DATE: Winter 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 sixth 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, and operated by a contract with The Gallup Organization and the Mental Health Association of Southeastern Pennsylvania. The ADS Center helps people design, implement and operate programs that reduce discrimination and stigma associated with mental illnesses. In this issue are:

• Spotlight on...
• The Pandora Foundation ( Netherlands)
• National Stigma Clearinghouse ( U.S.)
• Individual Placement and Support ( New York State)
• Research...
• ?Special Section on Stigma as a Barrier to Recovery,? Psychiatric Services, Dec. 2001
• ?Stigma Is Social Death,? by Deborah Reidy
• In my opinion: ?Assessment Tool Promotes Recovery,? by Wilma Townsend, Senior Program Manager, Technical Assistance Collaborative, Inc.
• In my experience: ?Stigma May Create Opportunities for Recovery,? by Edward L. Knight, Ph.D., CPRP, Vice President for Recovery, Rehabilitation and Mutual Support, ValueOptions, a large managed behavioral health care company; and Adjunct Professor of Rehabilitation Science, Boston University

To receive this memorandum or future memoranda by e-mail, please e-mail us at info@adscenter.org. 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 info@adscenter.org or call us at 800-540-0320.

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

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.

The Resource Center to Address Discrimination and Stigma (ADS Center) is committed to helping to reduce discrimination and stigma. 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.

In This Edition...

The theme of this edition of the Memorandum is Recovery.

Not too long ago, mental illness was considered a life sentence. A diagnosis of mental illness meant that whatever plans you had made ? college, a career, marriage, a family, a respected place in the community ? were destined to fail.

But that has changed. We now know that people with serious mental illnesses are capable of holding gainful employment, getting married, rearing children, practicing their religion, joining clubs, enjoying hobbies, participating fully in the community ? in short, living a meaningful life.

This knowledge is the result of what we know based on research and a revolution in the way people think about mental illnesses: It is now widely accepted that people who have mental illnesses can ? and do ? recover.

This understanding is reflected in the vision ? ?A life in the community for everyone? ? and mission ? ?To build resilience and facilitate recovery for people with or at risk for substance abuse and mental illness? ? of the Substance Abuse and Mental Health Services Administration. It is also reflected in the vision statement of the President's New Freedom Commission on Mental Health, which begins, ?We envision a future when everyone with a mental illness will recover . . .? The report identifies recovery as ?the goal of a transformed system,? and envisions the future: ? Because recovery will be the common, recognized outcome of mental health services, the stigma surrounding mental illnesses will be reduced, reinforcing the hope of recovery for every individual with a mental illness.?

Research

Psychiatric Services ?Special Section on Stigma as a Barrier to Recovery?

In its December 2001 issue, Psychiatric Services, a journal of the American Psychiatric Association, published a ?Special Section on Stigma as a Barrier to Recovery.? According to the introduction by Deborah A. Perlick, Ph.D., ?the aim of this special section is to elucidate the adverse effects of stigmatization on the recovery of people with mental illness.?

Perlick continued: ?In focusing on stigma as a barrier to recovery, we intend to highlight the potential role of stigma both in reducing the effectiveness of efforts at psychosocial rehabilitation ? for example, psychopharmacology combined with social skills training ? and in impeding the restoration of self-esteem, a sense of purpose, and a better quality of life for persons with mental illness. Although we cannot address the full range of ways in which stigma potentially limits the prospects of recovery for persons with mental illness, the papers in this section were chosen to represent central areas of concern for persons with mental illness: treatment-adherence behavior, self-esteem management, and social adjustment.?

The abstracts of the four articles, all of which were published in the December 2001 edition of Psychiatric Services, follow:

?Stigma as a Barrier to Recovery: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence?

Jo Anne Sirey, Ph.D., Martha L. Bruce, Ph.D., M.P.H., George S. Alexopoulos, M.D., Deborah A. Perlick, Ph.D., Steven J. Friedman, M.S. and Barnett S. Meyers, M.D.

