Amy C. Watson

Mental Illness Stigma And Care Seeking

For the past 40 years, researchers have attempted t o explain why some people with mental illness seek services while others do not. R esearchers have hypothesized that the negative effects of stigmatizing attitudes may diss uade people from seeking care because they do not want to suffer the corresponding label of “mental patient.” Fairly compelling literature shows that people who may benefit from m ental health services do not seek them. Research from two nationwide epidemiologic st udies suggested that 50% to 60% of people who would benefit from treatment do not s eek it (Kessler et al., 2001 ;Regier et al., 1993). Subsequent analyses of these data have shown tha t respondents with psychiatric diagnoses were more likely to avoid ser vic s if they were unreceptive to treatment (e.g., agreeing that people should not se ek care if they have a mental or emotional problem) or believed that family members and others would have a negative reaction to these services ( Leaf et al., 1986, 1987 ;Kessler et al., 2001 ).

Blame, Shame, and Contamination: The Impact of Mental Illness and Drug Dependence Stigma on Family Members

Family members of relatives with mental illness or drug dependence or both report that they are frequently harmed by public stigma. No population-based survey, however, has assessed how members of the general public actually view family members. Hence, the authors examined ways that family role and psychiatric disorder influence family stigma. A national sample (N = 968) was recruited for this study. A vignette design describing a person with a health condition and a family member was used. Family stigma related to mental illnesses, such as schizophrenia, is not highly endorsed. Family stigma related to drug dependence, however, is worse than for other health conditions, with family members being blamed for both the onset and offset of a relatives disorder and likely to be socially shunned.

Improving police response to persons with mental illness: a multi-level conceptualization of CIT.

The large numbers of people with mental illness in jails and prisons has fueled policy concern in all domains of the justice system. This includes police practice, where initial decisions to involve persons in the justice system or divert them to mental health services are made. One approach to focus police response in these situations is the implementation of Crisis Intervention Teams (CIT). The CIT model is being implemented widely, with over 400 programs currently operating. While the limited evidence on CIT effectiveness is promising, research on CIT is limited in scope and conceptualization-much of it focusing on officer characteristics and training. In this paper we review the literature on CIT and present a conceptual model of police response to persons with mental illness that accounts for officer, organizational, mental health system and community level factors likely to influence implementation and effectiveness of CIT and other approaches. By moving our conceptualizations and research in this area to new levels of specificity, we may contribute more to effectiveness research on these interventions.

Adolescent attitudes toward serious mental illness

While there is a growing literature on mental illness stigma and strategies for reducing stigma among adults, less is known about how children and adolescents view persons with mental illness. In this paper, we describe the Attitudes Toward Serious Mental Illness Scale–Adolescent Version (ATSMI-AV) and our initial examinations of its factor structure and variations among subgroups of adolescents. Findings suggest that strategies aimed at reducing stigma in this age group would be wise to specifically target categorical thinking about mental health and mental illness and perceptions of persons with mental illness being violent and out of control.

Crisis Intervention Teams and People With Mental Illness Exploring the Factors That Influence the Use of Force

The Crisis Intervention Team (CIT) program was first developed to reduce violence in encounters between the police and people with mental illness as well as provide improved access to mental health services. Although there is overwhelming popular support for this intervention, scant empirical evidence of its effectiveness is available—particularly whether the program can reduce the use of force. This investigation seeks to fill this gap in the literature by exploring the factors that influence use of force in encounters involving people with mental illness and evaluating whether CIT can reduce the likelihood of its use.

