STIGMA CHANGE! What and Where is the Evidence? Patrick Corrigan, Psy.D. Illinois Institute of Technology Chicago Consortium for Stigma Research

The Goals Today EVIDENCE Stigma Change is the Goal Many examples What works for whom and where? EVIDENCE For all stakeholders

STIGMA CHANGE PUBLIC STIGMA SELF-STIGMA Protest, Education, Contact Group identification and support

What’s Out There? Current Programs World Psychiatric Association www.worldpsychiatricassociation.org/sections/stigma/index.shtml Programs by country (N>50) US SAMHSA's Resource Center www.stopstigma.samhsa.gov/default.aspx Programs by state (N>100) Canada Programs “…the Commission is launching a major, national 10-year anti-stigma and discrimination reduction campaign. This campaign will be the largest systematic effort to reduce the stigma of mental illness in Canadian history”

RESOURCES

Media Watch Fright Night Scream Park www.nami.org./stigma

Public Service Announcements what a difference a friend makes http://www.whatadifference.samhsa.gov/

Personal Stories

Ahead of the Data! Intervene Now! “There's a temptation for the Commission to sprint out of the gate with a mass marketing campaign, but that would be a mistake.” Canadian Mental Health Commission Ahead of the Data! Intervene Now!

The Evidence Where is the evidence? What is evidence? Using evidence to make decisions

Lessons from mental health services research What works regionally? Governmental policy/support (SAMHSA) Supported employment Assertive community treatment What works locally? How does supported employment actually work in Chicago?

Evidence for Stigma Change What kind of stigma change strategies should Governments/NGOs support? Education, contact… Do these strategies work locally? Chicago, London, Paris Beijing, Delhi, Riyadh

N=213 Stigmatizing Attitudes and Behavioral Intentions Contact: Responsibility Education: Responsibility Control Contact: Dangerousness Education: Dangerousness Attitudes and Intentions @ post and 1 wk f-up

SELECTION CRITERIA STAKEHOLDER PERSPECTIVE State of the Evidence Participatory Action Research State of the Evidence Ratio of Cost to Benefit

Participatory Action Research PERSPECTIVE: Understanding the broad questions related to stigma change POLITIC: interest and authority in subsequent stigma change Who are the stakeholders? diversity

SELECTION CRITERIA Stakeholder perspective STATE OF THE EVIDENCE Participatory action research STATE OF THE EVIDENCE Ratio of cost to benefit

Evidence Based Considerations Dependent measures ATTITUDES Physiological change Information processing Social behavior Behavioral intention BEHAVIOR

Evidence Based Considerations Dependent measures Psychometrics (reliability and validity) Sensitivity Social desirability

Evidence Based Considerations Reducing discrimination versus affirming actions Not just what does it stop (less prejudice) but what is improved (more work) Specificity Not just whether it “changes” people, put does it change important groups Employers, landlords, health care providers 19

Evidence Based Considerations Effect Size Is the effect noticeable? Does it matter? (social validity) Iatrogenic effects Mental illness is a brain disorder Manuals and Fidelity Need to catalogue interventions Feasibility If you provide it, will they come Fect 20

Example Supported employment: Get more people with mental illness back to work. Get more employers to participate in supported employment. Challenge employer stigma: In Our Own Voice: Telling one’s stories

Example Dependent measures: Attitudes Behavior Affirming actions Immediate: Participating in supported employment Hiring people with mental illness Affirming actions Specificity Effect size Manuals and fidelity

SELECTION CRITERIA Stakeholder perspective State of the evidence Participatory action research State of the evidence RATIO OF COST TO BENEFIT

Cost-Benefits The size of the sample The depth and breadth of effects Local or broad The depth and breadth of effects Effect size Specificity Outcomes (no stigma versus more affirming actions) The costs of the change strategy The cost of evaluation

PUTTING IT ALL TOGETHER

Evidence Based Approach WHO is to be targeted. WHAT needs to be changed. HOW will this be changed. WHEN will change occur. MEASURE IT

For Evaluating Programs Meant to Erase the Stigma of Mental Illness TOOLKIT For Evaluating Programs Meant to Erase the Stigma of Mental Illness Patrick Corrigan draft Oct 23, 2008

Patrick Corrigan corrigan@iit.edu