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Substance Abuse and Mental Health Services Administration Department of Health and Human Services

Substance Abuse & Mental Health Services Administration Center for Mental Health Services

Last Updated: 6/22/2012

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SAMHSA’s Resource Center to Promote Acceptance,
Dignity and Social Inclusion Associated with
Mental Health (ADS Center)

 
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Archived Issue — Spring 2004

DATE: Spring 2004

TO: Colleagues

FROM: Resource Center to Address Discrimination and Stigma Associated with Mental Illness

SUBJECT: Informational update addressing discrimination and stigma associated with mental illness

This is the fourth in a series of informational updates that you will be receiving periodically from the Resource Center to Address Discrimination and Stigma (ADS Center), a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. The ADS Center helps people design, implement and operate programs that reduce discrimination and stigma associated with mental illnesses. In this issue are:

  • Research: Community Integration
    • New Penn RRTC Leads the Way in Promoting Community Integration
    • An Attribution Model of Public Discrimination towards Persons with Mental Illness
    • Familiarity With and Social Distance From People Who Have Serious Mental Illness
    • Challenging Two Mental Illness Stigmas: Personal Responsibility and Dangerousness
  • In my opinion: ?Olmstead can be an effective tool in addressing discrimination,? based on a telephone interview with Sue Jamieson of the Atlanta Legal Aid Society, lead counsel in Olmstead v. L.C.
  • In my experience: ? 'Not In My Neighborhood' Is Not the Last Word,? by Lynn Gurko, Recovery Consultant and Director of Recovery Services for Crestwood Behavioral Health, Inc.
  • Spotlight on...
    • Like Minds, Like Mine (New Zealand)
    • Arab Community Center for Economic and Social Services (Detroit)
    • Breaking the Silence (U.S.: National)

To receive this memorandum or future memoranda by e-mail, please e-mail us at promoteacceptance@samhsa.hhs.gov. If you wish to comment on anything in the attachments to this memorandum or tell us about your anti-discrimination/anti-stigma work, please e-mail us at promoteacceptance@samhsa.hhs.gov or call us at 800-540-0320.

Who we are

The goal of the Resource Center to Address Discrimination and Stigma (ADS Center) is to enhance mental health consumer independence and community participation by ensuring that people have the information they need to develop successful efforts to counter discrimination and stigma.

According to the report of the President's New Freedom Commission on Mental Health, ?Increasing public understanding about mental health and mental illnesses requires action at every level of government and in the private sector. The first step is to reduce the stigma surrounding mental illnesses, using targeted public education activities that are designed to provide the public with factual information about mental illnesses and to suggest strategies for enhancing mental health, much like anti-smoking campaigns promote physical health.?

Please visit our Web site, www.adscenter.org, and contact us via a toll-free number, 800-540-0320, which is staffed from 9 a.m. to 5 p.m. Eastern Time, Monday through Friday, to provide assistance.

The ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Research

New UPenn Collaborative Leads the Way in Promoting Community Integration

A new Rehabilitation Research and Training Center (RRTC) promises to dramatically advance the goal of full community integration for persons with psychiatric disabilities. The UPenn Collaborative on Community Integration is the first RRTC to focus on community integration as it applies to people with psychiatric disabilities. Based at the University of Pennsylvania, the Collaborative engages researchers across the country and is conducted in partnership with the Mental Health Association of Southeastern Pennsylvania and Horizon House of Philadelphia, both of which provide services to persons with mental illnesses. Through a combination of research, trainings and technical assistance, the Collaborative will promote community integration as a key element of mental health programs across the country.

Rehabilitation Research and Training Centers (RRTCs), funded projects of the National Institute on Disability and Rehabilitation Research, within the U.S. Department of Education, are responsible for developing new knowledge and translating it ? through training, technical assistance and dissemination activities ? to the stakeholder community: mental health consumers, advocates, policymakers, program administrators and practitioners. The UPenn Collaborative is a five-year RRTC with goals of eliminating barriers that prevent people from being full members of their community, developing system supports, and identifying and fostering practices which enable people with mental illnesses to participate in their communities as active, equal members.

