Erasing the Stigma of Mental Illness What Says

Erasing the Stigma of Mental Illness What Says the Dodo Bird? Patrick Corrigan Illinois Institute of Technology

STOP

UNINTENDED CONSEQUENCES Everybody has won and all must have prizes!

Everything Works Psychoanalysis Cognitive Therapy What do we do? Unintended Consequences

Social Justice

BEAT RACISM X

BEAT HOMOPHOBIA DON’T ASK DON’T TELL

Pope Francis I Inaugural Mass March 19, 2013 “THE POOR!” “THE WEAK!” “THE LEAST IMPORTANT!”

Pope Francis I Inaugural Mass March 19, 2013 BESTOW“THE POOR!” “THE WEAK!” EMPOWER “THE LEAST IMPORTANT!” “Whatsoever you do to the least of my brethren, that you do unto me!” John

LOKI

Psychiatric Rehabilitation 12

WHAT IS STIGMA?

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People with mental illness are homicidal maniacs In the movies 20

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People with mental illness are homicidal maniacs In the newspapers 23

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People with mental illness are homicidal maniacs In advertising 27

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People with mental illness are homicidal maniacs In comics 32

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Benevolence stigma 36

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Trenton State Hospital has fire.

Roasted Nuts 43

Has Stigma Changed? DANGER Phelan, Link et al 44

Has Stigma Changed? DANGER Phelan, Link et al 45

Has Stigma Changed? DANGER Phelan, Link et al 46

Has Stigma Changed? DANGER Phelan, Link et al 47

------types-----S t r u stereotype c t u prejudice r e s discrimination Public stigma Selfstigma Label Structural avoidance stigma 48

WHAT IS STIGMA?

STEREOTYPES PREJUDICE DISCRIMINATION ◦ All Irish Americans are drunks and beat their wives. ◦ That’s right. They’re drunks and I loathe them. ◦ So, don’t: hire, rent, or befriend them 50

STEREOTYPES PREJUDICE DISCRIMINATION ◦ People with MI are: weak, dangerous…. ◦ They are bad because: scary, shameful. ◦ So, don’t: hire, serve, or rent to them 51

S t r u c t u r e s -------types-------Public stigma Selfstigma Label avoidance stereotype prejudice discrimination 52

The Egregious Effects of Public Stigma: Its Impact on SOCIAL INCLUSION Lost employment Subpar housing Worse health care Worse educational opportunities Diminished legislative support Alienated faith communities Coercive treatment

WORSE HEALTH CARE PTCA: percutaneous transluminal coronary angioplasty Druss et al. , 2000

S t r u c t u r e s -------types-------Public stigma Selfstigma Label avoidance stereotype prejudice discrimination 55

Self-Stigma Decreased self-esteem ◦ I am not worthy Decreased self-efficacy ◦ I am not able Why try? ! ◦ I am not worthy of a good job ◦ I am not able to live alone

S t r u c t u r e s -------types-------Public stigma Selfstigma Label avoidance stereotype prejudice discrimination 57

Care Seeking Label Avoidance 45% Epidemiological Catchment Area, National Co-morbidity Survey, NCSII 58

Adherence Label Avoidance 22% Canadian Community Health Survey Corrigan, P. W. (2004). How stigma interferes with mental health care. American Psychologist, 59, 614 -625 59

June 14, 1965 ERASING STIGMA IS NOT ENOUGH You do not wipe away the scars of centuries by saying: Now you are free to go where you want, and do as you desire, and choose the leaders you please. Affirming attitudes and actions

Affirming Attitudes People with mental illness recover. They should determine all their goals and interventions to reach those goals. Actions: ◦ Reasonable accommodations ◦ Community supports

S t r u c t u r e s -------types-------Public stigma Selfstigma Label avoidance stereotype prejudice discrimination 62

S t r u c t u r e s ---types---Public stigma stereotype prejudice Label avoidance TWO AGENDA TO ERASE STIGMA discrimination 63

S t r u c t u r e s ---types---- stereotype Public stigma Label avoidance SERVICES AGENDA RIGHTS AGENDA prejudice discrimination 64

TWO AGENDA Services Agenda ◦ Services help ◦ Decrease stigma to get people into care. ◦ Mental illness is treatable. Rights agenda ◦ Discrimination is WRONG. ◦ Decrease stigma to support life goals ◦ Social justice message

DIFFERENCE beyondblue Recovery MEN DO GET DEPRESSION! THERE IS HOPE TREATMENT CAN HELP. MOST PEOPLE RECOVER Dental DENTAL HYGIENE FLOSS DAILY

similarity 11 10 9 pre post 8 7 6 beyondblue recovery dental

disempowerment 12 11 10 pre 9 post 8 7 6 beyondblue recovery dental

HOW DO WE ERASE STIGMA? UNINTENDED CONSEQUENCES

EASY STUFF: Just change the words!

Just Change the Words! Leprosy to Hansen’s Disease Dementia to Alzheimer’s Mental Retardation to Intellectual Disability Mania to Bipolar Illness

The East Asian Experience Japan: Seishin-Bunretsu-Byo to togo shitco sho “mind split disease” Korea: “integration disorder” Jeongshin-bunyeol to Johyun-byung “mind splitted disorder” “attunement disorder” Jing Shen Fen Lie to Si Jue Shi Tiao Hong Kong: Singapore, China “splitting of the mind” “dysfunction of thought and perception” Sartorius et al. , 2014

Schizophrenia: Bleuler’s Syndrome RESEARCH “ 47 studies” Lasalvia et al. , 2015 correspondence, editorial, comments, forum -Professional Impact -Public Impact

It Looks easy: NIMH and other funders decrease support Advocacy groups: No longer a problem

Framing Stigma Change -------processes---- Protest Education Contact v e h i c le Mediabased In vivo 75

KNOWLEDGE IS GOLD: Educate stigma away!

