Some slides from Patrick Corrigan PhD, IL Institute of Technology, international stigma researcher WISE Basics Increasing Inclusion, Hope and Support Beating the Stigma of Mental Illness Within Schools Sue McKenzie, Co-Directors, Rogers InHealth

Statewide collaboration of organizations and individuals. Promote evidence based practices, current research and outcomes evaluation. Majority speak from experience of stigma and recovery. Offer insights, resources, and support for stigma reduction

WISE Active Partners: Care Connections (Waukesha County NAMI Support Group) Center for Suicide Awareness COPE Services Dry Hootch Grassroots Empowerment Project Illinois Institute of Technology LaCrosse Mental Health Coalition Latino Health Coalition – Mental Health Action Team MHA Wisconsin Milwaukee Center for Independence Marian University NAMI WI, Greater Milwaukee & Racine Prevent Suicide WI Rogers InHealth University of WI Milwaukee and Madison WI Department of Health Services WI Family Ties WI United for Mental Health ETC.

 Explore stigma ◦ Public stigma ◦ Internalized shame ◦ Within School Settings  Frame stigma change  Consider options for individual and organizational action GOALS TODAY 4

 IIT – Patrick Corrigan PhD  Yale  U Penn  Rutgers  Temple National Consortium on Stigma and Empowerment

6 Stigma Definition and Types Stigma Definition  Stereotype-ideas  Prejudice-beliefs  Discrimination- actions Types  Internalized Shame  Public  Structural

Avoidance and apathy  self esteem So, why try? I am not good Internalized Shame Public Stigma  sense of efficacy I am not able

8 Racial Discrimination

9 Religious Discrimination

Gender Discrimination

Co-Occurring Stigma (public and internalized)  Heterosexism  Racism  Sexism  Ableism  Etc YRBS data showed LGBT youth in WI had: - 5X the rate of suicide attempts - 3X more likely to skip school due to feeling unsafe - 50% felt like they did not belong at school

12 Movies Drivers of Public Stigma Newspapers Advertising Unethical Research, Drug Side Effects & Poor Quality Care

13 Benevolent Stigma People with mental illness are “lovable and incapable”

14 OK, but isn’t it better lately?

Despite what you might think, the percentage of Americans who viewed people with mental illness as dangerous doubled from 1956 to Source: BG Link, JC Phelan, M Bresnahan, A Stueve, BA Pescosolido American Journal of Public Health 89 (9),

…That figure held steady from 1996 to Source: BG Link, JC Phelan - The Lancet, 2006

Public Stigma: It’s Impact on SOCIAL INCLUSION  Lost employment  Subpar housing  Worse health care  Diminished education opportunities  Alienated from faith community  Coercive treatment

Healthcare Workers and Stigma  Stigmatizers  Stigmatized  De-stigmatizers ( ROSS C. A. & GOLDNER E. M. 2009)

“Healthcare personnel, including nurses, are considered by consumers to be primary contributors to stigma and discrimination against those with mental illness.” (Sartorius 2007)

Nursing staff in emergency departments (when patients were suicidal or in psychiatric crises), and intensive care units (for care post-suicide attempt) in particular, were found to hold blaming/hostile attitudes… (Anderson & Standen 2007, Patterson et al. 2007, Thornicroft 2007) As the point of contact in crisis, there is opportunity to be a de-stigmatizer.

 When am I most likely to notice fear, condemnation, frustration, anger, etc. rising within me related to youth or parent behaviors that may be indicative of mental health challenges? Personal Reflection

Confidentiality paradox Lack of understanding and experience of resilience and recovery Understanding of “compliance” and “relapse” Restraints on disclosure within the workforce and with students What Are The Drivers Of Stigma Within Schools?

 Protest  Education  Contact 23 What Works to Reduce Stigma?

24  Protest o Review stigmatizing images o “Shame on you for thinking that way” o Unintended consequences of well intended actions o “The white bear” -Beware of the rebound effect

25  Education Review key myths and facts that counter these myths

Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011 DOES STIGMA DECREASE AS KNOWLEDGE INCREASES?  Knowledge: Causes of Mental Illness  Stigma: Acceptance

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

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

 Impact? ◦ Blame went down ◦ Belief in recovery also went down Decade of the Brain

30  Contact “Meet John, Mike, Charles, Jackson, Tim, and Mark”

31  Their Recovery Story ◦ My name is ______ and I have a mental illness and/or addiction… ◦ My childhood was… (normal/traumatic) ◦ My mental health challenges were difficult for me and others. They did not go away quickly… ◦ Combining my internal resources with external resources, I found recovery… ◦ I have achieved a satisfying life with several accomplishments.

Contact with someone with lived experience was more effective than education in reducing the perception of people with mental illness as dangerous. A randomized control trial: Corrigan, P.W., et al. (2002). Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28,

The effects of contact versus education were also greater when measuring attitudes of avoidance.

The effects of contact on attitudes of avoidance were sustained at the one month follow-up.

35 Framing Stigma Change Protest Education Contact Media- based XXX XXXX LiveXXX XXXXXX vehiclevehicle processes

The relationship between adults and students in a school setting is the foundation for meeting all education and personal development goals.

Yet, there exists a curtain of ignorance about resilience and recovery.

A process of change through which people work to improve their own health and wellbeing, live a self- directed life, and strive to achieve their full potential. SAMHSA’s four essential dimensions of recovery: ◦ Health ◦ Home ◦ Purpose ◦ Community

 Targeted  Local  Credible  Continuous  Change-focused  Contact The TLC4 Model 40

 Contact with peer  Example- Nurse to nurse Pastor to pastor Football player to football player What is CREDIBLE Contact? 41

 What do you want the target group to do differently as a result of the contact? CHANGE-FOCUSED Contact

Recovery Stories are the Gold of the Movement

the Grand Plan Speak up everyone Speak up everywhere Honest, Open & Proud “strategic disclosure” Carefully

Levels of Disclosure  Social Avoidance – avoid situations  Secrecy – work to keep it a secret  Selective Disclosure – share it with select people  Open Disclosure – no longer hide it  Broadcast Your Experience – actively share it

 Do I encourage one to disclose- what to say, when, to whom, etc. (HOP is a resource)  Do I disclose? Ethical Implications of Strategic Disclosure and Youth

 Three principles most relevant to ethical aspects of self- disclosure are beneficence; nonmaleficence; and the fiduciary relationship between clinician and patient, where the interests and welfare of the patient always predominate.  Intentional self-disclosures may be therapeutic, supportive and alliance-building; or they may be seductive, exhibitionistic, care-seeking, and the like.  Patients may be ambivalent about having personal questions answered: the therapist’s task is to explore and determine whether the patient truly needs to hear the answer to prevent a therapeutic impasse. Psychiatric Times (Guthell May, 2010)

 Handout and Discussion Statewide Study on Youth Disclosure

SIX WAYS TO END STIGMA TOGETHER 1.Seek out people with lived experience - listen to their story. 2.Reinforce & support their resilience & recovery. 3.Wear lime green to create curiosity - be prepared to speak up. 4.Consider the story you can tell about recovery 5.Share other’s stories – for short video stories go to Rogersinhealth.org 6.Bring the conversation to your community – work, civic, faith, schools

Discussion: What can I begin to do today? What can my school do to support stigma reduction internally?