?The Supreme Court's Olmstead decision and the report of the President's New Freedom Commission on Mental Health established community integration as a critical and immediate goal for people with psychiatric disabilities,? says Mark Salzer, Ph.D., Project Director for the Center. ?Olmstead is discussed a lot in the field, but it hasn't been made real. This RRTC is the means to make sure that we follow through on its mandate.?

Stigma and discrimination against people with mental illness are among the major barriers to community integration that the Collaborative will address. These factors mean that many do not receive equal access to housing, community resources and employment opportunities. Discrimination against those with psychiatric disabilities keeps many from recovering their mental health and having opportunities to succeed. Yhe final report of the President's New Freedom Commission on Mental Health has stated that the need to reduce stigma is a major priority for people with psychiatric disabilities particularly because ?[e]liminating stigma will also help reduce the isolation of these individuals from society.?

Salzer points out that these issues are central to the Collaborative's work. ?We will be conducting research to identify potential discrimination in the areas of housing and child custody in addition to studying supports aimed at enhancing community integration. We are also developing training and technical assistance materials that address discrimination and stigma in many areas, with the goal of increasing consumer self-determination and changing those policies and practices that undermine community integration.?

During the life of the project, the results of nine studies in the core areas of Factors, Policy, and Interventions will be translated into a series of five professional community integration trainings. Correspondingly, five technical assistance packages comprising fact sheets, resource toolkits, program guidelines, training manuals and other literature will be produced for national distribution.

Among the topics to be researched are assessment of the residential segregation of people with psychiatric disabilities, custody rights for women with psychiatric disabilities, and the impact of Olmstead implementation and assessment of consumer participation in Olmstead planning. Others are the use of a circle of support in supported employment, intervention to enhance natural supports within a case management context, Internet peer support for people with psychiatric disabilities, and non-disability peer supports in post-secondary education. All of the RRTC products will employ results of its research to help reduce barriers and promote the systematic change necessary for community integration to become a reality.

?We will be leading the field with cutting-edge research and translating it into practice,? said Salzer. He acknowledges, though, that research is just the beginning. ?We need to value people based on ability, not on disability, and to move beyond people with mental illnesses simply living in the community to becoming a part of the community.?

For more information visit http://www.upennrrtc.org/, send inquiries to pennrrtc@mail.med.upenn.edu or phone: 215-746-6713, fax: 215-349-8715; TDD: 215-751-9655.

The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Link, B.G., Struening, E.L., Neese-Todd, S., Asmussen, S., Phelan, J.C. Psychiatric Services, 2001, Vol. 52, No. 12 (December): 1621-1626.

?Objective: The objective of this study was to determine whether stigma affects the self-esteem of persons who have serious mental illnesses or whether stigma has few, if any, effects on self-esteem. Methods: Self-esteem and two aspects of stigma, namely, perceptions of devaluation-discrimination and social withdrawal because of perceived rejection, were assessed among 70 members of a clubhouse program for people with mental illness at baseline and at follow-up six and 24 months later. Results: The two measures of perceptions of stigma strongly predicted self-esteem at follow-up when baseline self-esteem, depressive symptoms, demographic characteristics, and diagnosis were controlled for. Participants whose scores on the measures of stigma were at the 90th percentile were seven to nine times as likely as those with scores at the 10th percentile to have low self-esteem at follow-up. Conclusions: The stigma associated with mental illness harms the self-esteem of many people who have serious mental illnesses. An important consequence of reducing stigma would be to improve the self-esteem of people who have mental illnesses.?

An Attribution Model of Public Discrimination towards Persons with Mental Illness. Corrigan, P., Markowitz, F.E., Watson, A., Rowan, D., Kubiak, M.A. Journal of Health and Social Behavior 2003, Vol. 44 (June): 162-179.

Recent research has begun to explore how social rejection of people with mental illnesses is influenced by perceptions of dangerousness and by beliefs about the causes and controllability of a person's mental illness. In this study, the authors presented 518 college students with vignettes about a person with mental illness that varied in terms of information about the cause of the illness and past violent behavior. Findings indicate that beliefs about controllability and dangerousness influence emotional reactions and behavior toward persons with mental illness. Namely, when the onset of a mental illness is viewed as controllable (i.e., preventable), and when a person with mental illness is seen as dangerous, people are likely to avoid and withhold help from that person, and endorse coercive treatment. These beliefs also lead to decreased feelings of pity and increased feelings of anger and fear, which in turn lead to rejecting people who have mental illnesses. Fear is a particularly strong predictor of support for social avoidance and coercive treatment. These findings have clear implications for anti-stigma programs.

