Decreasing Discrimination and Stigma Associated with Mental Illness in the African American Community : Decreasing Discrimination and Stigma Associated with Mental Illness in the African American Community May 5, 2005 www.stopstigma.samhsa.gov


Slide2: This teleconference is sponsored by the SAMHSA Resource Center to Address Discrimination and Stigma Associated with Mental Illness (ADS Center). The ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS). The ADS Center provides practical assistance in designing and implementing anti-stigma and anti-discrimination initiatives by gathering and maintaining best-practice information policies, research, and programs to counter stigma and discrimination. We actively disseminate anti-stigma and anti-discrimination information and practices to individuals, States, local communities, and public and private organizations. Sponsor www.stopstigma.samhsa.gov


Slide3: SAMHSA ADS Center 11420 Rockville Pike Rockville, MD 20852 Toll free: 1-800-540-0320 Fax: 240-747-5470 Web: www.stopstigma.samhsa.gov The Moderator for this call is Michelle Hicks Address www.stopstigma.samhsa.gov


Slide4: Questions? At the end of the speaker presentations, you will be able to ask questions. You may submit your question by pressing 01 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the conference operator announce your name, you may proceed with your question. www.stopstigma.samhsa.gov


Slide5: King Davis, Ph.D. Speakers Dr. Davis is a professor, the Robert Lee Sutherland Chair in Mental Health and Social Policy, and Director for the Hogg Foundation for Mental Health. His research and teachings at the University of Texas at Austin have focused on mental health public policy, culturally competent mental health services, health care for those with mental illnesses, and disparities in rates of illness and service delivery for consumers of color. www.stopstigma.samhsa.gov


Slide6: Wilma Townsend Speakers Ms. Townsend is a nationally recognized expert on consumer-focused recovery and cultural competence. She has extensive experience as a consultant to States, local government entities, managed care organizations, and consumer and family organizations in the areas of consumer recovery and recovery-oriented services, peer-operated services, consumer involvement and outcomes, and cultural competence. Ms. Townsend is involved in a research project titled, “Actualization of Best Practice Model System-Wide: Examination of Recovery-Oriented Services and Outcomes.” She contributed issue papers on the topics of consumer recovery and cultural competence to the President’s New Freedom Commission on Mental Health. www.stopstigma.samhsa.gov


Slide7: Marietta Bell Noel Speakers Ms. Noel is coordinator of the Central Texas African American Family Support Conference and Senior Planner at Austin Travis County Mental Health Mental Retardation Center in Austin, Texas. She provides process direction and coordination for Center-wide strategic and annual plans and serves as a planning liaison for various community entities involving Center services. Ms. Noel has worked in health and human services in both the private and public sectors and has more than 30 years of successful experience in program management, case management, and consumer and family relations. She is a current member of the Center’s Cultural Diversity Committee. www.stopstigma.samhsa.gov


Decreasing Stigma Associated with Mental Illness in the African American Community : Decreasing Stigma Associated with Mental Illness in the African American Community King Davis, Ph.D. Executive Director Hogg Foundation for Mental Health The University of Texas at Austin


Intersection Concept: Intersection Concept Illness/Beliefs/ Information Help-seeking Treatment Experiences Provider/Service System King Davis, 2003 Community Traditions Income/ Priorities


Four Critical Questions: Four Critical Questions How do African American populations obtain information about mental illness? How accurate is the information that this population receives? How does the information influence help- seeking behavior and ideas about illness and recovery? How does information influence compliance with health guidelines?


Sources of Information: Sources of Information Religious organizations Educational institutions Newspapers Local radio programs Television news Television stories Movies and films Oral tradition – stories Medical organizations


Prospective Frequency Of Illness: Prospective Frequency Of Illness Source: Davis, King., Johnson, Toni, & McClendon,A. (2002). Guidebook. Baltimore: Casey Foundation Mental Health: A Report of the Surgeon General, DHHS, 1999.


