Substance Abuse & Mental Health Services Administration

CMHS Consumer Affairs E-News
August 11, 2006, Vol. 06-87

Mental Health News You Can Use...
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August 2006
Issue 13

This electronic update is written by SAMHSA's Resource Center to Address Discrimination and Stigma Associated with Mental Illness (ADS Center), a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services* (CMHS). We invite you to share this information with your friends and colleagues who share your interest in confronting stigma and discrimination associated with mental illness and to post this information in your own newsletters or listservs. Visit the ADS Center on the Web at http://www.stopstigma.samhsa.gov.

In this issue...

August 2006 Spotlight

Archived SAMHSA ADS Center training teleconference: Overcoming Barriers and the Stigma Associated With Mental Illness in Rural Communities

Upcoming training event: Protest and reward strategies for addressing stigma and discrimination, September 14, 2006

Featured Research Articles

"Rural suicide-people or place effects?" by F. Judd, et al.

"Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town," by S. Wrigley, et al.

Additional Research

Models, Programs, and TA Tools

"Montana Mental Health Association Public Awareness Campaign" by Deb Mateucci

Additional resources

In My Experience.

Anonymous, New Mexico

Additional experiences and commentary

*The contents of this informational update do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

 

August 2006 Spotlight
Archived SAMHSA ADS Center Training Teleconference

Overcoming Barriers and the Stigma Associated With Mental Illness in Rural Communities

According to the National Institutes of Mental Health, the 60 million residents of rural areas in the United States experience a rate of mental illness equal to or greater than that of their urban and suburban counterparts. While this statistic seems to indicate a need for equal or greater access to mental health information in these communities, several barriers exist to prevent rural residents from gaining a better knowledge of mental illnesses and corresponding treatments. One of these barriers, the stigma and discrimination associated with mental illness, manifests itself in the form of negative stereotyping that equates mental health problems and the need for treatment with personal or spiritual failing and a fear of rejection by family and friends.

The effects of stigma and discrimination in rural communities often are magnified by other characteristics of life in the country. For instance, geographic isolation frequently limits opportunities for mental health education and exposure to mental health services, high rates of poverty and scarcity of resources often result in a lack of appropriate services and qualified mental health providers, and close scrutiny by neighbors and the possibility for dual relationships outside the clinic between service providers and consumers raise serious questions about maintaining confidentiality of care in rural communities. Given the unique combination of factors contributing to the prevalence of stigmatizing behavior and discrimination in rural communities, what exactly do we know about rural stigma and what is being done to counter negative attitudes about people with mental illnesses in order to set the record straight in rural America?

On June 28, 2006, the SAMHSA ADS Center brought together a national audience of mental health consumers, advocates, providers, researchers, friends, and family to discuss and explore the topic of stigma in the rural communities of the United States. In addition to offering an overview of the problems and concerns related to stigma and discrimination in rural America, our guest speakers outlined models and programs currently being used to address stigmatizing attitudes and discriminating behavior in select rural communities across the Nation. We also learned about one woman's experience of rural stigma and how she managed to overcome negativity.

You have an opportunity to hear the speaker presentations and listen to the audience discussion through our Training Archive. You also may be interested in the training teleconference, Addressing Stigma and Discrimination in Rural Communities. Visit the SAMHSA ADS Center's Web site to obtain instructions on accessing teleconference recordings and downloading the accompanying presentations.

 

Upcoming Training Event
Teleconference on Protest and Reward Strategies for Addressing Stigma and Discrimination, September 14, 2006

On September 14, 2006, the SAMHSA ADS Center will host a training teleconference exploring the development, implementation, and effects of two types of interventions to reduce stigma. The training will focus on anti-stigma protest strategies, which are designed to promote nonstigmatizing behavior by calling attention to and requesting corrections to discrimination and stigma, and reward strategies, which recognize and encourage the positive contributions of individuals and organizations toward advancing the understanding of mental health and the important contributions that people with mental illnesses make to society.

 

Featured Research Articles
Judd, F., et al, (2006). "Rural suicide-people or place effect?" Australian and New Zealand Journal of Psychiatry, 40(3):208-216. [NLM Pubmed abstract]

This article looks at available literature on suicide in rural communities and explores factors that may help explain the difference in suicide rates between rural and urban areas.

Rural communities experience higher suicide rates than urban regions, particularly when it comes to suicides by young males. In rural areas, there is evidence of less health service utilization, possibly due to poor service availability, lack of access, or community or cultural attitudes to mental illness and seeking help. Stoical young rural males may be particularly unwilling to seek help, and with increased accessibility to firearms, may be at greater risk for suicide.

