wise health care increasing inclusion, hope and support reversing the stigma of mental illness
DESCRIPTION
Care Connections (Waukesha County NAMI Support Group) Center for Suicide Awareness Dry Hootch Grassroots Empowerment Project Illinois Institute of Technology Latino Health Coalition – Mental Health Action Team MHA Sheboygan MHA Wisconsin Marian University NAMI WI, Fox Valley, Greater Milwaukee, Racine Prevent Suicide WI and local coalitions Rogers InHealth University of WI campuses WI Department of Health Services WI Family Ties WI United for Mental Health Wood County Health Department ETC. WISE Partial List of Active Partners:TRANSCRIPT
WISE Health Care
Increasing Inclusion, Hope and SupportReversing the Stigma of Mental Illness
Statewide collaboration oforganizations and individuals
Promote evidence based practices, current research and outcomes evaluation
Majority speak from experience of stigma and recovery
Offer framework, consultation and resources for stigma reduction
Academic research advisor: Patrick Corrigan PhD, IL Institute of Technology
Care Connections (Waukesha County NAMI Support Group)Center for Suicide AwarenessDry HootchGrassroots Empowerment ProjectIllinois Institute of Technology Latino Health Coalition – Mental Health Action TeamMHA SheboyganMHA WisconsinMarian UniversityNAMI WI, Fox Valley, Greater Milwaukee, RacinePrevent Suicide WI and local coalitionsRogers InHealthUniversity of WI campusesWI Department of Health Services WI Family TiesWI United for Mental HealthWood County Health DepartmentETC.
WISE Partial List of Active Partners:
Explore stigma in a shame and blame free environment
Spotlight stigma in the culture of health care
Frame stigma change Connect to your work and lives
GOALS
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Patrick Corrigan PhD And other stigma researchers in the U.S. and
world
Academic Research and Partnership
schizophrenia
depressiontrauma
anxiety
eating disordersDrug and alcohol abuse
They are us.
1 in 4
47% in our lifetime
What is stigma?
Where does it come from?
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Stigma Definition and Types
StigmaDefinition:Stereotype (ideas) > Prejudice (beliefs) > Discrimination (actions) In a relationship of power = Oppression
Types: Internalized Shame Public Structural
Language?
Examples of Stereotypes- Ideas
People with mental health challenges are incapable, fragile, dangerous, cannot recover
Mark
Mike
Linda and Nneka
Val
Dori
Examples of Prejudice- Beliefs
They are scary, shameful, less than. Mental illness history overshadows other diagnostic information.
Charles
Simone
Sumi
A. van Nieuwenhuizen, et al. Emergency department staff views and experiences on diagnostic overshadowing related to people with mental illness. Epidemiology and Psychiatric Sciences, 2012.
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Social-I don’t want them to live next door, be a co-worker, marry into my family
Structural◦ Workplaces◦ Insurance companies◦ Schools◦ Etc.
Examples of Discrimination- Actions
Paul
Pastor TimDenise
Avoidance and apathy
self esteem
So, why try?
I am not good
Internalized Shame/Self StigmaPublic Stigma
sense of efficacyI am not able
Characteristics of People Facing Mental Health and Addiction Challenges
Stubborn
Strong
Resilient
Flexibile
Compassionate
Organized
Intelligent
Empathic
Creative
Funny
Short
Tall
Old
Young
Agnostic
Religious
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Racial Oppression
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Religious Oppression
Gender Oppression
Co-Occurring Stigma (public and internalized) Heterosexism Racism Sexism Ableism Etc.
2011 YRBS data showed LGBT youth in WI had:
- 5X the rate of suicide attempts - 3X more likely to skip school due to feeling
unsafe- 50% felt like they did not belong at school
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Movies
Drivers of Public Stigma
Stories of unethical research, drug side
effects & poor quality care
Advertising
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Benevolent Stigma
People with mental illness are “lovable and incapable”
Stigma’s Impact on SOCIAL INCLUSION
Lost employment Subpar housing Worse health care Diminished education opportunities Alienation from faith community
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OK, but isn’t it better lately?
Trenton State
Hospital has fire.