Familiarity With and Social Distance From People Who Have Serious Mental Illness. Corrigan, P.W., Green, A., Lundin, R., Kubiak, M.A., Penn, D.L. Psychiatric Services, 2001, Vol. 52, No. 7 (July): 953-958.

?Objectives: This study examined the effects of familiarity with and social distance from persons who have serious mental illness on stigmatizing attitudes about mental illness. Methods: A total of 208 community college students completed three written measures about familiarity, perception of dangerousness, fear, and social distance. Path analysis with manifest-variable structural modeling techniques was used to test a version of a model in which familiarity influences the perception of dangerousness, which in turn influences fear, which influences social distance from persons with serious mental illness. Results: Most of the participants reported experience with mental illness. Scores on the three written measures largely supported the path model. Correlations between the perception of dangerousness and fear as well as between fear and social distance were particularly strong. Conclusions: Approaches to social change that increase the public's familiarity with serious mental illness will decrease stigma. Further studies are warranted that focus on how contact between members of the general public and persons who have serious mental illness may be facilitated.?

1 New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.

In my opinion:

Olmstead can be an effective tool in addressing discrimination
Based on a telephone interview with Sue Jamieson of the Atlanta Legal Aid Society, lead counsel in Olmstead v. L.C.

Although battles have been fought for the civil rights of people with disabilities for decades, the significance of the Olmstead decision is that the Supreme Court finally said that, under federal law ? the Americans with Disabilities Act (ADA) ? we now have a mandate to prevent discrimination against people with disabilities who are victims of unnecessary segregation in nursing homes and state institutions. The most amazing thing is that the implications of Olmstead still are not clear to many states, which still resist the idea that it violates the ADA to provide disability services to someone in a segregated environment.

I spend most of my time trying to understand why we are still confining people in institutions and figuring out how to get them out of there into appropriate community services. Throughout the process with the Supreme Court, one of the results I was hoping for was simply a tool that lawyers and other individuals could use to get people with a disability label out of an institution.

Unfortunately, I do not think too many of us are using Olmstead at that level; we are more interested in what systemic reforms Olmstead can accomplish ? and there is nothing wrong with that. But in my individual efforts to get people out of institutions, I have found that Olmstead is a very effective tool.

Before Olmstead, most of the people who were doing this work had to look to state laws, which usually say that there is no obligation imposed on states to provide community services to an individual who moves from an institution into the community. Once we had Olmstead, we could tell a hospital or clinical director that if an individual has the capacity to live in the community with appropriate supports and the state and/or the hospital administration is failing to take the necessary action to make sure that happens, then the state and the state hospital are violating his rights under the ADA and Olmstead.

Usually, you can find ways to enforce Olmstead without necessarily returning to federal court, which is often beyond the capacity of many individuals, even attorneys.

Some of the characteristics of a potential ADA/Olmstead ?tool kit? are (1) direct regular outreach to an identified institution; and (2) very clear access by people in institutions to those who are trying to help them get out. This could be a legal services organization, a protection and advocacy system, or a group of individuals who have been previously institutionalized, who have received training tailored to their state's involuntary hospitalization procedures.

There are various ways to proceed:
The internal complaint mechanism. Every hospital in every state has a complaint mechanism. Often, however, due to institutional bias, whatever the inpatient is complaining about is found to be unjustified; so at first glance such internal complaint mechanisms are useless. But at second glance, we have found that they are very useful and not very difficult to access. You do not need to be an attorney, but you need to be prepared to stand firm, because the process often fails.

The internal complaint mechanism is usually used to address incidents within the institution. But, with training in that context, you can use the mechanism to address the person's general experience in the mental health system ? repeated hospitalizations or long-term confinement ? and challenge the system to develop a comprehensive, community-based, individualized plan. If you use the language in the ADA, which is very straightforward ? ?services must be provided in the most integrated setting appropriate to the needs of the individual? with a disability ? you have the tool you need to make sure that the state protects that person's civil rights. It's hard work, and it just gets one person at a time the services he or she needs. But if you have a good institutional-based project that addresses such issues, it also tends to influence the way others in that institution are treated.

