Stigma and Mental Health Youth with Mental and

Stigma and Mental Health: Youth with Mental and Neurodevelopmental Disorders… and What Does It Mean in the Era of COVID-19? Stephen P. Hinshaw University of California, Berkeley University of California, San Francisco 4/14/20

SCCAP Webinar Stigma and Mental Health: Youth with Mental and Neurodevelopmental Disorders… and What Does It Mean in the Era of COVID-19? Presenter: Stephen Hinshaw Professor, UC Berkeley and UC San Francisco Moderator: Omar Gudino Associate Professor, University of Kansas

Audience Questions and Answers Submit a question during the webinar: • Post your questions for the Q&A segment! On right side of screen, click on the Questions tab on the Go-To-Webinar control panel, and submit your questions Upcoming webinars: Submit your ideas for our 2020 Webinar Series: sccapdiv 53@gmail. com Previous webinar recordings are available on https: //sccap 53. org/resources/education-resources/webinars/ 2020: May 12 Noon ET Addressing Intersectionality When Working with Children and Families: Applying the Multicultural Guidelines - Alfonso Mercado Ph. D, & Earl Turner Ph. D June TBA Working in Integrated Pediatric Primary Care Settings - Meghan Lines and Cheyenne Hughes-Reid July TBA Preparing for Internships Panel Discussion Sept. 11 Noon ET Children and Technology Use - Justin Parent, Ph. D Sept. 29 Noon ET Cannabis Use in Adolescents - Mary Fristad, Ph. D Fall 2020 R. Bob Smith Excellence in Assessment Webinar, Free Member CE – Catherine Lord, Ph. D

Objectives • Understand the concept of stigma • Many new attendees today, since February webinar, so a bit of ‘basics’ • What about stigma related to youth mental and neurodevelopmental disorders? • What can be done to overcome stigma? • What about stigma—and the need for ‘social distancing’—in the era of COVID-19?

Stigma Hinshaw (2007), The Mark of Shame (Oxford U. Press) • Ancient Greece: Literal ‘mark of shame’ • Brands placed on slaves or traitors • Today, usually psychological /social “branding” • Which groups are stigmatized? • Racial minorities, sexual minorities, women, left-handers, physical disabilities, adoptees, obese, delinquent youth, mental illness, developmental disorders… • Can things change? See attitudes re: gay marriage • Thus, hope for optimism—malleability of social/cultural views • Most stigmatized today: • People with mental illness, homelessness, substance abuse

Major Change in Perspective • Conceptions of stigma today: • Stigmatizing processes part of ‘normative’ social cognition • Important distinction between explicit and implicit bias/stigma • Thus, distinguish… • Stereotypes (cognitive) • Prejudice (affective) • Discrimination (behavioral) • Stigma • All this plus…global nature of castigation/self-fulfilling prophecies • Important: • Although public knowledge is up, public attitudes have not changed in 60 years (and actually far worse in terms of perceptions of violence)

Evidence for MI Stigma and Discrimination • Studies of overt attitudes • S. Fiske: “lowest of the low” • Perceived as lacking in both warmth and competence • Insula--‘lights up’ with relevant images (disgust) • B. Pescosolido: National survey of adults • Re: children with depression or ADHD--stigma prevalent • Covert/implicit attitudes • Rejection occurs at unconscious level • Examination of laws and everyday practices • In many states, no vote/jury/driving/run for office/child custody • Media portrayals (still dominated by school shootings) • Until relatively recently, Massachusetts ‘stubborn child law’

Why Such Stigma? We need only a year’s seminar to discuss… • Threat theory: • Threatens perceiver’s sense of stability, may ‘prime’ sickness/death fears • Control: • Attribution theory: Negative attributes believed to be controllable are more stigmatized (thus, medical model should help) • Structural Reasons: • System justification, in hierarchical societies (all!): If those lower in the hierarchy are to blame for their own ills, we sleep more soundly at night