Self-stigma of mental illness scale—short form: Reliability and validity

The internalization of public stigma by persons with serious mental illnesses may lead to self-stigma, which harms self-esteem, self-efficacy, and empowerment. Previous research has evaluated a hierarchical model that distinguishes among stereotype awareness, agreement, application to self, and harm to self with the 40-item Self-Stigma of Mental Illness Scale (SSMIS). This study addressed SSMIS critiques (too long, contains offensive items that discourages test completion) by strategically omitting half of the original scales items. Here we report reliability and validity of the 20-item short form (SSMIS-SF) based on data from three previous studies. Retained items were rated less offensive by a sample of consumers. Results indicated adequate internal consistencies for each subscale. Repeated measures ANOVAs showed subscale means progressively diminished from awareness to harm. In support of its validity, the harm subscale was found to be inversely and significantly related to self-esteem, self-efficacy, empowerment, and hope. After controlling for level of depression, these relationships remained significant with the exception of the relation between empowerment and harm SSMIS-SF subscale. Future research with the SSMIS-SF should evaluate its sensitivity to change and its stability through test-rest reliability.

Defying Negative Expectations: Dimensions of Fair and Respectful Treatment by Police Officers as Perceived by People with Mental Illness

Programs to improve police interactions with persons with mental illness are being initiated across the country. In order to assess the impact of such interventions with this population, we must first understand the dimensions of how police encounters are experienced by consumers themselves. Using procedural justice theory as a sensitizing framework, we used in-depth semi-structured interviews to explore the experiences of twenty persons with mental illness in 67 encounters with police. While participants came into contact with police in a variety of ways, two main themes emerged. First, they feel vulnerable and fearful of police, and second, the way police treated them mattered. Findings elaborate on dimensions of procedural justice theory and are informative for police practice and mental health services.

How Children Stigmatize People With Mental Illness

Many advocates have called for more anti-stigma programs targeting the attitudes of children towards people with mental illness as a way to forestall subsequent prejudice and discrimination as they age and develop. In order to better understand how children stigmatize people with mental illness, we reviewed the substantial literature on social cognitive development and ethnic prejudice. This literature suggests a curvilinear relationship. Children as young as three show some endorsement of stereotypes about people of color, which slowly increases and seems to peak around age fi ve to siX. Older children, interestingly, show lower rates of ethnic prejudice. Differences between mental illness and ethnicity-related stigma may influence the form of this relationship and we provide some hypotheses representing this difference. We then summarize the literature on stigma change, focusing on how specific strategies interact with what is known about social cognitive development and prejudice. Strategies that are reviewed include education, contact, social cognitive skills training, role play for empathy, peer interaction, protest and consequences. Implications for continued research in this area are highlighted throughout the article.

“’Cause Everybody Likes to Be Treated Good”: Perceptions of Procedural Justice Among Mental Health Court Participants

There is mounting evidence that mental health courts (MHCs) reduce criminal recidivism and increase use of mental health services. Although not yet empirically tested, procedural justice has been proposed as one potential mechanism that promotes change and improves outcomes for MHC participants. In this article, we investigate MHC participants’ perceptions of procedural justice in interactions with MHC staff as well as the role of procedural justice in participants’ MHC program experiences. Participants from two MHC programs were invited to complete quantitative measures and a semistructured interview about their MHC experiences and perceptions of procedural justice. Univariate and bivariate analyses and qualitative analysis were used to examine the data. Findings indicate that MHC participants perceive a moderate level of procedural justice in interactions with MHC team members. However, perceptions of procedural justice are complex, involve multiple actions and inaction, and are affected by all members of the MHC team, not just the judge. Although scores on quantitative measures of procedural justice do not differ by court, participant perceptions discussed in semistructured interviews do vary. Implications for practice, policy, and research are discussed.

Solutions to Discrimination in Work and Housing Identified by People With Mental Illness

Several studies have examined the breadth and depth of the impact of the stigma and discrimination associated with mental illness. This study examines perceived solutions to discrimination in housing and employment situations. We expected identification of solutions to be positively associated with disease insight and personal empowerment. One hundred people with serious mental illness completed measures of perceived solutions to discrimination exhibited by an employer or a landlord. They also completed measures of empowerment and insight. Results showed high frequency solutions included looking for a job or apartment elsewhere, or seeking help from family and friends. Insight was significantly associated with number of endorsed solutions, while the interaction between insight and empowerment described a nonsignificant trend. Implications of these findings for stigma change are discussed.