Probate court. This is a lower-level court that has jurisdiction over guardianships and mental health issues. It is frequently the court that handles the involuntary hospitalization procedures, but it also has a general kind of jurisdiction over people with disabilities. In other words, state law includes a spectrum of individual rights that are designed to protect people receiving mental health services both in institutions and in the community. The probate court also has the authority to enforce those rights. Probate judges tend to have more exposure to people with mental health diagnoses and are less likely to impose stereotypes and stigmas because they have acquired a better understanding of mental health issues. They certainly understand how ineffectual it is to have people repeatedly hospitalized without a stable, community-based individualized plan of care. Before Olmstead, a probate court could focus on various rights, such as the right to treatment or the right to refuse treatment; but we have noticed that the ADA and Olmstead have helped us make the point that appropriate services must be provided in the community pursuant to an appropriate individualized plan. (You would need to work with an attorney to access the probate court.)

An example of how we have used the probate court: Mr. J, 45 years old, called Legal Aid after he had been involuntarily hospitalized, asking if we could help him determine whether the commitment was legal and whether we could prevent him from being discharged without appropriate services. (He was fearful of being discharged to a homeless shelter.)

We went to the institution and met with Mr. J, and we learned that he is routinely institutionalized because he is either in a homeless shelter or he goes back to the home of a family member who is unable to support him in the home. Sometimes he stays in a hotel or an extended living motel for part of a month, until his SSI check runs out and he has nowhere to go. It is a typical pattern.

His hospital staff felt very strongly that Mr. J could live successfully in the community if he had some supports, and they did not think it was clinically appropriate for him to be repeatedly thrown into and out of a psychiatric hospital. Repeated hospitalizations emphasized all the negative aspects of his clinical condition. So the team took the position that he should be placed in the community but only with adequate residential services. The client was willing to wait until we could assure him that he had appropriate services in the community.

We got an individualized service plan developed with the help of the hospital treatment team and we presented the individualized service plan to the community-based service provider system. Their reaction was, ?Fine, but we do not have the money for residential services so he has to stay in the hospital.? We then filed an individual case in probate court and presented Mr. J's position, which is that (1) he wanted to leave the hospital, (2) his treatment team agreed he could leave, and (3) it would not be a ?fundamental alteration? of anything to serve him because these community-based services exist. These are the three Olmstead requirements. The only thing missing was the willingness of the system to provide him with services. Partly because of language in the state law and partly because of Olmstead, the probate judge ruled for him and said the hospital and service system must ?implement the individual service plan.?

Mr. J was placed in a small group setting for people with mental health diagnoses. He was in a stable environment for the first time in at least 10 years, if not longer. He has since been briefly rehospitalized once and returned to the same community-based setting, so he finally sees it as his home; and even when he has a crisis or is unable to stay there for a few days, the whole system does not fall apart for him.

He has found a friend ? another client of ours who had been institutionalized for a long time and lived with his family after returning to the community ? and Mr. J now spends a lot of time at his new friend's house, has gotten to know his parents, and goes to movies with him, etc.

Administrative initiatives. This is the most common ? and probably most effective ? use of Olmstead for the individual. This means that you first ask that the hospital develop the appropriate community-based plan. The hospital-based treatment team is almost always willing to acknowledge that, with appropriate supports, an individual could live successfully in the community. They might immediately add that there is insufficient funding for such supports. But once they have agreed that an individual would be able to live in the community, you have established the person's ADA rights ? because Olmstead says that if the person can live in the community and the treatment team agrees, then it is discriminatory not to place him in the community.

You can then make a request at the next level, at your state Department of Human Resources or equivalent agency. There are various ways to do this, but you might write a letter or hold a meeting where you require that the person's civil rights be protected by placing him or her in a more integrated setting. In my experience, that is enough to get the person into a community program. It also gives you the opportunity, when you have tried everything ? by creating a paper trail from the hospital up to the highest state administrator ? to file a claim in federal court.

