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Authentic Inclusion: Campaign Plan for Reducing Stigma and Discrimination in Alameda County Submitted by Peers Envisioning and Engaging in Recovery Services To Alameda County Behavioral Health Care Services June 30, 2011

"We envision an authentically inclusive community that welcomes people with mental health and substance abuse issues, and their families, with equal opportunities to live, love, learn, lead, work, pray and play; and most of all to see a community in which people with mental health issues are not defined by their diagnosis, but by the life they lead."

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   Acknowledgements  from  the  Executive  Director    This  year,  Peers  Envisioning  and  Engaging  in  Recovery  Services  (PEERS)  celebrated  its  ten-­‐year  anniversary.  It  also  launched  the  major  Alameda  County  Social  Inclusion  Campaign,  funded  under  Proposition  63,  the  Mental  Health  Services  Act.    Celebrating  these  two  momentous  achievements,  I  would  like  begin  by  acknowledging  and  thanking  all  those  who  are  and  have  been  dedicated  to  breaking  down  the  barriers  for  consumers  and  families  who  have  or  are  living  with  the  effects  of  mental  health  stigma  and  discrimination.      This  document  is  the  culmination  of  an  intensive,  year-­‐long  planning  process  that  involved  the  community  at  all  levels  in  developing  strategies  to  increase  respect  and  dignity  for  people  with  mental  health  challenges  and  their  families.    Informed  by  both  research  and  personal  experience,  the  plan  received  input  from  the  PEERS  Social  Inclusion  Advisory  Board,  the  PEERS  Board  of  Directors,  the  Behavioral  Health  Care  Services  (BHCS)  Social  Inclusion  Committee,  BHCS’s  Mental  Health  Services  Act  Ongoing  Planning  Council,  and  current  and  former  consumers  of  mental  health  and  substance  abuse  services,  their  family  members,  providers,  spiritual  and  faith-­‐based  leaders,  ethnic  and  cultural  leaders,  educators,  and  community  members  across  the  lifespan.    Thanks  to  their  advocacy,  hard  work  and  expertise,  we  have  a  thorough  plan  that  takes  positive  and  strengths-­‐  based  approaches  to  reducing  stigma  and  discrimination.    And  while  this  report  represents  the  contributions  of  many  people,  special  thanks  are  in  order  to  Lisa Smusz, PEERS Program Manager, who was the primary writer of the plan.  It  is  important  to  note  how  we  got  this  opportunity  to  make  a  difference.  The  Mental  Health  Services  Act  (MHSA)  became  California  law  on  January  1,  2005  after  being  passed  by  the  voters  (as  Proposition  63)  in  November  2004.  This  initiative  provided  for  a  one  percent  surcharge  on  personal  income  over  $1  million  to  expand  community-­‐based  public  mental  health  services.      The  Alameda  County  Social  Inclusion  Campaign  is  supported  through  the  MHSA’s  Prevention  and  Early  Intervention  (PEI)  funding,  which  specifically  calls  for  efforts  to  reduce  stigma  and  discrimination  towards  people  with  mental  illnesses.    In  2009,  Alameda  County  identified  reducing  stigma  and  discrimination  as  a  top  priority  in  its  PEI  plan.  This  was  an  important  step  towards  transforming  the  mental  health  system  and  promoting  community  integration  of  people  with  mental  health  issues.    The  efforts  of  the  Pool  Of  Consumer  Champions  during  the  county's  PEI  stakeholder  process  was  highly  instrumental  in  defining  a  multi-­‐faceted,  comprehensive  county-­‐wide  program  as  an  important  need.  The  hope  is  that  this  plan  will  serve  as  a  model  for  other  counties  to  develop  their  own  local  stigma  and  discrimination  reduction  programs.      The  importance  of  this  social  inclusion  campaign  and  reducing  stigma  and  discrimination  has  been  a  focus  of  consumers  and  family  members  throughout  the  years,  echoed  by  both  the  state  and  federal  governments.  The  2009  California  Department  of  Mental  Health  

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Strategic  Plan  on  Reducing  Mental  Health  Stigma  and  Discrimination  acknowledged  that  “Stigma  and  discrimination  can  shatter  hopes  of  recovery  and  social  inclusion,  leaving  the  person  feeling  devastated  and  socially  and  personally  isolated.”    A  1999  report  by  the  United  States  Surgeon  General  recognized  “Stigma  as  the  most  formidable  obstacle  to  progress  in  the  arena  of  mental  illness  and  health.”    This  work  is  vital  for  the  well-­‐being  of  our  community  and  though  our  planning  year  has  ended,  I  want  to  emphasize  that  reducing  stigma  and  discrimination  for  people  with  mental  health  challenges  is  an  effort  that  requires  continued  dedication  and  collaboration  with  the  community.    Through  our  ongoing  work  that  joins  consumer-­‐run  and  family  organizations,  consumers  and  their  families,  mental  health  providers,  ethnic  and  cultural  leaders  and  researchers  across  the  county,  state  and  nation,  we  are  committed  to  making  a  positive  impact.    Our  ultimate  goal  is  not  only  to  change  people’s  hearts  and  minds  but  also  behaviors,  system  policies,  and  practices.    Thank  you,        Khatera  Aslami-­‐Tamplen          

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 I. Background  The  number  of  Americans  affected  by  mental  health  issues  is  significant  —  in  any  given  year,  roughly  one  in  four  adults  suffer  from  a  diagnosable  mental  disorder  and  nearly  one  out  of  every  five  children  experience  some  degree  of  emotional  or  behavioral  difficulty.1  The  situation  in  California  is  even  more  acute;  nearly  one  in  five  adults  —  about  4.9  million  people  —  said  they  needed  help  for  a  mental  or  emotional  health  problem.  Approximately  one  in  25,  or  over  one  million  Californians,  reported  symptoms  associated  with  serious  psychological  distress  (SPD).  Of  those  adults  with  either  perceived  need  or  SPD,  only  one  in  three  reported  seeking  help  from  a  mental  health  professional.2  However,  individuals  with  mental  health  and  substance  abuse  issues  face  more  than  the  effects  of  their  condition:  stigma  and  discrimination  pervade  the  atmosphere  of  their  recovery  and  compromise  their  resiliency  and  wellness.      Stigma,  which  refers  to  the  negative  attitudes  towards  those  with  mental  health  issues,  often  leads  to  discrimination,  which  refers  to  the  unequal  and  unfair  treatment  of  those  with  mental  health  issues.  Discrimination  can  make  it  impossible  for  a  person  with  mental  health  challenges  to  gain  access  to  basic  needs  such  as  housing,  employment,  medical  care,  or  credit,  just  to  name  a  few.        In  2007,  the  California  Mental  Health  Services  Oversight  and  Accountability  Commission  published  the  California  Strategic  Plan  on  Reducing  Mental  Health  Stigma  and  Discrimination.  The  report  defines  stigma  as  referring  to  attitudes  and  beliefs  that  lead  people  to  reject,  avoid  or  fear  those  they  perceive  as  being  different,  and  discrimination  when  people  and  entities  act  upon  these  attitudes  and  beliefs  in  ways  that  can  deprive  others  of  their  rights  and  life  opportunities.3  It  defines  three  categories  of  mental  health-­‐related  stigma:    

• Public stigma refers to feelings expressed and attitudes held by members of the general public towards individuals experiencing mental health challenges or their family members.

• Institutional stigma encompasses negative attitudes and behaviors about mental illness that are incorporated into the practices, cultures and policies of organizations and social systems (such as employment, education and health care).

                                                                                                               1 National Institute of Mental Health. (2009). Statistics. Retrieved January 12, 2009 from website http://www.nimh.nih.gov/health/statistics/index.shtml 2 Grant, D., Kravitz-Wirtz, N., Aguilar-Gaxiola, S., Sribney, W.M., Aydin, M., Brown, E.R. (2005) California Health Interview Survey (CHIS 2005). Retrieved June 9, 2011 from website http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=419 3 Mental Health Services Oversight and Accountability Commission. (2007). Eliminating the stigma and discriminations against persons with mental health disabilities: a project of the California Mental Health Services Act. Retrieved January 13, 2009 from website: http://www.dmh.ca.gov/MHSOAC/docs/StigmaAndDiscriminationReport07jun12.pdf

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• Self stigma, also called internalized stigma, occurs when individuals internalize the negative attitudes and disrespect that society, the community or peers perpetuate and may turn the challenged individual away from seeking treatment for their condition.

All these types of stigma and discrimination present an obstacle course for people who are already coping with the problems and effects of mental illness. In many cases, self-stigma keeps individuals with mental health challenges from seeking help at all, and discrimination can cause shame, despair and hopelessness that isolates people, preventing them from living full lives and engaging with their communities. The Alameda County Prevention and Early Intervention plan notes that consumers of mental health services have repeatedly communicated their experiences of stigma and discrimination, and how detrimental the impact has been on their lives:

• In a 1998 focus group conducted by the California Network of Mental Health Clients (CNMHC), discrimination was the most frequently reported experience of mental health clients.

• During Alameda County’s October 2007 Conference, “Breaking the Ties that Bind: Challenging Stigma and Discrimination,” mental health consumers surveyed described overwhelming barriers to recovery, hope, caring, empathy, and social inclusion that are generated by stigma and discrimination.

Stigma, discrimination and their negative impacts are not well understood by the general public. Nearly half of the adults in the 1996 McArthur General Social Survey reported that respondents were unwilling to work with or live near people with mental health issues,4 and the 1999 Surgeon General’s Report stated, “Stigma is the most formidable obstacle to progress in the arena of mental health.”

Misconceptions and biases — both internalized and coming from others — diminish hope and can hinder consumers from living, working, and participating fully in the community. Stigma and discrimination also affect family members, companions, parents and caregivers of those living with mental health conditions, as they are often seen as responsible for their loved one’s challenges and treated with suspicion or disapproval – parents in particular bear the brunt of blame for causing a child’s emotional difficulties. Mental health symptoms may be ignored or inappropriately treated, causing unnecessary trauma, suffering and further isolation. Studies have shown that those who do seek treatment report experiencing social stigma and stigmatizing attitudes from mental health professionals.5

Children and Transition-Age Youth are particularly susceptible to peer exclusion and social isolation and are even more vulnerable to stigmatizing affect than adults. Many individuals, families and communities experience the burdens of stigma and discrimination due to multiple

                                                                                                               4 Pescosolido, B.A., Martin, J.K., et al. (2000) Americans’ views of mental health and illness at century’s end: continuity and change. Public Report on the McArthur Mental Health Module, 1996 General Social Survey. Bloomington: Indiana Consortium for Mental Health Services Research and Joseph P. Mailman School of Public Health, Columbia University. 5 Angermeyer, M.C., Schulze, B., et al. (2003). Courtesy stigma – a focus group study of relatives of schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology, 38, 593-602.

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conditions — such as children or youth in foster care or special education; racial or ethnic communities; persons with physical disabilities; LGBT or gender-questioning individuals; persons with co-occurring disorders; seniors; rural populations and veterans. Of particular interest to the diverse population of Alameda County is the identification of public stigma as a key factor and need to expand services and supports that focuses on the whole person, utilizing the holistic traditional healing practices from each community.

Stigma and discrimination occur in many places, such as mental health institutions and programs, the community, workplace and schools. Individuals encounter social exclusion and challenges in finding and keeping housing or employment and participating in school activities.

Housing – Landlords are far less likely to consider renting to individuals who reveal they have received in-patient mental health treatment,6 even though doing so violates the Federal Fair Housing Act. Homelessness increases the experience of multiple stigmas and threat of violence; although less than five percent of the general population experiences a severe mental illness, researchers estimate that between 20-40% of the homeless population is comprised of these individuals.7

Employment – A 1995 survey of U.S. employers revealed that half would rarely employ someone with a psychiatric disability, and almost one-quarter would dismiss someone who had not disclosed a mental illness.8

Education Systems – Even though schools are in a unique position to dispel misconceptions about behavioral disorders and mental illness – and some do specifically address stigma and discrimination – many consumers, family members and advocates see the educational system as a setting that multiplies the effects of stigma. By the time the student reaches college, negative attitudes are already deeply ingrained: a 2008 study revealed that only 30% of college students considered “seeking help from a mental health professional if they were having a personal problem that was really bothering them,” yet over 50% reported to have felt so depressed that it was difficult to function and 20% of students reported to have seriously considered suicide.9

Institutions – Studies demonstrate that damaging stigma is often perpetuated by the very systems intended to help and protect the individual with mental health problems: for example, mental health and medical services intended to help are often perpetrators of significant stigma and discrimination. When people encounter stigmatizing attitudes from systems designed to provide help and assistance, they may avoid seeking or continuing treatment. In addition, the criminal justice system is ill-equipped to respond to mental health problems and is also a source of stigma and discrimination that results from the fact that people don't receive mental health services in

                                                                                                               6 Page, S. (1995). Effects of the mental illness label in 1993: Acceptance and rejection in the community. Journal of Health and Social Policy, 7, 61-68 7 California Psychiatric Association. (2009). Homelessness and mental health. Retrieved July 15, 2009 from website http://www.calpsych.org/publications/access/homelessness.html 8 Manning, C. & White, P.D. (1995). Attitudes of employers to the mentally ill. Psychiatric Bulletin, 19, 541-543 9 American College Health Association. (2009). Fall 2009 National College Health Assessment. Retrieved August 12, 2009 from website: http://www.acha-ncha.org/docs/ACHA-NCHA_Reference_Group_Report_Fall2008.pdf

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the community - of the 30,000 inmates in California prisons who have a serious mental illness, the majority are nonviolent, low-level offenders who landed in the criminal justice system partly because they did not receive adequate community treatment.10

Media – Studies have found a clear connection between negative media portrayals of mental health challenges and public attitudes and stereotypes.11 Since many people learn about mental illness from the media and entertainment industries,12 inaccurate information can inadvertently promote stigma and discrimination.

