Tuesday 2 August 2016

Contact and Mental Health Literacy and Stigma Among Adolescents

This post is by Katharine Chisholm (pictured above), Research Fellow in the School of Psychology at the University of Birmingham. In this post she discusses the study she and colleagues conducted of mental health education for young people, published in their paper 'Impact of contact on adolescents' mental health literacy and stigma: the SchoolSpace Cluster Randomised Controlled Trial' published in BMJ Open. 

Educating young people about mental health and ill-health is important. Mental disorders impact young people disproportionally, with around two thirds of mental illnesses having their onset prior to the age of twenty-five. Young people also tend to have a relatively poor understanding of what mental illness is, and with a lack of mental health education in schools, young people report relying on popular media or cult images to gain an understanding of what mental illness might look like. These representations tend to be sensationalist at best and wildly inaccurate at worst; the Joker from Batman, reports of ‘psycho’ criminals on the news, and the (now regular) outcry from mental health charities as yet again various shopping retailers offer a ‘deranged mental health patient’ as a Halloween costume. 

Knowledge of what good mental health looks like is important in helping young people to maintain their own mental health. An understanding of when an individual might benefit from seeking help for their mental ill-health, and what kinds of help are available, is also beneficial. This kind of knowledge can help adolescents to develop resilience to stressful events, and to feel able to seek support if and when they need it. Reducing stigma and misconceptions of mental illness is of benefit to individuals who already experience mental ill-health, but also may mean that young people in need of support feel more able to seek this help, rather than feeling ashamed or ‘weak’ for not coping.

Changing the attitudes of society towards mental illness has historically proved challenging. A letter to the editor from a 1942 edition of The Lancet discusses the challenges of disassociating negative connotations from mental illness, with the evolving description of the ‘madhouse’ to ‘lunatic asylum’, to finally ‘mental hospital’, with the stigma associated with these names evolving along with the changing terminology.

Contact between individuals from a stigmatised group and those who stigmatise them has been a successful method of reducing stigma in a number of areas. For example, during the process of desegregation in the USA, white housewives living in desegregated public housing schemes reported lower levels of stigma towards their black neighbours, and vice versa. This method of contact between the stigmatised and those who stigmatise them has been used with adults to improve attitudes towards individuals with mental illness, generally with success. However, despite that fact that stigma tends to develop throughout childhood and adolescence, there is very little research which has looked at the impact of contact with young people. 

For my PhD I developed and managed an intervention trial which aimed to reduce stigma, to increase knowledge of mental illness, and to promote mental health. I also wanted to test whether contact with individuals who have experienced living with a mental illness would help to achieve these goals. With the help of mental health professionals and a group of young people who were currently experiencing depression, psychosis, bipolar disorder, and borderline personality disorder, we worked with 11-13 year olds in six Birmingham schools. To test the hypothesis that contact with individuals who had experience of mental illness would reduce stigma and increase knowledge, in half of the school classes a volunteer spoke about what it is like to live with a mental illness; this was our ‘Contact group’. In the other half of the classes the students did not receive this element of the intervention; our ‘Education-alone group’.

In class types, stigma, mental health, and some kinds of knowledge all improved significantly. Young people reported that the thing they most valued about the intervention was hearing the real life experiences of mental illness; however the results from our questionnaire measures show that in the education-alone classes, knowledge of mental illness and a number of other measures improved more than in the Contact classes. The answer to our question of whether contact works with adolescent populations is therefore complicated!

I think there are three potential reasons for our conflicting findings. Firstly, mental illness in the ‘real world’ is not as neat as the diagnostic categories we teach would suggest; real people are messy, and do not usually have symptoms which perfectly conform to diagnostic manuals. This could have meant that the contact was confusing to the adolescents in light of the diagnostic information they had been taught earlier in the day. 

Secondly, contact is especially good at normalising mental illness; at promoting the message that mental illness happens to ‘normal’ people. This message may be a frightening one to consider if it means that you or someone you love could develop a mental illness and may have led to the adolescents disengaging somewhat from the intervention. 

My final suggestion it that the adolescents may have engaged, considered, and thought about the contact element of the day at the expense of engaging, considering, and thinking about the educational aspects of the day, resulting in them not doing as well on the questionnaire measures which asked them about the educational element of the day. The present research suggests that adolescents’ reaction to the use of contact to reduce stigma and increase knowledge of mental illness is complex; it may be a promising method, but caution is warranted, and further research is certainly necessary to investigate if there are ways that contact may be a successful method to reduce stigma and improve knowledge of mental illness in adolescent groups.

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