The Medicaid Rehabilitation Option (MRO). This is a Medicaid program designed to enable a person who needs mental health services to get them in the community. If a state has the Medicaid Rehabilitation Option (which reimburses community-based services) and it is utilized effectively, it should bring in a lot more resources to support people in the community.

Unfortunately, from the point of view of an individual in an institution, the Medicaid Rehabilitation Option has been virtually inaccessible. We had hoped that, because the Rehabilitation Option covers residential services, an individual could apply and at least get on a waiting list for a residential program in states that have the MRO in place, but so far that has not been the case. People attempting to enforce the rights of institutionalized persons in state institutions in states that have the Medicaid Rehabilitation Option can assert the right of the person to apply for community-based services, have a written determination of eligibility, and a hearing if their application is denied. One of the reasons that it is important to clarify these due process rights is because otherwise the community services funded through this program are inaccessible to these individuals.

Office for Civil Rights (OCR). The Office for Civil Rights, under the U.S. Department of Health and Human Services, has regional offices around the country and a special Olmstead coordinator. Ever since the Olmstead decision, OCR has particularly focused on making sure that states use their Medicaid dollars consistent with the stipulations in the Supreme Court decision. You can file a very straightforward complaint with OCR and say, ?Mr. Smith is in a nursing home; all he needs is assistance getting in and out of bed and bathing and he could easily live in the community; and I have talked to his doctor and he said that, if there is a place in the community, that would be fine.? If you've got those basic facts and Mr. Smith wants to get out, you can file a complaint. Again, you do not need to be a lawyer to do this.

Finally, however, you will end up with certain individuals who have tried everything and they still remain in an institution. This brings us to the question of whether Olmstead is making a difference at the system level.

There are still thousands and thousands of people around the country who are institutionalized unnecessarily. Getting them out is a long, slow, discouraging process. It is unfortunately looking like the post-Brown v. Board of Education period: we know that the Supreme Court has said that the states are segregating people within institutions and nursing homes, and we know that has to change, but courts and states are slow because it takes money and courage and a major change of attitudes.

I am fairly confident that, over a period of time, the ADA will be implemented so that people will no longer be unnecessarily confined in institutions. But I cannot tell you when that will happen.

In the post-Olmstead landscape, what the federal courts and many others have misunderstood was that what the Supreme Court meant by a ?comprehensive plan with a waiting list that moves at a reasonable pace? was to create a list of people currently in institutions and Medicaid recipients in nursing homes who could live in the community. The Supreme Court was looking at our plaintiffs and said that the states may not be able to move everybody out immediately; they may need to create a list. But clearly the Supreme Court intended that these individuals be moved out, because otherwise the primary holding ? unnecessary institutionalization and segregation ? would have no meaning.

I am quite sure that the courts will eventually get this straight. Unfortunately, one or two courts have looked at the case and said: ?States can consider what other resources they have and, if they are really limited, then they may not have to move people into the community right now, as long as they can show that they are trying and that they have done a lot to redesign their system.?

However, what the Supreme Court was saying was that if the state can show the court that it has a list of people and it is trying to move them into the community at a reasonable pace, then the people on that list may have to wait their turn.

It is important to note that even we who are working to uphold the rights of people with disabilities still stigmatize and discriminate against people in institutions. Our society's discrimination against people with disabilities is so profound that one of its results is that we have absolutely abandoned a certain percentage of people with disabilities in institutions. At presentations I make around my state, I ask how many people present at the meeting are living in institutions, and I know the answer will be nobody. They do not come to our meetings, and we do not make the effort to bring them out and get them involved in our initiatives. We sometimes think of them as a different group. It is strange to admit that the institutionalized population has benefited from a significant civil rights decision almost five years ago, but most of them have never heard about it. We might have to examine our own consciences about whether our work is directed to release the individuals that the Supreme Court was attempting to help return to the community and refocus our work to get them into the community.

In our experience

?Not In My Neighborhood? Is Not the Last Word
By Lynn Gurko

Discrimination and stigma are alive and well and living in a town near you. We often believe that we, as a society, have risen above these degrading practices, but we're only fooling ourselves. People with mental health disorders are often said to be the last group it is socially acceptable to discriminate against and stigmatize.