?Objective: Major depression is undertreated despite the availability of effective treatments. Psychological barriers to treatment, such as perceived stigma and minimization of the need for care, may be important obstacles to adherence to the pharmacologic treatment of major depression. The authors examined the impact of barriers that were present at the initiation of antidepressant drug therapy on medication adherence in a mixed-age sample of outpatients with major depression. Methods: A two-stage sampling design was used to identify adults with a diagnosis of major depressive disorder, as determined by the Structured Clinical Interview for Diagnosis, who sought mental health treatment at outpatient clinics. Additional instruments were administered to 134 newly admitted adults who had been taking a prescribed antidepressant medication for at least a week to assess perceived stigma, self-rated severity of illness, and views about treatment. The patients were reinterviewed three months later and were classified as adherent or nonadherent on the basis of self-reported estimates of the number and frequency of missed doses. Results: Medication adherence was associated with lower perceived stigma, higher self-rated severity of illness, age over 60 years, and absence of personality pathology. No other characteristics of treatment or illness were significantly related to medication adherence. Conclusions: Perceived stigma associated with mental illness and individuals' views about the illness play an important role in adherence to treatment for depression. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.?

?Stigma as a Barrier to Recovery: The Consequences of Stigma for the Self-Esteem of People With Mental Illnesses?

Bruce G. Link, Ph.D., Elmer L. Struening, Ph.D., Sheree Neese-Todd, M.A., Sara Asmussen, Ph.D. and Jo C. Phelan, Ph.D.

?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.?

?Stigma as a Barrier to Recovery: Adverse Effects of Perceived Stigma on Social Adaptation of Persons Diagnosed With Bipolar Affective Disorder?

Deborah A. Perlick, Ph.D., Robert A. Rosenheck, M.D., John F. Clarkin, Ph.D., Jo Anne Sirey, Ph.D., Jamelah Salahi, B.S., Elmer L. Struening, Ph.D. and Bruce G. Link, Ph.D.

?Objective: The purpose of this study was to evaluate the effect of concerns about stigma on social adaptation among persons with a diagnosis of bipolar affective disorder. Methods: The sample comprised 264 persons who were consecutively admitted to a psychiatric inpatient or outpatient service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I disorder, bipolar II disorder, or schizoaffective disorder, manic type. Patients were evaluated with use of the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-L), the Brief Psychiatric Rating Scale (BPRS), and a measure of perceived stigma. Social adjustment was measured at baseline and seven months later with the Social Adjustment Scale (SAS). Results: As predicted, patients who had concerns about stigma showed significantly more impairment at seven months on the social leisure subscale but not on the SAS extended family subscale, after baseline SAS score and symptom level had been controlled for. More refined models using SAS-derived factors as dependent variables indicated that concerns about stigma predicted higher avoidance of social interactions with persons outside the family and psychological isolation at seven-month follow-up, after baseline SAS and BPRS scores had been controlled for. Conclusions: Concerns about the stigma associated with mental illness reported by patients during an acute phase of bipolar illness predicted poorer social adjustment seven months later with individuals outside the patient's family. Greater attention to patients' concerns about stigma is needed from both researchers and clinicians.?

?Stigma as a Barrier to Recovery: The Extent to Which Caregivers Believe Most People Devalue Consumers and Their Families?

Elmer L. Struening, Ph.D., Deborah A. Perlick, Ph.D., Bruce G. Link, Ph.D., Fredric Hellman, B.A., Daniel Herman, D.S.W. and Jo Anne Sirey, Ph.D.

Objective: This study of 461 caregivers of persons with serious mental disorders measured how strongly they believed that most people devalue consumers and their families. . . . Methods: Caregivers of 180 consumers with schizophrenia, major depression, or bipolar disorder and caregivers of 281 consumers with bipolar disorder or schizoaffective disorder, manic type, completed a 15-item survey. Eight of the 15 items addressed the devaluation of individual consumers, and seven items addressed the devaluation of consumers' families. Results: ?About 70 percent of all the caregivers surveyed indicated a belief that most people devalue consumers, and 43 percent expressed a belief that most people also devalue the families of consumers.? Conclusions: ?Strong evidence from previous research indicates that the caregiving role is very demanding, is frequently distressing, and may be harmful to health and injurious to one's quality of life.? The study concluded that the caregivers and families of people with serious mental disorders feel that their lives are even more difficult because of their perceptions that the general public stigmatizes them. The study concluded that it would be challenging and worthwhile to work on creating more supportive and understanding communities.