Summary of Research Findings: Summary of Research Findings Davis, 2002


Conceptualizing Disparities: Conceptualizing Disparities Prevalence Rehabilitation Incidence Participation Services Outcomes Treatment Acceptable Norms Prevention Personal Choice Recovery Racial causation Help seeking Help utilization Information King Davis, 2003


Service Disparities: Service Disparities Racial, ethnic, and cultural differences in twenty characteristics designed to define and describe the nature of behavioral health service provision Source: K. Davis (2003)


Slide16: Individual Degree of Impairment Family Burden Community Stigma Organization Practitioner: Evidence Base Theory and Model: Recovery Consumer Self help PHASE 3 PHASE 2 PHASE 1 DECISIONS TO UTILIZE SOME FORM OF HELP COMMUNITIES OF COLOR Professional: Evidence Based Delayed Help Seeking Self Help Religious Based Help Conceptual Framework C. Individual & Community Factors D. Formal Helping System B. Number of Psychiatric Episodes Faith Absorption Information A. Organizing Concepts Boundary Expansion Collective Caring Family Choices/Actions King Davis, Hogg Foundation 2003


Slide17: Professional: Evidence Based Delayed Help Seeking Self Help Religious Based Help Family Choices/Actions Family Choices/Actions King Davis, Hogg Foundation 2003


Slide18: DECISIONS TO UTILIZE SOME FORM OF HELP COMMUNITIES OF COLOR Organizing Concepts Faith Absorption Information A. Organizing Concepts Boundary Expansion Collective Caring King Davis, Hogg Foundation 2003


Slide19: PHASE 3 PHASE 2 PHASE 1 Number of Psychiatric Episodes King Davis, Hogg Foundation 2003


Slide20: Individual Degree of Impairment Family Burden Community Stigma Organization Practitioner: Evidence Base Theory and Model: Recovery Consumer Self help Formal Helping System King Davis, Hogg Foundation 2003


Slide21: Individual Degree of Impairment Family Burden Community Stigma Church Organizations Practitioner: Evidence Base Theory and Model: Recovery Consumer Self help PHASE 3 PHASE 2 PHASE 1 DECISIONS TO UTILIZE SOME FORM OF HELP COMMUNITIES OF COLOR Professional: Evidence Based Delayed Help Seeking Self Help Religious Based Help Conceptual Framework C. Individual & Community Factors D. Formal Helping System B. Number of Psychiatric Episodes Faith Absorption Information A. Organizing Concepts Boundary Expansion Collective Caring Family Choices/Actions King Davis, Hogg Foundation 2003


Service Disparities 1760-2000: Service Disparities 1760-2000 >Frequency of Inaccurate Diagnosis >Findings of Severe Mental Disorder >Inpatient Hospitalization/LOS >Involuntary Commitments >Recidivism/Relapse >Involvement in Criminal Justice System >Mortality Rates (Primary Health Problems & Suicide) Uninsured/Underinsured

Service Disparities: Service Disparities >Delays in help seeking Executions while mentally disabled

Contextual Hypotheses: Contextual Hypotheses Immunity Hypothesis 1763-1865 Exaggerated Risk Hypothesis -1865-1980 No-difference Hypothesis 1981-1990s _____________________ Immunity Hypothesis Recycled 2001 Exaggerated Risk Hypothesis Recycled 2001 No-difference Hypothesis Recycled 2001


The Immunity Hypothesis: The Immunity Hypothesis “Slaves are immune from stress and from the subsequent risk of mental illness because they do not own property.” John Galt, M.D.(1840)


Causes of Disparities: Causes of Disparities Societal policies: race, gender, income Focus/content of professional education Focus /content of research Service design and implementation Cultural traditions: beliefs/help seeking Dissemination of information Bundling health care to employment


Overall Conclusions: Overall Conclusions Stigma, born out of history and limited information inhibits help seeking in African American communities. The essence of the disparities controversy is the absence of information, knowledge, and evidence about how people of color view and experience behavioral health, disorder and service and the application of that knowledge into public policy, pre-service curriculum, continuing education, clinical practice, prevention, help-seeking, and the community. There is a need for research on how African American populations receive and respond to information about mental illness.


Decreasing Stigma Associated with Mental Illness in the African American Community: Decreasing Stigma Associated with Mental Illness in the African American Community Wilma Townsend, MSW President WLT Consulting, LLC


What is Stigma: What is Stigma Stigma is an invisible mark of shame, disgrace or disapproval, of being shunned or rejected by others.


It happens when …: It happens when … People are embarrassed or unwilling to talk openly about their condition because they perceive it to be different or weird.


Stigma and Mental Illness: Stigma and Mental Illness Some degree of stigma (internal and external) is usually associated with mental illness. For centuries mental illness has been seen as shameful, dangerous, unpleasant, embarrassing, a weakness of character, incurable and something to be hidden away, without hope of recovery.