As difficult as these attitudes and beliefs are to change, there is hope: we can learn from various approaches that have been used in other civil rights movements to make strides against stigma and discrimination, such as efforts to address racial discrimination, women’s rights, homophobia and discrimination against people with physical disabilities. The next section addresses these opportunities and the approach we are undertaking.

Our Approach

As a consumer-run organization and one of the original partners collaborating with ACBHCS in developing the model for the Stigma and Discrimination Reduction Campaign, PEERS has a thorough understanding of the needs and requirements of ACBHCS, consumers, family members, and the community. The experience of the planning year has “put a face” on the data and allowed us a unique perspective and opportunity to make real change. Along with our county partners, PEERS is ready to stand with the community to fight stigma and discrimination associated with mental health challenges and create a society that values and includes all people.

Our approach is to integrate the outcomes of our intensive stakeholder input, academic research, the experience of other campaigns and the benefit of our own research and planning of the last year to define and craft a campaign plan that will have specific reach and deep impact. Alameda County currently has very limited programs for reducing the negative outcomes associated with mental health stigma and discrimination. Addressing these negative outcomes, such as suicide, unemployment, homelessness, barriers to treatment, and the effects of trauma, is fundamental to the work of the mental health system. The PEERS Stigma and Discrimination Reduction Campaign is a blueprint for long-lasting change in Alameda County by reducing the stigma and discrimination mental health consumers and their families experience and by fostering their full integration and acceptance into the community

II. Situational Analysis and Project Rationale

Efforts to confront and reduce mental health stigma and discrimination are relatively new and the body of research and evaluation to date on this emerging area is still limited. The first efforts

                                                                                                               10 Little Hoover Commission. (2000). Being there: Making a commitment to mental health. Sacramento, California: Little Hoover Commission. 11 Edney, D.R. (2004). Mass media and mental illness: a literature review. Canadian Mental Health Association, Ontario. Retrieved January 14, 2009 fro website: http://www.ontario.cmha.ca/docs/about/mass_media.pdf 12 California Association of Social Rehabilitation Agencies. 2008. Stigma and discrimination: a curriculum for the CalSWEC mental health initiative. Instructors Manual.

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began in the 1990s and leadership drew from the successful experiences on many different fronts, including disability rights, civil rights and other anti-discrimination and human-rights efforts.

Recent work on stigma and discrimination reduction campaigns at the state, national and international levels provides a basis from which to begin. Based on the literature reviewed from the CA DMH Strategic Plan On Reducing Mental Health Stigma And Discrimination and the SAMHSA Stigma Reduction guidelines, we know that the World Psychiatric Association initiated the first major anti-stigma campaign in 1996 in a pilot program in Canada. The focus was on increasing positive mental health coverage in the media. The Open the Doors campaign grew to include efforts in 19 countries and stimulated other initiatives globally.13

Early campaigns utilized primarily national mass media advertising to educate the public, and often included advocacy for more accurate media portrayals of those with mental health challenges. Over time, it has become clear that education was not enough: education alone can produce a better-informed populace, but not necessarily reduce discrimination. Researcher Bernice Pescosolido concludes that because the public embraces a primarily neurobiological understanding of mental illness, there is support for services but not for work to decrease stigma. Pescosolido believes that in response, advocates and providers may need to shift to an emphasis on competence and inclusion to move stigma reduction initiatives forward.

Campaigns now incorporate various approaches for deeper impact, aiming to influence attitudes and behaviors at multiple levels. And campaigns are looking at ways to incorporate more thorough and reliable means of evaluation. However, given the persistence and nature of prevalent attitudes and behaviors, the impact of campaigns takes time to develop. Planning and executing campaigns should be viewed with long-term frameworks in mind.

Social Marketing as a Framework

Social marketing (not to be confused with social media) is a method of utilizing marketing principles and tools to encourage behavioral change as opposed to promoting the purchase of goods or services. Social marketing can be an excellent tool for reframing behavior, reducing barriers to change, motivating individuals to explore behavioral alternatives, reaching underserved or inappropriately served populations and nudging norms toward positive change. Successful social marketing efforts stress the importance of being very specific with respect to your target populations — strategically researching, defining and staying focused on the best means to reach and influence them.

Based on the available literature review, the hallmarks of a successful social marketing campaign include the following:

• Carefully planned approaches to targeting and influencing audiences

                                                                                                               13  Sayce,  L.  (2003)  Beyond  good  intentions:  making  anti-­‐discrimination  strategies  work.  Disability  and  Society,  18,  625-­‐642  

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• Multifaceted, using the full array of methods to achieve change

• Multi-level, focused concurrently at the individual, family, schools, community, organizational and systems levels, locally and statewide (the so-called Social-Ecological Model)

• Focused on changing both attitudes and behaviors

• Long-term, as attitudes and behaviors do not change quickly and reinforcement is necessary

• Adequately funded

• Actively involving key stakeholders and program partners both within and outside the mental health community

• Incorporating benchmarks and evaluation and using the results to inform future efforts14 15 16

The social-ecological model and social marketing have both played a critical role in numerous public health efforts by applying interventions simultaneously at multiple levels, which constantly interact and feedback to each other, magnifying and sustaining the effect.

Strategies Used in Other Campaigns Anti-stigma campaigns have used methods, or interventions, for creating change in attitudes and behaviors. The methods most commonly and successfully utilized are:

• Direct Interpersonal Contact — PEERS’ partner and nationally-known stigma reduction researcher Dr. Patrick Corrigan has demonstrated that the best way to change negative attitudes towards people with mental health challenges is through the contact method.17 The contact method asserts that the most effective way to reduce stigma is through credible, sustained personal contact with those who have lived experience with mental health challenges. Interpersonal contact between people with mental health challenges and the general public has been shown to be more effective in improving attitudes than other approaches (e.g., protest or education), and also produces the most significant sustained effect in reducing stigma.

• Education – Public education campaigns have been proven effective at changing attitudes and behavior in the public health field as well as in mental health stigma and discrimination reduction. Carefully crafting messages conveyed through coordinated and strategic partners is key to success. Research has shown the benefits of tailoring content and materials to

                                                                                                               14 Substance Abuse and Mental Health Services Administration. (2006). Developing a stigma reduction initiative (SAMHSA Pub.No.SMA-4176). Rockville, Maryland: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 15 National Institute for Mental Health in England. (2004). Scoping review on mental health anti-stigma and discrimination: Current activities and what works. Leeds, United Kingdom. 16 Sartorious, N. (2006). Lessons from a 10-year global programme against stigma and discrimination because of an illness. Psychology, Health & Medicine, 11(3), 383-388 17 Corrigan, P.W. (2004). Target-specific stigma change: a strategy for impacting mental illness stigma. Psychiatric Rehabilitation Journal, 28, 113-121.

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specific groups to increase a message’s effectiveness, 18 and that some education efforts have produced short-term improvement in attitudes.19

• Advocacy, coalition building and support – Anti-stigma advocacy has focused on influencing the media, policy and law. Media advocacy is a particularly important area for action, as sensationalist news coverage and film portrayals are believed to be one of the main factors contributing to distorted public attitudes about individuals with mental health challenges.20 Legal advocacy has resulted in powerful anti-discrimination laws, including the Fair Housing Act and the ADA. An important component of anti-stigma and discrimination campaign success is strength in numbers: coalition building of different individuals, organizations and sectors working together toward a common goal.

Offering a broad range of support services and resources to help those with mental health challenges gain information is also a critical piece of the effort. Preliminary studies from two federally funded research centers and many researchers have found that the benefits of participation in peer-led, self-help include increased independence and self-reliance; improved self-esteem; enhanced coping skills and feelings of personal empowerment; and increased knowledge of services, rights, housing, employment and other issues of special concern to those experiencing a mental health challenge.

What Works? (a sidebar on 2 successful examples)

Elimination of Barriers Initiative - SAMHSA

In 2003, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched the Elimination of Barriers Initiative (EBI). The EBI was a three-year demonstration designed to test approaches to  addressing  discrimination  and  stigma  in  eight  pilot  States and aimed to build awareness of and counter the discrimination and stigma associated with mental illnesses. The EBI laid much of the groundwork for SAMHSA’s National Anti Stigma Campaign (NASC). A key component of the EBI is grassroots support and outreach. Each of the eight States that participated in the EBI formed partnerships, mobilized volunteers, and conducted other on-the-ground activities that generated attention from the media, paved the way for entry into school systems and businesses, and took mental health out of the shadows. Indeed, the program’s impact was deepened through the vibrant community-based initiatives conducted by groups and individuals, including local speakers’ bureaus and other activities intended to foster direct contact between people with mental illnesses and the public at large.

New Zealand: Like Minds, Like Mine

                                                                                                               18 Alcalay, R. & Bell, R.A. (2000). Promoting nutrition and physical activity through social marketing: current practices and recommendations. Center for Advanced Studies in Nutrition and Social Marketing, University of California, Davis. 19 State of California, Department of Finance. (2009). California current population survey report: March 2007. Retrieved January 12, 2009 from website: http://www.dof.ca..gov/research/demographic/reports/census-surveys/documents/CPS07_fial.pdf 20 Edney, D. (2004), Mass media and mental illness: a literature review. Canadian Mental Health Association, Ontario.

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New Zealand’s national Like Minds, Like Mine program has drawn praise for its comprehensive, multilevel, long-term, social marketing-based approach to countering stigma and discrimination. In place since 1997, it is the longest running national program and is widely regarded as one of the most successful mental health antidiscrimination programs.21 In 2006, more than 50 percent of surveyed consumers reported reduced levels of stigma and discrimination from family, mental health services, and the public, and about 50 percent reported a reduction in stigma and discrimination in the employment arena.22 After 11 years, the percentage of the public viewing those with mental health challenges as more dangerous than others decreased by 14 percent.23 The program has used a range of methods, including: • Nationwide television and radio advertising campaigns • Public speaking engagements by people with mental health challenges sharing their

experiences • Local programs and activities, such as photography and art exhibitions, public marches or

protests, and Maori cultural events • Media advocacy to disseminate positive personal stories, guidelines for journalists, training

for journalism students, and other efforts to encourage nondiscriminatory reporting • Promotion of discrimination-prevention policies and equal access to housing, education, and

employment The program is a collaborative effort involving a broad spectrum of agencies, such as mental health service providers, consumer-run organizations and networks, and non-governmental organizations and includes national public relations efforts and regional promotional and training activities. Over time, the program has been adapted and it is working to strengthen the role that people who have experienced mental challenges play in the program’s leadership, management, and operation as well as broad stakeholder involvement in planning and implementation (not just same stakeholders, but new voices and champions from outside – ex: educators, business owners, faith leaders, etc). The success of these two initiatives points to key success factors for PEERS as we embark on the implementation of the Social Inclusion Campaign in Alameda County: • The importance of partnerships and coalition building as critical elements for leveraging

PEERS’ Social Inclusion Campaign efforts

• Engaging local and credible sources already within the community to deliver messages (i.e., grassroots advocacy)

                                                                                                               21 Myers, F., Woodhouse, A., et al. (2009). Evaluation of “See me” – the national Scottish campaign against stigma and discrimination associated with mental ill-health. Scottish Government Social Research. Retrieved January 20, 2009 from website: http://www.scotland.gov.uk/Resource/Doc?257385/0076396.pdf 22 Ministry of Health. (2007). Like minds, like mine national plan 2007-2013:Programme to counter stigma and discrimination associated with mental illness. Wellington Ministry of Health. Retrieved January 20, 2009 from website: http://www.moh.gov.nz/moh.nsf/indexmh/like-minds-like-mine-national-plan-200713 23 Wylie, A., Cameron, A., et al. (2008). Impacts of national media campaign to counter stigma and discrimination associated with mental illness. Survey nine results for campaign 4. Phoenix Research: Research report for Ministry of Health.

