The Difference Between Stigma Reduction and True Social Inclusion

I went to a social messaging conference and learned once the difference between behavior change and policy change. Most stigma reduction programs are run as policy change program when they need to targeted instead toward kids that are really in need:

“Cool” kids have different needs than preppy kids:

Al Cunningham sticks his head into the penguin tank we toured at the Atlanta aquarium after learning about stigma reduction at the Health Care Messaging Conference

Al Cunningham sticks his head into the penguin tank we toured at the Atlanta aquarium after learning about stigma reduction at the Health Care Messaging Conference

One of the most well thought out and researched programs presented at the 2011 Health Care Messaging and Media conference came from Jeff Jordan. He started Rescue Social Change Groupwhen he was 17.  He said that you can either affect policy change, or cultural/behavioral change. Policy change can be done by the “clean cut, preppy, ambitious” young people [his words] that are good at talking to adults, interested in volunteering for us, and want to make a difference for other young people. But these kids are not at risk.

The at risk kids are “cool kids, highly interested in what their peers think, and very involved with youth culture.” He said these kids will have nothing to do with a policy change campaign. He has designed many cultural change campaigns that are on his website, mainly where they bring “cool” people into bars to talk about anti-tobacco messaging. He said the two campaigns have to look and smell and feel totally different. He said you can either do one kind of campaign or the other kind and if you want to do both you have to do two separate campaigns. He said it’s like people who eat healthy food and people who eat fatty food. If you prepare a salad and then put a bunch of pork rinds on it, no one is going to eat it. You can’t meet in the middle with your campaign because then no one will listen.

So this is why almost all stigma reduction programs face a catch-22: How do you talk about mental health when all the “cool people” run the other direction as soon as you mention the two words “mental health”?

How programs reach the “cool kids”?

In Poetry for Personal Power, our  theme of overcoming adversity seems to break through the tendency to avoid discussion of mental health concerns, and holds universal appeal. It builds a bridge and creates a message that “we’re all

Simeon Taylor of Soul Sessions told me once that "Bling" for Urban Guys is like makeup for women. Trey Newman is one of our feature poets working on stigma reduction. He's also been a semi-finalist at the Brave New Voices national teen poetry slam.

Simeon Taylor of Soul Sessions told me once that “Bling” for Urban Guys is like makeup for women. Trey Newman is one of our feature poets working on stigma reduction. He’s also been a semi-finalist at the Brave New Voices national teen poetry slam.

in this together.” We noted that more than half the contestants naturally addressed mental health issues within their presentation (emotional distress, depression, emotional turmoil, interpersonal difficulties, grief and loss), in addition to issues of damaged identity (racism), and historical trauma (the legacy of slavery). Students performed spoken word poetry about their experience of trauma, the need for respect for young people, the need for hope, and the importance of community. Mental health issues were clearly one of their biggest sources of struggle for many.

Poetry for Personal Power may be a vehicle for “storytelling as prevention” by serving as a creative outlet for emotions and energy, and as a way to express how intense emotional experiences shape and challenge us. Through the medium of poetry we hope that people can take their most difficult moments and transform them into sources of personal power and use their unique strengths and abilities to impact the world. Our project approach interfaces with recent discussions of the need for community based prevention. At a 2011 National Dialogue on Psychopharmacology Annelle Prim, the Deputy Medical Director of the American Psychiatric Association explained the complete idea behind our program for stigma reduction. She (inadvertantly) told the entire story of how it works for mental health and suicide prevention as well and for stigma reduction and social inclusion.

Deputy Medical Director of the APA says that public education about resilience is essential:

“”We haven’t talked much about what happens before people get in the door to services. And things are such that many people never get in the door. They’re below the level of the iceberg. I think some people in the community may be engaging in self-care and not even realize that what they’re doing may be valuable. There needs to be more public education that takes place around this. This is a pre-medication discussion but I think it might even be protective for people so they don’t end up on a medication scheme if that’s not appropriate. This really maximizes some of the self-care that’s also resonant with a lot of prevention that health care reform is all about.”