For African Americans: For African Americans We have taken on all of the above barriers of stigma plus the mistrust of the overall health care system, we have been very reluctant to utilize the system. Example of my families experience with the mental health system back in the 1940’s


Statistics on African Americans: Statistics on African Americans African Americans represent approximately 2% of psychiatrist, 2% of psychologist and 4% of social worker professionals African Americans are committing suicide at a rate of 5 per day. The rate of suicide for Black youth ages 10-19 increased 114% between 1980 and 1995


Other examples of barriers: Other examples of barriers Slavery-built a sense of having to take care of self Misdiagnosis (theory that African Americans were not capable of being depressed) Tuskegee Syphilis Experiment (1932-1972) Medication differential (amount and type) Use of family information as part of the symptom, rarely used as part of the healing Community and family sense that we must not show weakness (the double whammy syndrome)


Other examples of barriers cont.: Other examples of barriers cont. Families try to totally take care of the person w/out any professional help, so that by the time they go for help the person is very ill. Not enough African American behavioral health professionals Cultural barriers between the helping professional and the African American individual. Social economic factors that may limit access to services


What needs to change : What needs to change Culturally competent assessment should be conducted on all organizations and systems that serve diverse populations Organizations and systems should utilize the National Cultural Competence Standards to establish outcomes Organizations and systems that serve a large population of African Americans should have a culturally diverse advisory committee that includes African American community members, families and consumers.


What needs to change: What needs to change Mental health education programs in the African American community Establish, develop and support mental health promotion/intervention initiatives that are specifically geared toward African Americans. Integration of cultural diversity in major written material (i.e. Emerging Best Practices in Mental Health Recovery 2nd Edition)


What needs to change: What needs to change Increase the number of African Americans in the field of mental health, including psychiatry Increase research specific to the area of African Americans that is led by African American researchers Include the natural support systems within the African American communities to assist with policy development, evaluation, and service delivery as part of the solution


What needs to change: What needs to change African American consumers and family members must speak out about their recovery process The African American community must began talking about mental health and participating in mental health initiatives


Contact Information: Contact Information Wilma Townsend WLT Consulting, LLC 224 Glenhurst Court Gahanna, Ohio 43230 (614) 414-0705 telephone (614) 476-9991 telephone wtownsend@columbus.rr.com www.recoveryinstitute.net


Central Texas African American Family Support Conference(CTAAFSC): Central Texas African American Family Support Conference (CTAAFSC) A Model for Reducing Stigma In HealthCare May 2005


Program Goals: Program Goals What is CTAAFSC? -Vision, Mission and Goals CTAAFSC Highlights -The “Event” A Catalyst for Change -CTAAFSC Outcomes


What is CTAAFSC?: What is CTAAFSC? A diversity initiative hosted by Austin Travis County MHMR (ATCMHMR) Center and community partners to: -fulfill the Center’s Strategic Plan -support initiatives called for in the 1999 and 2001 Surgeon General’s Reports


What is CTAAFSC?: What is CTAAFSC? Community partners providing support include: individuals ~nonprofit & for-profit social service agencies~ local pharmacies~national pharmaceutical companies~ ~state health & human service agencies~ churches~other regional MHMR Centers~local newspapers ~banks~private foundations and healthcare networks~advocacy agencies~ universities~restaurants. Among them are Lower Colorado River Authority, Eli Lilly & Co., The Wood Group, The Villager Newspaper, Seton Healthcare Network, Advocacy Inc., Hogg Foundation for Mental Health, Texas Dept. of State Health Services, Wells Fargo Bank, Huston-Tillotson University, New Milestones Foundation, NAMI-Austin, and the Junior League of Austin.


What is CTAAFSC?: What is CTAAFSC? Conference Vision: CTAAFSC is a partnership of stakeholders dedicated to the empowerment of families and individuals with behavioral healthcare needs by providing information, support, and networking opportunities that inspire hope for a brighter future.


What is CTAAFSC?: What is CTAAFSC? Conference Mission: CTAAFSC shall continue to strengthen family and individual awareness of available healthcare services, behavioral and physical, through culturally sensitive education, supports, and partnerships.


What is CTAAFSC?: What is CTAAFSC? Conference Goals: 1. Reduce stigma towards mental illness and increase awareness of the various aspects of mental health and mental illness in Austin and Central Texas, particularly in communities of color.


What is CTAAFSC?: What is CTAAFSC? Conference Goals cont. 2. Provide information and education to consumers, families, service providers and the community about mental health, developmental disabilities, chemical dependence, and co-occurring disorders that will enhance, expand, and strengthen healthcare resources.


What is CTAAFSC?: What is CTAAFSC? Conference Goals cont. 3. Integrate a health focus for total community health that includes mental health and physical health.