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• Utilizing outlets that connect with different age groups and cultural groups (e.g., language-

specific newspapers, social media for youth) • Emphasizing the use of positive reinforcement whenever possible      III.  What  We’ve  Learned  in  Alameda  County  

Turning to data from the subject community in Alameda County, there are several avenues of research that PEERS reviewed and took on towards planning this campaign:

• Existing County Prevalence, Housing and Ethnicity Data and African American Utilization Report, Goals and Recommendations, Winter 2011

• Original Research: Stigma and Discrimination Reduction Survey, Breaking the Ties that Bind: Challenging Stigma and Discrimination Conference, October 2007

• Original Research: African American and Housing Town Hall Meeting Surveys, Winter 2011

Alameda County Prevalence Data and African American Utilization Report

California leads the nation in racial and ethnic diversity: the 2010 Census revealed that only 40% of the population self-identify as non-Hispanic Caucasian; 38% are of Hispanic descent; 13% are Asian; 6% are African American and 5% are of mixed race (less than 2 % are Native American or Pacific Islander). Alameda County’s population reflects this diversity; however, the African American and Asian populations are roughly twice the average statewide percentages.

2010 Population Demographics Alameda County California 2010 Population 1,510,271 37,253,956 % Population change 2000-2010 4.6% 10% White, non-Hispanic 34% 40% Asian 26% 13% Hispanic Descent 22.5% 37.6% African American 12.6% 6.2%

Culturally appropriate strategies to address stigma and discrimination are particularly necessary in California, as the state is expected to become even more diverse in the near future. Studies suggest that various ethnic groups frequently experience stigma and discrimination in radically different ways, with African Americans, Latinos and Asians perceiving the threat or

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“dangerousness” of contact with individuals experiencing mental health challenges much higher than Caucasians.24

The Behavioral Risk Factor Surveillance System put into place by the Centers of Disease Control and Prevention monitors behavioral risk factors in adult populations. An optional mental illness and stigma question inserted into the 2007 Monitor revealed that African Americans in particular hold a more negative view of mental illness and its treatment outcomes than other ethnic groups.

Alameda County has a very diverse population base, representing a range of service potentials. A lens through which to identify priorities is the prevalence and service ratio data of consumers of mental health services in Alameda County.

Prevalence and User Disparities by Ethnicity in Alameda County

Ethnicity % Prevalence in Population

% Frequent Users Served

Service Disparity

African American 23% 43% 20%

Asian/Pacific Islander 20% 12% -8%

Caucasian 23% 28% 5%

Latino 27% 14% -13%

Native American 1% 1% N/A

Other 6% 2% -4%

Source: BHCS System Data, 2008

The 2000 Census indicates that reported prevalence of mental illness per population25 in Alameda County is fairly consistent across ethnicities (with some exceptions) but that disadvantaged African American youth and adults are served by mental health services in the County at levels higher than proportionate to their population or to the prevalence of mental illness within the population. Dr. Marye Thomas, Director of Alameda County Behavioral Health Care Services, noted,26 As statistics show, most behavioral health care programs in California serve African Americans

                                                                                                               24 Whaley, L.A. (1997). Ethnic and racial differences in perceptions of dangerousness of persons with mental illness. Psychiatric Services, 48,1328-1330 25 2000 census data, Estimates of Prevalence of Persons with Serious Emotional Disturbance (SED) and Serious Mental Illness (SMI) in Alameda County. 26 Crowder, G.R. African American Utilization Report. (2011). Alameda County Behavioral Health Care Services.

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at a disproportionately higher rate than other ethnic communities, and these services are provided in extremely restrictive (often involuntary) settings such as hospitals and jails. Here in Alameda County, low income African Americans with serious mental illness (and co-occurring disorders) represent 25% of our population, yet receive 40% of all mental health services. Despite this “over-provision” of services, across the lifespan, positive mental health outcomes among African Americans in Alameda County and across the state are inconsistent, which leads us to conclude that many African Americans are being inappropriately served.” Dr. Thomas goes on to further articulate ACBHCS’ priorities as follows: …BHCS recognized that we needed to scrutinize our service delivery system and determine ways of improving outcomes for African American consumers, their families and the County’s African American community at large. The Mental Health Services Act (MHSA) provided funding and opportunities to begin addressing these disparities in ways that in the past would have otherwise been difficult.

Key recommendations of the Report include:

• Continue to innovate in building a system of care that intrinsically provides appropriate services for all consumers and their families in Alameda County, recognizing each ethnicity’s distinct social, cultural and spiritual affinities.

• Implement African American cultural sensitivity and behavioral health awareness training for all County staff, including BHCS, Public Health Services, Social Services and Criminal Justice employees and contractors.

• Develop collaborations and supportive infrastructure between BHCS, Public Health and other County agencies to earlier engage consumers who are experiencing or are at risk for serious mental health issues, specifically in departments with an over-representation of African American adults, e.g., Criminal Justice and Social Services.

• Enlist and educate the African American faith community to reduce stigma and provide effective services to support consumers and family members.

• Increase the accuracy and reduce bias of diagnoses and treatment options among children and youth by promoting the use of Clarifying Assessments, community-based consultations, and best interventions for trauma practice.

• Strengthen the cultural relevancy of services by increasing the number of multidisciplinary, culturally appropriate case management teams in the field.

• Ensure that new programs and infrastructure are developed with input from African American subject matter experts.

• Expand peer-to-peer support programs, community capacity building and therapeutic activity group (TAG) programs throughout the TAY and Adult systems of care.

• Increase the links and communication channels among BHCS, providers and the primary

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care community across all ages; provide screenings for Post Traumatic Stress Disorder (PTSD) and depression within the primary care setting.

• Provide primary care providers with culturally relevant training on Differential Diagnosis to address co-occurring conditions linking mental health, substance abuse and physical health issues, especially in older African American adults.

• Recognize the impact of historical trauma across the African American community, and explore solutions to instill a belief and trust in the effectiveness of the County system of care.

These findings and recommendations are the source of our conclusion that the African American consumer of mental health services in Alameda County is a priority area of focus for PEERS as we conceive of and develop our 2011-2013 Social Inclusion Campaign.

We have also learned that the original timeline of one year for the African American and Housing-focused Social Inclusion Campaign is insufficient. The limit of a one-year timeline only allows for the development of relationships with integral parties; it does not allow for evaluation and refinement of strategies. By extending the Social Inclusion Campaign timeline to two years, PEERS will be able to build relationships, implement strategies, and evaluate the effectiveness of the strategies in year one and then adapt, refine, and implement evaluated strategies, as well as continue to deepen relationships in year two. During the second year, we will also plan strategies for another community and another power holder group. This extended timeline will allow the campaign to be more effective in reducing stigma and discrimination against people with mental health issues.

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IV. Guiding Principles Gathered from Situational Analysis Guiding Principle 1: Change Attitudes (Impacting Stigma) by Emphasizing Contact Method As discussed previously, PEERS’ partner and nationally-known stigma reduction researcher Dr. Patrick Corrigan has demonstrated that the best way to change negative attitudes towards people with mental health challenges is through the contact method. The contact method asserts that the most effective way to reduce stigma is through credible, sustained personal contact with those who have lived experience with mental health challenges. Interpersonal contact between people with mental health challenges and the general public has been shown to be more effective in improving attitudes than other approaches and also produces the most significant sustained effect in reducing stigma.27 Although PEERS will continue to use education and advocacy throughout the campaign, the evidence supporting the contact method has led us to choose a plan that emphasizes the contact method over other approaches. Guiding Principle 2: Messages and Strategies Must Meet and Fit the Cultural and Linguistic Needs of Alameda County While the Social Inclusion Campaign will address the issue of stigma and discrimination within the community at large, special emphasis in 2011-2013 will be placed on partnering and supporting change within the African American community which has been historically inappropriately served in the mental health system. Some of our earliest strategies in the implementation year will be to spend time building relationships within natural communities that exist within the African American community including: faith-based groups, black-owned businesses, older adult populations, TAY, men’s and women’s issues groups, and families of people with mental health issues. After hosting a town-hall meeting for those involved with the African American community, PEERS learned about some key issues involved in reducing stigma and discrimination and in building our network of allies in the work ahead. PEERS discovered the importance of not isolating the idea of spirituality to one area of the campaign, but rather to weave in spirituality and outreach to faith-based communities into all parts of campaign. We plan on partnering with the faith-based community to host educational gatherings, support groups, and community events (such as WRAP, eCPR, public art, community gardens, etc.). In addition to the faith-based communities, we plan on providing skills building trainings around trauma and discuss its association to mental health and wellbeing. A Public Health Crisis. Alameda County Violent Death Reporting System 2002-2004 report page 3 indicates that “Although African Americans make up only 35% of the total population in Oakland, they represent more than 77% of the homicide victims.” This data overwhelmingly highlights the need to address trauma in Alameda County’s highly diverse metropolitan city.

                                                                                                               27  Corrigan,  p.w.  (2004).  Changing  the  Stigma  Through  Contact.  Advances  in  Schizophrenia  and  Clinical  Psychiatry.  1(2):54-­‐57.    

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In addition, because the African American community possesses a wide array of individuals with differing ages and life experiences, it is essential to create culturally- and age-appropriate messages and outlets, particularly an African American community brochure. In addition to producing African American-specific educational and outreach materials, PEERS is committed to producing specific informational materials that promote social inclusion in multiple ethnic and cultural groups. Campaign informational materials will be available in five languages (English, Chinese, Vietnamese, Spanish, and Farsi), and articles and public service announcements will be placed in language-specific news outlets. In our efforts to expand the message of inclusion to a broader audience in our diverse county, Wellness and Recovery Action Planning (WRAP) groups and informational materials have been expanded to serve the Spanish speaking community. Partnerships and trainings (such as eCPR) are being planned with the faith-based communities as well as training in Spirituality 101 for Mental Health practitioners. Guiding Principle 3: Fully Engage Stakeholders in Planning and Implementation of Campaign As discussed earlier, one of the key take-away messages we found in the research and examination of other campaigns was the necessity of fully engaging all stakeholders and the community at large in all phases of campaign planning and implementation. During our planning year, we made a concerted effort to reach out to, actively involve, and incorporate the input of consumers and family members from across the lifespan, power group holders, and members of the diverse ethnic communities that make up Alameda County. We humbly recognize that if our efforts are to be successful, we will need to continue to build relationships and trust by respectfully engaging members of the African American community and Housing power group holders, continuing to listen and adapt our efforts in response to the knowledge they share with us about their communities and the issues they face in eliminating stigma and discrimination. Due to the importance of relationship and trust-building, we will form community action teams, finding natural groups of stakeholders within the focus communities, including older adults, spiritual communities, and TAY. These action teams will aid in the implementation and evaluation of the stigma reduction strategies, giving feedback to the PEERS team for refinement throughout the implementation period. Our outreach and relationship building is in its infancy, but already it has yielded rich information and allies. Some of our efforts to engage and activate champions within the greater Alameda County community included: • Community Dialogue: In October 2010, PEERS hosted the Social Inclusion Campaign Community Dialogue, a daylong event that featured a keynote talk by Dr. Corrigan and introduced the campaign to PEI recipients and community leaders, informing them of our plans and requesting their involvement and participation. • Advisory Board:

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In addition to receiving guidance from Dr. Corrigan and community leaders at the Dialogue, PEERS formed an advisory board for the campaign to help shape and direct strategies for the implementation year. To ensure a diverse community presence, board members were selected to represent a cross-section of the populations with whom PEERS works. The advisory board represented groups including consumers, family members, TAY, older adults, providers, faith-based leaders, K-12 educators, post-secondary educators, African Americans, and Asian Americans. The role of each advisory board member was to bring information and opinions to the workgroup based on the knowledge of the community they represented. They were also expected to become champions and deliverers of the message to their respective communities. As a whole, the advisory board was responsible for selecting two focus groups for the implementation year of the Social Inclusion Campaign. One group was to be an ethnic community, and the other group was to be a significant power holder in the community. For the ethnic group, the advisory board selected the African American community, as it has been inappropriately served over time and received no PEI funding. For the power group, the advisory board selected the housing sector, as its members collectively decided that no one can be truly mentally healthy unless one first has access to safe, welcoming, and sustainable housing. A visual summary of the Advisory Boards’ process and all recommendations can be accessed in the Appendices of this report. • Town Hall Meetings: In planning for the Social Inclusion Campaign, PEERS conducted two Town Hall meetings where community members including consumers and family members were surveyed. The first Town Hall focused on African American consumers and family members and their views about sources of support, key sources of messages about mental health issues, their feelings with respect to those messages, obstacles to getting the help they need and concerns about mental health issues. As discussed in our findings from research and previous campaigns, we will need the support of our community partners and stakeholders in delivering messages, implementing projects, and creating real change in our communities. PEERS has identified and has begun developing working relationships with the following system partners and stakeholders: PEERS Stakeholders

