Opening Minds in High School: Results of a Contact-Based Anti-Stigma Intervention

Purpose

Stigma and discrimination have gained the attention of the public health and policy communities as a hidden and costly burden cause by society’s prejudicial reaction to people with a mental illness (World Health Organization, 2001). Stigma and discrimination pose major obstacles in virtually every life domain, carrying significant negative social and psychological impacts. Reducing stigma and discrimination have become important policy objectives at both international and national levels (Sartorius & Schulze, 2005). The 2009 launch of the Mental Health Commission’s Opening Minds anti-stigma/anti-discrimination initiative marked the largest systematic effort to combat mental illness related-stigma in Canadian history.

The Opening Minds program has partnered with a number of programs that deliver contact-based education to primary and high school students throughout Canada. Contact-based education involves people who have experienced a mental illness educating students by telling their personal stories and allowing time for active discussion. In some cases, teacher lesson plans accompany the classroom presentations. This report is intended to provide programs with an overview of their key evaluation results.

Methodology

Students were surveyed before and after the contact-based intervention. All programs participating in this network initiative used the same pre- and post-test survey questionnaires to collect their data. These surveys were adapted from items used by the six contact-based programs that participated in the instrument development phase of this project. The resulting Stigma Evaluation Survey contained 22 self-report items. Of these:

• 11 items measured stereotyped attributions
  • controllability of illness – 4 items,
  • potential for recovery – 2 items, and
  • potential for violence and unpredictability – 5 items
• 11 items measured expressions of social tolerance, which include both social distance and social responsibility items
• desire for social distance – 7 items, and
• social responsibility for mental health issues – 4 items

All items were scored on a 5-point agreement scale, ranging from strongly agree to strongly disagree. To avoid potential response sets,some items were positively worded while others were negatively worded. Items were scored so that higher scores on any item would reflect higher levels of stigma. The scales had good reliability in this pooled sample with a pre-test Cronbach’s alpha of 0.70 for the stereotype scale and 0.85 for the social tolerance scale. Both are at or above the conventional threshold of 0.70, indicating that they are highly reliable. Information on gender, age, grade and prior contact with someone with a mental illness (close friend or family member) was also collected.

Data were collected on two types of interventions, one with speakers with lived experience and one without speakers with lived experience. This analysis focuses only on the intervention which had speakers with lived experience. Twenty-five high school students completed both pre-test and post-test surveys. It is important to note that the base size is very small and extreme caution should be used when interpreting the results.

Key Findings

5.1 Sample Characteristics The characteristics of the students are presented in Table 1. The majority of students were female (75%), 17 years old (88%) and in grade 12 (100%). On the pre-test, the majority (78%) of the students indicated they knew someone with a mental illness and 22% indicated that they had a mental illness.

5.2 Stereotyped Attributions

Stereotyped attributions items are shown in Tables 2, 3 and 4. For ease of presentation, items were recoded into three groups: agree (strongly agree and agree), neutral, and disagree (disagree and strongly disagree). Table 2 shows the majority of respondents held positive (non-stereotypical) attitudes toward people with a mental illness on the controllability items. For example, before the intervention students tended to disagree with the common stereotypes people with a mental illness “get what they deserve” (100% disagree) or that they “could snap out of it if they wanted” (91% disagree). Eighty-six percent disagreed that people with a mental illness “tend to bring it on themselves.” Eighty-one percent disagreed with the statement “People with a mental illness often don’t try hard enough to get better.” Also reported in Table 2 is the change score from pre-test to post-test. The Controllability item with the largest positive change was “People with a mental illness often don’t try hard enough to get better.” At baseline, 81% disagreed with this statement whereas 95% disagreed at post-test (a 14% positive change).

Table 3 shows the stereotyped attributions for the recovery items. Again, prior to the intervention, the majority of respondents held positive (non-stereotypical) attitudes toward people with a mental illness on both items. At post-test, positive change was seen for the item “People with a mental illness need to be locked away” (a 14% positive change).

Table 4 shows the stereotyped attributions for violence and unpredictability. All five of the items changed in a positive direction. The largest change was for the item “People with a mental illness often become violent if not treated.” On the pre-test, 29% of respondents disagreed with this statement; at post-test, 71% of respondents disagreed with the statement, reflecting a 43% improvement. This was the largest positive change realized for any one item. Three items had a 19% positive shift.

5.3 Expressions of Social Tolerance

Social tolerance items are shown in Tables 5 and 6. Table 5 presents the items that relate to the expression of social distance. Prior to the intervention, the majority of students showed non-stigmatizing responses for all items but one, with positive responses ranging from 73% to 96%. Only half (50%) disagreed with the item that involved the most intimate social interaction prior to the intervention: “If I know someone had a mental illness I would not date them.” The only positive shift was seen for the item “If I know someone had a mental illness I would not date them.” At baseline, 50% disagreed with this item; at post-test, this increased to 64% indicating a 14% positive shift. Social responsibility items are presented in Table 6. Before the intervention students were generally socially responsible with positive ratings ranging from 73% to 95%. One item, “I would tutor a classmate who got behind in their studies,” showed a positive shift (14%).