* * *

?Stigma Is Social Death: Mental Health Consumers/Survivors Talk About Stigma in Their Lives,?

Deborah E. Reidy, Education for Community Initiatives, Holyoke, Mass. (1993).

?Forty-six people were interviewed to determine their views on the topic of stigmatizing aspects of mental health programs. Of the forty-six, thirty-four identified themselves as current or former consumers/survivors. Some of these individuals were also mental health practitioners or professional advocates. Ten participants were family members or professionals who did not identify themselves as consumers/survivors.?

?People described a number of sources of stigma. Major sources included family, friends and intimates, the job market and co-workers, neighbors, people at church and in school. They also described the practices of the housing market, insurance companies and the social security system as being stigmatizing.?

?While respondents cited a variety of sources of stigma, most frequently mentioned were the attitudes and practices of the mental health system and its workforce. Following are attitudes, beliefs and practices within the mental health system thought to be stigmatizing.?

?Issues relating to power and control were most often mentioned. These included the practice of forced treatment as well as threats of forced treatment or of no treatment. People also cited lack of involvement in treatment planning or other aspects of decision-making about their lives. In addition, restrictions on the freedom to come and go; being "placed" in a house or apartment, and other examples were given.?

?The experience of having lower status than staff within the mental health system was commonly mentioned. Many examples were given, including cues within the physical environment such as separate staff-client bathrooms and eating areas, demeaning and infantilizing interactions between staff and consumers/survivors, differences in status embedded in program policies, and discriminatory treatment in employment of people with psychiatric disabilities as mental health workers.?

?Regimented and deindividualizing practices of both institutional and community programs were described as stigmatizing. Specifically, respondents mentioned dehumanizing admitting procedures, regimented activities, having to wait for appointments, and being forced to accept the psychiatric label.?

?A number of respondents described the practice of separating people with psychiatric disabilities from ordinary community life as stigmatizing. Several people also commented on the practice of grouping people with similar labels.?

?The absence of challenge or orientation to growth within the mental health system was also commonly described as stigmatizing.?

?The lack of respect for privacy was seen by a number of respondents as stigmatizing. Combined with the experience of always being observed by staff was the sense that one's behavior was ?overinterpreted? ? in other words, that any normal feelings or behavior were interpreted as pathology or symptoms of one's illness.?

?Some respondents indicated that they felt inadequate access to information was stigmatizing both to people with psychiatric disabilities and their families.?

?Other stigmatizing attitudes, beliefs and practices included lack of attention to potentially stigmatizing personal characteristics such as effects of medication and personal appearance; stigmatizing language; ?secondhand services?; and cues in the physical environment from the asylum era such as locked cabinets, bars on windows, etc.?

?Respondents then described the effects of these stigmatizing attitudes, beliefs and practices. Their comments focused especially upon ?internalized stigma? and its consequent effects on behavior and self-esteem: low motivation, anger, depression, heightened sense of vulnerability, social isolation, and stifling of growth and productivity.?

* * *

In my opinion...

Assessment Tool Promotes Recovery

By Wilma Townsend

Many systems, providers and consumers are exploring what recovery means to them in their respective roles in the mental health system. As far back as the early '90s, people were asking this question. At that time, Ohio funded four consumer-operated projects, and research was conducted on the projects to help provide answers.

These efforts resulted in a handbook called ?Emerging Best Practices in Mental Health Recovery.? This book clearly identifies specific roles and activities for the individual going through the recovery process, the role of the clinician/worker in assisting individuals in their recovery, and the role of the system and the community in supporting recovery.