• BHCS- Alameda County Behavioral Health Care Services (?) • ACNMHC- Alameda County Network of Mental Health Clients • ACMHA- Alameda County Mental Health Association

o FERC- Family Education and Resource Center • BACS-Bay Area Community Services • HHREC- Health and Human Resource and Education Center • AC NAMI- Alameda County National Alliance on Mental Illness • AC UACF- Alameda County United Advocates for Children and Families • EBRP-East Bay Recovery Project • BOSS- Building Opportunites for Self-Sufficiency

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• Bonita House Inc. • HHREC- Health and Human Resource Education Center • CNMHC-California Network of Mental Health Clients • Telecare-Villa Fairmont, Strides, Morton Baker • La Clinica de la Raza • La Familia Counseling Service • Horizon Services, Inc. • John George Psychiatric Services • Native American Health Center • Fred Finch Youth Center • STARS Community Services • Youth UpRising • Casa de la Vida • FPFY-First Place for You • Spiritual communities • CRIL- Community Resources for Independent Living • National Empowerment Center • Berkeley Mental Health • CHAA- Community Health for Asian Americans • ACCMHA-Alameda County Council of Mental Health Agencies

Guiding Principle 4: Change Actions (Impacting Discrimination) with 3-part approach Our campaign strives not just to impact attitudes, reducing stigma, but also to impact discriminatory behaviors. Many past campaigns for behavioral change have utilized strategies that emphasize evoking an emotional response in the audience (ex: “This is your brain on drugs” commercial), many more have used the strategy of informing the audience of the action they should take (ex: “Just Say No”), or trying to change the system to support change (ex: legislation to punish people for selling drugs). However, these strategies become far less effective at moving the audience to action when used separately rather than as part of a three-part approach that utilizes all of these tactics in prescribed manner. Building from the change model highlighted in the book Switch: How to Change When Change is Hard, our strategies uses a process in which each intervention consists of all three parts, rather than separating them into disjointed, unconnected attempts. First an emotional connection with the audience is made (get them to care about the issue). After the emotional connection has been established and while the audience is motivated, they are given a specific, achievable, measurable call to action. Lastly, clear any barriers to their participation immediately. The following is an example of how this model is applied in our strategies: (Emotional Connection) Our speakers’ bureau is scheduled to present at a meeting of housing managers that are fearful about having people with mental health issues living in their building. The speakers’ bureau will present an emotionally compelling, personal story of how mental health issues are but one facet of their personhood -- dispelling myths and fears -- and how stigma and discrimination affects their ability to find and keep housing. (Information) The audience is then asked to do three follow-up actions: 1. Sign-up for a training

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that will give them more tools and feel more confident to support tenants with mental health issues. 2. Take the “Stigma Stops with Me” pledge on line or by paper, and 3. Each One Teach One – spread the message they have learned to at least one other person. (Remove Barriers) In order to make it easy for audience members to follow up, sign-up sheets for the follow-up workshop are distributed at the event and reminder cards about the training date they have signed up for are given to registrants. Secondly, a laptop with wireless is provided for those who wish to take the pledge on site via Facebook, or a poster to sign for those who do not have a Facebook account. Lastly, brochures and palm cards with a summary of talking points and links to video presentations of the speakers’ bureau are distributed for audience members to share with others. Guiding Principle 5: Maintain a Strengths-Based Approach and Utilize Positive Reinforcement In keeping with our organizational values, the Social Inclusion Campaign will utilize a strengths-based, positive-reinforcement approach whenever possible. Our campaign will strive to seek out and support the “bright spots” (positive efforts being taken toward a more inclusive society) already existing within the Alameda County community. Instead of drawing attention and media exposure to negative actions, we will seek to find examples of what is already going well and provide positive reinforcement, media attention, and community support for those actions. Prior research has shown that the while traditional protest has a place and potential for impact, the long-term potential for change is uncertain and there is the possibility of backlash. By focusing our efforts on positive reinforcement, we hope to avoid the potential backlash possible with traditional protest models and instead promote buy-in and duplication. This positive-reinforcement approach has the additional benefit of promoting solutions that have emerged from the community of focus itself. As noted in the book Switch: How to Change When Change is Hard, these solutions are more likely to not only be more realistic and sustainable, but less likely to be rejected by the community as would “imported” solutions imposed by perceived outsiders. Guiding Principle 6: Use New Tools to Broaden Our Reach and Engage Individuals Across the Lifespan While the results of the contact method are central to the PEERS implementation strategy, the task of facilitating widespread change through face-to-face contact in a geographically dispersed and densely populated area such as Alameda County is daunting and requires a creative, thoughtful strategy. PEERS perceives the supplemental use of social media key to creating contact opportunities. Many people (particularly transitional age youth and adults aged 25-45) perceive social media outlets as a legitimate point of contact, as demonstrated by the socialization and shift in personal relationships facilitated by Facebook and online dating. In addition, social media in particular is a powerful way to distribute messages and content. Nearly three quarters (73%) of online teens and an equal number (72%) of young adults use social network sites.28 Over the past 10 years, transitional aged youth as well as adults aged 25-45 have consistently been the two groups most

                                                                                                               28    Lenhart,  Amanda,  Kristen  Purcell,  Aaron  Smith,  and  Kathryn  Zickuhr.  “Social  Media  and  Young  Adults.” Pew  Internet  and  American  Life  Project:  http://www.pewinternet.org/Reports/2010/Social-­‐Media-­‐and-­‐Young-­‐Adults.aspx.  

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likely to go online. Interestingly, online media is not just a tool that can be used to engage young adults more effectively, but is increasingly becoming an effective means of reaching older adults (over the age of 65) as demonstrated by recent significant increases in internet usage in older adults (over the age of 65).29 V. Strategies and Methods

Messages: As an exercise, PEERS asked members of our staff and community stakeholders to define what social inclusion, stigma, and discrimination meant to them. As you might imagine, there were nearly as many definitions as participants. This simple exercise echoed the sentiment reflected in the feedback of consumers surveyed at the 2007 Breaking the Ties that Bind Conference, as well as the recommendations of SAMHSA in their guide to developing stigma reduction initiatives: The complex matter of stigma and discrimination must be distilled into several messages and slogans that convey critical information and calls to action in an easily understandable manner. These campaign messages are the foundation from which talking points, PSAs, newspaper articles, and marketing materials are developed, giving us a common language and frame of reference to talk about the goals of our campaign in a consistent manner. Our first step in developing messages was to research what other campaigns had done, learning from both their successes and failures. Secondly, we as a team thought deeply about what research had demonstrated to be effective in combating stigma and what key concepts we wanted to convey. Finally, and most importantly, we listened to our stakeholders: consumers, family members, providers, and power holders ensuring that the messages were crafted to resonate with and be clearly understood by our audience. Based on this analysis, we determined that the following message qualities were critical: 1. The messages must be strength-based, emphasize recovery, and inspire hope. 2. The messages must serve to promote inclusion and respect toward people with mental health

issues and their families rather than identify, separate, or inspire pity or a sense of powerlessness and victimization.

3. The message should help the audience understand why they should care about people with mental health issues, pointing out their likely personal connection to the issue.

4. The message should be accessible to the broadest possible audience. The message must be written in simple, clear language free from jargon understandable to members of the general population, not only those who have experience within the mental health system.

5. The message should do more than just raise awareness, rather it must be a call to action and personal responsibility to help change our society.

6. The message must be congruent with the adage of “nothing about us, without us.” 7. The message should convey that mental health issues are a single facet of a unique human

being and not their defining characteristic, existing within a context of both individual strengths and weaknesses.

                                                                                                               29  Ibid.  

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With those qualities in mind, we are using the following messages in our campaign. This list is not intended to be exhaustive, but a starting point of clear messages to be adapted and expanded upon depending on the audience and forum. The first bolded line is a slogan that might be used to draw the audience member in or grab attention, followed by an explanation of the message’s intent and talking points that might be more fully developed in the brochure, postcard, PSA, article, event theme, speech, etc:

• “Stigma Stops With Me.” Our campaign is about action, not just raising awareness. We strive to create an equal sense of personal responsibility in all community members (those with lived experience of mental health issues and those without lived experience) to stop stigma and discrimination and create a more inclusive society. We create small, clearly measurable, achievable actions that community members can commit to publicly. This slogan, printed on t-shirts, online pledges, and posters provides a call to action. Key talking points might include:

o You can make a difference in the way people view and treat people with mental health issues if you:

Learn and share the facts about mental health. Share your own personal story of recovery if you are a person with lived

experience of mental health issues. Treat people with mental health issues with dignity and respect. Speak out

when others are disrespectful or spread stereotypes and misinformation. Support the development of community resources for people with mental

health issues and their families. Respect the rights of people with mental health issues and don’t

discriminate against them when it comes to housing, employment, or education.

o “Each One, Teach One.” Everyone has the ability and responsibility to educate others about what they have learned. People are more likely to listen to and act on information they hear from a known, trusted source rather than someone who is perceived as an “outsider.” You can be that trusted source of information. If everyone takes responsibility for educating at least one other person about what they have learned, our efforts to change our community can grow exponentially.

• “Hope isn’t a 4-letter word.” Too often, people with mental health issues and their families are afraid to, or are actively discouraged to, hold out hope for recovery and full life after a mental health diagnosis. Yet hope is a powerful tool for working toward wellness, and the facts show that people with mental health issues can and do recover. There are many paths and tools that can be utilized and adapted in a journey to recovery including but not limited to: working with mental health professionals, self-help strategies, community supports, peer support, medications, spiritual practices, and more. Our message is: Don’t allow anyone to take away your hope for a better future and take charge of your recovery process.

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• “Look Closer: I am more than my diagnosis.” Modeled after the U.K. campaign “Time to Change,” individuals would introduce themselves to viewers (via video), talking about their lives, successes, and roles along with the fact that they have a mental health diagnosis. The viewer is confronted with an image of a whole, complex individual that does not meet the pre-conceived stereotypical portrayal of a person with mental health issues. The brief introduction to the person is followed by the message: “Not what you expected? Look closer at … [what you believe] [people before you judge them] [how you treat others] [the messages you see in the media]. Despite what you may have heard … [mental health issues are but one facet of a complex human experience and do not define the individual] [people with mental health issues are more likely to be victims of violent crime than the perpetrators] [people can and do recover from mental health issues]. People with mental health issues surround you everyday and make important contributions to our families and our society. It’s time to stop the lies and stop the discrimination. [Insert call to action.]”

• “Mental health is part of all our lives.” This message was developed by SAMHSA to both normalize the experience of mental health issues and to make the issue personally relevant to the audience, pointing out that mental health problems are quite common and affect almost every family in America. In California, 1 in 5 are living with a mental health issue. That means either you, or someone you know is very likely to be affected by the issue of stigma and discrimination.

• “Uncover, Recover, Discover”

This message, used primarily by our speakers’ bureau “Lift Every Voice and Speak,” summarizes the approach to storytelling that we utilize in our efforts to combat stigma. Participants first “uncover” by coming out about their personal experiences with mental health issues, discussing the origins and factors that played a part in their difficulties. Speakers next focus on their experiences on the road to recovery – both successes and failures – and the tools and support strategies that helped them on their journey. Finally, the audience and the speaker “discover” what we can do to support others who might be experiencing mental health issues, how we ourselves can find greater wellness, and how to create a more inclusive and welcoming community together.

