stigma and barriers to care - Uniformed Services University of the ...

Conceptualizing Stigma and Barriers to Care 57
knocks, and when no one answers, they go through the house. The second, which I
call the Friendster video, is a short PSA that shows all the people you are friends with
on Facebook. Then it shows all the people you go clubbing with, a smaller group.
That is followed by all the people you see on Friday nights and watch DVDs with,
an even smaller group. Finally, it asks, “Are you going to be the one who stands by a
person with mental health problems” The third PSA involves two guys on a couch
playing video games. One discloses to the other that they have a mental illness, and
the question is, “Are you going to be the one who stays, or are you going to be the
one who runs”
The sixth finding involves our laboratory study using a physiological marker
and a national survey. The two methods produced the same finding, which is that
overall PSA campaigns showed a reduction in stigma. But each PSA worked very
differently. The Friendster video is the clear winner. This one showed the greatest
and most consistent reduction in stigmatizing attitudes among the target audience,
18 to 25 year olds. Older respondents found the video game PSA insulting, but
the younger ones liked it. The Door PSA had either no effect or actually increased
stigma. It does have some semblance of a horror movie trailer so I can see why that
one did not work. I think we have to consider the plus and minus of focus groups
in this kind of evaluation research. People who come to focus groups want to help
us make things better so they do not tell us if something is bad. They just try to help
us make it better.
The seventh finding from the national stigma studies was that there have been
modest changes over the last decade with regard to the adoption of neuroscientific
beliefs underlying mental illness. We found that significantly more Americans attribute
depression and schizophrenia to chemical imbalance, as well as to genetics,
than was the case in the past. There are also fewer people associating mental illness
with God’s will. However, there has been some negative change. More Americans
are associating alcohol dependence with bad character. Finally, the disappointing
finding from this study is that if we look across the different venues in which people
can interact with or reject individuals with mental illness, there has been absolutely
no change in the United States along these lines.
In terms of general take-away points from this research agenda, the science base
is much stronger now than it was a decade ago. The fact that we have been working
in trained disciplinary groups, like this meeting, is very important. Treatment-based
stigma has decreased but community-based rejection has not. We need to rethink
our models. Since World War II, the National Alliance on Mental Illness and other
groups have taken the disease model to try to reduce stigma. I do not know if that
model has failed because there are no good data on which to make that claim but I
think the model has taken us as far as it can go. In fact, Jo Phelan’s research suggests
that there is some backlash to the genetic attribution of mental illness.
Even if PSA campaigns are effective, and this is one of the first studies of their
effectiveness, the traditional logistics with regard to younger age cohorts and the
development of new media suggest that this may not be the way to go in terms of
stigma reduction. While beliefs and attitudes are powerful markers, because of the
LaPierre study that Ron Kessler mentioned earlier, in terms of changing the hearts
and minds of Americans that may not be the way to go. We need to think more
strongly about institutional regulations that prohibit people from acting upon
whatever prejudicial beliefs and attitudes they might have. We have conducted an
analysis of 1,640 hours of television showing that at least one time during each unit