Deborah Leiter, VP Campaign Director

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National Anti-Stigma Campaign Research Findings
and Strategy
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Agenda

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Agenda

• Research Objectives and Goals
• Research Findings
• Campaign Strategy
• Questions and Answers

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Exploratory Research Objectives and Methodology
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Objectives

• Explore the publics perceptions of people with
  mental illness and what can be done to
  effectively change these perceptions
• How are people with mental illnesses perceived
• What information is most effective in helping to
  overcome negative perception of people with
  mental illness
• How does the public define recovery
• Add texture and richness to the vast amount of
  existing research on this topic
• Should be additive to the research conducted for
  EBI

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Methodology

• 20 individual, one hour, in depth interviews
  among adults ages 25-75
• 2 markets St. Louis and Atlanta
• Mix of men and women and racially diverse
• All respondents screened to exclude those who had
  personally experienced a mental illness or who
  had close friends or family members with any
  mental illness.

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Methodology

• Interviews consisted of
• Discussion of experience with and knowledge of
  mental illnesses
• Homework assignment asked to bring 4 pictures
  that show how they feel about mental illnesses
• Responses to false statements to assess some of
  the roots of stigma
• Responses to statements that could be
  springboards for advertising messages

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Research Findings
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Knowledge of and Experiences with Mental Illnesses

• Little direct experience with mental illnesses -
  hadnt had to deal with a family member with
  mental illness or close friend
• They get most of the information that shapes
  their perceptions from the media
• News (Florida drownings, Terry Schiavo, school
  shootings, Michael Jackson)
• Oprah (positive stories on recovery)
• Movies (One Flew Over the Cuckoos Nest, Sybil,
  Lifetime movies, The Aviator, A Beautiful Mind)
• However, personal experiences, positive or
  negative, are far more influential

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Perceptions of Mental Illnesses

• Believe that people with mental illnesses are
  stigmatized and discriminated against, especially
  in the workplace
• However, a mental illness can be hidden unlike
  race, age, gender or physical disabilities
• Difference in treatment between mental illnesses
  versus physical illnesses
• I can see a broken leg. I know what cancer is.
  I can imagine having both of these problems. But
  mental illness, its harder for me to relate. I
  feel sorry for them, but I cant relate to them.

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Perceptions of Mental Illnesses

• Huge disparity in knowledge and levels of
  fear/discomfort depending on the specific type of
  mental illness
• Depression
• Anxiety Disorder
• Bi-Polar Disorder
• Schizophrenia

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Older Adults (ages 55-75)

• For the most part, consistent with those 25-54
• Some variances in degree were seen among those 70
  and older
• Less knowledgeable and less willing to discuss
  what they didnt know
• More private in their own daily lives
• Less accepting, even of depression
• I wouldn't want to go to my friends and tell
  them if I was depressed. Why? Pride. I wouldn't
  tell them that, you want a little pride in
  yourself if you have any left."

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Feelings about Mental Illnesses
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Compassion

• I want to reach out and comfort them but I dont
  know how

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Curiosity and an openness to learn more
Its still a mystery. Its very
interestingthe mind is so difficult to fathom.
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Curiosity and an openness to learn more
I feel curious. I want to know what happened to
thembut I dont want to be nosy.
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Negative Feelings

• However, the pictures also provided insight into
  the respondents own stigma towards those with
  mental illnesses

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Protection of self and family

• Mental illness seen as a potential threat to
  their well being
• I feel most of all, the need to protect myself.
  Its instinctive.

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Fear of triggering an episode

• One of the worst things about major mental
  illnesses, according to the respondents, is the
  unpredictability of the situation
• He might go postal at any moment
• Its like a ticking time bomb
• I could make the situation much worse without
  even knowing it

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Fear of triggering an episode
Id always be wondering what are they going to
do? Are they going to go postal
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Shame at not knowing how to act

• Its like when theres a death in your
  neighbors family. I never know what the right
  thing is to say. So I dont say anything at all.
  I know thats wrong, because it makes them feel
  more isolated, but I just dont know what to do.

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Shame at not knowing how to act
Sometimes I find myself turning away from or
just ignoring someone with a mental illness,
avoiding eye contact. I know it is not their
fault but sometimes I dont know how
to communicate with them.
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Responses to Motivational Concepts

• What can we say to overcome these feelings?