VI.  African  American  Community  Workplan    Media  Strategies  for  the  African  American  Community    In  implementing  various  forms  of  informational  and  communications  materials,  the  media  prong  of  the  Social  Inclusion  Campaign  will  utilize  both  culturally  appropriate  and  technologically  advanced  strategies.    Culturally  relevant  media:  Remaining  true  to  the  needs  of  the  target  population  in  the  implementation  period,  PEERS  will  produce  an  African  American-­‐specific  informational  brochure.  The  brochure  will  give  an  overview  of  mental  health  using  both  accessible  language  and  imagery,  as  well  as  give  

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contact  information  for  providers  already  trusted  by  and  established  in  the  community.        In  addition,  PEERS  will  produce  a  short  film  on  the  African  American  community  and  mental  health  stigma.  The  film  will  profile  members  of  the  community  who  have  been  diagnosed  with  and  recovered  from  a  mental  health  condition,  and  the  role  of  family,  friends  and  culture  in  their  recovery  process  as  it  relates  to  the  African  American  community.  PEERS  will  seek  to  explore  the  role  of  race,  class,  and  historical  trauma  in  mental  health  issues  and  provide  a  way  for  audience  members  to  take  action  to  end  stigma  and  discrimination.  Further,  PEERS  will  also  promote  its  principles  of  hope  and  recovery  and  encourage  those  in  the  African  American  community  who  may  be  struggling  with  a  mental  health  issue.    In  addition  to  producing  hard  copy  materials  targeted  at  the  African  American  community,  PEERS  will  also  have  a  customized  page  on  its  Web  site  providing  a  quick  and  easy  way  for  users  to  find  specific  and  relevant  information.  By  housing  resources,  articles,  blog  posts,  and  videos  on  African  Americans  and  mental  health  in  one  place,  PEERS  is  able  to  cater  to  both  savvy  Internet  users  as  well  as  those  who  may  just  be  going  online  for  the  first  time.  Just  as  with  the  hard  copy  informational  materials,  PEERS  will  ensure  all  online  materials  feature  resources  and  messaging  specific  to  the  African  American  community.  We  will  also  ensure  that  the  variety  of  the  African  American  community  is  adequately  captured,  including  all  sectors,  professions,  and  age  groups.      Radio  show  and  podcasts:  PEERS  will  produce  and  host  its  own  shows  to  deal  with  mental  health  stigma  within  the  African  American  community.  The  media  team  will  produce  both  a  call-­‐in  radio  show  and  corresponding  podcast  with  similar  content  in  different  formats.  For  those  who  have  questions  they  would  like  answered  or  who  do  not  use  podcasting  and  are  less  tech  savvy,  the  radio  show  will  be  a  useful  tool.  Conversely,  for  those  who  don’t  necessarily  want  to  call-­‐in  but  just  want  to  listen  or  who  are  more  tech  savvy  and  enjoy  downloading  audio,  the  podcast  will  be  an  excellent  fit.    Television  show:  Expanding  beyond  radio,  PEERS  also  produces  and  hosts  a  public  access  television  show  called  “Mental  Health  Matters.”  In  the  implementation  year,  the  show  will  feature  episodes  dealing  specifically  with  mental  health  and  the  corresponding  stigma  in  the  African  American  community.  The  video  will  also  be  posted  in  its  entirety  on  Blip.Tv  as  well  as  in  digestable,  sharable  clips  on  YouTube  and  the  PEERSnet  video  section,  where  users  can  share  ratings  and  comments.      PSAs:  In  addition  to  creating  original  news  content,  PEERS  will  pursue  relevant  radio,  print,  and  broadcast  media  outlets  to  air  public  service  announcements  on  mental  health.  Radio  will  be  especially  emphasized,  as  it  is  a  media  outlet  widely  utilized  and  recognized  by  the  African  American  community  (see  Appendix).  Print  news  will  feature  drop-­‐in  PSA  articles  profiling  a  prominent  community  member  with  mental  health  issues  and  dispelling  mental  

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health  myths  from  facts.  Local  television  outlets  will  air  PEERS-­‐produced  PSAs  (see  Appendix).    TAY:  (Across  The  Lifespan)  When  engaging  in  outreach  with  any  population,  it  is  important  to  customize  messaging  to  specific  age  groups;  therefore,  this  understandably  holds  true  for  the  African  American  community.  Research  has  shown  that  the  majority  of  TAY  individuals  actively  use  social  media  to  communicate  with  one  another.  To  facilitate  the  discussion  of  mental  health  via  Web  2.0  means,  PEERS  will  heavily  publicize  the  Facebook  pledge  to  TAY  users  and  engage  them  as  much  as  possible  to  share  what  they  will  do  to  end  mental  health  stigma  with  their  online  friends.  Additionally,  PEERS  has  and  will  further  build  out  a  TAY-­‐specific  website  containing  a  discussion  board  and  other  features  that  allow  TAY  to  communicate  with  one  another  at  http://peers.lifeportal.com.      Empowerment Strategies for the African American Community Skills Building and Support Groups: Empowerment can come in many forms, and it is the goal of the Social Inclusion Campaign to foster and promote as many as possible within the African American community. Groups offered will include Wellness Recovery Action Planning (WRAP), Trauma-informed mindfulness practice for wellness, Intentional peer support trainings and certifications for consumers of mental health services in the African American community (by Shery Mead), and Re-form-a-tion Mask Groups. To start, PEERS will provide age-appropriate ongoing WRAP groups across the lifespan, including sites that focus on supporting TAY and older adults. Groups will be focused in a traditionally African American community and at trusted and accessible locations, such as churches and community centers. PEERS will also outreach to consumers of mental health services who are African American and provide training opportunities for the growth and certification of new WRAP facilitators from within the community. Trauma-informed mindfulness practice groups will focus on helping consumers of mental health services develop and maintain a personal mindfulness practice to deal with stress and sustain wellness and recovery. The mindfulness practice groups will be led by consumers of mental health services who have been trained by PEERS and our partners at University of California San Diego Mindfulness Institute in trauma-informed mindfulness techniques and have developed/maintain their own mindfulness practice. In partnership with UCSD, these mindfulness groups will be part of a year-long study in which we will examine the effectiveness of mindfulness as a tool for healing from trauma and wellness and recovery in the African American community. Finally, we will partner with a grantee of the Alameda County Behavioral Health Care Services Innovations Grant Program by offering “Re-form-a-tion: Moving beyond stigma” groups. This workshop focuses on providing participants with the tools to recognize society’s stigmatized perception of them and their own internal perception of themselves. Using multiple flat masks, combined with visuals from magazines, drawings, writings, and other artistic tools, mask-makers

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can express how they feel they are seen by others and how they see themselves, helping them to create a dialogue about who they truly want to be. Arts: Over time, many consumers have expressed the importance of participation in the arts to their empowerment and recovery. To that end, PEERS will sponsor art, photography, poetry, and craft shows in the African American community. Such shows will happen twice per year, with dates to be determined. Following scheduling confirmation, PEERS will prepare outreach materials including palm cards, posters, and electronic invitations promoting gallery openings and opportunities to meet the artists. Additionally, PEERS will host artist discussion evenings the week after a gallery opening. Potential gallery locations and contributors include housing sites, the Oakland Museum, Inferno Gallery, PEERS Walk-A-Thon, Berkeley Market at Adeline BART station, Berkeley Rep Theatre, Black Repertory Theatre, coffee shops, restaurants, public libraries, and Souletys in Jack London Square. Another piece of the art-for-empowerment concept will focus on the use of film. In the implementation year, PEERS will host an annual film contest exploring mental health in the African American community and ways people in the community are putting an end to stigma. To go along with the film contest, PEERS will promote one film workshop (with the potential to be an ongoing series) engaging those with an interest in writing and producing shorts, filming, and editing clips. Potential topics and subjects for workshop projects include presentations by Lift Every Voice and Speak. The workshop will also teach participants how to submit their works to area film festivals. Potential partnerships include the San Francisco Community College Department of Film, Youth Uprising, Berkeley Digital Film Institute, and Academy of Art University. Finally, PEERS will hold one special film screening at the Grand Lake Theatre, providing an opportunity for shorts created in the workshop to be shown to a broad and diverse audience. Poetry open-mic nights will be prominent in the implementation year. Held once a month in a variety of locations within the African American community, the open-mic nights will supplement and be promoted along with outside, pre-existing open-mic nights. By confirming our mic nights do not conflict with others and promoting those talent nights that are not held by PEERS, we hope to create a collective voice and form valuable partnerships. In cooperation with the Outreach Component of our campaign, members of Lift Every Voice and Speak as well as Black Men Speak will participate in outside events such as poetry slams in the community to bring the message of mental health and recovery as well as the issue of stigma and discrimination to a wider audience. Potential locations for PEERS sponsored events include a coffee house on a Saturday evening, community event center with our own coffee and baked goods, a faith-based community, or a housing site that is convenient to the African American community. Any chosen location must be easily accessible by public transit. In order to gain as many friends and allies as possible, the poetry performances will be videotaped and distributed on the PEERS Web site as well as shared with partners in the community.  Outreach Strategies for the African American Community:

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Outreach and Education Via Natural Communities Prompted by the clear feedback received at the African American Town Hall meeting and recommendations of other focused group meetings, PEERS will produce culturally-specific contact opportunities/speakers’ bureaus as well as educational curriculum and materials (ex: Lift Every Voice and Speak, Black Men Speak, information on creating welcoming spiritual communities, and an African American community brochure). As requested in the Town Hall meeting, these materials will explore specific issues that face people with mental health issues within the African American community, the language that feeds external and internal stigma, as well as information about mental health wellness and recovery and culturally-responsive resources in the community. These contact opportunities/speakers’ bureau engagements, and educational materials will be offered in partnership with organizations already working within the African American community and via natural community hubs such as: book stores, restaurants, black-owned businesses, spiritual communities, older adult facilities and organizations, youth organizations, family support organizations, and laundry mats or barber shop/hair salons. By leveraging a wide variety of natural communities, we seek to share the much needed information and contact opportunities to a diverse audience of all ages. Establishing Stigma-Free Zones and Business Certifications As stated previously, one of our key goals is to move people beyond the theoretical and into action against stigma and discrimination. In addition to creating opportunities for individuals to make a public declaration of their stand against stigma and discrimination (see media section for more details on the Facebook pledge application), we plan to create opportunities for businesses within the African American community to become “certified stigma-free zones.” Business owners wishing to participate in this program will attend a workshop where they have contact with people with lived experience of mental health issues (via Lift Every Voice and Speak and Black Men Speak), learn basic skills for responding appropriately to people who may be experiencing distress, as well as learn some basic talking points about mental health issues for sharing appropriately with others. Finally, participants will be asked to take the “Stigma Stops with Me” pledge and take a pre- and post-test to evaluate the impact the workshop has had on their attitudes about people with mental health issues. Once the participant has completed the workshop, he/she receives signage for their establishment indicating their space as a “Stigma Free Zone,” along with resources and materials for display. As an incentive to participate, certified businesses will receive free advertising in a PEERS published “Stigma Free” business guide, and will have their logos and contact information displayed on materials distributed at events sponsored by PEERS throughout the year. Special emphasis will be given to recruiting owners of hair salons / barber shops located in traditionally African American neighborhoods. As a place of natural gathering where customers often spend a significant amount of time socializing with proprietors while receiving services, these businesses afford a unique opportunity to spread messages and information about mental health issues, recovery, and fight stigma and discrimination within the community by a trusted

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source. After participating in the certification workshop, owners of salons and barber shops would be provided with follow-up to provide support and evaluate whether the training influenced discussions about mental health and wellness in their businesses (see evaluation and research). Education and eCPR (Outreach) Education for community leaders and family members is also an important component in the empowerment of the African American community and our efforts to eliminate stigma and discrimination. In addition to other educational opportunities (such as the Lift Every Voice and Speak speakers’ bureau, printed materials and online resources, cable access shows, etc.) we will utilize eCPR in our educational efforts. Deemed "emotional CPR," eCPR is an educational program designed to teach people to assist others through an emotional crisis. For more information on eCPR, please visit: http://www.emotional-cpr.org. Four eCPR trainings will be offered at various trusted locations within the community, including spiritual centers, business centers, recreational centers, and family/education centers. Dates, locations, and facilitators will be announced when scheduling is confirmed. Community projects: Community projects will also be launched in the implementation year within the African American community, and such projects will serve multiple purposes. First, by having mental health consumers and non-consumers working alongside each other, stigma and discrimination will be eliminated. PEERS’ partner and nationally known stigma researcher Dr. Patrick Corrigan maintains that such interactions and teamwork – deemed the “contact method” – are the most effective way to break stereotypes and prejudicial attitudes. Second, community projects will produce a tangible way of improving neighborhoods, and serve as a visual reminder of the accomplishments and positive qualities of those with mental health issues. Lastly, community projects are a method of empowerment, as consumers can work on and ultimately experience a finished product making a positive impact in the community. Ideally, the project would be sponsored by a known and trusted community entity, such as a business or church. Ideas include a community garden, labyrinth, tree and bench, fountain, or mural. VII. Housing Sector Workplan Media Strategies for the Housing Sector  Relevant  informational  materials:  Just  as  PEERS  will  produce  an  informational  brochure  specific  to  the  African  American  community,  so  too  will  we  produce  a  brochure  specific  to  the  housing  power  group.  At  the  town  hall  meeting  in  the  spring  of  2011,  housing  owners,  developers,  and  landlords  expressed  that  while  they  know  how  to  provide  accessible  housing  to  those  with  physical  disabilities,  they  were  less  clear  on  how  to  accommodate  those  with  mental  health  challenges.  By  clearly  explaining  how  power  holders  can  make  housing  fair  and  supportive  to  those  with  mental  health  challenges  –  as  well  as  explaining  the  importance  of  mental  health  and  how  to  help  a  tenant  in  who  is  experiencing  difficulties  with  mental  health  issues  –  we  hope  to  reduce  stigma  and  discrimination  in  the  housing  sector.    

