Transforming Mental Health Care in America: The First Steps

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Transforming Mental Health Care in America The
First Steps

• Chris Marshall
• Consumer Affairs Specialist
• Center for Mental Health Services
• HHS/SAMHSA

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Substance Abuse and Mental Health Services
Administration
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Who is SAMHSA?

• SAMHSA consists of three Centers and supporting
  Offices that administer and fund grant programs
  to support States efforts to address substance
  abuse and mental health issues.

• Center for Mental Health Services (CMHS)
• Leads Federal efforts to provide community-based
  services for adults with serious mental illnesses
  and children with serious emotional disturbances.
• Center for Substance Abuse Prevention (CSAP)
• Works to improve the quality of substance abuse
  prevention practices in every community,
  nationwide, through its discretionary grant
  programs.
• Center for Substance Abuse Treatment (CSAT)
• Promotes the quality and availability of
  community-based substance abuse treatment
  services for individuals and families who need
  them.

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The Matrix

• SAMHSAs budget, programs, and policies have been
  aligned to match a series of core priority issues
  and cross-cutting principles. These priorities
  are represented on the SAMHSA matrixan evolving
  tool that keeps the Agencys work focused on the
  most critical issues in behavioral health.

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Mental Health System Transformation
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Bridging the Quality Chasm
Transformation
The behavioral health care that we know to be
effective
Focus on recovery
The behavioral health care that Americans receive
Consumer-driven
Evidence-based practices
Health IT
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Addressing Stigma Discrimination as Central for
Recovery

• In this transformed system, stigma and
  discrimination against people with mental
  illnesses will not have an impact on securing
  health care, productive employment, or safe
  housing.
• Our society will not tolerate employment
  discrimination against people with serious mental
  illnesses in either the public or private
  sector.

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Recommendations Federal Action Steps

• Recommendation 1.1
• Undertake a national campaign to reduce stigma.
• Americans must understand and send this message
  mental disability is not a scandal it is an
  illness. And like physical illness, it is
  treatable.
• President George W. Bush
• April 29, 2002

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• Stigma a cluster of negative attitudes and
  beliefs that motivate the general public to fear,
  reject, avoid, and discriminate against people
  with mental illnesses.

Source Achieving the Promise Transforming
Mental Health Care in America
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Public Attitudes

• Surveys since the 1950s
• Mental illness as stigmatized condition
• No scientific understanding
• Unable to identify persons with MI
• Could not distinguish between MI and worry
• Fear of unpredictable violence

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MacArthur Mental Health Module, General Social
Survey, 1996

• Greater scientific understanding
• Able to distinguish between MI and worry
• Mix of biological and psychological stress
• Social stigma unchanged
• Belief that violence associated with mental
  illnesses nearly doubled

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Internalizing Stigma

• Embarrassment, Shame, Isolation
• Nearly two-thirds of all people with diagnosable
  mental health problems do not seek treatment
  (Regier et al., 1993 Kessler et al., 1996).

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Reducing Stigma

• Public Education Campaigns
• Reward / Protest
• Contact Approach

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History of National Efforts

• Spring to Action 2001
• EBI and ADS Center
• Older Adults Stigma Roundtables
• Presidents New Freedom Commission on Mental
  Health / Federal Action Agenda
• SAMHSA National Anti-Stigma Campaign

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SAMHSA Programs to Address Stigma

• ADS Center (Resource Center to Address
  Discrimination and Stigma)
• EBI (Elimination of Barrier Initiative)
• NASC (National Anti-Stigma Campaign)

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• Help States, organizations, individuals design
  and implement anti-stigma initiatives
• Gather and maintain best information, policies,
  research, practices, and programs to counter
  stigma and discrimination
• Actively disseminate anti-stigma and
  discrimination information and practices

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• Technical Assistance
• Training Teleconferences
• Informational Updates
• Web site
• Database
• Collaboration with EBI and NASC

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• Web site stopstigma.samhsa.gov
• Email stopstigma_at_samhsa.hhs.gov
• Telephone [phone]

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Elimination of Barriers Initiative (EBI)

• Eight State Demonstration
• Test Public Education Messages
• Reduce stigma and discrimination associated with
  mental illnesses using tools such as public
  education and contact
• Provide Evidence-base for National Campaign

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EBI Pilot States

• Ohio
• Pennsylvania
• Texas
• Wisconsin

• California
• Florida
• Massachusetts
• North Carolina

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EBI Results

• More than 273 million audience impressions
• TV 207 million
• Radio 67 million
• Equivalent airtime/advertising value nearly 3
  million

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EBI Lessons Learned

• Use a multifaceted approach
• Use a participatory process
• Involve consumers
• Work closely with a smaller subgroup of key
  partners
• Involve stakeholders early and often throughout
  the creative process
• Identify your audience(s) and speak to them in
  their own language

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Lessons Learned

• 7. Focus on positive, strength-based messages
  that demonstrate that recovery is both real and
  possible
• 8. Localize and personalize educational
  strategies
• 9. Choose a campaign theme that can be tailored
  to specific audiences

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Lessons Learned

• 10. Develop and implement a comprehensive
  evaluation
• 11. Use existing commemorative events
• 12. Generate and maintain enthusiasm
• 13. Provide basic training and tools on media
  outreach
• 14. Utilize train-the-trainer opportunities

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Lessons Learned

• 15. Provide forums for peer-to-peer information
  sharing
• 16. Additional training may be required in the
  development and ongoing operation of speakers
  bureaus
• 17. Recognize that messages directed at media
  gatekeepers may vary from those directed at
  the general public

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NASC Toolkit

• Section 1 Introduction
• Section 2 Mounting a Statewide
• Anti Stigma Campaign
• Section 3 Outreach Materials
• Section 4 Best Practices
• Section 5 Resources

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The First SAMHSA- Sponsored Voice Awards

• Film, TV, and radio writers and producers who
  have created respectful, accurate, and dignified
  portrayals of people with mental illnesses
• Mental health advocates whose efforts have
  expanded public understanding of mental illnesses
• Others whose activities promote mental health
  awareness

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SAMHSAs National Mental Health Information
Center

• www.mentalhealth.samhsa. gov
• 1-800-789-2647

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• Chris Marshall
• Consumer Affairs Specialist
• SAMHSA
• 1 Choke Cherry Road,
• Room 6-1071
• Rockville, MD 20857
• Phone [phone]
• Email chris.marshall_at_samhsa.hhs.gov