July 10th, 2002
Despite what you might think, the percentage of Americans who viewed people with mental illness as dangerous doubled from 1956 to 1996.
Source: BG Link, JC Phelan, M Bresnahan, A Stueve, BA PescosolidoAmerican Journal of Public Health 89 (9), 1328-1333
1956 19960%
20%
40%
60%
80%
100%
20%
40%
% who viewed those with mental illness as danger...
1956 1996 20060%
20%
40%
60%
80%
100%
20%
40% 40%
% who viewed those with mental illness as danger...
…That figure held steady from 1996 to 2006.
Source: BG Link, JC Phelan - The Lancet, 2006
Same is true for children: Psychiatr Serv. 2007 May;58(5):619-25
Nurses in: • inpatient psychiatric units, • emergency departments and • intensive care units in particular, were found to hold blaming/hostile attitudes towards people with mental illness.
(Anderson & Standen 2007, Patterson et al. 2007, Thornicroft 2007)
Stigma/discrimination was frequently experienced by people with mental illness when using health services, particularly mental health services.
Data supports that services often increase burden of mental health problems on patients and families.
J Harangozo, et al. Stigma and discrimination against people with schizophrenia related to medical services. International Journal of Social Psychiatry 2014, Vol. 60(4) 359–366
Health Services
When am I most likely to notice fear, condemnation, frustration, anger, etc. rising within me related to behaviors that may be indicative of mental health challenges?
Personal Reflection
• Relative status of mental health professions
• Lack of capacity – “We/I can’t help you.”
• Don’t see enough recovery
• Concepts of compliance and relapse
• Misapplication of HIPPA
• Restraints on professional self-disclosure
• Professional burnout
• Levels of reimbursement, lack of parity, silos…
• Etc.
What Are The Drivers Of Stigma Within Health Care?
Stigma and Compassion Fatigue
• Feel a lack of capacity to effect change• Gradual lessening of compassion over
time• Avoid trying to understand what clients
face
In any given situation we can be:
Stigmatizers Stigmatized De-stigmatizers
(Healthcare Workers and Stigma, Ross C. A. & Goldner E. M.
2009)
Protest
Education
Contact
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Stigma Change Processes
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Protesto Review stigmatizing imageso “Shame on you for thinking that way”o Be aware of unintended consequences of
well intended actionso The rebound effect
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Education
Counters myths with facts
Myth: People with serious mental illness can not care for themselves; need to be institutionalized.
Fact: Long term follow-up research suggests 2/3rds of people with schizophrenia learn to live with their disabilities.
RECOVERY is the rule
Myth: People with serious mental illness are dangerous.
Fact: People with untreated mental illness are slightly more dangerous especially when using drugs or alcoholBUT…◦They are more likely to be victims of violence
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
DOES STIGMA DECREASEAS KNOWLEDGE INCREASES?Results from a meta-analysis study:
Knowledge: Causes of Mental Illness Stigma: Acceptance
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Brain Disease
META-ANALYSIS FINDINGS: CAUSE
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Neighbor
META-ANALYSIS FINDINGS: ACCEPTANCE
Impact?◦Blame went down◦Belief in recovery also went down
1990-2000 Decade of the Brain
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Contact“I’d like you to meet
Simone, Mike, Linda, Nneka, Paul, Charles, Val, Sumi, Denise, Tim, Mark and Dori”
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Their Recovery Story (part1)My name is ______ and I have faced mental health and/or addiction challenges…My childhood was… My mental health challenges were difficult for me and others. They did not go away quickly…
Their Recovery Story (part2)Combining my internal resources with external resources, I found my unique path to recovery…
I have achieved a satisfying life with several accomplishments.
Many education efforts have helped us to understand the pain of mental health crises.
Yet, there exists a curtain of
ignorance about resilience and
recovery.