Wrigley, S., et al. (2005). "Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town." Australian and New Zealand Journal of Psychiatry, 39(6): 514-521. [NLM Pubmed abstract]

This article examines the role of perceived stigma and attitudes to seeking care for mental health problems from a general practitioner (GP). Researchers learned that there is a difference between attitudes about seeking help for mental health problems in general and seeking help specifically from a GP.

Stigma was associated with negative attitudes toward seeking help in general. But stigma was not associated with willingness to discuss mental health issues with a GP. Two-thirds of survey respondents said that they would feel comfortable talking to their GP about mental health issues. However, researchers learned that some people did not believe that GPs were an appropriate source of help for mental health problems. In fact, some respondents did not realize that GPs could help with mental health issues.

Additional Research
Boyd, C.P., et al. (2006). "Issues in rural adolescent mental health in Australia." Rural and Remote Health, 6(1): 501. [NLM/Pubmed abstract]

Farrell, S.P., & C.R. McKinnon (2003). "Technology and rural mental health." Archives of Psychiatric Nursing, 17(1): 20-26. [NLM/PubMed abstract]

Fuller, J., et al. (2000). "How definition of mental health problems can influence help seeking in rural and remote communities." Australian Journal of Rural Health, 8(3): 148-153. [NLM/Pubmed abstract]

Hauenstein, E.J. (2003). "No comfort in the rural South: Women living depressed." Archives of Psychiatric Nursing, 17(1): 3-11. [NLM/Pubmed abstract]

Hill, W., C. Weiner & S.Cudney (2006). "Influence of a computer intervention on the psychological status of chronically ill rural women: preliminary results." Nursing Research, 55(1): 34-42. [NLM/Pubmed abstract]

Palmer, G.A., P.L. Redinius & R.C. Tervo (2000). "An examination of attitudes toward disabilities among college students: Rural and urban differences." Journal of Rural and Community Psychology, E3(1). [Free text article]

Reed, F., & L. Fitzgerald (2005). "The mixed attitudes of nurse's caring for people with mental illness in a rural general hospital." International Journal of Mental Health Nursing, 14(4): 249-257. [NLM/Pubmed abstract]

Smith, A.J. (2003). "Rural mental health counseling: One example of practicing what the research preaches." Journal of Rural Community Psychology, E6(2). [Free text article]

Tyler, J.D., R. Green & D. Newberry (2004). "Adolescent preferences for help with mental health problems." Journal of Rural and Community Psychology, E7(1). [Free text article]

Wainer, J., & J. Chesters (2000). "Rural mental health: Neither romanticisim nor despair." Australian Journal of Rural Health, 8(3): 141-147. [NLM/Pubmed abstract]

Models, Programs, and TA Tools

Montana Mental Health Association (MMHA) Public Awareness Campaign by Deb Mateucci, Executive Director, MMHA

In November 2004, Montana Mental Health Association (MMHA) embarked on an extensive public awareness campaign. As part of the campaign, its creators identified stigma as one of the most significant barriers to accessing mental health care and acknowledged that much of the awareness training being conducted in Montana was only reaching mental health providers, consumers, and advocates who already recognized the problem. Instead of continuing to preach to the choir, MMHA staff decided to take a new approach, using broadcast and print media to erase, rather than perpetuate, stigmatizing beliefs. The campaign included three key elements:

A long-format video (14 minutes). This video has been shown to employer groups, civic organizations, policymakers, advocates, educators, PTA groups, daycare providers, and more! We show the video as part of a facilitated discussion on local mental health concerns, available resources, and local needs.

Radio and TV public service announcements (PSAs). As part of the overall outreach plan aimed at developing an educated public, the first phase of the campaign simply talked about the prevalence of mental illness. The ads ran during Montana's State Legislative Session and were shown to policymakers with the power to determine budgets for public mental health services. The second phase included information about the devastating effects of stigma. For example, one ad stated, "If you know that 1 in 5 is affected-that it is your friend, neighbor or co-worker. then why would you treat them the way that you do." The PSAs were launched in partnership with the Montana Department of Public Health and Human Services and the Montana Broadcasters Association.

Print media monitoring. MMHA monitors all print coverage of mental health, substance abuse, medications, and suicide (among other topics) in all daily and weekly papers across the State. In addition to reviewing article content, the monitoring program records the names of journalists, the story location, and the story lead (i.e., who or where it came from). The monitoring program has given MMHA an advantage when sending news alerts, press releases, and their own story leads. In addition to knowing who is printing what, MMHA staffers know if journalists and publications are giving fair and accurate coverage to mental health issues, and if a region of Montana is not being reached.

To date, the public awareness campaign has earned more than a twenty-to-one match for its initial investment. The MMHA has sponsored and aired over $500,000 in media placements statewide in just 6 months. Each PSA directs the public to visit the MMHA Web site or call a toll free number for more information. Since the start of the media campaign, internal monitoring of usage statistics has demonstrated that traffic to both of these resources has more than doubled and continues to increase.