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Positive  reinforcement  and  educational  video:  In  order  to  introduce  the  Social  Inclusion  Campaign  and  the  issue  of  mental  health  to  housing  power  holders,  PEERS  will  produce  a  short  film  on  housing  and  stigma.  The  film  will  provide  a  general  overview  as  to  the  link  between  housing  and  mental  health.  The  video  will  also  profile  current  power  holders  that  are  already  providing  fair  and  affordable  housing  and  welcoming  spaces  to  tenants  with  mental  health  challenges.  By  profiling  those  who  are  getting  it  right,  not  only  is  PEERS  adhering  to  its  strengths-­‐based  approach,  but  we  are  also  providing  tangible  examples  for  other  housing  leaders  to  follow.    Relevant  media:  Like  the  African  American  group,  the  housing  sector  will  also  get  a  specific  website  page  on  the  PEERS  Web  site.  This  space  will  host  resources,  videos,  brochures,  and  informational  materials  available  to  landlords,  housing  owners,  and  property  developers  in  one  simple,  easy-­‐to-­‐find  space.  In  addition,  consumers  will  also  be  able  to  find  housing  resources  to  suit  their  specific  needs.  As  with  all  parts  of  our  campaign  messaging,  wording  and  language  will  be  tailored  to  the  housing  power  group.    Radio  show  and  podcasts:  PEERS  will  produce  and  host  its  own  shows  regarding  housing  issues  around  consumers  of  mental  health  services  and  stigma.  The  media  team  will  produce  both  a  call-­‐in  radio  show  and  corresponding  podcast  with  similar  content  in  different  formats.  The  radio  show  will  be  aired  in  a  consistent  time  slot  (TBD),  while  the  podcast  will  be  available  for  download,  free  of  charge,  on  the  PEERS  Web  site.    Television  show:  In  “Mental  Health  Matters,”  the  PEERS-­‐produced  and  hosted  television  show,  PEERS  has  produced  and  posted  online  two  full  shows  on  housing.  One  features  Mary  Hogden,  a  consumer  and  mental  health  activist,  and  profiles  her  experience  with  the  housing  system  and  follows  her  journey  from  being  on  the  streets  to  living  in  and  funding  her  own  apartment.  The  other  episode  features  housing  experts  Robert  Ratner,  Director  of  Housing  Services  for  Alameda  County  Behavioral  Health  Care  Services,  and  Elaine  deColigny,  Executive  Director  of  EveryOne  Home.  The  latter  episode  features  take-­‐away  points  consumers  should  keep  in  mind  while  looking  for  housing  as  well  as  elaborating  on  housing  as  a  mental  health  care  issue.  The  episodes  have  been  posted  in  their  entirety  on  Blip.Tv  as  well  as  in  shorter  clips  on  YouTube  and  the  PEERSnet  video  section,  where  users  can  share  ratings  and  comments.  Selected  clips  from  these  shows  will  be  integrated  into  the  housing  web  page  for  viewing  by  the  power  group  holders,  and  will  be  integrated  into  presentations  with  relevant  housing  audiences.    PSAs:  In  addition  to  creating  original  news  content,  PEERS  will  pursue  relevant  radio,  print,  and  broadcast  media  outlets  to  air  public  service  announcements  on  mental  health  and  housing.  Drop-­‐in  articles  and  news  coverage  will  be  strategically  placed  in  targeted  newspaper  and  local  television  outlets  (see  Appendix).   Empowerment Strategies for the Housing Sector

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Empowerment Skill Building and Support Groups In our partnership with the housing sector, PEERS will host ongoing groups focusing on empowerment skills development in at least two housing sites or homeless shelters. Groups offered will include Wellness Recovery Action Planning (WRAP) and Mindfulness Practice for wellness. PEERS has already selected the Ridge as one location for a WRAP group, and will consult with Alameda County Behavioral Health Care Services Housing Director Robert Ratner for a second appropriate site. In these locations, WRAP groups and Mindfulness Practice groups will focus on helping consumers of mental health services maintain wellness with emphasis on tools and skills useful for dealing with issues related to housing (ex: roommate relationships, etc). Education: PEERS will provide both consumers and housing power holders with valuable educational opportunities about the link between mental health and housing. The priority in consumer education focuses on educating consumers about their rights as tenants. In collaboration with other non-profit housing partners, PEERS will sponsor a Tenants’ Rights educational session at a POCC monthly training luncheon. That luncheon will feature a panel of experts, QA sessions, and participants will walk away with a fulfillment handout that can utilized and consulted in the future. The session will be videotaped and posted on the PEERS Web site as a resource for those unable to attend. PEERS will also offer training in the Seeking Safety curriculum for providers and peer support specialists with the goal of establishing at least two new Seeking Safety groups in our community of focus during the implementation year. Begun in 1992, Seeking Safety was developed through grant funding from the National Institute on Drug Abuse by Lisa M. Najavits, PhD at Harvard Medical School/McLean Hospital. Seeking Safety is a present-focused therapy to help people attain safety from trauma/PTSD and substance abuse. It may be conducted in group or individual format and is suitable for implementation in a variety of settings. It is of special interest to PEERS during our implementation year as it has also been used successfully with people who have a trauma history but do not meet criteria for PTSD. Outreach Strategies for the Housing Sectors Community projects: Just as in the African American community, collaborative community projects will also be implemented at housing sites. Two such projects will be completed in 2011-2012: one in the Oakland/Berkeley area and another in Hayward/Fremont area. Potential community project ideas include gardens, labyrinths, trees and benches, community fountains, and public art projects such as murals. The rationale behind the Housing Community project is twofold: first to provide a significant contact opportunity, allowing members of the community, landlords, residents, and people with lived experience of mental health issues to meet as equals and work collaboratively for a period of time. Secondly, all too often consumers of mental health services are only viewed as recipients of assistance and services and are not perceived as a population that “adds value” or contributes to a community. This view is sadly often integrated into the

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consumer of mental health services perception of themselves as recipients of services or charitable actions, rather than one who has value and talents with which to help their community. The community projects offer an exceptional opportunity to change that perception, allowing consumers of mental health services to give back to their communities and be perceived as a valuable member of, rather than a drain on, society.   Education for Power Holders: One of the primary messages heard during our Town Hall meeting with housing power holders was a request for concrete skills training for landlords and property managers to help them better respond when residents experience times of crisis. In response, PEERS proposes holding housing site trainings in eCPR, providing landlords and property managers with tools to recognize and respond appropriately to someone experiencing signs of emotional distress. We will offer three eCPR trainings to housing power authorities over the course of the implementation year with attendees welcome to bring colleagues, friends, or whoever else they feel would be appropriate to attend (managers, maintenance, office staff, etc.). In addition to eCPR and other skill building educational outreach for power holders, PEERS will create meaningful contact opportunities between power holders in the housing sector and consumers of mental health services. This will be accomplished by holding a series of speakers bureau events and having individuals speak at housing events and public hearings on housing projects. Additionally, PEERS will promote the inclusion of consumer representatives (including our Outreach Coordinator) on existing housing boards and housing groups including EBHO, EveryOne Home board, and other landlord’s associations and property management group meetings. VIII. General Population Workplan: Although the main thrust of our campaign programs are focused on reducing stigma in the African American community and the Housing power group, the campaign will also address stigma and discrimination within the larger general population of Alameda County. Media: One means of having significant impact on the attitudes of the general population is through the media. The messages we are exposed to in the media are important in influencing our ideas and feelings about people. Unfortunately, inaccurate portrayals of people with mental health issues are all too common in news, television, radio, Internet, and film depictions. Our proposed Media Watch Program would leverage the power of the community in identifying, responding to and thereby shaping these messages. PEERS has further partnered with the Entertainment Industries Council in Los Angeles, the recipient of statewide Stigma and Discrimination Reduction CalMHSA funding to change media messages in cooperation with Hollywood studios, to expand the reach and power of our Media Watch Program. Community members wishing to affect social change are trained to track and analyze the ways in which individuals with mental health challenges are portrayed in various types of media. Volunteers are encouraged to track a form of media they already actively utilize, choosing from

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any of the six media types tracked by the program, including newspapers, magazines, television, radio, movies, and the Internet. Unlike traditional media watch campaigns, volunteers are encouraged to seek out positive, balanced depictions of people with mental health issues in addition to identifying those that are stigmatizing. The program emphasizes using the power of positive reinforcement to create more positive and accurate depictions of people with mental health issues in the media. Once a media watch sample is identified and screened by the PEERS staff, an Action Alert is created and posted on our website and social media outlets such as Facebook and Twitter. Members of the community are invited to take action by clicking on the Action Alert which then enables the user to send a pre-written email to the media outlet in question, praising them for their balanced depiction, or helping to raise their awareness in cases of negative depictions. Additionally, “Reverse Boycotts” can be organized utilizing social media, encouraging members of the community to attend movies that portray people with mental health issues in a positive manner, visit and share websites with accurate information, and otherwise support and patronize outlets who are working hard to change the way people with mental health issues are depicted in the media. When stigmatizing or discriminatory messages are identified, the focus of the Media Watch program’s efforts center around educating the creator of the message, utilizing the well-documented “contact method” wherein the individual has direct contact and interaction with individuals with mental health issues that do not fit stereotypical and inaccurate portrayals. While we agree that traditional protest has a place and some potential for positive impact, the long-term potential for change is uncertain and there is the possibility of backlash. By focusing the thrust of our efforts on education and positive reinforcement, encouraging media outlets that are already doing good work in their coverage of people with mental health issues, we hope to avoid the potential backlash possible with traditional protest models and instead promote duplication and inspire other media outlets to follow the example of those who are 'getting it right.' The community is actively involved in all parts of the effort: identifying media portrayals that deserve praise or further education, informing others about issues of stigma in the media via social media sharing, and in actively engaging the media creators in dialogue about their work. Outreach: PEERS will host community events that create opportunities for contact between the larger community and consumers of mental health services throughout the year. The first of these will serve to launch our campaign into the general community’s awareness during Mental Health Awareness week during the first week of October. Held at Cesar Chavez Park in Berkeley on October 1st, The Mental Health and Wellness Walk will feature political figures from the local and state level (tentatively scheduled: Mayor Jean Quan), leading mental health and wellness officials from Alameda County, leaders from within the consumer movement, entertainers, and consumer speakers. Instead of raising funds as in a traditional walk-a-thon, participants will strive to raise “pledges” (getting as many people as possible to take the “Stigma Stops with Me”

  34  

pledge online). The event will also feature an art exhibit by people with lived experience of mental health issues, a create your own art station, family activities, resource and information tables about mental health resources as well as ample opportunities for people from the community to meet and socialize with people who publically identify as a consumer of mental health services. Empowerment: Although special emphasis will be placed on offering culturally responsive empowerment activities and trainings to members of the African American community in the implementation year, PEERS will continue its ongoing efforts to support the empowerment of all consumers of mental health services. In addition to our well-known WRAP groups and WRAP certification trainings for consumers, and the new empowerment through creative arts meetings, PEERS will host a training in the use of humor and comedy in telling one’s story and combating stigma called: Stand Up for Mental Health. Created by David Granrier, a person who lives with depression, Stand Up for Mental Health is a course that teaches consumers of mental health services about the use of humor in combating stigma and discrimination and provides a hands-on workshop in which consumers are taught how to tell their story through comedy. “We use comedy to give consumers a powerful voice and help reduce the stigma and discrimination around mental illness,” says Granirer. “The idea is that laughing at our setbacks raises us above them. It makes people go from despair to hope, and hope is crucial to anyone struggling with adversity. Studies prove that hopeful people are more resilient and also tend to live longer, healthier lives.” More information on the program can be found at: http://www.standupformentalhealth.com/. IX. Campaign Strategies and Deliverables Media  Strategies  and  Deliverables    

African  American  Community  

Housing  Power  Holders   General  Population  

Short  introductory  film,  under  10  minutes,  about  mental  health  issues  in  the  African  American  community  

Short  introductory  film,  under  10  minutes,  about  the  issues  surrounding  mental  health  and  housing  

Short  introductory  film,  under  10  minutes,  about  PEERS  and  the  campaign  

Customized  webpage  for  with  resources,  articles,  blog  posts,  and  videos  specific  to  the  African  American  community  

Customized  webpage  with  resources,  articles,  blog  posts,  and  videos  specific  to  the  Housing  community  

Webpage  with  resources,  articles,  blog  posts,  and  videos  for  the  general  population    

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Produce  1  episode  of  Mental  Health  Matters,  aired  via  cable  and  internet,  about  mental  health  issues  in  the  African  American  community  

Produce  1  episode  of  Mental  Health  Matters,  aired  via  cable  and  internet,  about  mental  health  and  the  Housing  community  

