Lesson 11 Mental Health StigmaReadings Please note that th.docx

Lesson 11: Mental Health Stigma
Readings: Please note that the Corrigan article in the syllabus
has been replaced with the Collins and Corrigan articles below:
Required
Collins, R. L., Wong, E. C., Cerully, J. L., Schultz, D., &
Eberhart, N. K. (2012). Interventions to reduce mental health
stigma and discrimination. http://calmhsa.org/wp-
content/uploads/2011/12/Literature-Review_SDR_Final01-02-
13.pdf
Corrigan, P., Morris, S., Michaels, P.J., Rafacz, J.D. & Rusch,
N. (2012). Challenging the public stigma of mental illness: A
meta-analysis of outcome studies. Psychiatric Services 63(10).
doi: 10.1176/appi.ps.201100529.
http://ps.psychiatryonline.org/article.aspx?articleid=1372999&R
elatedWidgetArticles=true
Link, B., Phelan, J. Bresnahan, A.S. & Persosolido, B., (1999).
Public conceptions of mental illness: Labels, causes,
dangerousness and social distance. American
Journal of Public Health (89), 1328-1333.
http://ajph.aphapublications.org/cgi/reprint/89/9/1328.pdf
Swanson, J.W., Holzer, C.E., Ganju, V. K., Jono, R.T. (1990).
Violence and psychiatric disorder in the community: Evidence
from the Epidemiologic Catchment Area surveys. Hospital &
Community Psychiatry,
41(7), 761-770.
http://www.bing.com/videos/search?q=Mental+Health+Stigma+
Video&FORM=VIRE7#view=detail&mid=102935613330F098A
046102935613330F098A046
http://www.bing.com/videos/search?q=Mental+Illness+Stigma&

Form=VQFRVP#view=detail&mid=EC031B624F71269702CDE
C031B624F71269702CD
https://www.youtube.com/watch?v=Zn6yw2KUIwc&feature=yo
utu.be
Optional
Pettigrew, L. R. & Tropp, T.F. (2005). Relationships between
intergroup contact and prejudice among minority and majority
status groups. Psychological Science (16)12, 951-957.
Summary
Introduction
As many of you have noted in your discussion posts, mental
health stigma is a pervasive problem that profoundly affects the
lives of those suffering from mental illness. Aided by
newspapers, books, movies and television, persons with mental
illness have been portrayed and perceived as persons with bad
character, demonically possessed, weak, unpredictable, and
violent. As a result, many people have separated themselves
from those with mental illness out of “distrust, stereotyping,
fear, embarrassment, anger and/or avoidance.” (Surgeon
General’s Report, 1999).
While some progress has been made in the past 50 years, stigma
(often referred to as discrimination) continues to be a
significant barrier to persons with mental illness. As we have
seen in our readings, several recent documents have given
prominence to the issue of stigma. In SAMSHA’s 2011
strategic plan “Leading Change: A Plan for SAMHSA’s Roles
and Actions, 2011-2014”, Goal 4.3.2 is to “create a behavioral
health awareness campaign focused on decreasing
discrimination and improving employment outcomes for persons
with mental and substance use disorders.” (p. 59). SAMHSA’s
most recent strategic plan: Leading the Change 2.0: Advancing
the Behavioral Health of the Nation 2015-2018, Objective 4.4.3
is to “Decrease negative attitudes and discrimination toward

people with mental illness and/or substance use disorders and
their family members” (p. 26). The World Health Organization
recently published “A Mental Health Action Plan: 2013-2020”.
One of the action steps includes the implementation of mental
health promotion and prevention strategies that “redress the
stigmatization and human rights violations all too commonly
associated with mental disorders” (WHO, 2013). Furthermore,
according to the National Alliance on Mental Illness’s Policy
Platform, “NAMI condemns all acts of stigma and
discrimination directed against persons with mental illnesses,
whether by intent, ignorance, or insensitivity. Epithets,
nicknames, jokes, advertisements, and slurs that refer to persons
with serious mental illnesses in a stigmatizing way are cruel”
(NAMI Policy Plan, nod)
Stigma in Missouri
In Missouri, the issue of discrimination against those with
mental illness is still a significant issue. In both 2006 and 2013,
the Missouri Institute of Mental Health conducted a random
sample survey of adult Missourians on mental health stigma.
People were asked how willing they would be to have someone
with a mental illness work closely with them, have them as a
friend, socialize with and marry into their family. While the
large majority would be “very” or “somewhat” willing to
socialize and befriend someone with a mental illness, only a
little more than half (53%) would be willing to work closely
with him/her, fewer than half (45%) would be willing to have
them marry into their family and only 16% would be willing to
have that person as a boss. Stigma was highest toward people
with schizophrenia followed by bipolar disorder.
The two surveys were compared to explore whether there had
been reduction in stigma since 2006 when the Missouri
Department of Mental Health first explored stigma among adults
in Missouri. The study showed that while there was a decrease
in stigma toward people with depression, there was an increase

