“protest, education, and contact,” all three of which seem to resonate with the
ideas brought up during our focus groups (Byrne, 2001, p. 283).
“If you teach
sexual health, why not teach mental health?”
“It’s also an
education thing…they don’t know how to handle [mental illness] because they’ve never been
equipped with that information.”
Action
Plan
(1) Plan for addressing the issue/problem:
To help reduce mental health stigma and to empower
individuals who are living with mental illness, we are tailoring a plan based
on the responses from our focus groups to address mental health stigma from a
variety of angles.
Our interventions will include:
-
A policy brief paper that will be used to educate lawmakers, school districts,
etc. This paper will discuss why stigma is an issue that should be
addressed, as well as possible solutions to reduce mental health stigma, such
as providing mental health education in schools or having a statewide mental
health awareness day.
-
Facilitating a partnership between the University of Utah College of Social
Work and YouthMove, which would allow YouthMove to educate future mental health
professionals about the consequences of mental health stigma.
- Creating a training template for YouthMove to use in
future presentations with lawmakers, educators, healthcare providers, and
students.
- We will support YouthMove with their fundraising event, “Strike-Out Stigma,” a bowling tournament
for Children’s Mental Health Awareness, taking place on May 2nd,
by spreading the word about the event and encouraging people around us to
attend.
(2) Goals for
addressing the issue/problem:
Education
is the number one goal as we look to reduce stigma, based on research we have
done and our focus group results. Studies have been done to show that stigma
develops as young people misattribute information that they have learned to
categorize people in an effort to simplify their understanding of the
world. Social Learning Theory (Jones and
Corrigan, 2014) and Developmental Intergroup Theory (Bigler and Liben, 2006)
provide two different examples of how kids take in information, categorize it,
and assimilate it into stereotypes and stigma. Faulty information or education
acquisition lead to stigma and could be remedied through better education on
mental health issues. The sub-goals we
have regarding education are:
- Educating mental health providers about how
they might perpetuate stigma in their interactions with young people, and how
they can reduce stigma.
- Promoting better education on peer support
and mentoring programs within existing school programs. YouthMove’s “strategic sharing” of personal stories
is one strategy that can be used in schools. Additionally, anti-bullying
campaigns are in the limelight currently, and could be modified to include
education about mental health.
- Educating young people with mental health
issues about the importance of communication and assertiveness. Their ability to advocate for themselves plays
a valuable role in educating others.
YouthMove described this as the butterfly effect; as they educate
individuals around them, their message gradually ripples out to others that
each person is in contact with.
(3) Social
change model most appropriate to meet the goal:
The social change
model most representative of our goal and efforts toward it is Gamble’s (2010)
“Organizing Functional Communities.” Our
desired outcome is support of YouthMove’s efforts to reduce the stigmatization
of mental illness, particularly in the lives of children and adolescents –
targeting prejudicial attitudes and behaviors that cause significant suffering
in this population. The systems targeted
for change are primarily the general public, educational institutions, and
state government as a vehicle for engaging the latter. Our primary constituency is people in the
community who share our awareness of this issue. We identify our primary community practice
role in terms of advocacy, i.e. supporting and helping YouthMove members in
their efforts to have their voices heard and to empower themselves. A second model that applies to our goal is
Speaker for Advocacy, demonstrated by our reaching out with a policy plan to
State officials and our appeals to educators.
Our scope of concern is advocacy and support for not only YouthMove but
also for the population as a whole.
(4)
Strategies and tactics that can be implemented:
We are hoping to have
what Pyles (2014) termed “tactical diversity” (p. 149-150), in our
interventions, because the issue we are
fighting is tough to fight in just one arena, it instead needs a wide variety
of interventions.
Some strategies that could be used in
implementing our interventions may be:
-Promoting awareness for YouthMove and their
events through social media sites, distributing flyers, emailing friends and
family, and encouraging individuals to attend the events.
-Contacting College of Social Work professors
about having YouthMove present to classes on mental health stigma in order to
educate future clinicians.
-Promoting YouthMove’s efforts in going to the
legislature by distributing information about the Rally for Recovery, compiling
information relevant to policy concerns, and providing a policy brief for
YouthMove’s use.
- A policy brief written to lawmakers in hopes
of influencing policy in the way Pyles (2014) described as “legislative advocacy”
(p. 151).
(5) Manner in
which the target population can play a key role in the efforts:
Although we can
assist YouthMove, we must recognize that they are experts on mental health
stigma through their firsthand experience.
The group members talked adamantly about how sharing their stories had a
cumulative effect. Continued sharing is
something they can do to help with our shared cause. Currently, YouthMove does small events to
bring awareness to their cause and connect them with people working for the same
goal. By working together and increasing connections, we can increase awareness
for this issue, which is one of our major goals. YouthMove’s ability to ask for help is a
strength they have, and they show strength and humility in allowing us to help
as outsiders. Additionally, as young
people they might better understand the benefits of youth organizing and their
unique abilities as youth to enact change (Pyles, 128-30). They have a passion for this cause that cannot
be found in other places, and their ability to “strategically share” their
experiences is something that only those personally affected by stigma can
offer.
YouthMove could
also provide a forum for the education and involvement of young people, which
could help achieve the goal of empowering individuals with mental illness. YouthMove
also has the strength of capacity building in asking us to help them compile
educational information they can share (Pyles, 118), ultimately helping with
the goals of reducing stigma and effecting social change.