Produce  20  episodes  of  Mental  Health  Matters,  aired  via  cable  and  internet  

Produce  2  call-­‐in  radio  shows  and  downloadable  podcasts  regarding  mental  health  issues  in  the  African  American  community  

Produce  2  call-­‐in  radio  shows  and  downloadable  podcasts  regarding  mental  health  and  housing  

Expand  upon  existing  TAY-­‐specific  website:  http://peers.lifeportal.com  

Produce  informational  brochure  specific  to  the  African  American  community  

Produce  informational  brochure  specific  to  the  Housing  community  

Produce  informational  brochure  regarding  PEERS,  the  campaign,  stigma,  and  discrimination  

Pursue  media  outlets  widely  recognized  by  the  African  American  community,  including  radio,  print,  and  broadcast  media,  regarding  the  issues  of  mental  health,  stigma,  and  discrimination  in  the  African  American  community  

Pursue  drop-­‐in  news  articles  and  news  coverage  regarding  the  issues  of  mental  health,  stigma,  and  discrimination  to  raise  awareness  of  issues  to  power  holders  

Pursue  media  outlets,  including  radio,  print,  and  broadcast  media,  regarding  issues  of  mental  health,  stigma,  and  discrimination  

    Launch  and  research  the  effectiveness  of  the  Facebook  pledge  application  to  end  stigma  and  discrimination  

    Advertise  on  mass  transit,  including  the  interior  of  BART  trains  and  the  exterior  of  AC  Transit  buses  for  the  Mental  Health  and  Wellness  Walk  and  the  Stigma  Stops  with  Me  pledge  

    Media  Watch  program          Empowerment  Strategies  and  Deliverables  

  36  

 African  American  

Community  Housing  Community   General  Population  

Offer  2  WRAP  groups  in  a  traditionally  African  American  community  

Offer  2  ongoing  support  groups  in  housing  sites  and/or  shelters  

Offer  WRAP  groups  throughout  the  county,  appropriate  to  groups  across  the  lifespan,  including  TAY  and  older  adults    

Host  1  “Re-­‐form—a-­‐tion:  Moving  beyond  stigma”  workshop  series  in  a  traditionally  African  American  community  

Host  Tenants’  Rights  workshop  in  partnership  with  the  POCC  

Host  1  “Re-­‐form-­‐a-­‐tion:  Moving  beyond  stigma”  workshop  series  for  the  general  population  

Provide  trauma  informed  mindfulness  practice  groups  in  a  traditionally  African  American  community  site  

Provide  2  trainings  in  Seeking  Safety  curriculum  for  providers  and  peer  support  specialists  

Provide  mindfulness  training  to  consumers  to  become  mindfulness  practice  group  leaders  

Sponsor  5  art  workshops  and  shows,  including  visual  art  and  spoken  word  in  a  traditionally  African  American  community  

  Sponsor  5  art  workshops  and  shows,  including  visual  art  and  spoken  word  

    Stand  Up  for  Mental  Health  workshop  in  telling  your  story  through  comedy  

   Outreach  Strategies  and  Deliverables  

African  American  Community  

Housing  Community   General  Population  

Host  2  Stigma  Free  Zone  certification  workshops  for  businesses  in  the  African  American  community,  with  a  goal  of  10  businesses  achieving  certification  

Host  2  eCPR  trainings  for  housing  power  holders  

Host  1  comedy  night  in  a  public  space  after  Stand  Up  for  Mental  Health  workshop  

Present  Black  Men  Speak  at  5  public  speaking  events  

Facilitate  1  community  garden  at  a  housing  site  

Present  the  Speakers’  Bureau  at  5  public  speaking  events  

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Facilitate  1  public  art  project  in  a  traditionally  African  American  community  

  Host  Mental  Health  and  Wellness  Walk  on  October  1  as  a  kick-­‐off  event  to  Mental  Health  Awareness  Week  in  Northern  Alameda  County  

    Host  a  community  event  for  Mental  Health  Awareness  month  in  May  in  Southern  Alameda  County  

   Spirituality  Strategies  and  Deliverables  

African  American  Community  

Housing  Power  Holders   General  Population  

Create  lists  of  faith-­‐based  communities  in  traditionally  African  American  communities  

  Host  National  Mental  Health  Day  of  Prayer  event  on  October  3  

Present  2  workshops  on  creating  more  welcoming  faith  based  communities  at  faith-­‐based  organization  in  traditionally  African  American  community  

  Host  Yoga  and  Meditation  training  

    Present  1  Mental  Health  101  workshop  at  faith-­‐based  organization  

X. Evaluation and Research In the implementation year of the Social Inclusion Campaign, PEERS will conduct both evaluations and research to measure the effectiveness of campaign strategies. Evaluation refers to the assessment of events occurring throughout the implementation period. Rather than evaluating the program upon its conclusion, our evaluation strategy will provide staff with “real-time” feedback, allowing them to make adjustments to the plan as needed during the implementation process. Without evaluation, PEERS would not learn about the effectiveness of certain methods until the implementation period, thus missing important and valuable opportunities to make corrections or modifications in a timely and efficient manner. Because the implementation of campaign strategies is an iterative process, evaluation holds great

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importance. Evaluation will be conducted at the conclusion of individual events -- such as Speakers Bureau presentations, trainings, community events, or educational sessions – and will examine the responses and attitudes of the event’s attendees. Areas covered in the evaluation will include perceived quality of the event, effectiveness, educational/attitudinal impact, and recommendations from the audience in how to improve our efforts. While the plan is an educated hypothesis born from extensive research, other campaigns, and feedback from stakeholders, we do not expect perfection; rather, we anticipate something of high enough quality to implement, but also from which to learn. Our approach is one of curiosity and humility, and as such, requires that we implement, evaluate, adjust, re-evaluate, and share key take-away points as they arise. Research refers to the collection and analysis of data over the two-year implementation period, at which point any significant trends, behaviors, or changes will be discovered. Although preliminary data from research efforts can be used in modifying and adapting our programs, final research analysis will not complete until two-year implementation period has concluded. By utilizing research methodology, we will learn about the broader question of attitudinal shifts over time. Defining penetration and impact In the evaluation and research processes, we will measure both penetration and impact. Penetration refers to how visible and pervasive the campaign message is to the general public, as well as how often people are interacting with campaign efforts. This is often measured through statistics around Web site hits, social media activity, and registration for various events. Impact refers to the degree to which campaign efforts have affected attitudinal change regarding people with mental health issues. In analyzing evaluation impact, PEERS will administer short surveys; in analyzing research impact, PEERS will utilize Dr. Patrick Corrigan’s measure of attitudinal change as a pre- and post-test. Evaluation strategies In evaluating penetration, we will monitor data on a monthly basis in the following areas:

Web hits. Facebook likes. Number of pledges taken in the "Stigma Stops with Me" intiative. Number of video views on PEERS YouTube page and PEERS Web site videos. Readership stats for date when PSA article appears in paper, based on print circulation for the date the article is published Viewership stats for date when PSA featured on television or Radio channels. Podcast downloads of PEERS radio shows and podcasts.

Sign-in sheets for WRAP groups, training sessions, speakers bureau performances, outreach activities and attendance at events. In evaluating impact, we will implement qualitative evaluations to measure attitudinal shifts, analyzing:

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• Training evaluations • Speakers Bureau evaluations • Discussion Board comments about pledge activity • Event surveys Quarterly web-based surveys to YouTube subscribers, listservs, newsletter

recipients, and Facebook page subscribers to evaluate effectiveness of messages and events

Research strategies PEERS, along with the help of Dr. Patrick Corrigan and his research team, will measure changes in attitude over time in the general community via the Facebook Pledge Research Project Plan. The “Stigma Stops with Me” Facebook application, which allows users to make an online pledge describing how they will end stigma and discrimination, will be used in determining how online users’ views towards people with mental health challenges change over the course of months. After a user takes the online pledge, PEERS will send them an invitation to complete a survey on their attitudes towards mental health consumers. Then, to measure change, we will send that same user another email three months later. We plan to start the process on July 1, 2011, have research completed by January 1, 2012 and analysis completed by June 1, 2012. PEERS also plans on conducting research on changes in attitudes in our focus populations for the implementation year, namely the African American community and housing sector. In the Barbershop/Salon Research Project Plan, PEERS plans on providing incentives to beauty parlors and hair cutting businesses that become “safe spaces” in which individuals can talk about mental health issues. Business owners/managers attend a workshop and are given information about the myths and facts of mental health issues, basic listening skills practice, as well as information on local resources for recovery and support. Incentives for those who complete the training include business certifications, awards, and free advertising and publicity in PEERS publications both in print and on-line. As a follow up study with a research associate, PEERS plans on tracking how often the topic of mental health arises in “safe spaces” and the quality of information conveyed compared to those areas with no such designation. With regards to the power holders in the housing sector, PEERS will measure impact through qualitative surveys and evaluations posing questions about attitudes. Our initial effort will be focused on Speakers Bureau presentations to housing owners and landlords, and reviewing the attendees’ self-described reactions in written form. Summary of strategies Evaluation Research Penetration PEERS will keep real-time

statistics on various measures, including Internet activity, media viewership, and event sign-ins.

PEERS will total statistics on various measures, including Internet activity, media viewership, and event sign-ins after one year.

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Impact Surveys and evaluations will be conducted to learn of attitude changes in response to PEERS-sponsored events.

PEERS will utilize Dr. Patrick Corrigan’s measure of attitudinal change as a pre- and post-test.

Reporting PEERS will present the findings and results of the campaign’s implementation in various ways. As part of the ongoing effort to establish real-time results and provide real-time feedback, PEERS will report penetration measures in a monthly oversight report. In addition to providing hard data, PEERS will also summarize and graph evaluation responses in the oversight report to depict any trends in a visual manner. PEERS will also be analyzing attendance and evaluation after each event and strategize necessary adjustments to the campaign. We will be doing this to increase campaign reach and effectiveness prior to implementing the next instance of event (ex: Speakers Bureau session). At the end of the first implementation year, PEERS will compile all statistics, evaluations, research projects, and learning outcomes in an annual report. At that time, the research projects will also be submitted for publication. APPENDICES Appendix A Our Thanks to the People Who Made This Work Happen Advisory Board Joe Anderson Sarah Ashbrook boona cheema Christina Cross Tim Dreby Derethia DuVal Karina Foote Renu Garg-Peter Linz Jonathan Griggs Ernest Hardmon III Sheldon Koiles Abobaker Mojadidi Cheyenne Pronga Dianne Rush Woods Melany Spielman Dina Tyler Sally Zinman

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Oversight Committee Judith Ghidinelli Tracy Hazelton Mary Hodgen Jay Mahler Barbara Majak Lupe Mariscal Genevieve Tregor Rosa Warder Gary Spicer Khatera Aslami Lisa Smusz PEERS Board of Directors Luther Jessie Board President Jonathan Griggs Treasurer Paulette Malak Secretary Quintara Nielson Board Member Marti Winterhalter Board Member Melany Spielman Board Member Staff and Key Contractors participating in the planning year Staff: Khatera Aslami Christal Byrd Jenee Darden Lala Doost Letty Elenes Shannon Eliot Mary Hogden

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Latasha Howel Nancy Lee Enrique Lopez Tracy Love Kristin Magruder Daniel Oden Lauri Pamisciano Lisa Smusz Natalie Stone Brianna Williams John Woodruff Contractors: Yaffa Alter Monique Tarver Sally Zinman Consultants: Kathleen Brown Pat Corrigan Chi Chi Okonmah Laurel Mildred Laura Peck Karen Perkins Colette Winlock Appendix B

Original Research: Stigma and Discrimination Reduction Survey, Ties that Bind: Challenging Stigma and Discrimination Conference, October 2007

The POCC Stigma and Discrimination Workgroup was led by Sally Zinman at the “Breaking The Ties That Bind: Challenging Stigma and Discrimination” conference in October 2007. The survey participants included consumers, family members and providers as follows:

Participants in 2007 Stigma and Discrimination Survey

Ethnicity Consumers Family Members Providers Caucasian 31% 41% 47% African American 36% 45% 22% Asian 9% 0 15% Latino 16% 9% 12% American Indian 3% 0 0 Multi-ethnic 3% 5% 3%

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Non-Caucasian respondents comprised the majority in two of the three categories; providers who responded to the Survey were less representative of diversity than consumers and family members and were the only group for which Caucasians were the largest single ethnicity.

Three key questions were asked of respondents and their answers collated:

Question 1: What groups stigmatize and discriminate against people with mental disabilities?

All three groups ranked “the criminal justice system” and “community members and society” as the first and second groups of people that most exhibit stigma and discrimination.

Consumers and family members identified “the criminal justice system” as the most discriminating in significant numbers, while providers identified “community members and society” almost as much as “the criminal justice system” as the most discriminating.

