STIGMA CHANGE! What and Where is the Evidence?

1
STIGMA CHANGE!What and Where is the Evidence?

• Patrick Corrigan, Psy.D.
• Illinois Institute of Technology
• Chicago Consortium for Stigma Research

2
The Goals Today

• Stigma Change is the Goal
• Many examples
• What works for whom and where?
• EVIDENCE

For all stakeholders
3
STIGMA CHANGE

• PUBLIC STIGMA
• Protest, Education, Contact
• SELF-STIGMA
• Group identification and support

4
Whats Out There?Current Programs

• World Psychiatric Association
• www.worldpsychiatricassociation.org/sections/stigm
  a/index.shtml
• Programs by country (Ngt50)
• US SAMHSA's Resource Center
• www.stopstigma.samhsa.gov/default.aspx
• Programs by state (Ngt100)
• Canada Programs
• the Commission is launching a major, national
  10-year anti-stigma and discrimination reduction
  campaign. This campaign will be the largest
  systematic effort to reduce the stigma of mental
  illness in Canadian history

5
RESOURCES
6
Media Watch
Fright Night Scream Park
www.nami.org./stigma
7
Public Service Announcements
what a difference a friend makes
http//www.whatadifference.samhsa.gov/
8
Personal Stories
9

• There's a temptation for the Commission to
  sprint out of the gate with a mass marketing
  campaign, but that would be a mistake.
• Canadian Mental Health Commission
• Ahead of the Data!Intervene Now!

10
The Evidence

• Where is the evidence?
• What is evidence?
• Using evidence to make decisions

11
Lessons from mental health services research

• What works regionally?
• Governmental policy/support (SAMHSA)
• Supported employment
• Assertive community treatment
• What works locally?
• How does supported employment actually work in
  Chicago?

12
Evidence for Stigma Change

• What kind of stigma change strategies should
  Governments/NGOs support?
• Education, contact
• Do these strategies work locally?
• Chicago, London, Paris
• Beijing, Delhi, Riyadh

13
N213
Stigmatizing Attitudes and Behavioral Intentions
Contact Responsibility
Education Responsibility
Control
Contact Dangerousness
Education Dangerousness
Attitudes and Intentions _at_ post and 1 wk f-up
14
SELECTION CRITERIA

• STAKEHOLDER PERSPECTIVE
• Participatory Action Research
• State of the Evidence
• Ratio of Cost to Benefit

15
Participatory Action Research

• PERSPECTIVE Understanding the broad questions
  related to stigma change
• POLITIC interest and authority in subsequent
  stigma change
• Who are the stakeholders?

diversity
16
SELECTION CRITERIA

• Stakeholder perspective
• Participatory action research
• STATE OF THE EVIDENCE
• Ratio of cost to benefit

17
Evidence Based Considerations

• Dependent measures
• ATTITUDES
• Physiological change
• Information processing
• Social behavior
• Behavioral intention
• BEHAVIOR

18
Evidence Based Considerations

• Dependent measures
• Psychometrics (reliability and validity)
• Sensitivity
• Social desirability

19
Evidence Based Considerations

• Reducing discrimination versus affirming actions
• Not just what does it stop (less prejudice)
• but what is improved (more work)
• Specificity
• Not just whether it changes people, put does it
  change important groups
• Employers, landlords, health care providers

19
20
Evidence Based Considerations

• Effect Size
• Is the effect noticeable?
• Does it matter? (social validity)
• Iatrogenic effects
• Mental illness is a brain disorder
• Manuals and Fidelity
• Need to catalogue interventions
• Feasibility
• If you provide it, will they come
• Fect

20
21
Example

• Supported employment Get more people with mental
  illness back to work.
• Get more employers to participate in supported
  employment.
• Challenge employer stigma
• In Our Own Voice Telling ones stories

22
Example

• Dependent measures
• Attitudes
• Behavior
• Immediate Participating in supported employment
• Hiring people with mental illness
• Affirming actions
• Specificity
• Effect size
• Manuals and fidelity

23
SELECTION CRITERIA

• Stakeholder perspective
• Participatory action research
• State of the evidence
• RATIO OF COST TO BENEFIT

24
Cost-Benefits

• The size of the sample
• Local or broad
• The depth and breadth of effects
• Effect size
• Specificity
• Outcomes (no stigma versus more affirming
  actions)
• The costs of the change strategy
• The cost of evaluation

25
PUTTING IT ALL TOGETHER
26
Evidence Based Approach

• WHO is to be targeted.
• WHAT needs to be changed.
• HOW will this be changed.
• WHEN will change occur.
• MEASURE IT

27

28


A TOOLKIT For Evaluating Programs Meant to
Erase the Stigma of Mental Illness Patrick
Corrigan draft Oct 23, 2008
29

• Patrick Corrigan
• corrigan_at_iit.edu