Based on this book, two curricula were developed. The first, for clinicians/workers, offers a specific process for helping individuals in their recovery through the development of individualized services/care plans that are consumer-driven. The second helps consumers understand the recovery process and how to use tools to assist them in this process.

Third, to help systems understand their role in supporting recovery, an assessment tool ? Comprehensive Assessment of Recovery Readiness for Systems (CARRS) ? was developed. To refine this tool, we had staff, consumers, and administrators review a number of recovery indicators, including attitude, an organization's mission and value statements, consumer involvement, and others. Through a quality improvement process of evaluating all of the assessments that I had conducted to determine the indicators that had the most impact in supporting recovery, and after conducting a national review of the literature on this topic, I identified the following nine indicators, which are now used to assess the recovery readiness of systems. These nine indicators are:

The assessment is conducted by a survey that is filled out by system providers, consumers and staff. On some occasions, staff and consumer focus groups may be convened.

Again, the main focus of this assessment is to determine what it would take to make the systems more recovery-focused. For example, the finding from the community relations indicator may reveal that the service providers and mental health authority have not given the community a positive message about mental health recovery ? i.e., that recovery is even possible ? or promoted human interest stories about individuals' recovery as part of an ongoing public relations campaign. The assessments may find that the community relations efforts have concentrated on disseminating information about the system's services and where to call to get these services. The general public interprets this as information about services to help someone in crisis rather than to help someone achieve recovery. This kind of information can exacerbate stigma: it makes people think only of the illness ? and at its worst.

In this situation, the assessment would note that it is very important for people to know how to access the system. However, it would add that by focusing on the system as it serves individuals in an acute state of need, we do not leave the general public with the impression that people who have mental illnesses can work, learn, and live meaningful lives in their communities. Instead, the public visualizes the system as having custody of ?the mentally ill.?

It is important to move beyond the stigma so that we focus on recovery. That means making sure we let the community see the positive side of the story: individuals living productive lives in the community. It also means focusing on the community role in this process, e.g., conveying recovery stories not just about the consumers but about the people in the community who assisted these individuals in their recovery. This will give the community more of a sense of their role in the recovery process.

This is just a single example of how one of the indicators can help promote recovery. Some of the other possible supports that could come out of this assessment are the development of recovery-focused agency policies and a culturally competent, recovery-focused system of care.

Every system is unique and has special resources and tools that can promote recovery as well as barriers that can hinder recovery. The CARRS assessment tool can help identify both, and put them in a framework to build a recovery-focused system that helps individuals reach their optimal level of recovery and assists staff in facilitating the recovery process.

For more information on CARRS, contact Wilma Townsend, Technical Assistance Collaborative, Inc., 220 Market Street, Suite 202, New Albany, Ohio 43054, 614-855-7030; wtownsend@tacinc.org. Wilma Townsend is a Senior Program Manager with Technical Assistance Collaborative (TAC). She provides consultation for states, local government entities, managed care organizations, and consumer and family organizations in the areas of cultural competence, consumer outcomes, consumer involvement, and developing a recovery-oriented system.

* * *

In my experience:

Stigma may create opportunities for recovery

By Edward L. Knight, Ph.D., CPRP

Sometimes stigma creates opportunities. Here is how stigma gave me an opportunity to work on my recovery.

One weekend in the state hospital, I was having a full-blown panic attack. I approached the social worker on duty, told him of my panic, and asked if I might talk with him. ?Are you suicidal or homicidal?? he asked abruptly. ?No,? I replied. ?Well, then, you can't talk to me. I'm here for emergencies. You'll have to talk to your own therapist on Monday. In the meantime, learn to tolerate it.? He turned and walked away.

We need not internalize stigma by believing its message. In this case, the message was that I wasn't worth talking to, or that I might ?abreact,? i.e., act out. (In some psychotherapeutic circles, there is a theory that one ought not to engage people diagnosed with psychosis in exploring their emotional problems because it might make them psychotic.)

When I have described this encounter and my subsequent actions to colleagues who are psychiatrists, they comment about the stigma demonstrated by the social worker and the resilience I showed.

