Presented by: Marcia Gibson London UK January 23, 2009

Why do we label? Why do we label? In general terms: make sense of the world (child development) – our never-ending need to categorize In terms of negative labels: fear; generalizing a negative experience

What is Beyond the Label? An educational kit for people working in the fields of mental health and/or addiction treatment An interactive framework to discuss, learn, understand and reflect on the impact of stigma on people living with concurrent mental health and substance use problems .

Concurrent disorders Any combination of mental health and substance use disorders. Some examples are: an anxiety problem and a drinking problem schizophrenia and cannabis dependence borderline personality disorder and heroin dependence depression and dependence on sleeping pills

Why was it developed? Forty to sixty per cent of people who have mental health problems will also have a substance use problem during their lifetime. These percentages are similar for people who seek help for their substance use. Concurrent disorders is not the exception. CD clients need the most help but often receive the least help or no help because the two systems are not always well integrated. Health Canada (2001). Best practices: Concurrent Mental Health and Substance Use Disorders. Ottawa: Author.

Service Provider Stigma Negative attitudes toward clients with concurrent disorders can arise for several reasons. These may include: Attribution of responsibility Feelings of inadequacy, frustration, disappointment when working with client with complex needs Perception of poor prognosis

What are the objectives? To help service providers ensure that their services are accessible and that their attitudes and practices are supportive of people living with concurrent disorders. To provide mental health and addiction workers with a concrete tool that they can use in their agencies and in the community to raise awareness about the stigma associated with concurrent disorders.

Who developed BTL? A CAMH team including two volunteers living with concurrent disorders, an education specialist, a product developer and program consultants from different areas in the province of Ontario 15 reviewers 17 pilot facilitators

What’s inside the kit? 10 stigma-busting activities (menu) Master sheets to use as photocopy handouts Background information for facilitators Presentation tips Discussion points Examples of opportune times to use the kit

The activities explore: The facts and myths about concurrent disorders The power of language and how words can wound Stigma, prejudice and discrimination as barriers to recovery for people living with concurrent mental health and substance use problems Ways we can incorporate anti-stigma practices into our work Ways we can all be part of the solution.

Approaching the elephant We acknowledged that everyone has blind spots, that many service providers do their best not to stigmatize and some are already part of the solution (stigma busters!) . Facilitated presentations both internally and externally

Sample activity #3 Rethinking Normal

How was BTL tested? 12 pilot workshops 13 different facilitators 10 different communities in Ontario, Canada 159 participants Pre-test/post-test evaluation tool From 6 to 28 participants in each pilot workshop Some co-facilitation; lone facilitation 2 facilitators helped develop the package, the remaining 11 were unfamiliar with the resource; 8 worked for CAMH; 5 were allied professionals Workshops varied in length and facilitators chose the activities that worked for them / their group 13 questions pre-test/post-test

Pilot test results After the workshop, participants indicated that they: Had a better understanding of concurrent disorders Felt more comfortable interacting with clients with CD Had an increased awareness of the the effect of stigma on people with CD Were more intent on addressing stigma whenever they could

Promotion Promotion started before the kit was completed Regular project updates got people interested in what was to come The needs assessment, review and pilot processes were opportunities to promote Beyond the Label….so we did! .

Feeding the elephant The Dissemination Plan Recruited and oriented CAMH program consultants across Ontario PCs were encouraged to co-facilitate BTL presentations with key stakeholders in their community Stigma-busters received copies of the manual Promotional materials widely distributed Data collected every 3 months

The stats Over a 3-year period, 3,983 individuals attended one of 198 BTL sessions .

Today, BTL lives on… Incorporated into: Talking About Mental Illness presentations in secondary schools Workplace health presentations A Concurrent Disorders and Housing workshop Mental Health and Addiction 101 online tutorials Concurrent disorders curriculum for colleges and universities

Keys to success Kept focus on Concurrent Disorders A project budget to produce the kit Easy to incorporate BTL activities into other learning modules Accessible CAMH’s provincial capacity in policy, education and health promotion

Keys to success (con’t) Available in English and French Easy to use; no train-the-trainer required Time to get stakeholders involved, incorporate their feedback and anticipate the product Leadership and passion

Things you can do to stamp out stigma Acknowledge the prevalence of concurrent mental health and substance use problems. Try to “walk in the shoes” of a person who is stigmatized. Watch your language. Monitor media and openly critique stigmatizing material. Respond directly to stigmatizing material with a letter to the editor. Speak up about stigma to friends, family and colleagues. Be aware of your own attitudes and judgements. Provide support for organizations that fight stigma. There are a number of things that we can do to stamp out stigma, but the first and most important thing we can do is to assess our own attitudes, language and practices.

“The limits of my language… mean the limits of my world “The limits of my language… mean the limits of my world.” - Ludwig Wittgenstein (1963) Everything begins with a change in language which allows us to see beyond the label.

For further information This resource is available at: www.camh.net/beyond_the_label www.camh.net/fr/beyond_the_label Marcia Gibson, Program Consultant marcia_gibson@camh.net 1-613-569-6024 ext: 8209