Stigma and Stigmatization Reducing Stigma Through a Public Educational Campaign Which Targets Key Influencers Heather Campbell Northeast Mental Health Centre, Sudbury, Ontario In the Northeast Region of Ontario, Canada (291,292 square kilometers, 632,200 population) there are a variety of distinct mental health services distributed across six vast (mainly rural) districts. The Northeast Mental Health Public Education Campaign also known as the “We All Belong” Campaign, seeks to shape appropriate public attitudes regarding mental illness and to create and disseminate new knowledge about public education campaigns. It currently is operating as a prototype campaign in year two of a five-year period. It will utilize multi-media and key influencer strategies as well as a parallel curricula development program intended for the educational system. The Campaign will assist with the implementation of a regional mental health reform process, address the stigma of mental illness in order for communities to be more welcoming and provide best practices for other parts of Ontario. The Campaign includes nine target audiences with one of the nine being the criminal justice system. This presentation will report on: - the campaign‟s work and evaluation techniques, - consumers‟/significant others‟ roles, - the direction of mental health reforms and - the issue of stigma generally speaking. Wherever possible, reference will be made to the campaign‟s relationship with the criminal justice system. It will also illustrate how traditional stereotypes sometimes found in the criminal justice system, can be addressed through such a campaign. Those who attend this session will be encouraged to participate in a discussion concerning issues and techniques for addressing community fears of mental illness and violence. Rethinking Stigma and Motivation: The Pathways Disclosure Model Gerry Cooper Center for Addiction and Mental Health, Ontario People interacting with the criminal justice system increasingly have mental health and/or addiction problems. Unfortunately, only a minority of those requiring help for these kinds of problems have received treatment; stigma is often a factor. This is the context in which the Pathways Disclosure Model (PDM) was developed. The PDM is an approach that articulates the advantages of receiving assistance through the Internet. That is, online asynchronous discussion groups hold particular promise for those who experience personal problems where stigma is involved. By availing themselves of online forms of help, individuals essentially control all of the levers of personal disclosure and are, therefore, more likely to „test drive‟ help-oriented interventions. Research conducted by the author with people experiencing gambling problems suggests that this provides a staged approach to face-to-face treatment for many who otherwise may not have considered treatment. For example, seventy percent indicated that they had previously avoided attendance at face-to-face programs because of concerns related to stigma. Those who experienced the greatest degree of stigma were individuals who had not received any care. Exposure to an online peer-support group was associated with participation in future treatment. Most reported that the ability to secretly lurk at this online group contributed to their disclosure of personal information. These findings led to the development of the Pathways Disclosure Model, to explain why online assistance may be of particular utility for some. The model and its implications within the criminal justice and mental health fields are discussed. Stigmatization of Patients with Mental Disorders and its Psychological Correction D.V. Kensin Novosibirsk Medical Academy, Novosibirsk The stigmatization of persons with mental disorders has had, unfortunately, a very long history as reflected in psychosocial approaches typical of the former USSR and utilized in modern day Russia. In this study, the most specific traits of this psychosocial phenomenon are analyzed, including the impact of stigmatization on the concept of self, on identity, on family relations and on professional activities. It is found that in the sphere of social functioning, stigmatization objectively limits opportunities for the application of skills and knowledge, and leads to a general decline in motivation. Simultaneously, it stimulates the person to escape into his/her internal world, promotes isolation, and impairs goal- directed activity. In patients with schizophrenia, stigmatization impacts the amplification or even re-appearance of symptoms specific to this disorder. Patients suffering from stigmatization often acquire the psychology of a victim and assume a new, unusually compliant, stereotype of behavior. Moreover, fear of stigmatization was also found to interfere with the effectiveness of prescribed treatments. Methods of group cognitive-behavioral psychotherapy, directed at overcoming stigmatization, improving skills of interpersonal dialogue and developing new behavioral stereotypes were applied. Quality world beliefs and system of values were the main target of the therapeutic efforts, which reflected the typical situation wherein which stigmatization changes the individual‟s world so as to make it impossible for him/her to reach previous levels of communication, and often leads to the development of a complex of inferiority. Impact and Effects of the Marielito Stigma Félix Masud-Piloto DePaul University During the summer of 1980, 125,000 Cubans arrived in the United States on what came to be known as the Mariel boatlift, an operation authorized unilaterally by the Cuban Government. The boatlift was the culmination of a long series of tensions and hostilities between Cuba and the United States. That environment, coupled with numerous press reports about Fidel Castro‟s attempts to “pack the boats with criminals and social deviants,” led to the universal stigmatization of the 125,000 boatlift participants as “Marielitos” (Read criminal or social deviant). Using published reports, news stories, and opinion polls about the “Marielito” criminality, this work argues that labeling all Mariel entrants as criminals and social deviants, was both inaccurate and unjust. The work also analyzes the impact and effect of the stigma twenty years after the boatlift. Psychological Aspects Close to Associated Stigma of Relatives to Persons With Mental Illness Margareta Ostman Lunds University Hospital As part of a multi-centre study of the quality of the mental health services performed in Sweden in 1997, the psychological aspects of the associated stigma of relatives to both voluntarily and compulsorily admitted patients were investigated. The results showed