I decided to face my anxiety and tolerate it. The social worker gave me no advice on how to do this and I was given none by any other professional. Instead, I drew upon my powers of concentration.

It is extraordinarily difficult to pay attention to anxiety; everything in your being tries to drive your attention elsewhere. I knew the process would take many painful hours. I practiced, and continued to strengthen my attention when not in panic by focusing on a tree, first with my eyes open for a minute and then with my eyes closed for a minute. Slowly I increased the time I was able to concentrate.

In ?The Meaning of Anxiety,? by Rollo May, which I found in the library, I discovered the theory that schizophrenia (my diagnosis) was once thought to be related to an anxiety neurosis. May did not elaborate, but what I imagined was that people often become afraid of their emotions and, on top of that, become afraid to feel that fear.

Fear of fear is one of a group of processes that I call emotions about emotions. I may have primary emotions, like anger, fear, sadness. Then I may have emotions about these emotions. For example, I may get angry about my fear or sadness. These feedback loops make coping quite complex; nevertheless, they can be sorted out and dealt with. However, professionals are sometimes afraid to explore these processes with you because of stigma, as described above.

I set about understanding my anxiety. Using the concentration techniques that my Sufi meditation teacher had shown me, I explored the images and memories attached to the anxiety. I located the anxiety in various parts of my body rather than experiencing it as free-floating. Sometimes the memories or images that I saw brought on a flood of very painful emotion, and I would start to ?space out.? I feared that if I became frightened of spacing out, or of going insane, the panic would worsen.

Experts in the field of cybernetics ? the theoretical study of communication and control processes in biological, mechanical, and electronic systems, especially the comparison of these processes in biological and artificial systems ? call this a ?positive feedback loop.? The feedback loop is not ?positive? in the sense that it is ?good?; it is positive in the sense that it increases in power. I was in a positive feedback loop of fear: I feared and then feared my fear, thus making this negative emotion increasingly powerful until I would find myself going out of control.

I discovered that I could refocus my attention away from anxiety, negative emotions and fearful images. I paid attention to the tree, or to my breath going in and out, and in this way I rode out the panic. I reduced the power of the positive feedback loop of fearing fear. Occasionally, I would hear my demons talk to me when the panic got bad enough. I rode that out by refocusing as well.

By watching my own emotional and mental processes, I discovered that I had a fundamental fear of people unless I was talking with them about abstract, intellectual things. I faced my fear. As I walked around on the hospital grounds, I began to engage strangers in chitchat. I became an expert at weather: gardening weather, fishing weather, swimming weather, weather creating difficulties in getting to work. I learned to socialize without being an intellectual.

I had done something about a very common ?trigger? in my life: people ceased to trigger anxiety. Ignoring the trigger and substituting something else, like paying attention to a tree, would mean no contact with people. Continuing to intellectualize would mean no ?real? contact with people. Instead, I had assumed responsibility for my ?trigger.? It was me, not the environment, that I needed to adjust.

After my success in using my spiritual practice to begin to face anxiety, I would read that anxiety is the great spiritual teacher, as Kierkegaard points out.

There are real processes that can be understood in the chaos of mental illness. Many consumers have insight into these processes, which deserve to be explored by formal qualitative research. Stigma keeps this from happening. After all, we, the ?mentally ill,? are ?incapable of insight.?

We may also be considered incapable in general. For example, when I was in the state hospital I already had earned my Ph.D.; but when I told my psychiatrist that I wanted to do mental health research or start self-help groups or publish, he said I was having delusions of grandeur.

Luckily, a psychologist on my next treatment team told me never to give up on my delusions of grandeur. ?Those are your goals,? he said. I have since accomplished all of these goals.

It is vital for mental health professionals to rid their minds of stigma and adopt a more enlightened approach in order to help those they are mandated to serve to achieve their own goals.

Edward L. Knight, Ph.D., CPRP, is Vice President for Recovery, Rehabilitation and Mutual Support at ValueOptions, a large managed behavioral health care company; and Adjunct Professor of Rehabilitation Science at Boston University.