in stigma towards those with schizophrenia and bipolar
disorder. (Missouri Institute of Mental Health, 2013).
The most recent Missouri statewide mental health needs
assessment identified stigma as one of the major concerns of
mental health policy makers, providers, consumers and the
general public (Missouri Institute of Mental Health, 2008). In
that report, a Missouri Area Agency on Aging director stated
that, “the current generation of older persons still views mental
illness as a “personal flaw,” not an illness that can be
successfully treated” (p. 88). An adult focus group member
living in rural Missouri stated that in her town “they got rid of a
pastor who admitted to being depressed” (p. 95). According to
one African-American male study participant, “I’ve had people
try to run me down and beat me up…the basic person is going to
say he’s got mental problems; he is crazy” (p. 98).
Effects of Stigma
How does stigma affect those with mental illness? The negative
effects of mental illness stigma include fewer employment and
housing opportunities, greater family stress, and exclusion from
friendships (Link et al., 2001). In addition, those with severe
mental illness may internalize stigma reactions resulting in
depression, increased anxiety, poor social performance, lower
self-esteem, and the adoption of secrecy and withdrawal as
coping strategies (Penn & Martin, 1998). Poor self-esteem
caused by stigma may result in a fear to pursue goals and form
new relationships. Finally, stigma can also impact treatment
participation and effectiveness. When persons with a mental
illness become aware of the stigma associated with mental
illness, they may not access mental health treatments in an
attempt to avoid being labeled incompetent, weak, or dangerous
(Clement et al., 2015; Corrigan, 2004).
Combatting Stigma
Some suggested strategies for reducing public stigma include

protest, education, and contact (Corrigan & Penn, 1999).
Protest approaches highlight the injustice of specific stigmas
and lead to a moral appeal for people to stop holding stigma.
Education approaches replace the myths of mental illness with
facts that counter the myths. Approaches that utilize contact
involve meeting or otherwise interacting with people with
mental illness. Out of the three approaches, contact has been
shown to have greatest impact on changing stigma (Tropp &
Pettigrew, 2005), with in-person contact being more effective
than video contact (Corrigan et al, 2012).
One major deterrent to contact is the myth of perceived
dangerousness. The risk of violent behavior among persons
with serious mental illness is modest relative to the risk
associated with age, gender, violence history, socioeconomic
status, and educational level (Penn & Martin, 1998). Yet a high
percentage of Americans believe that most violent acts are
perpetrated by people with mental illness. However, in a study
by Meloy et al., (2001), only 23% of adolescents who had
murdered three or more people in one event had a diagnosable
mental illness. A very recent poll of Americans found that 63%
blamed mental illness for mass gun violence (Washington
Post/ABC News Poll, October 2015) and according to a 2013
Gallup poll, almost half (48%) of Americans blamed the mental
health system "a great deal" for U.S. mass shootings. The media
has played a role in perpetuating this belief and helped fuel the
fear that many people have toward mental illness as we have
seen in the shootings in Oregon, Texas, South Carolina,
Colorado, and Connecticut in the past few years (McGinty,
Webster & Barry, 2011).
Nonetheless, persistent myths about the dangerousness of
people with mental illness result in a greater desire for social
distance, thus creating a cycle in which fear of social contact
with people with mental illness results in avoidance. The desire
for social distance discourages social contact, which contributes
to the dangerousness myth by deterring information that might

otherwise counter the myth. This principle was illustrated a
study by Alexander & Link (2003), who found that social
contact with mentally ill persons was strongly related to the
perceived dangerousness of that person. As total contact
increased, the perceived dangerousness and desired social
distance from the person with mental illness decreased. Other
studies have also demonstrated that stronger beliefs in the
dangerousness of persons with mental illness result in a greater
desire for social distance (Angermeyer & Matschinger, 2005).
So, how can national, state and local efforts to reduce stigma
promote greater contact and acceptance of mental illness?
Many mental health advocates in recent years have believed that
providing more information about the genetic causes of mental
illness would result in greater empathy and acceptance toward
persons with mental illness because the disorder would be seen
as outside the personal control of the sufferer (Hinshaw & Steir,
2008). However, some studies have shown that genetic
explanations for mental illness have increased negative
attitudes, perceptions of dangerousness and fear (see Read et al.
2006, and Read, 2007 for reviews). However, Martin,
Pescosolido, & Tuch (2000), using data from 1,444
respondents who completed the General Social Survey (GSS) in
1996, reported that those who felt that “genetic transmission”
was a cause of mental illness were more willing to associate
with someone with a mental illness. The perception of a
chemical imbalance as a cause, another biogenic explanation,
did not alter perceptions of social distance. Phelen et al.
(2000), using the same dataset, found that genetic explanations
and negative attitudes regarding mental disorders both increased
between 1950 and 1996.
Anti-Stigma Efforts
This discussion of stigma highlights the complexity of
combatting the stigma surrounding mental illness. Suggested
approaches include speaker’s bureaus and other programs that
link persons with mental illness to the community, ad
campaigns, radio and television spots, media education,