I thought I knew the scope of stigma and discrimination against people with mental health issues. As a person who identifies as a mental health consumer in recovery, I felt like I had experienced stigma firsthand; after all, I had been through stigmatizing experiences of my own as a result of being labeled ?mentally ill.? But nothing prepared me for what I was about to witness on July 24, 2002.

As the director of our local mental health anti-stigma campaign, I was asked to attend an ?open house? to support the possible development of a mental health rehabilitation center in an adjacent town. Because of a lack of funding, Contra Costa County, in California, had long been without this level of mental health care, so the need was great. Crestwood Behavioral Health, Inc., had a good reputation, and I was willing to support any project that would bring folks in treatment back to their community and closer to their families. Crestwood was willing to partner with our county's mental health division and already had a longstanding role in providing care for mental health clients in their facilities in other counties.

The size of the crowd at the open house that night was far beyond what anyone had anticipated. The meeting was held in the facility where the proposed program was to be established; but the large building was woefully inadequate to contain the rage and hate that spewed forth during that meeting. The number of people crammed into the lobby only intensified the mob mentality.

As the Crestwood management explained the proposed program, which would be in an unlocked setting, the neighbors' fury began to escalate and was exacerbated by heckling comments from the sidelines: ?Are we going to have people running around like maniacs?? ?They'll go to the liquor store; it'll help them with their medication.? ?We don't want our children walking past these pedophiles.? ?Nobody wants these people. We work hard every day. We don't want to have to come home and face this, worrying that someone's going to hop my back fence and go wacko. It belongs on a farm somewhere.? ?Half the people who work at Crestwood belong in there. I've seen them at the liquor store.?

No matter how hard Crestwood and county mental health employees tried to assuage people's fears, it was impossible to make any headway in educating the neighbors. Their minds were made up: they weren't about to let ?crazy people? roam their neighborhood. As I listened to the rage intensify, I could feel my blood pressure approach boiling point, and I thought, ?And they call us dangerous??

That was just the beginning: in an article in the local paper after the open house, a neighbor who lives across the street from the facility stated that if the program were to open, she would like to build a moat around her house and fill it with piranhas.

In the months following the open house, my colleague Jay Mahler and I became more involved in supporting the Crestwood staff in trying to educate the community in an effort to reduce their fears about having people with mental illnesses as neighbors. The concerns expressed to the Crestwood staff included: ?I don't want them roaming the canal that runs through the neighborhood,? and ?Our children will pass the building every day on the way to school. What will they see as they walk past the front window??

I knew my cynicism was increasing when I became amused by a statement that was made at a meeting with a few neighbors: ?What will they do during their free time? Are they going to jump the fence, go to Safeway and steal my purse and then return to the facility?? (I wanted to burst out laughing but I was too busy biting my tongue.)

As the process continued to unfold, I became increasingly impressed by the strength and integrity of the future facility's staff, particularly the administrator and the program director. The more I saw, the more I wondered, ?How do they stand the persecution and ignorance day after day and not throw in the towel? Nobody should have the unenviable job of having to justify why people like us ? mental health consumers ? should be allowed to be a part of their own community.?

Because of the hype generated by a few neighborhood ringleaders, the emotional charge had reached a fever pitch. From the time of the open house and throughout the battle, one of the neighbors spent much of his time circulating fliers that incited the local residents into a frenzy. These fliers appealed to people's fear for the safety of their children and were filled with derogatory statements about how having mental health clients in the neighborhood would put their children's lives at risk.

When it was time for the Planning Commission to hear the proposal for the use permit, the crowds at the meetings were no less raucous then they had been at the open house the year before. The neighbors packed the chambers with their young children in an effort to prove how ?at risk? they were.

When it became politically incorrect to tout the dangers of ?the mentally ill,? the neighborhood residents changed their tactics and claimed their property values would plummet. When those claims proved to be unfounded, they switched gears and began attacking the moral fiber of Crestwood. This then became their battle cry for the remainder of the fight: they became resolute in attempting to expose Crestwood for the ?corrupt? organization that it surely was.

