Elsevier

Clinical Psychology Review

Volume 30, Issue 8, December 2010, Pages 907-922
Clinical Psychology Review

Measuring the impact of programs that challenge the public stigma of mental illness

https://doi.org/10.1016/j.cpr.2010.06.004Get rights and content

Abstract

Public stigma robs people with mental illnesses from rightful opportunities related to work and other important life goals. Advocates have developed anti-stigma programs meant to address the prejudice and discrimination associated with these conditions. Evidence is now needed to make sense of program impact; this paper looks at measurement issues related to stigma change. Community-based participatory research is central to this research and includes the involvement of a diverse collection of stakeholders in all phases of evaluation. Investigators should be cautious about measures vis-à-vis social desirability effects and should directed by social validity of targeted audiences. Conceptual domains with some research support that correspond with assessments include behavior, penetration, psychological perspective, knowledge, and physiological/information processes. These issues are summarized as ten recommendations for evaluation of anti-stigma programs.

Section snippets

Where is clinical psychology in this effort?

Clinical psychology has mostly been at the sidelines regarding stigma and stigma change programs, despite research in this area having mushroomed. Our review of the literature from 1998 to 2008 showed journal articles on stigma in general have quadrupled from 178 to 641, with about one third of these focusing on the stigma of mental illnesses (in 2008, 231/641). No more than nine of these articles were found in journals with Clinical Psychology on its masthead (which is approximately 1.4% of

Who is the focus of this paper?

Stigma and mental illness are unwieldy concepts. One way to make sense of these constructs is to limit our focus on a group which is especially harmed by mental illness stigma: people with serious mental illnesses. We made this choice because of its public health priority and because of the relative wealth of research and recommendations that may guide this paper (Corrigan, 2005). What do we mean by serious? Clinical definitions of disease severity have merged with the idea of psychiatric

Defining stigma

Our approach towards understanding stigma is largely informed by research on social cognition and is laid out in Table 1. Stereotypes are general beliefs about the characteristics, attributes, and behaviors of people who are categorizable as a member of a particular social group—what we think members of a particular group are like (Corrigan and Kleinlein, 2005, Major & O'Brien, 2005). For example, “Irish Americans are drunks” or, of relevance here, “The mentally ill are dangerous.” By the time

Changing the public stigma of mental illnesses

Stigma change programs vary for public stigma compared to self-stigma. The research literature on the two domains is vast, with approaches that represent public stigma meaningfully different than self-stigma. In addition, erasing the public stigma of mental illnesses has become a top priority for advocates and is the focus of this paper (cf., President George W. Bush's New Freedom Commission; Hogan, 2003). Thus, we focus on the assessment of stigma change programs aimed at reducing public

Design and method considerations

Insights from services research (Wells, Miranda, Bruce, Alegria & Wallerstein, 2004), social psychology (Morawski, 2000, Stone et al., 2008), and community psychology (Barnes, 1997, Trickett, 2009) provide useful insights for research that evaluates stigma change. In this light, we review an essential ingredient to research of anti-stigma programs: community-based participatory research. Then we review issues relevant to valid measurement: the effect of social desirability and the relationship

Recommendations for future research

Table 3 lists recommendations that evolved from the paper. Research needs to represent an agenda of priorities, with this agenda reflecting the interests and exigencies of the community of relevant stakeholders. This begins with development of a CBPR team, the group with ultimate control of program evaluation. The CBPR team includes local stakeholders with the most prominent group there being people with psychiatric disabilities. Diversity is important when developing CBPR teams. Relevant

Final considerations

Public stigma is only one form of prejudice. Self-stigma and label avoidance offer their own paradigms for understanding and evaluating stigma change and hence have their own implications for measurement. Also note; we addressed the issue of stigma and stigma change in terms of social psychological models which are likely to be more available to readers of this journal than those that have developed out of sociology and marketing. Nevertheless, research needs to incorporate other paradigms for

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