Plans for 2006 include the development of another long format video addressing children's mental health issues, followed by a series of PSAs on the same topic. MMHA also has partnered with the Youth Suicide Prevention Task Force to develop a series of PSAs about suicide prevention. They also plan to continue monitoring print journalism and actively seeking new partners and funding sources in order to grow the campaign.

For more information, please see http://www.MontanaMentalHealth.org. Please direct e-mail inquiries to info@MontanaMentalHealth.org.

Additional Resources
Western Interstate Commission for Higher Education (WICHE) Center for Rural Mental Health Research

The Western Interstate Commission for Higher Education (WICHE) Center for Rural Mental Health Research works to ensure that depressed rural populations benefit from the new care models currently being adopted to improve the depression care in urban populations. Although the prevalence and entry into care for mental health problems is generally comparable in rural and urban populations, the care that rural patients receive for mental health problems may be of poorer quality, particularly for residents in outlying rural areas. In order to ensure that rural patients receive similar quality care to their urban counterparts, the WICHE Center uses a five-step process to promote the adaptation and adoption of evidence-based practice (EBP) for persons with depression and other serious mental illness by rural primary care delivery systems.

For more information about the WICHE Center for Rural Mental Health Research, please visit: http://wiche.edu/MentalHealth/ResearchCenter/ResearchCenter.asp.

What's On Your Mind? With Ross Szabo

Ross Szabo, Director of Youth Outreach for the National Mental Health Awareness Campaign (nostigma.org), shares a powerful message of his own experience with mental illness during high school and college in "What's On Your Mind?," an hour-long co-production of WNED and Erie County Mental Health Association of Erie County, Inc. Szabo provides facts about teens and mental illness, talks about his diagnosis, treatment, and recovery-and the stigma he faced throughout the process-and explains why we need to break down stereotypes.

For more information, or to view this engaging video in its entirety or smaller segments, please visit: http://www.thinkbright.org/Families/viewResource.asp?ContentID=4207.

In My Experience.
Anonymous, New Mexico
These are the words of a Native American man living in New Mexico:

To explore Native American stigma and discrimination among their cultures deserves fair representation of their mental health spiritual journeys. Mental illness is too harsh of a term used by the predominant culture. Native American spiritual concepts of journeys consist of legends, nature, the cosmos, arts, and relating to people just as if they were my relatives. It is the belief that we are all inter-related with nature. We all have a center of balance within ourselves, our homes, our families, and our rituals which we need to heal ourselves from within-the spirit.

When mankind finally is able or willing to humble himself to the elements of the universal systems, he will then come to understand different dimensions of spirituality. For example, the poor directional concept of relationship with the universe is understood as the circle of life journey. It is especially significant that the female, in Indian cultures are the strength and foundation of their people. Thus we relate to the earth as our mother, the sun as the father together, and both together will reproduce human life. The Eastern direction represents the infant or baby stage of life; it is a beginning. The South represents teenage or adolescent experiences of exploration. The West represents the period of journey when we become adults. The North represents the elder or golden years of wisdom. The Dineh (Navajo) people respectfully honor their elders for their wisdom and harmony. We do not believe in putting our elders in nursing homes because they want to be among their!
families in order to remain centered within themselves and the universe.

These Native concepts of recovery and resiliency are not described as mental illness. Instead, community and family members all contribute their wisdom, dance, rituals, singing, feasting, and socializing in order to show that they are helping take a part of the illness out from within the person who is ill. It is believed that holy people or spirits are happy and willing to participate in the recovery period of these ceremonial practices. After this there usually come 4 days of sacredness that allow for as little contamination by social influences as possible. Respect is essential.

Additional Experiences and Commentary
Flatow, I. [Presenter] (2005, June 10). "Survey: Half of U.S. residents will suffer mental illness [Radio episode]." Talk of the Nation [Radio broadcast]. Washington, D.C.: National Public Radio. [Listen to audio]

Size, T. (1998, March/April). "Would John Wayne ask for Prozac?" Rural Health FYI. [Free text article]

Slama, K. (2004, January). "Rural culture is a diversity issue." Minnesota Psychologist. [Available from the APA Resource Center for Rural Behavioral Health.] [Free text article]

About the ADS Center
SAMHSA's Resource Center to Address Discrimination and Stigma (ADS Center) helps people design, implement, and operate programs that reduce discrimination and stigma associated with mental illnesses. With the most up-to-date research and information, the Center helps individuals, organizations, and governments counter such discrimination and stigma in the community, in the workplace, and in the media
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The Center for Mental Health Services is a component of the Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services.