Throughout the process, Crestwood officials were victims of ongoing character attacks, constantly accused of lying, and heckled by neighbors during their testimony. It was ugly.

We were sure that the Planning Commission would support the Americans with Disabilities Act (ADA), so we were stunned when they denied our use permit.

Crestwood immediately appealed the decision, and the process began all over again with the City Council. The fever pitch never wavered, and most neighbors refused to let themselves be educated about the true nature of the consumers we would serve at what was now being called the ?Crestwood Healing Center.?

Through it all, I was continually amazed by the strength and integrity of the Crestwood staff. We had all decided early on that we would take the ?higher ground? and not stoop to fighting fire with fire. Our strength came in large part from the unwavering support we received from the mental health stakeholder groups ? consumers, family members, and mental health organizations ? in our county. They came in numbers to show their support and give testimony, all the while being heckled by the neighborhood group. Their support was vital to our perseverance.

In an effort to establish good will with the city and the neighbors, Crestwood was forced to make the following concessions:

  • Crestwood was required to pay for a risk assessment survey not usually required of incoming businesses.
  • A costly public relations campaign was created in an attempt to educate the community regarding mental health issues.
  • Neighborhood meetings were conducted with a facilitator provided at Crestwood's expense.
  • Extensive conditions were put in place limiting consumers who would qualify for the program, and also limiting pass privileges at a level not required at any other facility.

The use permit was finally granted, but not willingly. A City Council member stated in effect that City Council was only granting the permit because their hands were tied, and she wished she had never heard of the ADA. Before the final decision, the neighbors staged a protest march to the City Council chambers, and then they began to picket in front of the facility on a daily basis. In spite of the City Council ruling in favor of Crestwood, the picketing continued.

There were positive outcomes as a result of the emotionally draining year and a half battle with the neighbors. In the process, we were afforded the time to create the first consumer-written, recovery-based program of its kind approved by the California State Department of Mental Health.

The Crestwood Healing Center finally opened its doors on October 10, 2003. Our first three consumers had to cross picket lines as their inauguration into the recovery process. Crestwood Behavioral Health spent an unprecedented $3.5 million in the fight to provide recovery-based services to consumers; yet our journey to fight discrimination and stigma must continue.

Lynn Gurko is Recovery Consultant and Director of Recovery Services for Crestwood Behavioral Health, Inc.

Spotlight on...

New Zealand Ministry of Health sponsors multi-year advertising campaign

The Like Minds, Like Mine campaign conducted by the New Zealand Ministry of Health has employed television advertisements featuring prominent New Zealanders who have a mental illness. Nationwide surveys indicate that the campaign has helped to foster more accepting attitudes toward people who have a mental illness.

Situation: In 1996 a team led by a judge conducted a review of New Zealand's mental health services. The report stressed ?the importance of addressing community knowledge, attitudes and behaviour towards those with experience of mental illness,? and it concluded: ?There is no doubt that the feeling created by stigma is one of the significant reasons cited for loss of hope and relapse by those who experience mental illness. We support a public awareness campaign ? it is a must.?

Solution: Beginning in 2000, the Ministry of Health aired nationwide television advertising campaigns featuring famous New Zealanders, including popular musicians, a fashion designer, and a Member of Parliament. Additionally, the documentary ?Sticks and Stones? explained how the people in the advertisements had succeeded in spite of mental illness. The campaign's other activities included media training for providers, a quarterly newsletter, and media awards for accurate portrayal of mental health issues.

Results: Evaluations of the campaign have revealed substantial positive impact. In an evaluation conducted among over 300 mental health consumers nationwide, 80 percent said that the advertisements were helping to reduce the discrimination and stigma associated with mental illness. Over half reported reduced stigma among family, whanau (extended family ? an important aspect of indigenous Maori culture), and the public, while about a third reported reduced stigma and discrimination among media and the police.

Larger surveys were conducted among the general public, both before and after the advertising campaigns. After the second major round of advertisements, 88 percent of the population were able to name a step that could be taken to reduce the discrimination associated with mental illnesses. A comparison of the data from before and after the advertising campaigns revealed that, afterwards, people generally were more accepting of people with mental illnesses.

