Stigma and its Consequences for Youth

HeatherStuart,ProfessorandBellCanadaMentalHealth&ResearchChair,Queen’sUniversity,Canada;SeniorConsultant,OpeningMinds,MentalHealthCommissionofCanada

heather.stuart@queensu.ca

Stigma is a growing policy issue world-wide

Stigma a key barrier to mental health and mental health reform. The fight against stigma and its consequences is the most important challenge of our time.

World Health Organization, World Health Report 2001; World Psychiatric Association, Open the Doors, Sartorius, 2002; World Association of Social Psychiatry, Kobe Declaration, 2004; Kirby Commission, Canada, 2005.

LearningObjectives

Atthecloseofthispresentation,youwillhaveabetterunderstandingof:• thestigmaprocessasitpertainstopeoplewithamental

illness• Theimplicationsofstigmatizationfortheself,family

members,andbroadersystems• Theimportanceoftargetinganti-stigmaeffortstoyouth

ATourofTerms

Prejudice• Anegativeattitudethatisresistanttochange• Reflectsnegativestereotypiccharacterizations

Discrimination• Unfairandunjusttreatment

Stigmatization• Notamarkoranattitude,butacomplexsocialprocess

involvingprejudiceanddiscrimination• Onlypowerfulgroupscanstigmatize• Embeddedinasocialjusticeframework

Literacy• Knowledgeaboutsymptomsofmentalillnesses,their

treatments,andavailableservices• Maybeadverselyaffectedbystigma

Escher: Tower of Babel

TheNatureofStigma

• StructurallyImposed– Socialandorganizationalstructures– Overtandcovert

• Sociallyimposed– Individualandgroupinteractions

• Self-imposed– Internalizedstereotypes

GeneralConsequencesofStigma

HumanRightsViolations• Socialmarginalization&exclusion• Inequitableaccesstohealthandsocialservices• Unemployment&under-employment• Poverty&disadvantage• Lackofstableorsafehousing• Prematuremortality(allcause)

Stigmareverberateswidely….

• Amongpeoplewithamentalillness• Familymembersandfriends• Mentalhealthprofessionals• Mentalhealthdeliverysystems• Mentalhealthresearchcommunity• Businessesandworkplaces• Educationalsystems

WhyFocusonYouth?

• Youthathighriskformentalhealthproblems/illness• Mostinternationalanti-stigmaprogramstargetyouth• OpeningMindsAnti-stigmaInitiative– youthamongthefirst

targetgroupsaddressed• Canadianyouth,atparticularlyhighriskofmentalhealthproblems

12-monthStigmaImpactbyAgeGroup(weighted%ofthosetreatedforamentalhealthconditioninthepastyearwhoreportedsomestigmaimpact)

Canadian Youth Service Users Report Greater Stigma Impact

Source: Statistics Canada, Rapid Response Survey, 2011, Funded by Opening Minds, Mental Health Commission of Canada

Studentshaveleverage

Stereotypes begin early…

Mediasocializationbeginsearly

• Televisionasteacher– TVoccupiesmoretimethananyotheractivity– Bythetimechildrengotoschooltheyhavewatchedtheequivalentofthree

schoolyearsofTV– Bythetimetheyareadults,theyhavewitnessedmanythousandmediamurders

involvingsomeonewhoismentallyill

• Mediaimagesteachchildren– Howtothinkaboutmentalillness&treatments– Whatwordstousetorefertomentalillness– Howtoreacttopeoplewhoarementallyill– Whatwillhappentothemiftheybecomementallyill– Whethertofeelembarrassedashamed,orguiltyiftheyhaveamentalillness

Programsaimedatchildrenunder10

• 50%ofprogramsaimedatchildrenunder10containreferencestomentalillness

• Oneinfivemaincharactersareportrayedasmentallyillorunbalanced

• Mentallyillcharactersareobjectsofamusement,derision,&fear

• Disparagingtermsareusedtolinkmentalillnesstolossofcontrol

• Denigratinglanguageisusedtosegregate&alienate

DisneyCartoons

85%containverbalreferencestomentalillnessorcharactersthatactin‘crazy’ ways

• Dumbo’smadelephantmotherwaskilled

• Belle’sfatherinBeautyandtheBeastwascrazyandneededtobelockedup

• HyenasintheLionKingweredepictedascrazyandthecraziestbititsownleg

HighSchoolStereotypes

Source:YouthPilotProjects,OpeningMinds,MentalHealthCommissionofCanada,2013

Stigmaentrenchedbyadulthood

StigmaDonna, Canada, 2003

Schoolsareanimportantinterventionpoint

• Themajorityofmentaldisordersbeginduringyoungadulthoodsoyouthareahighriskgroupforstigma

• Studentsareinterestedinmentalhealthandeagertolearn

• Accesstoyouthinschoolsmakestargetedprogramsfeasibleandcost-effective

• Studentsbringasenseofsocialjusticetothetablethatisimportantinfightingstigma

• Schoolscancreatementallyhealthyenvironmentsandmodelnon-stigmatizingbehaviours

Yet…

•Traditional school-based public health programs avoid mental health issues•School bullying and violence is an increasing problem•Mental health education seen as outside of the mandate of “education”•Materials often outdated and inaccurate•Teachers do not feel confident to provide materials (need training)•Links to the mental health community are often weak

Stigmareductionshouldbeanimportanteducationalgoal

• Schoolcurriculamustroutinelyaddressmentalhealthandmentalillness

• Contact-basededucationreducesstereotypesandsociallydistancingintentions

• Weneedtothinkaboutwaysofcreatingmentallyhealthyschoolswherestigmadoesnotimpededisclosureandhelp-seeking

• Wecanempowerstudentstoactivelypursueanti-stigmaprogramming

HeadstrongSummits

20

Asummitbringstogetherstudentsfromvariousschools,alongwithschoolstaff(teachersandadministrators),tolearnaboutmentalhealthproblemsandmentalillnessesandstigma,andtochallengethestereotypesandmisconceptionsthatfuelstigma.Studentslearntoleadanti-stigmainterventionsintheirownschoolsandcommunities.

Source:MentalHealthCommissionofCanada,OpeningMindsAnti-stigmaInitiative

• ContactBasedEducation(TalkingAboutMentalIllnessPrograms)inHighSchoolsWork

• ResultsfromOpeningMindsYouthPilotProjectsshowsthatinterventions—thoughheterogeneous—tendtohaveapositive(moderate)effectonattitudesandbehaviouralproxies

Source:KollerandStuart,2016

ForestPlotofEffects

Itistimeto…

• Advocateforanti-stigmaprogramminginschools

• Supportlocaladvocacygroups(suchasTAMI-likeprograms)inprovidingcontactbasededucation

• Helpteachyouthbecriticalofstereotypicalimagesofmentalillness

• Helpyouthlookatthingsthroughamentalhealthlensandaskiftheyarefair

• Empoweryouthtobeanti-stigmaadvocates

• Helpteacherstogaintheskillsandconfidenceneededtoincludementalhealthandillnessintolessonplans

TakeHomeMessages• Threelevelsofstigma– structural,public,self• Stigmahasimportanthealthandsocial

outcomesforpeoplewithamentalillness,thosearoundthem,andmentalhealthsupportsystems

• Itisimportanttotargetanti-stigmaeffortstoyouth

• Schoolsareanexcellentpointofentry• Wecanalladvocateforschoolbasedanti-

stigmaprograms