Resilience and RecoveryResilience- the capacity of children and adults to succeed and thrive, despite experiencing trauma, mental illness and/or addiction. Resilient people have internal and external "protective factors.” Recovery- A process of change through which people work to improve their health and wellbeing, live a self-directed life, and strive to achieve their full potential.Four dimensions of recovery:
My Health A safe and supportive Home A sense of Purpose in my life Belonging to Community
(from SAMHSA)
Contact with someone with lived experience was more effective than education in reducing attitudes of avoidance.
controlgroup
education:danger-ousness
education:responsibility
contact:danger-ousness
contact:responsibility
-4
-3
-2
-1
0
1
2
3 pre post
controlgroup
education:danger-ousness
education:responsibility
contact:danger-ousness
contact:responsibility
-4
-3
-2
-1
0
1
2
3 pre follow-up
The effects of contact on attitudes of avoidance were sustained at the one month follow-up.
Solutions in the Medical Arena
Education AND Contact
And address other drivers: structural, burnout, etc.
Claire Henderson, et al. Mental health-related stigma in health care and mental health-care settings, LancetPsychiatry2014; 1: 467–82
Targeted Local Credible Continuous Change-focused Contact
TLC4
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Who Should the TARGETS Be?
Health care professionalsEmployersLandlordsTeachersLegislatorsFaith communities
x
MILWAUKEE
Does it play in
Wausau?
What is LOCAL Contact?
Contact with peer
Example- • Nurse to nurse• Pastor to pastor• Football player to football player
What is CREDIBLE Contact?
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Once is not enough
And variety is needed
CONTINUOUS Contact
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What do you want the target group to do differently as a result of the contact?
Ask those we serve!
CHANGE-FOCUSED Contact
More acceptance of me as a full human, less judgment
Labels would be less important Open communication – trust in
confidentiality and yet less need for confidentiality
No fear in my gut about how health care professionals will treat me
A stigma-free environment in health care:
My physical concerns would be taken seriously and treated no differently
Health care professionals would be more approachable
Disclosure would not be only my decision- providers would also make careful decisions to disclose or not
Peer support and peer advocates would have a strong voice within the organization
Stigma-free (cont)
Parent and family input would be welcomed, sought and respected
Regular collaboration between primary care, psychiatrists, therapist
The staff would be more educated about mental illness and recovery- know what they are doing
Care providers would readily admit to not knowing and seek advice from someone who does
Stigma-free (cont.)
Lack knowledge about my condition and feel uncomfortable not knowing
Burnout of professionals- # of patients, stuck in one way of treatment, close minded
They need more time for reflection, peer learning and support, self-care and encounters with people living in recovery
COMPASSION FATIGUE!
Reasons for Stigma?
Targeted Local Credible Continuous Change-focused Contact
TLC4
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the Grand PlanSpeak up everyoneSpeak up everywhere
Honest, Open & Proud
“strategic disclosure”
Carefully
Levels of Disclosure
Social Avoidance – avoid situations
Secrecy – work to keep it a secret
Selective Disclosure – share it with select
people
Open Disclosure – no longer hide it
Broadcast Your Experience – actively share it
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Your Recovery Story
Do I encourage one to disclose- what to say, when, to whom, etc. (HOP is a WISE resource)
Do I disclose?
Ethical Implications of Strategic Disclosure in Health Care
Three principles guide ethical aspects of self-disclosure: ◦ To act for the other’s benefit;◦ To do no harm; and ◦ Interests and welfare of the person served
always predominate.
Intentional self-disclosures may be:◦ Therapeutic, supportive and alliance-building;
or ◦ Seductive, exhibitionistic, and care-seeking.
Psychiatric Times (Guthell May, 2010)
Motivated engagement
self esteem
I care for myself & others
I am good
Reversing Self and Public Stigma
Public Stigma
sense of efficacyI am able
Inclusion and Self-Directed Support
Engage Organizations Seeking to Reduce Stigma
Train/Support Storytellers
General Public Programs/Contact
Components:
1. WISE Basics Discussion
2. Support for Strategic Disclosure HOP
3. Consultation with organizations as they Design, Implement and Evaluate TLC4
4. Share learnings statewide
What YOU Can Do Today 1. Seek out people with lived experience - listen to
their story.2. Reinforce & support their resilience & recovery.3. Wear lime green to create curiosity - be
prepared to speak up.4. Consider the story you can tell about recovery 5. Share other’s stories – one resource for short
video stories is Rogersinhealth.org6. Bring the conversation to your community –
work, civic, faith, schools
Discussion