It should be noted that rates of acceptance of people who have schizophrenia did not increase. A report analyzing the campaign recommended that, as a means of addressing this lack of improvement, future advertisements should feature people who have schizophrenia.

Contact: Mental Health Foundation, P.O. Box 6563, Marion Square, Wellington, New Zealand; Phone: + 64 4-384-4002; Fax: + 64 4-384-4003; E-mail: debbiep@mentalhealth.org.nz; Web site: http://www.likeminds.govt.nz/

Spotlight on...

Social services agency in Dearborn, Michigan, seeks to reduce stigma among Arab-Americans

The Arab Community Center for Economic and Social Services (ACCESS) is one of five agencies contracted with by the Detroit-Wayne County Community Mental Health Agency to conduct anti-stigma programs in the Detroit area.

Situation: Immigrants and second-generation Americans from cultures that are less accepting of mental illness ? including Middle Eastern cultures and many others ? are unlikely to seek treatment for mental health concerns and are less likely to know about improvements in mental health treatments and services, according to program director Adeeb Samaan, M.D., Ph.D. Many clients served by ACCESS, a multi-function social services agency, have recently fled Iraq, where they experienced the trauma of war; some have even been subjected to torture. In the United States, many immigrants face language barriers to making new friends and accessing services.

Solution: In an effort to combat stigma, ACCESS holds group meetings and works directly with individuals, helping to convey basic messages vital to their recovery: that their conditions are not their fault or a sign of weakness; that simply escaping the trauma might not be the entire solution; and that people who have mental illnesses can achieve success. In group meetings, ACCESS serves refreshments and creates a supportive environment in which people are more willing to talk about problems that they are experiencing.

Results: Dr. Samaan and his colleagues conducted a study of more than 300 adults who sought treatment at a community mental health clinic over a period of four months, administering tests before and after receiving an anti-stigma orientation. The results indicated a significant improvement in many symptoms after receiving the anti-stigma orientation.

Contact: Dr. Adeeb Samaan, ACCESS, 6450 Maple St., Dearborn, MI 48126; Phone: (313) 945-8138; Fax: (313) 624-9418; E-mail: asamaan@accesscommunity.org; Web site: http://www.accesscommunity.org/

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National campaign provides materials for educating primary and secondary students about mental illnesses

Breaking the Silence (BTS) offers lesson plans and visual aids for teaching about mental illnesses in the classroom. Separate curricula are available for elementary, middle, and high schools, each addressing stigma and educating students about the symptoms and treatment of mental illnesses.

Situation: Despite the widespread impact of mental illness, there is a ?deafening silence? in American classrooms when it comes to mental health issues. As noted on the BTS Web site, ?Students in health classes learn about the dangers of drug and alcohol abuse, cancer prevention, and how a healthy lifestyle can prevent cardiovascular disease, asthma, diabetes, and other illnesses; but many graduate from high school without ever having had one lesson on mental illness.? Part of the problem is a scarcity of age-appropriate curriculum materials for teaching students about mental illnesses.

Solution: NAMI-New York State ? working in conjunction with veteran teachers who are also family members of people who have mental illnesses ? created three separate lesson plans, together with board games and posters, to teach upper elementary-, middle-, and high-school students about mental illnesses. Among the topics covered are overcoming the stigma surrounding mental illness; recognizing the symptoms of mental illnesses; and realizing that mental illnesses are treatable, common, and nobody's ?fault.? The curriculum includes both statistical information and personal stories that put a human face on mental illness. Curriculum materials may be purchased from NAMI-Queens/Nassau.

Results: Teachers in 43 states and six foreign nations have used the BTS instructional materials. Many who have used the curriculum have noted its positive impact upon students. One teacher noted that after teaching the course materials, his students ?view and talk about mental illness with the same ease and sensitivity as cancer or heart disease.? Another teacher reported that a student, after discussing the materials, convinced her mother to seek help for what was later diagnosed as schizophrenia.

Contact: Breaking the Silence, NAMI Queens/ Nassau, 1983 Marcus Avenue C-103 , Lake Success, NY 11042; Phone: (516) 326-0797; Fax: (516) 437-5785; E-mail: btslessonplans@aol.com; Web site: http://www.btslessonplans.org/


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