 

How does Poetry for Personal Power cause social inclusion?

Our campaign is clearly powerful in large part by virtue of its creative performing arts format. Engaging students in poetry slams reaches an audience that is often naïve to social messaging on mental health concerns or recovery, or which is open to revision of messaging. Many students actively embraced the medium. Perhaps because spoken word poetry is an art form that has roots in traditional African American life and in contemporary Hip Hop and Rap culture, we found this to be especially true for African American students.

Many of the most successful and well attended events took place in historically black universities and where African American student organizations or NAACP co-hosted the events. One social worker in training from Avila University said, “I was surprised how open people can be in a poem, and the authenticity of sharing stories. It’s very powerful stuff hearing people shout out how they feel through poetry.” Thus this approach may make it especially powerful tool for stigma reduction and prevention efforts in communities of color.

We address explicitly, and actively contest, common messages provided in some stigma reduction efforts that have proven ineffective. Research has shown that the message “mental illness is a disease like any other” tends to backfire and actually increases social stigma (Lam & Salkovskis, 2007). When people associate a psychiatric diagnosis with a neurobiological conception the effect is to increase, not decrease, desire for social distancing and social rejection (Pescosolido et al., 2010). Among the general public, endorsement of bio-genetic models has been found to be associated with less perceived personal responsibility, but also with desire for greater social distance. One potential explanation for the increase in social distancing is that a biogenetic understanding of mental illness produces the impression that mental illness is a stable, intrinsic part of a person.

The innovative Poetry for Personal Power approach is a substantive enhancement of, and an evolution beyond another form of stigma reduction effort, that of contact-based education. Research has shown that stigma can be significantly reduced when people are exposed to those with stigmatized conditions who tell their story, answer questions, and enter into dialogue with them (Couture, & Penn, 2003; Martin, 2009, Arbolecta-Floez & Stuart, 2012). Poetry for Personal Power includes, but goes beyond the contact-based education strategy, because it creates an open dialogue that describes adversity, resulting deep emotional distress or mental health concerns, and the power to pull together wellness tools and rebound as aspects of a shared humanity.

The Three Tiers of Stigma Reduction or Social Inclusion Attempts:

  1. Historically, stigma reduction started as messages along the lines of “Psych meds and labels aren’t that scary. Just love your labels and accept your meds and you’ll live happily ever after and we’ll reach the people who have been scared to get treatment.” But um, the meds don’t work (in the aggregate) and the labels make people lose hope, and although more people get treatment, social distance and the fear of the diagnoses has actually gotten worse, not better.
  2. The second tier of stigma reduction is, “Well, I recovered. You can too.” But recovered from what? Emotional distress is not an illness. It’s normal to grieve if someone dies. It’s normal to freak out during an existential crisis.It’s normal to be super wild and wacky if you go five days without sleep. It’s normal to be bummed if you hate your job and work too much and have a mean spouse who spends all the money. What we call psychosis is a normal protective reaction for the brain when things get too difficult.
  3. The third tier of stigma reduction is, “We all go through adversity. The best way through it is to talk to someone who’s been there before, and find what gives you personal power.” This is our message in Poetry for Personal Power. This is what we aim for.

What our poets do for stigma reduction every day:

CJ Pulliaum on “coming out” as stigma reduction: “Being a Gay Black Man”

Jorge Ruiz on building friendships and stigma reduction even while in prison:

Brittany Davis: “Beware Peer Pressure” – stigma reduction comes from ignoring peers when they are mean

Wordworks Blog Author: Corinna West

Corinna West is the founder and creative director of Wellness Wordworks, and is an Olympic Team Member and has a Masters Degree in Pharmaceutical Chemistry. Her Instant Peer Support might be the first in the mental health sector to remove the need for government and charity funding by creating a profitable interaction involving only our business and our direct customers.

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