75% US school districts 43 countries RESEARCH Uncertain effects No effects RTI (1994) Cal Dept Ed (1995) U Maryland (1998) Worse effects APA (1999) Indiana U (1992)

Framing Stigma Change -------processes---- Protest Education Contact v e h i c le EDUCATION Mediabased In vivo 78

MENTAL HEALTH LITERACY Learn about mental health challenges Learn about ways to address challenges Wellness and contribution

Framing Stigma Change -------processes---- Protest Education Contact v e h i c le EDUCATION Mediabased In vivo 80

Mental Illness is a Brain Disorder!

Mental Illness is a Brain Disorder! RECOVERY

Mental Illness is a Brain Disorder! RECOVERY HIRE THEM? RENT TO THEM? EQUAL HEALTH CARE?

Meta-Analysis: Knowledge and Stigma Knowledge: Causal Beliefs Stigma: Acceptance Sixteen representative samples of nationdefined populations 230 to 6000 Ss Response rates: 65 -85% Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011

META-ANALYSIS FINDINGS: CAUSE Inherited/Genetic Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011

META-ANALYSIS FINDINGS: CAUSE Brain Disease Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011

META-ANALYSIS FINDINGS: ACCEPTANCE Co-worker Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011

META-ANALYSIS FINDINGS: ACCEPTANCE Neighbor Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011

Framing Stigma Change -------processes-------v e h i c le Protest Education Contact PROTEST Mediabased In vivo 89

PROTEST: The Pros and CONs!

Protest ◦ Review stigmatizing images ◦ Shame on you for thinking that way 91

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�Beware the rebound effect the white bear 93

Wonderland 2000 NAMI - stigmabusters

The JASONUT The SUICIDE SQUEEZE The CRAZY FACE Located in Campbell and San Jose California

Join the national on-line food fight. Help turn lemon donuts into lemonade. Join the national on-line food fight. Help turn lemon donuts into lemonade.

examiner. com I'm an advocate of equal rights and a more tolerant world toward all people of different races, religion, gender, and sexual orientation; but that is it. Any thing else is just moronic. Stan Rezaee, Aug, 2009

FRANCHISE OPPORTUNITIES

Framing Stigma Change -------processes---- Protest Education Contact v e h i c le CONTACT Mediabased In vivo 99

CONTACT vs EDUCATION The Pros and CONs!

Contact “Meet Bob Lundin” 10 1

Bob’s story I have ◦ My name is ______ and a severe mental illness called schizo-affective disorder ◦ My childhood was not unusual… ◦ Unfortunately, my mental illness was It did not go away quickly… traumatic. I have achieved ◦ Despite these problems, several accomplishments. 10 2

Meta-Analysis: Contact vs Education DV’s ◦ Overall ◦ Attitudes ◦ Behavior > 38, 000 Ss 79 studies; 13 RCTs Corrigan, Michaels et al. , 2012

Mean effect sizes: RCTs only p<. 05

TLC 3

TLC � Targeted � Local � Credible � Continuous � CONTACT Corrigan, 2011 10 6

Who should targets be?

Targets Landlords Health care professionals Teachers Legislators Employers

What is local?

LOCAL X

LOCAL Does it play in PEORIA? CHICAGO: the heart and brains of Illinois x ILLINOIS

Local �City �Office �Church, synagogue, mosque �School 11 2

� Good stigma change �credible �continuous 113

Credible �Contact with whom? �Example ◦ Military (PTSD) ◦ Other enlisted members �Marines from marines �Sailors from sailors 114

Continuous �Once is not enough �And cannot be carbon copies 11 5

TLC � Targeted � Local � Credible � Continuous � CONTACT Corrigan, 2011 11 6

The GRAND PLAN

Come out everyone out everywhere

the Grand Plan Come out Mad Come out Proud

Patty Duke Rod Steiger Mike Wallace Margot Kidder

Thurgood Marshall Effect BEAUTIFUL MIND

COMING OUT PROUD to erase the stigma of mental illness

Public stigma stereotype prejudice discrimination Selfstigma Label avoidance

Public stigma stereotype prejudice discrimination Selfstigma Label avoidance

What’s in an name? LGBT agenda ◦ Confusing ◦ Objectionable ◦ Honest, Open, Proud

Disclosure? Passive COMING OUT PROUD ◦ assertive

Disease Identity DONT BE A MENTAL PATIENT

Human Identity EMBRACE WHO YOU ARE

PRIDE? Accomplishment ◦ Overcoming disability Who I am ◦ Ethnic pride Authenticity

Coming Out Proud program Three Lessons ◦ Consider the pros and cons of disclosing ◦ There are different ways to disclose ◦ Telling your story 2 RCTs

Disclosure Benefits Rusch et al. , 2014 N=100 p<. 05 2 X 3 ANOVA F=4. 70, p<. 01

COP MULTI-SITE

17 16 15 14 13 12 * * pre post * follow-up ** 11 10 9 COP control APPLY COP control HARM SELF STIGMA

29 27 +* 25 23 ** ** pre post 21 19 follow-up + 17 15 COP control STIGMA HARM ± p<. 10 * p<. 05 COP control COPING RESOURCES ** p<. 01

the ADVOCATE’S AGENDA

“I must fight in the open!” Clifford Beers - 1909

“Let our first act every morning be to make the following resolve for the day: I shall not fear anyone on earth. I shall fear only God. I shall not bear ill will toward anyone. I shall not submit to injustice from anyone. I shall conquer untruth by truth. And in resisting untruth, I shall put up with all suffering. ” Mahatma Gandhi 140

National Consortium on Stigma and Empowerment www. ncse 1. org corrigan@iit. edu