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Responses to motivational concepts

• A number of statements were tested in order to
  assess which were the best at changing
  perceptions and attitudes about mental illnesses

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Prevalence of the condition

• In 2003, an estimated 28 million adults received
  treatment for mental health problems. This
  estimate represents 13.2 of the adult
  population, or 1 in 7.
• Our initial hypothesis was that the prevalence of
  mental illnesses would help to normalize it in
  peoples minds, however
• Majority unimpressed by 13.2 of the population
  seeking treatment, nor were they impressed by the
  actual number of 28 million people and they were
  even unimpressed with the ratio 1 in 7 people
• The respondents who were impressed were the ones
  who knew the least and would require the greatest
  amount of work to educate

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Recovery

• Mental health organizations have changed their
  approach to helping people with mental illness.
  It is no longer about accepting long-term
  disability and treating symptoms but rather about
  helping people recover.
• 74 of people diagnosed with schizophrenia
  recover with early intervention1
• 80 of people diagnosed with depression recover2
• 1 NIMH, 2003
• 2 National Advisory Mental Health Council, 1998

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Recovery

• Impressed that new goal is recovery
• Most hopeful of all the messages hope for
  better outcomes
• Newsworthy information they reacted with
  shock to recovery statistics.

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What does recovery mean to them?

• Cured a return to normal life without the
  need for medication
• Able to function in society
• Illness is gone and wont come back
• Many respondents were concerned that the word
  recovery promises more than is possible and
  were more comfortable with terms like
  management of the illness

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Summary and Conclusions
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Summary and Conclusions

• Overall consistency in findings among age,
  gender, race and location
• People dont think about mental illness or how
  they respond to people with mental illness unless
  put in a situation in which they are forced to
  confront their beliefs and behaviors.
• When confronted, they are ashamed of the way they
  behave but see it as necessary and inevitable.
• The fact that mental illness is a common
  occurrence is accepted as true but doesnt make
  mental illness any more normal or acceptable

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Summary and Conclusions

• There is a spectrum of severity and threat.
• Knowledge and experience with Depression has
  helped to normalize it within peoples minds
• Most hesitancy and fear was associated with
  schizophrenia -- least amount of knowledge and
  experience
• On a rational level, they dont believe people
  with mental illnesses are more violent than
  others, yet they are still hesitant and
  protective.
• Though respondents were admittedly ignorant they
  were not overtly mean-spirited toward those with
  mental illness

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Summary and Conclusions

• Compassion is counterbalanced by fear,
  uncertainty and doubt
• Fear of unpredictability
• Fear of unknown
• Fear of their own lack of knowledge in what to
  say or do
• The recovery idea helps to counter much of this
  fear

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Creative Strategy
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Why are we advertising?

• Campaign Objective
• To change negative attitudes associated with
  mental illnesses in an effort to reduce stigma

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To whom are we advertising?

• General Public, ages 25-65
• Given the prevalence of mental illness they
  probably know someone who has experienced a
  mental health problem, though they are not faced
  with this issue on a daily basis
• They feel as though they dont know much about
  mental illness, however, when pressed they will
  talk about negative media portrayals, negative
  personal experiences, and antiquated stereotypes
  related to institutionalization and
  out-of-control behavior
• Key element of this target is also those who have
  an unmet need for mental health care and are
  inspired to seek help

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Key Insight

• People are unaware how common it is to recover
  from a mental illness and that individuals with
  mental illnesses can overcome these problems to
  lead meaningful and productive lives

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What should the advertising say? (message/benefit)

• Recovery is real, recovery is possible
• Get more information seek help if you need it
• Call SAMHSAs National Mental Health Information
  Center

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Why should anyone believe us? (support)

• More people are recovering from mental illnesses
  than ever before
• 80 of people diagnosed with and treated for
  depression recover
• 74 of people diagnosed with and treated early
  for schizophrenia recover
• Mental Health professionals are treating mental
  illness differently, adopting an approach that
  helps people recover their lives and gain control
  over their illnesses.
• Recovery is a universally relevant and inspiring
  platform that can change attitudes and encourage
  those in need to seek help and work on their own
  recovery.

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What do we want the target to think/do as a
result of seeing the advertising?

• We want people to realize that individuals with
  mental illnesses recover and lead productive
  lives.
• If the viewer/listener is a mental health
  consumer we want this positive message to inspire
  them to log onto a website or call a toll free
  number to seek help.

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Whats the tone of the advertising?

• Honest and straightforward mental illness is
  not pretty and shouldnt be oversimplified or
  misrepresented
• Positive and hopeful, but not unrealistic or
  overly optimistic
• Provocative, but not accusatory
• Illuminating, but not didactic
• Strength-based and respectful images of mental
  health consumers

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How will we know when we have succeeded?

• Number of people calling the toll free number or
  logging on to the website to get more information
  or to request referrals for help.
• Changes over time in awareness and attitudes
  about recovery.

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What are the executional guidelines, constraints,
etc?

• Call to action to campaign website and toll free
  number get the facts about mental illness and
  seek help if you need it.
• The term recovery must be clearly defined
  creative should test different definitions and
  ways to discuss the idea of recovery.
• Need to be cautious NOT to reinforce negative
  stereotypes a rebound effect could happen if
  PSA messaging centers around existing negative
  beliefs and attitudes.
• SAMHSA and Ad Council logos
• TV, Radio, Print, Internet and Outdoor