Reasons #2 • Conditioning: • Pervasive media images of violence, incompetence • Evolutionary : • Natural Selection for bonds AND for lack of disease/exploitation • Kurzban & Leary (2001), Psychological Bulletin: ‘modules’ linked to infestation, low social capital, and ‘difference’ • Dehumanization: • Perception that person with mental illness or NDD isn’t fully human • Martinez et al. (2011): single word changes perceptions • Magnified for children • Most didn’t survive infancy until recent era in human history • Property, valued for ability to work and/or learn • Doubly magnified for children with disabilities (see below)

Self-stigma (internalized stigma) • Nearly all members of stigmatized groups are aware of the culture’s stereotypes/beliefs/practices • Thus, likelihood (though not certainty) that such individuals will internalize these beliefs • Even adjusting for initial levels of symptoms, self-stigma predicts (a) lack of treatment seeking and (b) early termination from treatment • Antidotes: advocacy, self-help, social power • Importance for parents of youth with ‘differences’

Courtesy Stigma—and Families • Goffman (1963): • If society has stigmatized a given class of people, it’s common courtesy to stigmatize those associated with such individuals, particularly family members • Parents of youth with mental disorders: Directly blamed for offspring’s problems for decades • Even genetic transmission places blame on parents • Objective burden and subjective burden • Subjective burden usually experienced as worse • Mental health professionals/scientists ‘in the shadow’

Child Mental Disorders, NDD’s, ASD • Stigma remains high overall • Not just for most severe forms of MD or NDD • High-functioning vs. more severe ASD • Stigma perceived as HIGHER by parents former • ADHD: why would it be stigmatized? • Its very inconsistency is crucial for attributions of control • LD: Youth seems ‘smart’—must be lack of effort

And…. • Trauma • Effects must be considered (e. g. , ACEs research) • But beware of attributions of permanence • E. g. , for traumatized youth, or those detained/warehoused at border • I worry about news emphasizing the permanent scars • Indeed, perhaps the largest antidote to stigma is (a) evidencebased treatment and (b) potential for resilience

Multi-level Problem/Multi-level Solutions • Systems: Non-discrimination, parity, insurance, training of relevant professionals in evidence-based care • Media: Reduce the prevalence of images of incompetence and/or violence • Individual/Social: Humanization, contact, acceptance • With the added benefit of reducing self-stigma • Pure “education” (i. e. , teaching of facts) may in fact reinforce stereotypes and increase stigma • All of the above and more are required!

Even More…. • Is ASD a ‘difference’ (e. g. , neurodiversity) vs. a disorder (i. e. , a disorder in need of treatment)? • Should society ‘accept’ and/or should individual receive intervention? OR BOTH?

Social Distancing • Clearly, this is essential RIGHT NOW, especially given our late start • But what a term! • “Social distance” first used in 20 s by sociologist Robert Park • Early 30 s: Bogardus creates “social distance scale” • How ‘close’ would you choose to be…. • Same county…neighborhood…project… go out with…let your daughter marry? • Social distance is what stigma-related investigators hope to REDUCE • Will we get used to/accept social distance vs. ethnic racial minority groups and people with mental/neurodevelopmental disorders post-COVID? • Replace with terms like ‘physical distance’ or ‘spatial distance’? • NY Times just beginning to do so

Can we maintain physical distance…yet maintain our species’ crucial need for social contact? • Perhaps our biggest challenge, moving forward… • With particular relevance for racial/ethnic and mental illnessrelated distance, stigma, and even hatred • Post COVID: Backlash or move forward?

Source Citation for this Presentation With website link-- • Hinshaw, S. P. , (2020). Stigma and Mental Health: Youth with Mental and Neurodevelopmental Disorders…and What Does It Mean in the Era of COVID 19? [Power. Point slides]. Retrieved from https: //sccap 53. org/resources/educationresources/webinars/ • Without website link- • Hinshaw, S. P. , (2020). Stigma and Mental Health: Youth with Mental and Neurodevelopmental Disorders…and What Does It Mean in the Era of COVID-19? [Power. Point slides]. Webinar sponsored by the Society of Clinical Child and Adolescent Psychology, Division 53 of the American Psychological Association. New York, NY.

Time for Questions! • No time for your question? • Still have questions? • **Please post them on the SCCAP Listserv to continue the community discussion div 53@lists. apa. org