Mental health transformation in Texas: Are stigma reducing strategies using target-specific and patient centered approaches to effectively reduce stigma?

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Mental health transformation in Texas Are stigma
reducing strategies using target-specific and
patient centered approaches to effectively reduce
stigma?

• Amanda Barczyk, M.S.W.1 Valarie Garza2
• The University of Texas at Austin
• School of Social Work1
• Texas Health Institute2

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Overview

1. Transformation in America
2. New Freedom Initiative
3. New Freedom Commission
4. Role of Substance Abuse and Mental Health
   Services Administration
5. Transformation in Texas
6. Transformation Workgroup
7. Selected Communities
8. Stigma Reducing Interventions
9. Strategies
10. Effective Components
11. Methods
12. Stigma Experienced By Consumer
13. Implemented Stigma Reducing Strategies
14. Effectiveness of Stigma Reducing Strategies

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Transformation in AmericaNew Freedom Initiative

• President Bush announces Initiative in February,
  2001
• Aims to
• Increase access to assistive technologies
• Expand educational opportunities
• Increase ability for Americans with disabilities
  to integrate into workforce
• Increase access into daily community living

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Transformation in AmericaNew Freedom Commission

• This key component was announced in April 29,
  2002
• First in 25 years
• Five Principle Goals
• Focus on desired outcomes
• Community-level models
• Policies that maximize the utility of existing
  resources by increasing cost-effectiveness and
  reducing unnecessary and burdensome regulatory
  barriers
• Use mental health research findings
• Follow principles of Federalism

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Transformation in AmericaNew Freedom Commission
Cont.

• Subcommittees developed
• Focused on smaller more specific areas
• Necessary to transform mental health system
• The goal of transformation is to restructure
  State systems to better meet the needs of
  individuals with or at risk of mental health
  problems and their families.
• Benchmarks/goals were set to track their effort

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Transformation in AmericaRole of Substance Abuse
Mental Health Services Administration

• The Federal Action Agenda First Steps
• Gave background of New Freedom Initiative
• Focused on five principles developed by
  Commission
• Created initial action steps
• Mental Health Transformation State Incentive
  Grants
• September, 2005, SAMHSA awarded 92.5 million to
  seven states over five year period
• Consumers and family members must be involved
• Required to provide a continuum of services
  including promotion, prevention, treatment, and
  recovery
• September, 2006 21.9 million given to two more
  states over a five year period

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Transformation in TexasTransformation Workgroup

• TWG developed to facilitate transformation
• Consists of 15 agencies/organizations
• Smaller workgroups developed specializing in
• Consumer voice
• Adults
• Children and adolescents
• Housing
• Workforce development
• Data/IT

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Transformation in TexasSelected Communities

• TWG put out RFP aiming for diverse communities
• Eight communities selected
• Urban
• Bexar County Safety Net Community Collaboration
• Williamson County Mental Health Task Force
• Dallas County Unified Public Mental Health
  Initiative
• Tarrant Transformation Project
• Rural
• West Texas Community Coalition
• Nacogdoches County Mental Health Collaborative
• Costal Bend Rural Health Partnership
• Border
• Terrell County Behavioral Health Collaborative

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Stigma Reducing InterventionsStrategies

• Protest
• Challenges inaccurate depictions of individuals
  with mental health problems by insisting on the
  cessation of negative stereotypes or negative
  images of individuals with mental health problems
• Education
• Promotes positive attitudes through the provision
  of information so that people are able to develop
  informed attitudes and beliefs about individuals
  with mental health problems.
• Contact
• Entails an individual with a mental health
  problem having a face-to-face encounter with
  others and sharing the personal experiences of
  working and living in the community with a mental
  health problem
• Combination

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Stigma Reducing InterventionsEffective Components

• Patient-centered
• Empower individuals to assist in development and
  implementation
• Target-specific
• Campaign targeting a group with power and
  discriminatory behaviors of that group

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Study Aim

• Explore the stigma experienced by communities in
  Texas, assess whether the stigma-reduction
  campaigns developed are target specific and/or
  use a patient-centered approach and assess the
  preliminary effectiveness of the campaigns

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Methods

• Two phase content analysis
• Phase I
• Interviews with representatives from seven
  communities
• Write-ups assessed for themes
• Phase II
• Roundtable discussions at Mental Health
  Transformation Focused Forum
• Write-ups assessed for stigma reducing strategies
  and effectiveness

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Stigma Experienced by ConsumersPhase I

• Three themes of stigma experienced
• Individual level
• Family level
• Community level
• Community level most predominant
• Law enforcement
• Providers
• School-based stigma

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Implemented Stigma Reducing StrategiesPhase II

• Campaigns utilized different strategies
• Target-specific
• Combined education and contact
• Focus on mental health not mental illness
• Consumer participation
• Only a small proportion showed an observed
  positive impact on reducing stigma

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Conclusions

• Research shows effective strategies, however
• Stigma reducing strategies in Texas are not all
  effective
• More implementation is needed in Texas in diverse
  areas
• Guidelines for implementation needed
• Pre-evaluation work with consumers
• Implementation and evaluation standards needed

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Questions?