advocacy efforts to change discriminatory laws and awards
ceremonies that publicly acknowledge mental health champions.
Nationally, the National Mental Health Anti-Stigma Campaign
launched in 2006 focuses on the importance of reaching out to
persons who might be in need of some mental health care. Other
countries also have invested significant resources into anti-
stigma campaigns as well (see BeyondBlue.org.au;
Seemescotland.org.uk). In Missouri, the National Alliance for
the Mentally Ill offers “In Our Own Voice” to organizations
throughout the state where persons with mental illness tell their
story to break down myths related to mental illness. The
Missouri Department of Mental Health (DMH) launched two
programs to combat stigma and increase understanding of the
issues facing those with mental illness. RESPECT is a
statewide program that trains persons with mental illness to
“tell their story” to the general public, thus increasing their
connection to their communities while educating the public on
the experience of mental illness. Mental Health First Aid is a
12-hour training aimed to inform individuals about different
mental illnesses and assist those in need seek help (see
http://mentalhealthfirstaidmissouri.com). The state also has an
annual Mental Health Champions Dinner honoring people with
mental illness who have championed mental health initiatives in
Missouri. It is also hoped that the new Health Care Home
initiative, by linking behavioral and physical health care, will
also result in a reduction in stigma.
Assignment and Group Discussion
Your response to the assignment below and your participation in
the group discussion will be worth points
There are anti-stigma efforts taking place across many states in
the U.S. and several countries. Identify a state or country with
an active campaign that has been researched for its
effectiveness. Outline the initiatives that are part of that
campaign with specifics about its approaches to combatting
stigma. Discuss the possible effectiveness and possible

unintended negative consequences of the campaign and/or its
components in reducing stigma. Include the website(s) for the
campaigns.
Again, please try to have your initial answers to the question on
the Discussion Board by Friday so that you can respond to
others in the class by Sunday night.
References
Alexander, L. A. & Link, B. G. (2003).The impact of contact on
stigmatizing attitudes towards people with mental illness.
Journal of Mental Health, 12, 271-289.
Angermeyer, M.C., Matschinger, H. & Corrigan, P.W. (2004).
Familiarity with mental illness and social distance from people
with schizophrenia and major depression: testing a model using
data from a representative population survey. Schizophrenia
Research 69. 175-192.
Corrigan, P. (2004). How stigma interferes with mental health
care. American Psychologist, 59(7), 614-625.
Corrigan, P. (2012). Research and the elimination of the stigma
of mental illness. British Journal of Psychiatry, 201: 7-8.
http://bjp.rcpsych.org/content/201/1/7.full.pdf+html.
Corrigan, P. & Penn, D. L. (1999). Lessons from social
psychology on discrediting psychiatric stigma. American
Psychologist, 54, 765-776.
Corrigan, P., Morris, S., Michaels, P.J., Rafacz, J.D. & Rusch,
N. (2012). Challenging the public stigma of mental illness: A
meta-analysis of outcome studies. Psychiatric Services 63(10).
doi: 10.1176/appi.ps.201100529.
http://ps.psychiatryonline.org/article.aspx?articleid=1372999&R
elatedWidgetArticles=true
Dietrich, S., Matschinger, H., & Angermeyer, M.C. (2006). The
relationship between biogenetic causal explanations and social
distance toward people with mental disorders: results from a
population survey in Germany. International Journal of Social
Psychiatry 52(2),166-74.

