1. Presented by:
Marcia Gibson
London UK
January 23, 2009

2. Why do we label? Why do we label?
In general terms: make sense of the world (child development) – our never-ending need to categorize
In terms of negative labels: fear; generalizing a negative experience

3. What is Beyond the Label?
An educational kit for people working in the fields of mental health and/or addiction treatment
An interactive framework to discuss, learn, understand and reflect on the impact of stigma on people living with concurrent mental health and substance use problems .

4. Concurrent disorders
Any combination of mental health and substance use disorders.
Some examples are:
an anxiety problem and a drinking problem
schizophrenia and cannabis dependence
borderline personality disorder and heroin dependence
depression and dependence on sleeping pills

5. Why was it developed?
Forty to sixty per cent of people who have mental health problems will also have a substance use problem during their lifetime. These percentages are similar for people who seek help for their substance use.
Concurrent disorders is not the exception.
CD clients need the most help but often receive the least help or no help because the two systems are not always well integrated.
Health Canada (2001). Best practices: Concurrent Mental Health and Substance Use Disorders. Ottawa: Author.

6. Service Provider Stigma
Negative attitudes toward clients with concurrent disorders can arise for several reasons. These may include:
Attribution of responsibility
Feelings of inadequacy, frustration, disappointment when working with client with complex needs
Perception of poor prognosis

7. What are the objectives?
To help service providers ensure that their services are accessible and that their attitudes and practices are supportive of people living with concurrent disorders.
To provide mental health and addiction workers with a concrete tool that they can use in their agencies and in the community to raise awareness about the stigma associated with concurrent disorders.

8. Who developed BTL?
A CAMH team including two volunteers living with concurrent disorders, an education specialist, a product developer and program consultants from different areas in the province of Ontario
15 reviewers
17 pilot facilitators

9. What’s inside the kit? 10 stigma-busting activities (menu)
Master sheets to use as photocopy handouts
Background information for facilitators
Presentation tips
Discussion points
Examples of opportune times to use the kit

10. The activities explore:
The facts and myths about concurrent disorders
The power of language and how words can wound
Stigma, prejudice and discrimination as barriers to recovery for people living with concurrent mental health and substance use problems
Ways we can incorporate anti-stigma practices into our work
Ways we can all be part of the solution.

11. Approaching the elephant
We acknowledged that everyone has blind spots, that many service providers do their best not to stigmatize and some are already part of the solution (stigma busters!) .
Facilitated presentations both internally and externally

12. Sample activity #3
Rethinking Normal

13. How was BTL tested? 12 pilot workshops 13 different facilitators
10 different communities in Ontario, Canada
159 participants
Pre-test/post-test evaluation tool
From 6 to 28 participants in each pilot workshop
Some co-facilitation; lone facilitation
2 facilitators helped develop the package, the remaining 11 were unfamiliar with the resource; 8 worked for CAMH; 5 were allied professionals
Workshops varied in length and facilitators chose the activities that worked for them / their group
13 questions pre-test/post-test

14. Pilot test results
After the workshop, participants indicated that they:
Had a better understanding of concurrent disorders
Felt more comfortable interacting with clients with CD
Had an increased awareness of the the effect of stigma on people with CD
Were more intent on addressing stigma whenever they could

15. Promotion Promotion started before the kit was completed
Regular project updates got people interested in what was to come
The needs assessment, review and pilot processes were opportunities to promote Beyond the Label….so we did! .

16. Feeding the elephant The Dissemination Plan
Recruited and oriented CAMH program consultants across Ontario
PCs were encouraged to co-facilitate BTL presentations with key stakeholders in their community
Stigma-busters received copies of the manual
Promotional materials widely distributed
Data collected every 3 months

17. The stats
Over a 3-year period, 3,983 individuals attended one of 198 BTL sessions .

18. Today, BTL lives on… Incorporated into:
Talking About Mental Illness presentations in secondary schools
Workplace health presentations
A Concurrent Disorders and Housing workshop
Mental Health and Addiction 101 online tutorials
Concurrent disorders curriculum for colleges and universities

19. Keys to success Kept focus on Concurrent Disorders
A project budget to produce the kit
Easy to incorporate BTL activities into other learning modules
Accessible
CAMH’s provincial capacity in policy, education and health promotion

21. Keys to success (con’t)
Available in English and French
Easy to use; no train-the-trainer required
Time to get stakeholders involved, incorporate their feedback and anticipate the product
Leadership and passion

22. Things you can do to stamp out stigma
Acknowledge the prevalence of concurrent mental health and substance use problems.
Try to “walk in the shoes” of a person who is stigmatized.
Watch your language.
Monitor media and openly critique stigmatizing material.
Respond directly to stigmatizing material with a letter to the editor.
Speak up about stigma to friends, family and colleagues.
Be aware of your own attitudes and judgements.
Provide support for organizations that fight stigma.
There are a number of things that we can do to stamp out stigma, but the first and most important thing we can do is to assess our own attitudes, language and practices.

23. “The limits of my language… mean the limits of my world
“The limits of my language… mean the limits of my world.” - Ludwig Wittgenstein (1963)
Everything begins with a change in language which allows us to see beyond the label.

24. For further information
This resource is available at:
Marcia Gibson, Program Consultant
ext: 8209