CTAAFSC Highlights: CTAAFSC Highlights 1999 Surgeon General’s Report “…stigma interferes with the willingness of many people—even those who have a serious mental illness—to seek help.” http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec4_1.html#chap8 Reduce stigma by dispelling myths about mental illness and by providing accurate knowledge to ensure more informed consumers. http://www.surgeongeneral.gov/library/mentalhealth/chapter8/sec1.html#overcome


CTAAFSC Highlights: CTAAFSC Highlights Mental Health: Culture, Race, and Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General (2001) …mental illnesses are just as real as other illnesses, and they are like other illnesses in most ways. Yet fear and stigma persist, resulting in lost opportunities for individuals to seek treatment and improve or recover. http://www.surgeongeneral.gov/library/mentalhealth/cre/


CTAAFSC Highlights: CTAAFSC Highlights ATCMHMR Strategic Plan http://www.atcmhmr.com/ Vision ATCMHMR envisions an understanding community that respects and accepts each person’s differences and responds with compassionate, comprehensive and quality services.


CTAAFSC Highlights: CTAAFSC Highlights Strategic Plan Mission ATCMHMR seeks to serve people whose lives are seriously affected by developmental disabilities, mental, emotional and substance use disorders.


CTAAFSC Highlights: CTAAFSC Highlights Strategic Plan Goals Six areas emphasized within ATCMHMR goals are: -Treatment and Support Services -Workforce -Continuous Quality Improvement -Advocacy and Education -Collaboration -Leadership


CTAAFSC Highlights: CTAAFSC Highlights Inaugural Conference – November 2000 First conference in Texas with a behavioral healthcare focus targeting the African American community and only the third in the United States Consumer and family member focused Funding for the conference is provided through sponsorships from community partners


CTAAFSC Highlights: CTAAFSC Highlights No costs to attendees which have ranged from 183 persons in 2000 to a record 541 in 2002 when former Surgeon General David Satcher was a keynote plenary speaker. Planning committee & conference attendees include: consumers, family members, and organizations throughout the 10 Central Texas counties. Conference program is planned to provide accurate knowledge and information to participants in ‘friendly’ and understandable language by experts, professionals, and researchers in the field.


CTAAFSC Highlights: CTAAFSC Highlights Conference programming includes: -well-known African Americans who are willing to share their ‘stories’ and offer hope, i.e. Texas State Representative Garnet Coleman; LaRita Booth Pryor, author; Helen Neal Pore, nationally known advocate of recovery for people with mental illness. -new and innovative programs/services/supports -opportunities for networking


CTAAFSC Highlights: CTAAFSC Highlights Conference programming includes: - Establishment of annual awards to recognize individuals working on a national, state, or local level to fight stigma and other health issues, especially mental health. Award categories: Consumer Family member Professional Community Leader


A Catalyst for Change: A Catalyst for Change Conference Outcomes - Inclusion of physical health track in conference programming - Continuing community partnerships through sponsorships and exhibitors - Support of state, city, and county officials


A Catalyst for Change: A Catalyst for Change Conference Outcomes -Community recognition and growing awareness that community health includes mental health, as well as physical health -Developing partnership with community ministers/ pastors of predominantly African American congregations


A Catalyst for Change: A Catalyst for Change Conference Outcomes - Assessment of the feasibility and sustainability of a Pastoral Care Project through a six month planning grant. - Inclusion of mental health in community Health Fairs http://www.atcmhmr.com/get_involved/CTAAFSC.html


Slide62: For more information, contact: www.stopstigma.samhsa.gov Dr. King Davis Hogg Foundation for Mental Health The University of Texas at Austin P. O. Box 7998 Austin, Texas 78713-7998 Ph:  (512) 471-5041 Fax:  (512) 471-9608 (888) 404-4336 (Toll Free) http://www.hogg.utexas.edu/ Wilma Townsend, MSW President WLT Consulting, LLC 224 Glenhurst Ct Gahanna, OH 43230-1759 Ph:  (614) 414-0705 Fax:  (614) 476-9991 wtownsend@columbus.rr.com Marietta Bell Noel Senior Planner Austin Travis County MHMR P.O. Box 3548 Austin, Texas78764-3548   Ph:  (512) 445-7739 Fax:  (512) 804-3079 or 440-4081 marietta.noel@atcmhmr.com


Slide63: Questions? You may submit your question by pressing 01 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the operator announce your name, you may proceed with your question. After you have asked your question, your line will be muted. The presenters will then have the opportunity to respond. www.stopstigma.samhsa.gov


Slide64: Thank you very much for participating in the SAMHSA ADS Center conference call, “Decreasing Discrimination and Stigma Associated with Mental Illness in the African American Community.” The Resource Center to Address Discrimination and Stigma (ADS Center) is a project of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Conclusion www.stopstigma.samhsa.gov