Gallup (2013). Americans Fault Mental Health Systems for Gun
Violence. Retrieved from
http://www.gallup.com/poll/164507/americans-fault-mental-
health-system-gun-violence.aspx.
Hinshaw, S.P. & Stier, A. (2008). Stigma as related to mental
disorders. Annual Review of Clinical Psychology, 4, 367-393.
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., &
Pescosolido, B. A. (1999). Public conceptions of mental
illness: Labels, causes, dangerousness, and social distance.
American Journal of Public Health, 89(9), 1328-1333.
Link, B., Struening, E., Neese-Todd, S., Asmussen, S., &
Phelan, J. (2001). The consequences of stigma for the self-
esteem of people with mental illnesses. Psychiatric Services,
52(12), 1621–1626. doi: 10.1176/appi.ps.52.12.1621. PMid:
11726753.
Markowitz, F. (1998). The effects of stigma on the
psychological well-being and life satisfaction of persons with
mental illness. Journal of Health and Social Behavior 42, 64-79.
Martin, J.K., Pescosolido, B.A., & Tuch, S.A. (2000). Of fear
and loathing: The role of ‘disturbing behavior’ labels, and
causal attributions in shaping public attitudes toward people
with mental illness. Journal of Health and Social Behavior, 41,
208-223.
McGinty E. E., Webster D. W., Jarlenski M., Barry C. L.
(2014). News media framing of serious mental illness and gun
violence in the United States, 1997-2012. American Journal of
Public Health, 104, 406-413. 10.2105/AJPH.2013.301557.
Meloy, J.R., Hempel, A.G., Mohandie, K., Shiva, A.A.,
Gray, B.T. (2001). Offender and offense characteristics of a
nonrandom sample of adolescent mass murderers. Journal of
American Academy of Child and Adolescent Psychiatry, 40,

719-728.
http://forensis.org/PDF/published/2001_OffenderandOffe.pdf
Missouri Institute of Mental Health (2008). Missouri Mental
Health Needs Assessment and Resource Inventory. St. Louis,
Missouri: Sale, E., Patterson, M., Evans, C., Campbell, J.,
Cook, J., Weil, G., Kryah, R., Whitworth, A., & Taylor, A.
Missouri Institute of Mental Health (2013). Telephone survey of
Missourians regarding attitudes toward people with mental
illness, substance use and developmental disabilities. St. Louis,
Missouri: Hendricks, M., Miller, C., Kryah, R. & Sale, E.
National Alliance on Mental Illness (2015). National Alliance
on Mental Illness Policy Plan (2015). Retrieved from
https://www2.nami.org/Template.cfm?Section=NAMI_Policy_Pl
atform&Template=/ContentManagement/ContentDisplay.cfm&C
ontentID=105496.
New Freedom Commission on Mental Health (2003). Achieving
the Promise: Transforming Mental Health Care in America.
Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD.
Penn, D.L., Judge, A., Jamieson, P., Garczynski, J., Hennesy,
M., & Romer, D. (2004). Stigma. In M. Seligman (Ed.), The
Annenberg adolescent mental health initiative. Oxford, England:
Oxford University Press.
Penn, D. L., & Martin, J. (1998). The stigma of severe mental
illness: Some potential solutions for a recalcitrant problem.
Psychiatric Quarterly, 69, 235–247.
Pescosolido, B. A., Martin, J.K., Link, B.G., Kikuzawa, S.,
Burgos, G., & Swindle, R. (2000). Americans’ views of mental
illness and health at century’s end: Continuity and change.
Public report on the MacArthur Mental Health Module, 1996
General Social Survey. Bloomington, Indiana: Indiana
Consortium for Mental Health Services Research.
Phelan, J.C. (2002). Genetic bases of mental illness- a cure for
stigma? Trends in Neurosciences, 25, 430-431.

Read, J., Haslam, N., Sayce, L., Davies, E. (2006). Prejudice
and schizophrenia: a review of the ‘mental illness is an illness
like any other’ approach. Acta Psychiatrica Scandinavica, 112,
303-318.
Read, J., & Harre, N. (2001). The role of biological and genetic
causal beliefs in the stigmatisation of ‘mental patients.’ Journal
of Mental Health,10, 223–235.
Stuart, H., & Arboleda-Florez, J. (2001). Community attitudes
toward people with schizophrenia. Canadian Journal of
Psychiatry, 46, 245-252.
Substance Abuse and Mental Health Services Administration
(2011). Leading Change: A Plan for SAMHSA’s Roles and
Actions 2011-2014. HHS Publication No. (SMA) 11-4629.
Rockville, MD: Substance Abuse and Mental Health Services
Administration.
Tropp, T.F., & Pettigrew, L. R. (2005). Relationships between
intergroup contact and prejudice among minority and majority
status groups. Psychological Science (16)12, 951-957.
U.S. Department of Health and Human Services. (1999) Mental
Health: A Report of the Surgeon General—Executive Summary.
Rockville, MD: U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration,
Center for Mental Health Services, National Institutes of
Health, National Institute of Mental Health.
Washington Post/ABC News (October 15, 18 2015), p. 10.
(http://apps.washingtonpost.com/g/page/politics/washington-
post-abc-news-poll-oct-15-18-2015/1852/.
World Health Organization (2013). A Mental health action plan:
2013-2020. Geneva, Switzerland.

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