high numbers of relatives experiencing the patient‟s mental illness to have affected their own relations to others. As well, results show that the patient‟s mental illness has in many cases led to mental health problems in the relative. Such relatives who experienced mental health problems of their own were shown to have had suicidal thoughts and/or wishes that the patient were „better off dead‟. The results indicate that female relatives more often wished that the patient were dead, spouses and relatives living together with the patient more often wished that the patient had never been born, or that the patient and them had never met. A majority of the relatives shared the burden with others, mostly other relatives and friends, but very seldom with the staff of the psychiatric services. Furthermore, the results showed no differences in the assessed aspects according to background factors of the patient These results indicate that new efforts to decrease such psychological effects suffered by relatives ought to be developed, since it has been shown that the existence of a well-functioning and supportive network of relatives surrounding the mentally ill person can reduce relapse. A Collaborative Approach to Reducing the Stigmatization of the Mentally Ill Michael Phillips The International Institute for Special Needs Offenders: Canada The restructuring of the mental health system in Ontario has resulted in a significant reduction in the number of hospital beds for mentally ill patients. Although community services are providing support to many of these individuals, they are frequently unable to deal with those who are severely mentally ill or hard to serve. With limited access to hospital beds and a lack of community alternatives, police frequently have no alternative but to charge a mentally ill individual with a minor offence and remand him/her in jail. This criminalization of the mentally ill results in them becoming dually stigmatized, since their involvement in the justice system sets up barriers to accessing the already inadequate community based supports and services. The result is a cyclical pattern of frequent brief encounters with both the mental health and justice systems. The criminal justice system is also unable to adequately meet the needs of mentally ill offenders and they present significant challenges to both managing them within the confines of the justice system and providing them with appropriate treatment. In Ontario, collaboration between the justice systems and the mental health system is staring to provide some unique answers to this serious dilemma. This presentation will focus on three major initiatives that are currently underway and that are beginning to reduce the number of mentally ill individuals who are further stigmatized through their contact with the criminal justice system. These three initiatives are: court based diversion of those charged with minor offences, discharge planning and linkages with community support for offenders who are released from jail, and psychiatric treatment in prison for sentenced offenders who are mentally ill. An Innovative Approach to Decreasing the Stigma Experienced by Forensic Patients Shirley E. Pullan Center for Addiction and Mental Health One of the strongest components of the stigma faced by psychiatric patients is the public perception of their risk for violence. This stigma is particularly entrenched in relation to forensic patients who have, by definition, come into conflict with the criminal justice system. Many of these individuals have a history of violence, both institutionally and within the community. Patient concerns regarding the stigma that they face in their efforts to receive clinical support, housing, vocational pursuits and recreational opportunities have been clearly identified in the literature. Clinical staff have also reported on the difficulties that they have experienced accessing services for their clients as a result of the “forensic label.” Administrative challenges faced in relation to the stigma associated with forensic patients when attempting to collaborate with community stakeholders, police and the local neighborhood have been ongoing. This presentation will describe a process undertaken to qualitatively explore the experience of stigma perceived by the clientele of the Law and Mental Health Program at the Centre for Addiction of Mental Health, Toronto, Canada. The results of staff and patient focus groups will be discussed. The development of a collaborative program involving forensic patients, forensic staff and administration to specifically target and decrease the stigma and biased responses experienced by the clientele of the LAMHP both within the hospital and in the community. Strategies related to public education, staff education, community partnerships and clinical support will be described. A Collaborative Approach to Reducing the Stigmatization of the Mentally Ill Pauline A. Radley The International Institute for Special Needs Offenders: Canada The 1990‟s brought increased recognition that many of the individuals that were coming into contact with the criminal justice system were clients that were already well known to both the mental health and social services systems. In addition to being mentally ill, many of these individuals also suffer from substance abuse, poverty and homelessness; they are also frequently difficult, chronic, multi-problem and/or “hard to serve”, lacking the skills, motivation and supports to receive treatment. The stigma attached to these individuals and the complexity of the problems they face, often results in these “common clients” falling through the cracks in service delivery systems and revolving through the health, community and justice systems. In 1997 as a result of collaborative work between policing services, the courts, correctional services, health and developmental services, the Ontario government approved a provincial strategy to coordinate, resource and plan the service delivery to these common clients. This provincial strategy requires ministries and service agencies to become involved in joint sector planning, service delivery and share accountability for the common client. However, there are no quick answers or easy solutions to providing services to this challenging client group. Changing systems is a long-term process and requires the continued commitment and efforts of all ministries and services agencies. Converting policy into effective implementation processes is a major challenge. This presentation will focus on these challenges and point to some of the strategies and areas where successful implementation has occurred.
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