Providers ranked “the mental health system” as more discriminating than consumers and family members did.

Consumers alone ranked “family members” among the most discriminating groups. Family members ranked “employers and landlords” as more discriminating than consumers and providers did. This, along with family members ranking of “the mental health system” within the top five, provides an insight into the barriers of family members’ experience in assisting their loved ones in accessing jobs, housing and the mental health system.

Question 2: What kind of attitudes did the group who discriminated or stigmatized exhibit?

0   20   40   60   80  100  120  

Criminal  Justice  System  

Community  Members  and  society  

Media  

Family  Members  

Mental  Health  System  administration,  

Employers  

Landlords/housing  personnel  

Provider  Response  

Family  Member  Response  

Consumer  Response  

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All three groups ranked “judgmental” as the most prevalent attitude exhibited by groups that stigmatize and discriminate. “Disrespect” and “Fear” also ranked among the top five most prevalent discriminating attitudes by all three groups. Both consumers and family members ranked the same five attitudes, although in different order. Providers ranked “Abuse” as the lowest of any attitude, while consumers and family members ranked it among the top three discriminating attitudes.

Question 3: What kind of Social Inclusion or Stigma and Discrimination Reduction program would you like to see Alameda County fund?

0   20   40   60   80   100  

Judgmental  

Abuse  

Disrespect  

Controlling  

Fear  

Ridicule  

Shunning  

Provider  Response  

Family  Members  Response  

Consumer  Response  

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All groups – consumers, family members and providers — ranked “a multi-faceted consumer operated program targeting employers, housing, schools, criminal justice/police, media, faith based agencies and health care professionals,” “enhance personal skills, abilities and self-esteem, such as WRAP programs, job mentorship and promoting independent living skills,” and “address external discrimination, such as legal and civil rights, discrimination in housing, employment and schools and an effective complaint system’ among their top five Stigma and Discrimination programs, although not in the same order. “A multi-faceted consumer operated program…” was the highest preference for all three groups.

Providers and family members – not consumers – ranked “target mental health and substance abuse providers and systems” as among their top five.

“Clarifying the stigma and discrimination message” was important to consumers only, possibly suggesting that consumers want to determine the anti-stigma and discrimination message as well as their dissatisfaction with prevailing anti-stigma and discrimination messages.

0   20   40   60   80  100  120  140  

Multi-­‐faceted  consumer  operated  program  targeting  employers,  housing,  schools,  criminal  justice/police,  media,  

Enhance  personal  skills,  abilities,  and  self  esteem,  such  

as  WRAP  programs,  job  mentorship,  and  promoting  

Address  external  discrimination,  such  as  legal  and  civil  rights,  discrimination  in  housing,  employment,  and  

Clarify  the  consumer  anti-­‐discrimination  and  stigma  

message  

Focus  on  and  inclusion  of  multi-­‐cultural  populations  and  

perspectives  

Media  campaign,  including  TV  and  radio  initiatives  

Target  mental  health  and  substance  abuse  providers  and  

systems  

Provider  Response  

Family  Member  Response  

Consumer  Response  

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Appendix C

Homelessness and Housing Instability in Alameda County

Another population of interest to Alameda County as a priority is the homeless. Available 2004 county data30 reveals that:

• As many as 16,000 people experience homelessness during the course of a year and 6,215 people are homeless on any given night (NOTE: this data precludes the 2008 onset of recession)

• 58% of homeless adults have one or more disabilities, including mental illness, HIV/AIDS and other physical disabilities

• Over 30,000 people with mental illness have extremely low incomes and are at risk of homelessness in Alameda County

• Nearly 1,000 people with mental illness are homeless on any given night, and over 30% of those are dually diagnosed with substance abuse addiction

• Approximately 34,000 (6%) of Alameda County’s 523,000 households are at severe risk of homelessness because they are extremely low-income renters paying more than 50% of their income on housing.

Appendix D

Original Research: African American and Housing Town Hall Meeting Surveys, Spring 2011

In planning for the Social Inclusion Campaign, PEERS conducted two Town Hall meetings where community members, including consumers and family members, were surveyed. The first Town Hall focused on the African American community and their views about sources of support, key sources of messages about mental health issues, their feelings with respect to those messages, obstacles to getting the help they need and concerns about mental health issues. The African American Survey questionnaire that was completed at the Town Hall meeting was developed by the African American members of the PEERS Advisory Board in collaboration with Gigi Crowder, BHCS Ethnic Services Manager and Project Manager of the African American Utilization Report.

                                                                                                               30 Everyone Home. (2004). Fact Sheet: Homelessness and Housing Instability in Alameda County. Alameda Housing and Community Development

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African American Community Town Hall Meeting Report

As a result of the completed questionnaires from the African American Town Hall Meeting, consumers and family members reported that community support groups, schools, mental health providers, spiritual groups including churches, friends and family are the greatest sources of support when dealing with mental health issues. Several Town Hall Meeting attendees mentioned NAMI East Bay and African American Family Support Group as community supports that are especially helpful. Another attendee finds support in other community groups, “BEST NOW helped me get involved in mental health service; POCC helps me to know the importance of leadership in mental illness field.”

0   2   4   6   8   10   12   14   16  

Community  Support  Groups  

Mental  Health  Providers  

Friends  

Spiritual  Community  /  Church  

Family  

Schools  

#  of  Attendees  Finding  Support  

Support    

Support  

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The vast majority of the attendees stated that the media is the largest source of the negative messages/myths received about mental health relating to African American/ Black people, followed by family, school and church.

0   2   4   6   8   10  

Media  

Family  

School  

Church  

Community  

Friends  

#  of  Attendees  Hearing  Message  from  Location  

Where  Message  Heard  

Hearing  Messages  

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When asked how the messages about mental health issues made them feel, the attendees overwhelmingly stated that the messages made them feel stigmatized, categorized, and discriminated against, followed second by negatively affected. The attendees feel that the main messages/myth being delivered are that “people with mental health issues are dangerous and violent” and are “criminals.” Another common message/myth is that “all you have to do to help yourself with mental health issues is pray.” Other attendees stated that the message that mental health is a weakness and should not be acknowledged is pervasive in the community.

0   5   10   15   20   25   30   35   40  

Well  Supported  

Understood  and  Truthfully  Represented  

Neutral  

Negatively  

Stigmatized,  Categorized,  and  Discriminated  Against  

#  of  Attendees  Feeling  

The  Feeling  

How  Messages  Make  You  Feel  

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Culturally incompetent practitioners, general lack of and lack in quality of resources, and the fear of stigma and stereotyping are the main obstacles faced as an African American / Black person when trying to get needs met during a mental health emergency. As reported by one attendee, “There are a shortage of black therapists so if you request one, there may be a delay in getting a black counselor which means a delay in getting help.”

0   2   4   6   8   10   12   14   16   18  

Lack  of  appropriate  resources  

Fear  of  stigma  and  stereotype  

Medication  issues  

Law  enforcement  

#  of  Attendees  Facing  Obstacle  

Obstacle  

Obstacles  in  Getting  Care  

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The need for education about wellness and recovery, services, resources, and mental health issues is a serious concern for the attendees at the Town Hall Meeting. The fee for services and working to maintain basic needs in order to maintain mental health were also areas of concern surrounding mental health issues in the African American / Black community. One attendee suggested, “Believe there’s a lot of potential for educating the Black community through its institutions, which are currently rather passive. Institutions to consider are religious institutions, schools, primary health care institutions, and hair care salons.” Another attendee saw the need in “providing more services, training police, and education [about mental health issues to the larger community].”

0   1   2   3   4   5   6   7   8  

Education  about  resources  and  mental  health  issues  

Cost  of  services  /  No  fee  

Maintain  basic  needs  

#  of  Attendees  Concerned  

Concern  

Concerns  about  Mental  Health  Issues    

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Appendix E Housing Community Town Hall Meeting Report

Housing Community Town Hall Meeting Report

Attendees of the Housing Community Town Hall Meeting overwhelmingly agreed that the programs and partnerships currently in place are incredibly bright spots in helping people with mental health issues find and maintain housing. For example, one attendee noted that the “Berkeley Mental Health Partnership between landlords and mental health community clinics” helps those struggling with housing. Other programs, such as MHSA Supportive Housing Funds, were also mentioned as bright spots. It has also been noticed that the general care and awareness for the need of housing is positive in the community. Attendees reported that, “people are coming out to listen, talk about, work together,” and that there are “people who are about other people and their needs.”

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Programs  and  Partnerships  

Care  and  Awareness  

Faith-­‐Based  Support  

Advocacy  

Consumer  Choice  and  Involvement  

Policies  

#  of  Attendees  Citing  Bright  Spot  

Bright  Spots  

Bright  Spots  

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In terms of the major barriers that the housing community faces, it was noted that the high cost of housing and the lack of funding, as well as the stigma attached to mental health issues, are the main barriers. Lack of awareness and education about the issue, in addition to the availability of services are other major barriers described by the attendees. One of the attendees described stigma as a barrier by noting the existence of “Personal biases against people with mental health issues and poor people in general." Another attendee reported on the barrier of funding by stating, “Funding for those with mental health issues is slow to materialize.”

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High  Costs  and  Lack  of  Funding  

Stigma  

Awareness  and  Education  

Availability  of  Services  

Lack  of  supports  

Safety  and  quality  of  housing  

#  of  Attendees  Citing  Barrier  

Barriers  

Barriers  

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Attendees stated that education and training about wellness and recovery in the community, having support programs to get and stay in housing, and having more affordable housing through greater funding are needed in order to remove the barriers and obstacles to finding and staying in quality housing. One attendee declared that “Educating that recovery is possible” and “Educating on housing rights and responsibilities” is essential. Another attendee noted the need for funding, education, and support by stating, “Increased funding for support and education—support can be in assisting in stabilization, intervention in evictions…and expectations that individuals with mental health issues deserve a quality residence.”

0   2   4   6   8   10   12   14  

Education  and  Training  

Housing  supports  

Affordable  housing  options  and  funding  

Safe  and  Quality  Housing  

More  effective  programs  and  partnerships  

Incentives  

#  of  Attendees  Citing  Need  

Need  to  Rem

ove  Barriers  

What  is  Needed  to  Remove  Barriers  

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Appendix F: “Lift Every Voice and Speak” The Alameda County Social Inclusion Campaign Speakers’ Bureau, Lift Every Voice and Speak, has been meeting since early March. Using the model of “Uncover, Discover and Recover,” members of the bureau have worked on crafting stories using portions of their lives to set context, identify turning points and highlight experiences and tools of recovery and wellness. Due to the commitment to monthly ToastMasters meetings, the work of the Speakers’ Bureau, Lift Every Voice and Speak, will continue throughout the beginning of the campaign’s implementation year. This time will be used not only to continue the work of story crafting, but will also be used to highlight several alternative ways in which to share stories and to have an adequate amount of time to prepare for our presentations within the larger communities of Alameda County. Lift Every Voice and Speak Messaging:

♦ Recovery is a process ♦ Hearing personal stories, empower consumers and caregivers ♦ How family supported or didn’t ♦ How stigma and discrimination impacted your recovery process ♦ Small targeted groups ♦ Facilitated by an officer and/or Natalie

As with any difficult experience or circumstance, attaining recovery and wellness is an evolutionary process. Personal stories are powerful tools in the education and empowerment of consumers, family members and community leaders. Using an approach that targets specific audiences, consumer stories can bring to life the effects of stigma and discrimination on those with mental health challenges and change hearts, minds and behaviors.

Conclusion – call to action

♦ Take the pledge – Facebook and written ♦ Leave with resources (including African American and Housing brochures) ♦ Each one teach one

This campaign is about action. So often people speak of stigma and discrimination, but do not offer actionable next steps. Today, we as Lift Every Voice and Speak would ask you to do three things. First, please see the Stigma Stops With Me cards, and take our pledge either online or here today. Second, take any and all resources that may be helpful to you, a loved one or the

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larger community. Third, share this experience, what you have learned and what inspired you to work to end stigma and discrimination with at least one other person. Appendix G: Media Outlets Targeted NEWSPAPER Bay Area News Group Alameda Journal Alameda Journal Berkeley Voice Oakland Tribune East Bay Express Oakland Post Sunday Morning News (Black Newspaper) WEBSITE Alameda Patch Berkeley Patch Berkeleyside.com Castro Valley Patch Lake Merritt-Uptown District Lake Merritt-Uptown District Oakland Local Oakland Local Ads Pleasanton Patch San Leandro Patch RADIO STATION KBLX (R&B Jazz) KPFA (news and music) KPFA "About Health" KPFA "Hard Knock Radio" KPFA PSA KQED (news) KQED "California Report" KQED PSA TV STATION ABC 7 KPIX 5 KPIX 5 KRON KTVU KTVU

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Appendix H Advisory Board Documents

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