* * *

Spotlight on:

Netherlands campaign uses contact with people who have mental disorders to combat stigma and discrimination

The Pandora Foundation, in the Netherlands, promotes the interests of people with mental disorders by providing information, advice, support and education. Its particular focus is on fighting stigma.

Situation: The Pandora Foundation was founded in 1964 to counteract the effects of discrimination and stigma in the Netherlands.

Solution: The Pandora Foundation created the ?Ever met a normal person?? information campaign. It provides oral (group) education aimed at a diverse group of organizations and institutions. This education is largely provided by people who have, or have had, psychological and/or psychiatric problems. (Besides group educational efforts, these individuals staff the Pandora Foundation's Depression Line twice a month. The Depression line offers callers a sympathetic ear, information and advice on depression. It operates weekdays from 6 p.m. to 11 p.m. and is also reachable by e-mail.)

The ?Ever met a normal person?? workshop has two goals: fighting prejudice experienced by people with a psychiatric history so as to strengthen their social position and improve the way that they are treated, and making psychiatric disabilities a topic of open discussion so as to prevent an increase in the incidence of stigma and discrimination. A particular objective is to improve the attitudes of aspiring as well as experienced service providers.

These goals are achieved by having people with firsthand experience of what it means to have mental illnesses provide the education. ?They bring the experiences, motivation and dilemmas faced by people with psychological and psychiatric problems to light,? according to Pandora Foundation literature.

Using their personal stories as the basis of their presentations, the speakers provide general education to schools, educational facilities, client groups, women's groups, police, and service providers. The emphasis changes depending on the group, and one or more meetings take place.

Results: According to 2001 statistics, the most recent year for which such information is available, the Pandora Foundation provided 230 educational presentations throughout the Netherlands. They worked in one of the Netherlands' six regions ? Amsterdam, North, East, Rotterdam, Utrecht, and South ? and provided public information for high schools/general audiences (26), client groups (18), health care education programs (115), buddy services (70), miscellaneous (9), and symposia (4). The total number of presentations in 2001 did not change compared to 2000.

Contact: Pandora Foundation (Stichting Pandora), 2e Constantijn Huygensstraat 77, 1054 CS Amsterdam; Phone: +31-(0)20-6851171; Fax: +31-(0)20-6123699; e-mail: info@stichtingpandora.nl: Web site: http://www.stichtingpandora.nl/gb_pandora_diensten.htm

Spotlight on...

Pioneer clearinghouse has long history of effective stigma-busting

The National Stigma Clearinghouse (NSC) is a nonprofit organization that tracks and protests unfair media images of mental illness and promotes accurate portrayals of mental illnesses and the correct use of psychiatric terms. It also provides assistance to others in responding to media images (e.g., providing addresses and phone numbers of media professionals and organizations, materials about mental illnesses with which to educate people in the media, and samples of letters).

Situation: NSC founders Jean Arnold, a community activist and family member, and Nora Weinerth, a communications consultant, saw misrepresentation of mental illnesses as a tidal wave overwhelming token positive images of people with mental illnesses.

Solution: From 1990 until the fall of 1996, the all-volunteer National Stigma Clearinghouse issued 64 monthly reports containing 640 items submitted by media watchers. The reports also included articles, letters, and other items of interest to the national stigma busters' network. The media's responses were outstanding, as shown in itemized recaps published by the Clearinghouse.

The NSC's focus on inaccurate images in news, advertising, and the entertainment media has broadened since 1990 to include a clippings and articles file on prejudice and related topics. It furnishes this information on request to mental health consumers, mental health organizations, educators, students, lawyers, researchers, families, and professionals in the mental health field.

In 1999, the NSC created its Anti-stigma Home Page to provide links to anti-stigma/anti-discrimination work done by a growing number of organizations in the United States and throughout the world.