(6) Evaluation for
Effectiveness of Action Plan:
In our action
plan, we focus on education and awareness of mental health stigma. These education and awareness measures will take
different forms, and we recognize that these measures are broad and may require
more resources than we are able to afford.
Therefore, we have chosen to approach our interventions from a community
based participatory research (CBPR) or service perspective. This perspective will also include our
investment in and use of coalition building.
Researchers who
have implemented interventions in marginalized communities have found that the
CBPR approach works better. In CBPR, the
individuals whom the interventions or research will help are involved at every
phase of the research or intervention.
These same researchers have found that sometimes programs fail because
they are not focused on important issues from the view of the target population
and don’t build on strengths and resources in the communities (Smith, Christopher,
& McCormick, 2004). For our project to be effective, we plan to
build on the strengths and resources of the target population and use results
from our focus groups. CBPR puts a lot
of emphasis on the target population, which can present challenges. The challenges may include keeping the population
motivated and coming up with measurable objectives. One researcher suggested focusing on
measuring social capital. The researcher
said that “increases in the level of social capital in a given community
indicate progress in the desired in the desired direction” towards the outcome
of interest (Petersen, 2002). We will try to focus on understanding whether
our social capital is increasing as we measure the effectiveness of our
interventions.
Other researchers
have found that when using a CBPR approach, a steering committee is
necessary. This steering committee
involves members of the target population as well as members from groups that
provide services to the target populations (Klemm,
Rempushesk, & Teixeira, 2013). Currently, we do not consult with those who
are offering services to our target population and we plan to contact these
providers soon. We will then seek
permission from the target population to have these providers be part of our
steering committee. Research shows that
policymakers are increasingly looking up to coalition programs to improve
services or solutions to some social and public health issues. Effective coalitions should be able to
identify interventions that should bring change and these coalitions should
have a number of organizations or stakeholders who are concerned about the
issues at hand (Kadushin,
Lindholm, Ryan, Brodsky, & Saxe, 2005).
As we build
effective coalitions and improve our CBPR approach. We will be satisfied to have included in our
program evaluation measures for effectiveness.
Our greatest tool in evaluating the effectiveness of our interventions
is going to be use of statistical methods.
Projects like ours find it very useful to design surveys that assess
knowledge or awareness of the problems at hand.
They then do a pre and post intervention survey of groups involved, then
analyze the results and compare the means and frequencies of the pre and
posttests (Akintobi et al.,
2011). We will employ these methods and test for
statistical significance.
References
Akintobi, T. H., Trotter,
J. C., Evans, D., Johnson, T., Laster, N., Jacobs, D., & King, T. (2011).
Applications in Bridging the Gap: A Community-Campus Partnership to Address
Sexual Health Disparities Among African-American Youth in the South. J Community Health, 36(3), 486-494. doi:
http://dx.doi.org/10.1007/s10900-010-9332-8
Bigler, R., & Liben L.S. (2006). A
developmental intergroup theory of social stereotypes and prejudice. Advances in Child Development and Behavior. 34:39-89.
Byrne, P. (2001). Psychiatric
stigma. British Journal of Psychiatry,
178, 281-284.
Clark, W., Welch, S. N., Berry, S.
H., Collentine, A. M., Collins, R., Lebron, D., Shearer, A. L.
(2013).
California’s historic effort to reduce the stigma of mental illness: The Mental
Health Services
Act. American Journal of Public Health,
e1-e9.
Gamble,
D. N., & Weil, M. (2010). Conceptual frameworks and models for community
practice.In Gamble, D.N. & Weil, M. (Eds.), Community practice skills:
Local to global perspectives (pp. 24-46). New York, NY: Columbia
University.
Jones, N. & Corrigan, P.W. (2014).
Understanding Stigma. In P.W.
Corrigan (ed.), The Stigma of Disease and
Disability: Understanding Causes and Overcoming Injustices (pp. 9-34). Washington, DC: American Psychological
Association.
Kadushin, C., Lindholm, M., Ryan, D., Brodsky, A., &
Saxe, L. (2005). Why It Is So Difficult to Form Effective Community Coalitions.
City & Community, 4(3), 255-275.
Klemm, P. R., Rempushesk, V. F., & Teixeira, J.
(2013). A nonprofit community service and academic collaboration to increase
outreach to older adults with cancer: Lessons learned. Journal of Gerontological Social Work, 56, 554-568. doi: http://dx.doi.org/10.1080/01634372.2013.793222
Petersen, D. M. (2002). The Potential of Social Capital
Measures in the Evaluation of Comprehensive Community-Based Health Initiatives.
American Journal of Evaluation, 23(1),
55-64.
Pyles, L. (2014).
Progressive Community Organizing:
Reflective Practice in a Globalizing World. New York, NY.
Routledge.
Rothman, J. (2007). Multi
modes of intervention at the macro level. Journal of Community
Practice, 15:4, 11-40. doi:10.1300/ J125v15n04_02
Smith, A., Christopher, S.,
& McCormick, A. K. H. G. (2004). Development and implementation of a
culturally sensitive cervical health survey: a community-based participatory
approach. Women & Health, 40,
67-86.