Results: The NSC's first gratifying success came in 1990, when Planters LifeSavers Co. switched the persona of Mr. Peanut, its trademark image, from ?finger-twirling nutty? to ?jaunty.? At the end of its first three years, the NSC network had chalked up 184 positive results, consisting of published articles, letters to the editor, and positive written responses from advertisers and media sources.

Even more significantly, the NSC succeeded in focusing media attention on the issue of stigma when such attention was rare, and it has been profiled or been mentioned in such national publications as Time and The New York Times.

Contact: National Stigma Clearinghouse, 245 Eighth Avenue, #213, New York, NY 10011, Phone: 212-255-4411; E-mail: stigmanet@webtv.net;

Web site: http://community-2.webtv.net/stigmanet/NATIONALSTIGMA/index.html

Spotlight on...

Employment is the goal of stigma-busting supported employment programs in New York State

Individual Placement and Support (IPS), a project of the Mental Health Association in New York State (MHANYS),is a supported employment program designed to help persons with serious mental illnesses obtain and maintain competitive employment.

Problem: Due in part to discrimination and stigma, the unemployment rate among people with serious and persistent mental illnesses is 90 percent ? far higher than the 50 percent unemployment rate among individuals with physical or sensory disabilities. In other words, only 10 percent of individuals with persistent mental illnesses who want to work, and are able, are working, according to statistics provided by the International Labour Organization. The report of the President's New Freedom Commission on Mental Health quotes a somewhat higher figure ? it says that only about one out of every three people with mental illnesses is employed ? but this is still abysmally low.

Solution: Individual Placement and Support (IPS) is built on the principle that individuals can and should work in competitive employment. Other principles include competitive employment as a goal, rapid job search, integration of rehabilitation and mental health clinicians, attention to consumer preference, continuous and comprehensive assessments and time-unlimited support. IPS is an evidence-based practice: it has repeatedly proven successful and is recognized nationally.

Results: IPS encourages systems change by bringing together business owners, clinicians, case managers and local government representatives. These for-profit and not for-profit sectors share ideas and act as stakeholders in the success of the IPS project in their community. These stakeholders foster long-term change in the community by building consensus around the IPS program and, at the same time, raising awareness throughout the community.

?In order to counter discrimination and stigma, the first year of the project is entirely based around education and consensus building,? explains IPS project specialist T. Ann Trask of MHANYS. ?We hold monthly stakeholder meetings in the community in which IPS will be implemented, involving business and political leaders, service providers, consumers, family members, and anyone else who is interested. We educate the stakeholders ? especially the business and political leaders ? about mental illnesses, and help them understand that people who have mental illnesses are able to work in competitive employment and live productively in the community. By doing this, the IPS project hopes to demolish the barriers that keep people from obtaining competitive employment.?

The IPS model has been successfully implemented in California, Connecticut, the District of Columbia, Illinois, Maryland, Massachusetts, New Hampshire, North Carolina, Oregon, Rhode Island, South Carolina and Vermont.

Through funding from the Substance Abuse and Mental Health Services Administration, the Mental Health Association in New York State (MHANYS) and the Mental Health Association of Columbia and Greene Counties are working together to replicate the IPS program model in Columbia and Greene Counties. MHANYS looks forward to replicating the IPS model in more counties throughout New York State.

While it is too early in the replication process to report outcomes for Columbia and Greene counties, replications of this model in other communities show a successful placement rate of, on average, 60 percent ( Human Service Center and the University of Chicago Center for Psychiatric Rehabilitation). ?The IPS Columbia and Greene counties project looks forward to helping to place as many consumers as possible into competitive employment and ensuring their continued success in the workforce,? said a MHANYS spokesperson.

Contact: Individual Placement and Support (IPS), Mental Health Association in New York State (MHANYS), 194 Washington Avenue, Suite 415, Albany, NY 12210, Phone: 518-434-0439, Fax: 518-427-8676; E-mail: info@mhanys.org, http://www.mhanys.org

Content in the InfoUpdate is current at the date of publication. Content and technology may change after the time of publication and affect the information presented here. If you are trying to locate a specific resource or research article, please contact the ADS Center directly.